The Influence of Education and Depression on Autonomy of Women with Chronic Pelvic Pain: A Cross-sectional Study

Objective Patient autonomy has great importance for a valid informed consent in clinical practice. Our objectives were to quantify thedomains of patient autonomy and to evaluate the variables that can affect patient autonomy in women with chronic pelvic pain. Methods This study is a cross sectional survey performed in a tertiary care University Hospital. Fifty-two consecutive women scheduled for laparoscopic management of chronic pelvic were included. Three major components of autonomy (competence, information or freedom) were evaluated using a Likert scale with 24 validated affirmatives. Results Competence scores (0.85 vs 0.92; p = 0.006) and information scores (0.90 vs 0.93; p = 0.02) were low for women with less than eight years of school attendance. Information scores were low in the presence of anxiety (0.91 vs 0.93; p = 0.05) or depression (0.90 vs 0.93; p = 0.01). Conclusions Our data show that systematic evaluation of patient autonomy can provide clinical relevant information in gynecology. Low educational level, anxiety and depression might reduce the patient autonomy in women with chronic pelvic pain.

The Changing Role of the CIO: Developing Skills by Means of Postgraduate Educational Programs

The objective of this research was to identify the skills and competences required by Chief Information Officers in their professional life and whether these skills can be developed by means of postgraduate education pro-grams. Although the changing role of the CIO has been studied for years by the academia, the ways of necessary skills development have not been paid significant attention. In order to obtain understanding of the topic and its main issues qualitative method was implemented and questionnaires and interviews were conducted with CIOs and other C-level executives to-gether with analysis of the curricula of postgraduate educational programs in the field of business designed for executives. Business skills and knowledge along with developed communication and leadership skills are among the most discussed and required from CIOs. According to the collected data and its further analysis, although the most important competences of an IT executive are technological, the im-portance of business related skills is emphasized by the majority of re-spondents and supported by the existing theory. Postgraduate educational programs have curricula that can develop the required competences, alt-hough not equally.

Handshake ecosystem for Educational Contents between Institutional Repository and OER based Repository

Poster at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Biodiesellaitteiston hankintaprosessi

Tämän diplomityön tavoitteena on ollut selvittää opetuskäyttöön tulevan biodiesellaitteis-ton hankintaprosessi sekä toteuttaa laitteiston hankinta ja käyttöönotto. Ensiksi on pereh-dytty Euroopan Unionin ja Suomen kansallisiin uusiutuvien polttoaineiden käytön tavoit-teisiin. Toiseksi on perehdytty julkisten hankintojen hankintaprosessiin ja koulutuskun-tayhtymän hankintamenettelyyn. Tarjousmenettelyn päätteeksi on valittu vaihtoesteröinti-menetelmään perustuva kasvi- tai kalaöljyä raaka-aineena käyttävä biodiesellaitteisto, jonka toimintaan ja tuotantoprosessiin on perehdytty opetuksellisesta näkökulmasta. Työssä on kiinnitetty erityistä huomioita työturvallisuuteen ja biodiesellaitteiston käyttöturvalli-suuteen.

Learning information technology business in a changing industry landscape. Introducing Team Entrepreneurship in Renewing Bachelor Education in Renewing Bachelor Education in Information

