Age-Specific Fertility Dynamics: Sub-Saharan African Fertility in a Global Context

Thesis (Ph.D.)--University of Washington, 2016-08

Les couples en difficulté aux XVIIe et XVIIIe siècles : les demandes de séparation en Nouvelle-France

L'étude de la famille suscite l'intérêt de nombreux historiens depuis une vingtaine d'années. L'apport des sciences sociales et les nouvelles problématiques contribuent à cette ouverture dans le champ de l'histoire sociale et des mentalités. Des recherches ont été entreprises sur la formation de la famille, sa composition et ses fonctions éducatives, socialisatrices et économiques. Des interrogations se portent aussi sur les relations entre conjoints, entre parents et enfants, sur la contraception et les relations sexuelles. Avant 1965, la croyance était répandue que la famille élargie représentait la famille ancienne et que la structure nucléaire n'apparaissait qu'au XIXe siècle. Les recherches historiques, alimentées par la démographie, sont venues briser la conception défendue par Le Play, sociologue français du XlXe siècle. Dans un volume datant de 1871, l'organisation de la famille Le Play favorisait le concept de famille-souche, condamnait la famille nucléaire comme instable et la qualifiait de moderne. Selon le sociologue français cette unité familiale, propre à la société industrielle, se déstabilisait lorsque les enfants la quittaient pour fonder de nouvelles familles conjugales (couple et enfants non mariés). L'opinion de Le Play, selon laquelle la famille-souche serait la forme la plus commune de vie familiale, fut contestée par l'historien anglais Peter Laslett. L'utilisation de la méthode "globale", qu'il a mise au point avec les historiens de Cambridge, lui a permis d'étudier la famille anglaise malgré la lacune des registres paroissiaux. Selon Laslett, les familles de l'Angleterre préindustrielle ne comptaient que 4 à 6 personnes. […]

Relational and reproductive trajectories leading to adolescent pregnancy in Portugal: a national and regional characterization

INTRODUCTION: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents' place of residence. MATERIAL AND METHODS: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). RESULTS: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents' partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. DISCUSSION: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents' needs in each region and should include high-risk male groups. CONCLUSION: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.

Avaliação da sensibilidade médica para o risco de gravidez não planeada

Prémio em Contraceção 2012 da Sociedade Portuguesa de Contraceção

Maladaptive defense mechanisms are associated with decoupling of testosterone from sexual desire in women of reproductive age

O presente artigo contém uma errata, disponível em: http://www.tandfonline.com/doi/full/10.1080/15294145.2015.1108503

Exploring fertility decisions among pregnant HIVpositive women on antiretroviral therapy at a health centre in Balaka, Malawi: A descriptive qualitative

Background The proportions of women of reproductive age living with the human immunodeficiency virus (HIV) vary between different regions of the world, with significantly higher proportions in sub-Saharan Africa. Family planning is one of the major issues that couples and families affected with HIV must confront. We aimed to assess the cultural and social factors associated with childbearing and family planning knowledge, decisionmaking, and practices among HIV-positive pregnant women attending antenatal clinic at a health centre in Balaka, Malawi. Methods This was a qualitative descriptive study carried out at Kalembo Health Centre in Balaka. A purposive sampling technique was used to select pregnant women enroled in the antiretroviral therapy (ART) programme. A sample size of thirty-five women was decided upon after data saturation. Qualitative inquiry was used during data collection. Data were analysed using systematic text condensation, while numbers and percentages were generated using Microsoft Excel. Results Out of 35 participants, 20 were aged between 25 and 34 years, and 18 had been married at least three times. All 35 women wished to have their own biological child. Factors, reported by participants, that promote childbearing included: the desire to please their husbands, fear of losing their husbands to others if they did not bear children, the knowledge that ART would help prevent their children from acquiring the virus, the desire to prove to others that they can also bear children, and a lack of family planning leading to unplanned pregnancies. Conclusions The factors that lead to pregnancies among women on ART in Balaka ranged from assured safety of the child from HIV, lack of contraception, to other factors related to their partners. The authors recognize and support the freedom for women to become pregnant and bear children, and, in the context of HIV infection, fertility and reproductive services should include a comprehensive approach towards addressing issues of HIV and AIDS and childbearing among infected women.

