Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India : study protocol and intervention adaptation of a randomised control trial

The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. Trial design The study is a randomised, controlled, non-superiority trial . Methods Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study is to evaluate the effectiveness of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10-14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This was to optimise and tailor-make the intervention and the study procedures and resulted in the development of the pictorial instruction sheet for how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion. Discussion In this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10-14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor. Trial registration: Clinicaltrials.gov NCT01827995. Registered 04 May 2013

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.

Negotiating collective and individual agency : a qualitative study of young women's reproductive health in rural India

The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.

Legal ethics is (just) normal ethics: towards a coherent system of legal ethics

The standards governing how lawyers ought to conduct themselves consist of a number disparate principles and rules, which are devoid of an overarching rationale. We argue that legal ethics is not a stand-alone social construct. Rather, it is the application of normal ethical principles so far as they relate to the law. Approached in this manner, legal ethics becomes a far more coherent and justifiable institution. In this paper we apply general moral theory to several key dilemmas facing lawyers. This results in outcomes which some may find counter-intuitive. We conclude that lawyers should not do pro bono work; that the first cab rank off the rank principle is unsound and that there is no relevant difference between expressly misleading the court and putting the other side to the proof of its case.

Caste, land and livestock holdings in India: an analysis

A ban on grazing, particularly by small ruminants, forms an important component of the Forest Policy and Joint Forest Management arrangements in India. Some caste groups keep larger number of small ruminants than the others. It is considered as a social trait that is sought to be corrected through extension efforts. This paper analyses the livestock structure of households by using a model of household behaviour based on profit maximisation. It shows that landholding plays a crucial role in livestock structure of households and because certain caste groups have smaller landholding they tend to keep small ruminants that can feed on the common lands and forest areas. The policy of a ban or restriction on grazing adversely affects such caste groups who therefore come to resent it.

Towards critical social work practice in mental health: a review

Progressive social work perspectives that draw on both critical theories and postmodern thought, provide highly relevant and appropriate frameworks to inform social work practice in the mental health field. Despite this, the literature overviewed indicates that the majority of social work practice conducted in mental health settings reflects an uncritical embrace of the medical model of psychiatric illness, and therefore largely neglects social work approaches which utilize critical principles. The following article explores the possibilities for applying a critical model of social work practice to the mental health field, and argues the necessity for social workers to actively engage with critical practice, even in medically dominated settings, to effectively work towards the espoused social justice ethics and mission of the social work profession.

Educational administration and social justice

After observing that texts in educational administration have largely failed to address the problem of the justice and fairness of social and educational arrangements, this article goes on to examine the necessary relationships between ethical leadership, community and the notion of social justice. Such relationships are argued to be necessarily political, although the field of leadership has historically seen administration as a substitute for politics. The relationship between social justice and disadvantage is examined, as are current approaches to community, choice and diversity. The importance of both redistributive and recognitional approaches to social justice is emphasized as a basis for a model of educational administration centred on the problem of the justice and fairness of social and educational arrangements.

The dynamics of business ethics: a function of time and culture-cases and models

Examines the construct of ethics in general and of business ethics in particular. Provides a conceptual discussion of the dynamics of ethics in society and the dynamics of business ethics in the marketplace. Ethics and business ethics constructs are dependent upon two principal parameters – time and culture. Eventually, ethics and business ethics are about what is perceived as acceptable or unacceptable at a specific time and in a specific cultural setting. What was ethical yesterday may not be ethical today, and what is ethical today may not be ethical tomorrow. Furthermore, both the company’s view and the views of others may determine what is acceptable or unacceptable in business ethics. This is a social construction that may differ between the parties involved in a specific context. The discussion is supported by two brief and different cases from the automobile industry. This research contributes a set of generic models that examine business ethics dynamics.

Reflection of eGovernance on websites of India and Russia

Governments of the developing countries have been exploring new ways to allow participation of citizens in the governance, enabled by the Internet revolution. In this paper, we have explored, through a preliminary analysis of national government web sites, the attempts of two developing nations -- India and Russia, to establish digital governance. We have used the KPMG E-Commerce maturity model, WiIIcoks eBusiness evolution model and the WebQual site analysis tool as a theoretical framework to analyse the website performance and content, as a social construct that reflects government intentions, attitudes, digital governance directions and policies.

An Asia Pacific six-country study on HIV-related discrimination : introduction

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

Competing on the higher ground : social expectations and sport

Research in sport ethics has traditionally focused on the ethical dimensions of the sport event and athletes, however the examination of the principles of ethics to the management and organisation of sport is a relatively recent phenomenon. The tension between the roles and responsibilities of sport as a business, and sport as an ethical and moral aspect of society has forced sport organisations to face an increased number of complex ethical dilemmas. As sport systems throughout the world become further professionalised and bureaucratised, the community understanding of what is ‘good’ is challenged. It is a commonly held expectation that there should be a high level of moral behaviour from those participating directly in the sport event (athletes, coaches, referees), however this expectation has extended to the sporting clubs and organisations which govern the sport itself.

Often used interchangeably, ethics and morality are complex terms concentrating on issues of right and wrong behaviour. Beauchamp and Bowie (1993) stated that the term morality suggests a social institution, composed of a set of standards which are pervasively acknowledged by the members of a culture, or alternatively a social construction. The application of ethics and moral values to the business environment applies across all sectors, including for-profit, non-profit and government, however Rubin (1990) found that the normative ethics, those which society accepts as ethical behaviour, varies from sector to sector. In the non-profit sector, to which many sport organisations belong, Rubin (1990) found that because the community expects more ‘good’, they accept less ‘bad’. As many sport organisations throughout the world remain largely non-profit, linked with the commonly held belief that sport is a foundation for moral behaviours, the idealistic expectation of ethical conduct placed upon them may be different to those of more mainstream business organisations.

Mewett (2003) noted the importance of sport as a social phenomenon which ramifies widely through society to become an intrinsic part of culture and community life. The different expectations of ethical conduct and moral value placed on sport organisations increases the public interest in the ethical dilemmas faced by these organisations. Using the concept of conflict of interest as an example, this paper will examine the tension and difference between the community and social understanding and expectations of sport, and those of the sport organisations themselves.