Speed, uncertainty and complexity are increasing in the business world all the time. When knowledge and skills become quickly irrelevant, new challenges are set for information technology (IT) education. Meta-learning skills – learning how to learn rapidly - and innovation skills have become more essential than single technologies or other specific issues. The drastic changes in the information and communications technology (ICT) sector have caused a need to reconsider how IT Bachelor education in Universities of Applied Sciences should be organized and employed to cope with the change. The objective of the study was to evaluate how a new approach to IT Bachelor education, the ICT entrepreneurship study path (ICT-ESP) fits IT Bachelor education in a Finnish University of Applied Sciences. This kind of educational arrangement has not been employed elsewhere in the context of IT Bachelor education. The study presents the results of a four-year period during which IT Bachelor education was renewed in a Finnish University of Applied Sciences. The learning environment was organized into an ICT-ESP based on Nonaka’s knowledge theory and Kolb’s experiental learning. The IT students who studied in the ICT-ESP established a cooperative and learned ICT by running their cooperative at the University of Applied Sciences. The students (called team entrepreneurs) studied by reading theory in books and other sources of explicit information, doing projects for their customers, and reflecting in training sessions on what was learnt by doing and by studying the literature. Action research was used as the research strategy in this study. Empirical data was collected via theme-based interviews, direct observation, and participative observation. Grounded theory method was utilized in the data analysis and the theoretical sampling was used to guide the data collection. The context of the University of Applied Sciences provided a good basis for fostering team entrepreneurship. However, the results showed that the employment of the ICT-ESP did not fit into the IT Bachelor education well enough. The ICT-ESP was cognitively too tough for the team entrepreneurs because they had two different set of rules to follow in their studies. The conventional courses engaged lot of energy which should have been spent for professional development in the ICT-ESP. The amount of competencies needed in the ICT-ESP for professional development was greater than those needed for any other ways of studying. The team entrepreneurs needed to develop skills in ICT, leadership and self-leadership, team development and entrepreneurship skills. The entrepreneurship skills included skills on marketing and sales, brand development, productization, and business administration. Considering the three-year time the team entrepreneurs spent in the ICT-ESP, the challenges were remarkable. Changes to the organization of IT Bachelor education are also suggested in the study. At first, it should be admitted that the ICT-ESP produces IT Bachelors with a different set of competencies compared to the conventional way of educating IT Bachelors. Secondly, the number of courses on general topics in mathematics, physics, and languages for team entrepreneurs studying in the ICTESP should be reconsidered and the conventional course-based teaching of the topics should be reorganized to support the team coaching process of the team entrepreneurs with their practiceoriented projects. Third, the upcoming team entrepreneurs should be equipped with relevant information about the ICT-ESP and what it would require in practice to study as a team entrepreneur. Finally, the upcoming team entrepreneurs should be carefully selected before they start in the ICT-ESP to have a possibility to eliminate solo players and those who have a too romantic view of being a team entrepreneur. The results gained in the study provided answers to the original research questions and the objectives of the study were met. Even though the IT degree programme was terminated during the research process, the amount of qualitative data gathered made it possible to justify the interpretations done.

Evaluating the Strategic Objectives of Cameroonian Higher Education: An application of the Balanced Scorecard

Contemporary higher education operates in an environment of dwindling and parsimonious resources; the increasing need for accountability and relevance to varying stakeholders with differing expectations. These relatively new trends in higher education have been faced by business organizations which have developed different ways of operating in response. This study outlines one way by which business organizations have addressed similar circumstances to show how the Cameroon higher education (HE) could learn from business organizations to manage strategic objectives. The balanced scorecard (BSC) has been used by business organizations to address similar trends. This study evaluates the strategic objectives of Cameroonian higher education using the balanced scorecard. The system level is used to identify the general strategic objectives and one state university is used to represent the translation and implementation of the objectives at the institution level. The BSC principles used include: operational strategic objectives; organizational alignment to the strategy; making strategy everyone’s everyday job; making strategy continual and; mobilizing the leadership for change. The underlying concepts in these principles are communication, consensus, relevance, and a participatory approach. The study employs data from policy documents, relevant literature, websites and semi-structured interviews. The research approach is qualitative and the analyses are done by making meaning of phenomena in their natural contexts. The results show that there is a general knowledge of the strategic objectives but there is disagreement on the relevance of these objectives to HE and on the type of approaches used in implementing the objectives. It was also found that the relevant stakeholders are known, but not all the respondents agree on the importance of these stakeholders. All stakeholders do not have the same level of influence-the state is the most influential. Reporting is sufficiently done but there are insufficient provisions for feedback from stakeholders. The study concludes that the BSC principles can be applied to the management of strategic objectives in Cameroon HE. For Cameroonian higher education, it is recommended that the focus should be first, on developing tools for strategy before the strategy itself. Even though the need for the BSC is confirmed the context does not seem sufficiently ready to implement the BSC as a strategic management tool. The proposed BSC framework can only be used as a communication tool. The barriers to managing strategic objectives in Cameroon HE are related to the communication, consensus, clarity and relevance. However, the system has prospects for improved management and eventual adoption of the BSC as both a strategic management and communication tool. In line with other BSC applications to higher education, this study concluded that it is more feasible to apply the balanced scorecard to a single higher education institution than to a higher education system. The study makes a contribution to the BSC by showing how its principles can be used in a non-business context. The study also opens up possibilities for future research on the same topic in a different context or the same context with a wider scope (more institutions and respondents); the same study with a deeper focus on the interrelationships between the different strategic objectives (strategy maps). The study could also be extended by including the perspectives of the identified stakeholders who are not directly part of the higher education system but constitute the environment in which higher education operates.