Sexualidade na Adolescência: Relatório de Estágio

Este relatório centra-se no tema da Sexualidade na Adolescência, tema pertinente em Enfermagem Comunitária e no Plano Nacional de Saúde. A promoção da sáude e o desenvolvimento de projectos, é uma das principais competências do Enfermeiro especialista em Enfermagem Comunitária. O principal objectivo deste relatório é apresentar, descrever e analizar as actividades desenvolvidas durante o estágio. Utilizando a metodologia do planeamento em saúde realizou-se um diagnóstico de situação numa escola da cidade de Portalegre, identificando-se necessidades de adolescentes, sendo estas a base o estágio. O estágio teve como objectivo contribuir para a implementação de actividades presentes no Plano Nacional de Saúde, intervindo nas seguintes áreas: sexualidade e afectos; métodos contraceptivos; prevenção de ist’s e mitos acerca da sexualidade. Definiram-se áreas prioritárias e, posteriormente, selecionaram-se estratégias. Foram planeadas e realizadas sessões de educação para a saúde em duas escolas da cidade de Portalegre. Estas foram desenvolvidas em sala de aula utilizando-se métodos desmonstrativos/interactivos e distribuindo-se de folhetos. Após as sessões aplicou-se um questionário de avaliação das actividades, cuja análise revelou a sua efectividade. Sumariamente, a maioria dos adolescentes reconhece a importância das sessões informativas sobre sexualidade, admitindo-se melhor informados acerca desta temática. Para o autor, o estágio contribuiu para o desenvolvimento pessoal e profissional enquanto prestador de cuidados e professional de Enfermagem

Relatório de Estágio – Sexualidade na Adolescência

O seguinte relatório permitiu-nos reflectir e descrever as nossas actividades ao longo do estágio que realizámos de 14 de Fevereiro a 30 de Junho de 2011. Este teve duas intervenções: uma na Escola Mouzinho da silveira, cujo objectivo era contribuir para uma sexualidade saudável dos adolescentes do 8º ao 10º ano e para uma turma de CEF, num total de 264 adolescentes. A segunda intervenção foi realizada na ESSP cuja intervenção foi no âmbito da promoção da saúde e da ESSP, dos cursos lá ministrados para os alunos de 9º e 12º anos da área Ciências e Tecnologia num total de 317 adolescentes, informando-os das oportunidades que Portalegre oferece de forma a evitar a desertificação das cidades do interior. A educação para a saúde e a educação sexual merecem particular atenção por parte da sociedade e a escola, integrando estratégias de promoção da saúde sexual, no desenvolvimento curricular, favorecendo a articulação com a família, parceiros locais e como as unidades de saúde no âmbito da actividade de saúde escolar. Foi por esse motivo pedida colaboração a ESSP. Neste contexto realizámos um diagnóstico de situação o qual serviu de base para o nosso projecto de Estagio e para este relatório. Seguimos a metodologia do planeamento em saúde com base no diagnóstico de situação, tendo sido abordados os seguintes temas: sexualidade, papéis de género, homossexualidade, gravidez na adolescência, IST, métodos contraceptivos e violência no namoro

Relatório de estágio

Este relatório destina-se a descrever as acções desenvolvidas no estágio, do 1º Curso de Mestrado em Enfermagem Comunitária, realizado na Escola Superior de Saúde de Portalegre. A intervenção comunitária, realizou-se na comunidade escolar de Portalegre, tendo tido duas vertentes: Educação sexual na adolescência; Promoção de comportamentos saudáveis nos estilos de vida dos adolescentes. As ações realizadas abordaram a educação sexual na adolescência, com base no diagnóstico de situação e, através da elaboração de um projecto de intervenção, aplicado em metodologia de planeamento em saúde. A intervenção comunitária teve como base a promoção de comportamentos saudáveis nos estilos de vida dos adolescentes, a alunos das escolas de Portalegre do 9º e 12º anos, na área de ciências e tecnologias. Todo este trabalho foi desenvolvido na fase teórica e suportou a nossa intervenção em estágio. Assim, após a conclusão deste diagnóstico, seguiu-se a fase de estabelecimento de prioridades, fixação dos objectivos, selecção de estratégias, preparação da execução e avaliação. Na adolescência, a educação sexual deverá ser orientada para a maturação psicossexual, para os afetos, para a contraceção e planeamento familiar e para a prevenção de doenças. É da responsabilidade dos profissionais de saúde, da escola, mas sobretudo da família, proporcionar um ambiente favorável à aprendizagem e ao diálogo. O realce da educação sexual, deverá ser colocado na igualdade de papéis, na tolerância face ao pluralismo de orientação e de condutas sexuais. Por outro lado, é também na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola e a família, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infecções sexualmente transmissíveis e cidadania

