Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Science is Primary - Children Thinking and Learning in theChemistry Laboratory

The goal of primary science education is to foster children’s interest, develop positive science attitudes and promote science process skills development. Learning by playing and discovering provides several opportunities for children to inquiry and understand science based on the first–hand experience. The current research was conducted in the children’s laboratory in Heureka, the Finnish science centre. Young children (aged 7 years) which came from 4 international schools did a set of chemistry experiments in the laboratory. From the results of the cognitive test, the pre-test, the post-test, supported by observation and interview, we could make the conclusion that children enjoyed studying in the laboratory. Chemistry science was interesting and fascinating for young children; no major gender differences were found between boys and girls learning in the science laboratory. Lab work not only encouraged children to explore and investigate science, but also stimulated children’s cognitive development.

Processes of feelings in a society with a violent past : A qualitative study of the communication for Societal healing in the Truth Commissions in East Timor, Sri Lanka and Ghana between 2002-2011

The research investigates in what extent and how communication for meeting feelings is provided in Truth Commission work. It examines if and in what way feelings are addressed in the communication officially published by the Truth Commissions in East Timor, Ghana and Sri Lanka, occurring between 2002-2011. The research is also looking at the healing processes in a time perspective to find out if there is a communication for Societal healing to be continued in a longer term. My conclusion is that two cases of three in my research, the TRCs in Ghana and East Timor, have communication clearly directed to meet feelings caused by the war. One of the three cases (East Timor) has a communication with a clear ambition to heal over a longer period, to continue after the existence of the Truth Commission. The research suggests that communication with a clear ambition to reach out widely in the society, a communication directed to meet and process feelings over a longer period, can make Societal healing more effective. It also concludes that, in the future, Societal healing, as a field in conflict resolution, will be more based on representational media than today, provided through web communication.

Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.