Prevalence of metabolic syndrome and its association with educational inequalities among Brazilian adults: a population-based study

The present study estimated the prevalence of metabolic syndrome (MS) according to the criteria established by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) and analyzed the contribution of social factors in an adult urban population in the Southeastern region of Brazil. The sample plan was based on multistage probability sampling according to family head income and educational level. A random sample of 1116 subjects aged 30 to 79 years was studied. Participants answered a questionnaire about socio-demographic variables and medical history. Fasting capillary glucose (FCG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were determined and all non-diabetic subjects were submitted to the 75-g oral glucose tolerance test. Body mass index (BMI, kg/m²), waist circumference and blood pressure (BP) were determined. Age- and gender-adjusted prevalence of MS was 35.9 and 43.2% according to NCEP-ATPIII and IDF criteria, respectively. Substantial agreement was found between NCEP-ATPIII and IDF definitions. Low HDL-C levels and high BP were the most prevalent MS components according to NCEP-ATPIII criteria (76.3 and 59.2%, respectively). Considering the diagnostic criteria adopted, 13.5% of the subjects had diabetes and 9.7% had FCG ≥100 mg/dL. MS prevalence was significantly associated with age, skin color, BMI, and educational level. This cross-sectional population-based study in the Southeastern region of Brazil indicates that MS is highly prevalent and associated with an important social indicator, i.e., educational level. This result suggests that in developing countries health policy planning to reduce the risk of MS, in particular, should consider improvement in education.

Collectiveness within startup teams – Leading the way to initiating and managing collective pursuit of opportunities in organizational contexts

While traditional entrepreneurship literature addresses the pursuit of entrepreneurial opportunities to a solo entrepreneur, scholars increasingly agree that new ventures are often founded and operated by entrepreneurial teams as collective efforts especially in hightechnology industries. Researchers also suggest that team ventures are more likely to survive and succeed than ventures founded by the individual entrepreneur although specific challenges might relate to multiple individuals being involved in joint entrepreneurial action. In addition to new ventures, entrepreneurial teams are seen central for organizing work in established organizations since the teams are able to create major product and service innovations that drive organizational success. Acknowledgement of the entrepreneurial teams in various organizational contexts has challenged the notion on the individual entrepreneur. However, considering that entrepreneurial teams represent a collective-level phenomenon that bases on interactions between organizational members, entrepreneurial teams may not have been studied as indepth as could be expected from the point of view of the team-level, rather than the individual or the individuals in the team. Many entrepreneurial team studies adopt the individualized view of entrepreneurship and examine the team members’ aggregate characteristics or the role of a lead entrepreneur. The previous understandings might not offer a comprehensive and indepth enough understanding of collectiveness within entrepreneurial teams and team venture performance that often relates to the team-level issues in particular. In addition, as the collective-level of entrepreneurial teams has been approached in various ways in the existing literatures, the phenomenon has been difficult to understand in research and practice. Hence, there is a need to understand entrepreneurial teams at the collective-level through a systematic and comprehensive perspective. This study takes part in the discussions on entrepreneurial teams. The overall objective of this study is to offer a description and understanding of collectiveness within entrepreneurial teams beyond individual(s). The research questions of the study are: 1) what collectiveness within entrepreneurial teams stands for, what constitutes the basic elements of it, and who are included in it, 2) why, how, and when collectiveness emerges or reinforces within entrepreneurial teams, and 3) why collectiveness within entrepreneurial teams matters and how it could be developed or supported. In order to answer the above questions, this study bases on three approaches, two set of empirical data, two analysis techniques, and conceptual study. The first data set consists of 12 qualitative semi-structured interviews with business school students who are seen as prospective entrepreneurs. The data is approached through a social constructionist perspective and analyzed through discourse analysis. The second data set bases on a qualitative multiplecase study approach that aims at theory elaboration. The main data consists of 14 individual and four group semi-structured thematic interviews with members of core entrepreneurial teams of four team startups in high-technology industries. The secondary data includes publicly available documents. This data set is approached through a critical realist perspective and analyzed through systematic thematic analysis. The study is completed through a conceptual study that aims at building a theoretical model of collective-level entrepreneurship drawing from existing literatures on organizational theory and social-psychology. The theoretical work applies a positivist perspective. This study consists of two parts. The first part includes an overview that introduces the research background, knowledge gaps and objectives, research strategy, and key concepts. It also outlines the existing knowledge of entrepreneurial team literature, presents and justifies the choices of paradigms and methods, summarizes the publications, and synthesizes the findings through answering the above mentioned research questions. The second part consists of five publications that address independent research questions but all enable to answer the research questions set for this study as a whole. The findings of this study suggest a map of relevant concepts and their relationships that help grasp collectiveness within entrepreneurial teams. The analyses conducted in the publications suggest that collectiveness within entrepreneurial teams stands for cognitive and affective structures in-between team members including elements of collective entity, collective idea of business, collective effort, collective attitudes and motivations, and collective feelings. Collectiveness within entrepreneurial teams also stands for specific joint entrepreneurial action components in which the structures are constructed. The action components reflect equality and democracy, and open and direct communication in particular. Collectiveness emerges because it is a powerful tool for overcoming individualized barriers to entrepreneurship and due to collectively oriented desire for, collective value orientation to, demand for, and encouragement to team entrepreneurship. Collectiveness emerges and reinforces in processes of joint creation and realization of entrepreneurial opportunities including joint analysis and planning of the opportunities and strategies, decision-making and realization of the opportunities, and evaluation, feedback, and sanctions of entrepreneurial action. Collectiveness matters because it is relevant for potential future entrepreneurs and because it affects the ways collective ventures are initiated and managed. Collectiveness also matters because it is a versatile, dynamic, and malleable phenomenon and the ideas of it can be applied across organizational contexts that require team work in discovering or creating and realizing new opportunities. This study further discusses how the findings add to the existing knowledge of entrepreneurial team literature and how the ideas can be applied in educational, managerial, and policy contexts.

