Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Om lärarskapets moraliska dimension : ett perspektiv och en studie av lärarstuderandes nätbaserade seminariesamtal

In this dissertation, an educational perspective called the moral dimension of teaching is developed. The work includes a theoretically informed discussion from a pragmatist point of view in which the concept of pedagogical rhythm is introduced. The concept captures the need for teachers to regularly shift their intentions and occasionally act in contradictory ways as a consequence of the moral which emerges from interaction in pedagogical situations. Using this perspective, criteria are developed for the characteristics of discussions of the work of teachers, which are desirable in order for students in pre-service teacher education to have opportunities to develop their teachership. Secondly, the educational perspective as it is conceptualised serves as a theoretical framework for a study of discussions taking place in net-based seminars among students in teacher education. The study consists of 14 recorded seminars in which discussions of the work of teachers are analysed in terms of content and direction for reflection. The result of the analysis is a construction of four different focal points for processes of making judgements: existential, performative, critical and professional. Mainly the performative, and to some extent the critical, focal points appear to be supported by the net-based environment, although potential for the professional focal point is found when available tools in net-based settings are used in deliberate ways. Finally, based on these four focal points, possible future predispositions among student teachers are deliberated. Student teachers’ future opportunities to develop a moral and epistemological authority are discussed, as well as teachers’ general opportunities to exercise professional responsibility. The conclusion emphasises that a perspective such as the one developed in the dissertation is important, as it creates an understanding for the need to educate student teachers to exercise a form of responsibility that goes beyond being accountable to society.