Sexual behaviour in early adolescence: a cross-national comparison of Australian and United States youth

Objective: This study used matched samples from schools in the states of Victoria and Washington to compare sexual behaviour in early adolescence. It was hypothesised that the contrasting dominant policy objectives of harm minimisation in Australia and abstinence in the USA would result in state differences for markers of sexual risk, mirroring prior cross-national findings in substance use. Method: A two-stage cluster sampling approach was used to recruit students from the two states. Self-reported sexual behaviour was examined for 1,596 students in annual surveys from Grade 7 in 2002 to Grade 9 in 2004. Prevalence estimates were derived for each measure of sexual behaviour, and comparisons were made between gender groups in each state. Results: State differences were found for girls' first sex, with significantly more girls in Washington than Victoria having had sex by Grade 7. By Grade 9, significantly more girls in Victoria reported sex in the last year and more sexual partners than girls in Washington. A large proportion of Grade 9 students across both states reported inconsistent contraception use. Conclusions: Contradicting the abstinence policy objective, first sex by Grade 7 was more prevalent in Washington than in Victoria. While sexual behaviour was more prevalent in Grade 9 in Victoria, the sexually active showed no clear cross-national differences in markers of risk such as contraception use and pregnancy outcomes. Findings demonstrate few cross-national differences in adolescent sexual behaviour despite the different policy contexts of Victoria and Washington.

Assisted reproductive technology – IVF treatment in Ireland: A study of couples with successful outcomes

Human Fertility 17(3):165-9 This article describes the experiences of twelve Irish couples who had successful IVF treatment in Ireland. Irish Medical guidelines specify that IVF may only be used when no other treatment is likely to be effective. This article is based on data drawn from a longitudinal research study by Cotter (2009) which tells the stories of 34 couples who sought fertility treatment. Initially, the women assumed that they would become pregnant when they stopped using contraception. As a couple, it was the ‘right time’ for them to have a child - they were ready, socially and financially. For several months they were patient, hoping it would happen naturally. With envy and some despair they watched as their friends had babies. Infertility came as a shock to most of them. They were reluctant to talk about it to anyone, and over time their anxieties were accompanied by feelings of regret, stigma and social exclusion. They finally sought medical treatment. The latter involved a series of diagnostic treatments, which eventually culminated in IVF which offered them a final chance of having a ‘child of their own’. While IVF can be clinically assessed in terms of cycle success rates, their stories showed treatment as a series of discoveries, as an extensive range of diagnostic tests and procedures helped to reveal to them where their problems might lie. They described their treatments as a series of sequential ‘hurdles’ that they had to overcome, which further strengthened their resolve to try IVF. Much more knowledgeable at that stage, they embraced IVF as a final challenge with single minded dedication while drawing on all their psychological and biological resources to promote a successful outcome. Of the 34 couples who took part in the study, twelve got pregnant. Unfortunately, two children died shortly after birth but eighteen babies survived (see Table I). The findings suggest that health policy should raise awareness of infertility, and advise women to become aware of it just as in the past, when health policy addressed contraception. Increased public knowledge would reduce the stigma attached to the inability to have a baby. In the Irish case, infertility diagnosis should be reviewed with a view to giving eligible couples earlier access to IVF.  