Suorituskyvyn johtaminen metalliteollisuuden yrityksessä

Tutkimuksen tavoitteena on selvittää, mitkä tekijät ovat tärkeimpiä yrityksen suorituskyvyn johtamisessa metalliteollisuusyrityksessä. Tavoitteena on myös löytää tekijät, joilla henkilökunta saadaan motivoitua ja sitoutettua yrityksen toimintaan. Lisäksi tavoitteena on saada selvitettyä kohdeyrityksen suorituskyvyn johtamisen nykytila. Tutkimus on empiirinen tutkimus, jossa käytetään kvantitatiivista eli määrällistä analyysia. Tutkimuksen teoreettisessa osuudessa tarkastellaan tutkimuksen aihetta perehtymällä aikaisempiin tutkimuksiin ja kirjallisuuteen. Kohdeyrityksen nykytilan kartoituksessa käytettiin valmista SUMO-kartoitusta, joka mittaa työmotivaation ja toiminnan tehostumisen taustalla vaikuttavia tekijöitä. Suorituskyvyn menestyksellinen johtaminen metalliteollisuusyrityksessä vaatii toimivaa suorituskyvyn mittaamisjärjestelmää, jota analysoimalla pystytään tekemään päätöksiä tulevaisuuden toimenpiteistä. Suorituskyvyn mittaaminen pitäisi lisäksi kytkeä palkitsemiseen. Työntekijöiden työmotivaatioon ja sitoutumiseen voidaan vaikuttaa monella tapaa. Työmotivaatioon ja sitoutumiseen vaikuttavat työntekijöiden vaikutus- ja koulutusmahdollisuudet sekä palkitseminen, viestintä ja tavoitteet. Näiden tekijöiden luomisessa johtaminen on avainasemassa.

Discerning Cultural Depictions and Mistakes in Kafe Piter, a Russian Language Textbook for Finnish Students

This thesis presents the results of an analysis of the content in the series of Russian textbooks Kafe Piter, which is widely used in Finnish educational institutions for adult learners at the time that the research is conducted. The purpose of this study is to determine and describe how a textbook may purvey an image of a foreign country (in this case, Russia). Mixed-methods research with a focus on the qualitative content analysis of Kafe Piter is performed. The guidelines for textbook evaluation of cultural content proposed by Byram (1993) are used in this study as the basis for creating a qualitative analysis checklist, which is adopted according to the needs of the current research. The selection of the categories in the checklist is based on major themes where direct statements about Russia, Russian people and culture appear in the textbook. The cultural content and the way in which it is presented in Kafe Piter are also compared to the intercultural competence objectives of the Common European Framework of Reference for Languages. Because the textbook was not written by a native Russian speaker, it was also important to investigate the types of mistakes found in the books. A simple quantitative analysis in the form of descriptive statistics was done, which consisted of counting the mistakes and inaccuracies in Kafe Piter. The mistakes were categorized into several different groups: factual or cultural, lexicosemantic, grammatical, spelling and punctuation mistakes. Based on the results, the cultural content of Kafe Piter provides a rich variety of cultural information that allows for a good understanding of the Russian language and Russian culture. A sufficient number of cross-cultural elements also appear in the textbook, including cultural images and information describing and comparing Russian and Finnish ways of life. Based on the cultural topics covered in Kafe Piter, we conclude that the textbook is in line with the intercultural competence objectives set out in the Common European Framework of Reference for Languages. The results of the study also make it clear that a thorough proofreading of Kafe Piter is needed in order to correct mistakes - more than 130 cultural and linguistic mistakes and inaccuracies appear in the textbook.

Development and Effect Analysis of the Asteri Consultative Auditing Process - Safety and Security Management in Educational Institutions

The Finnish legislation requires for a safe and secure learning environment. However, the comprehensive, risk based safety and security management (SSM) and the management commitment in the implementation and development of the SSM are not mentioned in the legislation. Multiple institutions, operators and researchers have studied and developed safety and security in educational institutions over the past decade. Typically the approach has been fragmented and without bringing up the importance of the comprehensive SSM. The development needs of the safety and security operations in universities have been studied. However, in universities of applied sciences (UASs) and in elementary schools (ESs), the performance level, strengths and weaknesses of the comprehensive SSM have not been studied. The objective of this study was to develop the comprehensive, risk based SSM of educational institutions by developing the new Asteri consultative auditing process and study its effects on auditees. Furthermore, the performance level in the comprehensive SSM in UASs and ESs were studied using Asteri and the TUTOR model developed by the Keski-Uusimaa Department for Rescue Services. In addition, strengths, development needs and differences were identified. In total, 76 educational institutions were audited between the years 2011 and 2014. The study is based on logical empiricism, and an observational applied research design was used. Auditing, observation and an electronic survey were used for data collection. Statistical analysis was used to analyze the collected information. In addition, thematic analysis was used to analyze the development areas of the organizations mentioned by the respondents in the survey. As one of the main contributions, this research presents the new Asteri consultative auditing process. Organizations with low performance levels on the audited subject benefit the most from the Asteri consultative auditing process. Asteri may be usable in many different types of audits, not only in SSM audits. As a new result, this study provides new knowledge on attitudes related to auditing. According to the research findings, auditing may generate negative attitudes and the auditor should take them into account when planning and preparing for audits. Negative attitudes can be compensated by producing added value, objectivity and positivity for the audit and, thus, improve the positive effects of auditing on knowledge and skills. Moreover, as the results of this study shows, auditing safety and security issues do not increase feelings of insecurity, but rather increase feelings of safety and security when using the new Asteri consultative auditing process with the TUTOR model. The results showed that the SSM in the audited UASs was statistically significantly more advanced than that in the audited ESs. However, there is still room for improvement in the ESs and the UASs as the approach to the SSM was fragmented. It can be assumed that the majority of Finnish UASs and ESs do not likely meet the basic level of the comprehensive, risk based the SSM.