Knowledge of and attitudes toward sexual and reproductive health among college students

Abstract Introduction: Knowledge provides the foundation for values, attitudes and behavior. Knowledge about sexual and reproductive health (SRH) and positive attitudes are essential for implementing protective behaviors. Objectives: The aim of this study was to evaluate SRH knowledge and attitudes in college students and their association with sexual and reproductive behaviors. Material and methods: A cross-sectional study was conducted in a sample of 1946 college students. The data were collected using a self-report questionnaire on the sociodemographics characteristics of the sample, an inventory on SRH knowledge and an attitude scale, and were analyzed with descriptive and inferential statistics (ANOVA and Pearson’s correlation). Results: The sample was 64% female and 36% male, with a mean age of 21 years. The majority were sexually active and used contraception. The SRH knowledge was moderate (22.27 ± 5.79; maximum score = 44), while the average SRH attitude score was more favorable (118.29 ± 13.92; maximum score = 140). Female and younger students studying life and health sciences had higher (P < .05) SRH knowledge and attitude scores. The consistent use of condom and health care surveillance were highly dependent on the students’ SRH knowledge and attitudes. Engagement in sexual risk behaviors was associated with lower scores for these variables. Conclusions: Strategies to increase SRH knowledge and attitudes are important tools for improving protective behaviors, especially with respect to contraception, health care surveillance and exposure to sexual risk. Older males studying topics other than life sciences should be a priority target for interventions due to their higher sexual risk

Les facteurs associés à la sexualité précoce chez les jeunes qui présentent des problèmes de conduites ou qui sont à risque d'en présenter

Les jeunes ayant des problèmes de conduites (PC) sont à risque d'avoir des conséquences développementales majeures tout au long de leur vie. Ces conséquences entraînent d'importants coûts autant pour eux que pour la société. Parmi celles-ci, il y a la sexualité précoce, qui doit faire l'objet d'études auprès des jeunes présentant des PC puisqu’elle augmente le risque de contracter une maladie transmise sexuellement, de vivre une grossesse non désirée chez les filles ou de la parentalité précoce chez ces jeunes en général. Selon la théorie développementale de Moffitt (1993), les jeunes, dont les conduites antisociales débutent avant 10 ans et qui persistent jusqu'à l'âge adulte, sont les plus à risque de sexualité précoce. Chez ces jeunes, il serait possible de prédire la sexualité précoce en se basant sur trois domaines de facteurs de risque : les conditions sociofamiliales adverses et les pratiques parentales inadéquates, le comportement de l'enfant et son tempérament, ainsi que le développement neurocognitif (Moffitt et Caspi, 2001). Dans la documentation scientifique, certains auteurs ont montré que des facteurs de risque de ces domaines étaient associés à la sexualité précoce. Néanmoins, plusieurs facteurs (p.ex. : la précocité des PC ou les facteurs du développement neurocognitif) demeurent à explorer. Le présent mémoire a pour objectif d'examiner le poids relatif de différents facteurs associés au risque de sexualité précoce chez les jeunes présentant des PC ou à risque d'en présenter. De plus, afin de vérifier si les mêmes facteurs sont associés à la sexualité précoce pour les filles et les garçons, les interactions entre les facteurs associés à la sexualité précoce et le sexe ont été explorées. Provenant d'une étude longitudinale d'envergure, l'échantillon est composé de 143 jeunes qui présentaient ou non des PC au début du projet. Les résultats suggèrent que cinq variables sont associées à une augmentation du risque de sexualité précoce, soit 1- la perception de comportements de rejets indifférenciés du parent envers son enfant, 2- l'affiliation du jeune à des pairs déviants, 3- la précocité des symptômes de PC,4- le fait d’être une fille ou 5- le fait d’être un garçon et de présenter des PC précoces. De leur côté, les habiletés verbales (fluidité) diminuent le risque de sexualité précoce chez les jeunes présentant des PC ou à risque d'en présenter. Ces différents constats militent en faveur d'adapter certains programmes de prévention des conduites antisociales persistantes en y ajoutant des modules sur la sexualité. Chez les jeunes qui présentent l'ensemble de ces facteurs de risque, il serait important d'éduquer les jeunes sur la sexualité afin d'éviter que ces jeunes aient d'autres activités sexuelles à risque. Par ailleurs, il serait souhaitable d’étudier d’autres variables susceptibles d’être associées à la sexualité précoce (par ex. : l'intelligence ou la réussite en lecture). De plus, ce domaine de recherche nécessite d'autres travaux afin d'évaluer si les facteurs associés à la sexualité précoce sont également liés à d'autres activités sexuelles à risque comme l'utilisation inconstante de contraception.

Factores asociados a embarazo no deseado en mujeres en edad reproductiva en Colombia 2010

Objetivo: Identificar factores sociodemográficos y de fecundidad, asociados a ocurrencia de embarazo no deseado en mujeres colombianas en edad reproductiva en el año 2010. Métodos: Se realizó estudio retrospectivo de corte transversal, basado en los datos de la ENDS Colombia-2010, del total de mujeres en edad fértil (13-49 años) que al momento de la encuesta se encontraban en embarazo. La variable de interés fue embarazo no deseado, se describió la población a estudio y se evaluó la posible asociación con variables sociodemográficas y de fecundidad, a través de análisis bivariado y multivariado. Se realizaron los mismos análisis por grupo de edad (adolescentes vs adultas). Resultados: La prevalencia de embarazo no deseado en las mujeres colombianas en el 2010 fue de 61,4 %. De acuerdo al modelo de regresión logística, no estar en unión a una pareja (OR: 4,01 IC95%: 3,066-5,269), tener hijos (OR: 2,040 IC95%: 1,581 – 2,631), estar en el quintil de menor riqueza (OR: 2,137 IC95%: 1,328-3,440), y ser adolescente (OR: 1,599 IC95%: 1,183-2,162), son factores que aumentan la probabilidad de tener un embarazo no deseado. Se encontraron diferencias en los factores asociados al realizar segmentación por edad. Conclusiones: La prevalencia de embarazo no deseado permanece alta en Colombia respecto a años anteriores y a otros países. Los resultados pueden ser de utilidad para el desarrollo de políticas en salud sexual y reproductiva teniendo en cuenta los factores asociados identificados priorizando a la población adolescente y de menor estatus socioeconómico, para la prevención de embarazo no deseado en Colombia.

Asociación de las violencias física, sexual y comunitaria con el embarazo en adolescentes: análisis multinivel

Objetivos Determinar si existe asociación entre la exposición a violencia, experimentada a nivel individual o municipal, y el embarazo adolescente en mujeres Colombianas entre 13 y 19 años de edad que contestaron la Encuesta de Demografía y Salud en el año 2010. Métodos Estudio de corte transversal, nacional y multinivel. Se tomaron datos de dos niveles jerárquicos: Nivel- 1: Datos individuales de una muestra representativa de 13.313 mujeres entre 13 y 19 años de edad provenientes de La Encuesta Nacional de Demografía y Salud del año 2010 y Nivel- 2: Datos municipales de 258 municipios provenientes de las estadísticas vitales del DANE. Resultados La prevalencia del embarazo adolescente fue del 16.8% IC 95% [16.2-17.4]. El análisis mostró que la asociación entre embarazo adolescente y violencia tanto individual, representada como violencia sexual [OR= 6.99 IC99% 4.80-10.10] y violencia física [OR= 1.74 IC99% 1.47-2.05] así como la violencia municipal medida con tasas de homicidios altas [OR= 1.99 IC99% 1.29-3.07] y muy altas [OR= 2.10 IC99% 1.21-3.61] se mantuvo estadísticamente significativa después de ajustar por las variables: Edad [OR= 1.81 IC99% 1.71-1.91], ocupación [OR= 1.62 IC99% 1.37-1.93], educación primaria o sin educación [OR= 2.20 IC99% 1.47-3.30], educación secundaria [OR= 1.70 IC99% 1.24-2.32], asistir al colegio [OR= 0.18 IC99% 0.15-0.21], conocimiento en la fisiología reproductiva [OR= 1.28 IC99% 1.06-1.54], el índice de riqueza Q1, Q2, Q3 [OR= 2.18 IC99% 1.42-3.34], [OR= 2.00 IC99% 1.39-2.28], [OR= 1.82 IC99% 1.92-2.25] y alto porcentaje de Necesidades básicas insatisfechas a nivel municipal [OR= 2.34 IC99% 1.55-3.52]. Conclusiones Este estudio mostró una relación significativamente estadística entre la violencia sexual y física con el inicio de relaciones sexuales y embarazo adolescente después de controlar por factores sociodemográficos y conocimientos en reproducción sexual en mujeres colombianas de 13 a 19 años en el año 2010. Esta asociación debe continuar siendo estudiada para lograr optimizar las estrategias de prevención y disminuir la tasa actual de embarazos adolescentes en el país y sus consecuencias.