Implementation of educational change in Finland: The case of the undivided basic education reform

For the past decades, educational large-scale reforms have been elaborated and implemented in many countries and often resulted in partial or complete failure. These results brought researchers to study policy processes in order to address this particular challenge. Studies on implementation processes brought to light an existing causal relationship between the implementation process and the effectiveness of a reform. This study aims to describe the implementation process of educational change in Finland, who produced efficient educational reforms over the last 50 years. The case study used for the purpose of this study is the national reform of undivided basic education (yhtenäinen peruskoulu) implemented in the end of the 1990s. Therefore, this research aims to describe how the Finnish undivided basic education reform was implemented. This research was carried out using a pluralist and structuralist approach of policy process and was analyzed according to the hybrid model of implementation process. The data were collected using a triangulation of methods, i.e. documentary research, interviews and questionnaires. The data were qualitative and were analyzed using content analysis methods. This study concludes that the undivided basic education reform was applied in a very decentralized manner, which is a reflection of the decentralized system present in Finland. Central authorities provided a clear vision of the purpose of the reform, but did not control the implementation process. They rather provided extensive support in the form of transmission of information and development of collaborative networks. Local authorities had complete autonomy in terms of decision-making and implementation process. Discussions, debates and decisions regarding implementation processes took place at the local level and included the participation of all actors present on the field. Implementation methods differ from a region to another, with is the consequence of the variation of the level of commitment of local actors but also the diversity of local realities. The reform was implemented according to existing structures and values, which means that it was in cohesion with the context in which it was implemented. These results cannot be generalized to all implementation processes of educational change in Finland but give a great insight of what could be the model used in Finland. Future studies could intent to confirm the model described here by studying other reforms that took place in Finland.

Implementation of educational change in Finland: The case of the undivided basic education reform

For the past decades, educational large-scale reforms have been elaborated and implemented in many countries and often resulted in partial or complete failure. These results brought researchers to study policy processes in order to address this particular challenge. Studies on implementation processes brought to light an existing causal relationship between the implementation process and the effectiveness of a reform. This study aims to describe the implementation process of educational change in Finland, who produced efficient educational reforms over the last 50 years. The case study used for the purpose of this study is the national reform of undivided basic education (yhtenäinen peruskoulu) implemented in the end of the 1990s. Therefore, this research aims to describe how the Finnish undivided basic education reform was implemented. This research was carried out using a pluralist and structuralist approach of policy process and was analyzed according to the hybrid model of implementation process. The data were collected using a triangulation of methods, i.e. documentary research, interviews and questionnaires. The data were qualitative and were analyzed using content analysis methods. This study concludes that the undivided basic education reform was applied in a very decentralized manner, which is a reflection of the decentralized system present in Finland. Central authorities provided a clear vision of the purpose of the reform, but did not control the implementation process. They rather provided extensive support in the form of transmission of information and development of collaborative networks. Local authorities had complete autonomy in terms of decision-making and implementation process. Discussions, debates and decisions regarding implementation processes took place at the local level and included the participation of all actors present on the field. Implementation methods differ from a region to another, with is the consequence of the variation of the level of commitment of local actors but also the diversity of local realities. The reform was implemented according to existing structures and values, which means that it was in cohesion with the context in which it was implemented. These results cannot be generalized to all implementation processes of educational change in Finland but give a great insight of what could be the model used in Finland. Future studies could intent to confirm the model described here by studying other reforms that took place in Finland.

The university as an educational institution

Teema: Yliopistohistoria.

Educational issues perceived by expectant lesbian couples /

Despite the increasing public profile of lesbian childbearing, public health resources for expectant women often bear heterosexist assumptions and create barriers to accessing information relevant to lesbian mothering experiences. This descriptive, exploratory study examined one lesbian couple's perceived educational needs for effective support, barriers to access, strategies for locating care, and the impact of childbearing on their lives, as well as their reflections on inviting ways to offer supportive practices in a public health context. A case study approach used feminist ethnographic methodology and purposeful convenience sampling. A prenatal and a postnatal open-ended interview were completed with 1 white, middle-class, able, lesbian childbearing couple, each ofwhom has birthed as coparent and biological mother in this couple relationship. Despite this couple's immense situated privilege, they struggled to locate the support they sought for childbearing in a way that offered optimal emotional and physical care from the preconceptual to postpartum stages and which maintained confidentiality or anonymity as desired. They created meaningful care through personal networks. The findings were framed using invitational and feminist theories: how people, places, programs, processes, policies, and politics contributed to educational support. A three part conceptual framework emerged which identified components of access to support: perceived safety of resources, disclosure status, situated privilege, and public or private availability of information. The consequences of lack of public access to comprehensive childbearing care for lesbian women and their communities are described. Educational possibilities addressed systemic heterosexism through the development of sensitive educators, meaningful curriculum, program planning, explicit policies, community partnerships, and political leadership with respect to both institutional and research venues.