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.

To achieve safe and respectful maternity care in tertiary level hospitals in Nepal, relatives are a valued addition to the provision of maternity care

Introduction: The White Ribbon Alliance for safe motherhood believes respectful maternity care is the universal right of every childbearing woman. Methods: NHRC in 2012 approved an inquiry of respectful care at facility-based childbirth. Individual-, focus group interviews and content analysis was used for gathering and analysis of data. Findings: The participating women and the SBAs shared similar views, and this was that together the SBAs and relatives ensured the women remained within the comfort and safety zone when giving birth in a tertiary level maternity unit. Conclusion: The SBAs strategy of having relatives provides basic care alongside the provision of medical care by the SBAs is a strategy that Nepal could use to improve the quality of its maternity care without any additional costs. Clinical implication: Prenatal classes might contribute to preparing relatives. Further Research: Further research could evaluate such a strategy in order to determine its effectiveness in reduction of morbidity and mortality.

Knowledge and perceptions regarding sexual and reproductive health among high school students in Kathmandu, Nepal

Background: Nepal recently began teaching sexual education in the school system and has established youth friendly services in order to meet the need of increased sexual and reproductive knowledge among the youth. Objective: To examine the sexual and reproductive knowledge and perceptions among young people attending schools in Kathmandu. Method: A written questionnaire was distributed to 160 students, in a classroom environment, in four schools in Kathmandu. Results: Two thirds of the females and nearly 60% of the males knew that it was possible to get sexually transmitted infection (STI) during one sexual encounter and more than half of the students knew when in the menstrual cycle conception was more likely to occur . One third of the participants did not know that it was possible to become pregnant after having intercourse once. The males demonstrated less knowledge than the females regarding every aspect of sex and reproduction, with the exception of pregnancy prevention. Conclusion and clinical implications: For the youths in this study, it was more important to prevent unwanted pregnancies than to protect oneself from STIs. Establishment of a hotline on the internet, where personalized and confidential counselling can be offered may complement the comprehensive sexual education in schools.

Dialectics of Diaspora Space: a Study of Contemporary, Diasporic, South Asian Fiction

In light of these continuing debates concerning immigration, national identity and belonging, re-examinations of immigrant and ethnic communities, often referred to as ‘diaspora,’ have become increasingly popular and prudent. Khachig Tololian, editor of Diaspora magazine, calls diaspora “exemplary communities of the transnational moment.”5 In an increasingly globalized world, where labor, capital, and resources are passed fluidly from continent to continent, diaspora are created by relocation or displacement of immigrant workers and their descendents.6 For these unskilled, immigrant laborers, middle class immigrants, and the children of both groups, adaptation to the culture, society, and life in a new ‘host’ country can be difficult, to say the least. So, in response to a new cultural landscape and a tenuous sense belonging, as well as to maintain a connection with a shared past, citizens of the world’s numerous diaspora replicate linguistic, cultural, and social norms, creating their own “cultural space[s]” that mirror and often replace a past relationship to their land of origin, or ‘home’.

Stranger in a Strange Land: The struggle for cultural and personal identity in Haruki Murakami's Hard-Boiled Wonderland and the End of the World

In order to explicate Murakami's version of the official culture, I have analyzed the novel with the works of several different theorists. Primarily, I drew my own understanding of the official culture from Raymond Williams's examination of culture in Marxism and Literature. His terminology became helpful in writing about the operation of the System and the Town, though it did not define that operation precisely. Williams's work also introduced me to the theory behind the official culture's manipulation and exclusion of historical aspects in order to create their "official" version of history, from which the official culture draws its identity. For further analysis of the treatment of history, I turned to Friedrich Nietzsche's On the Advantage and Disadvantage of History for Life. Though it examines the official culture's manipulation of history in a much more in-depth manner, it seems to have influenced Murakami's treatment of individual memories and cultural histories. For instance, the herd ofunicoms in the End of the World resembles Nietzsche's description of the ''unhistorical herd," or has the potential to resemble it. With these theories I was able to access the mechanisms of cultural control that Murakami depicts in the form of the System and the Town, and from there I was able to develop a model for how the narrator struggles to subvert that control. Both sides of that struggle are depicted and re-imagined many times throughout Hard-Boiled Wonderland and the End of the World.

Kim Besio, Ziskind Professor of East Asian Studies

Kim Besio, Ziskind Professor of East Asian Studies

A Catalyst for Culture: Early Child Development and Education in Japan

A popular Western perception of Japan is that it is an eminently homogeneous and conformist society. However, both conformity and homogeneity, recognized even by the Japanese themselves, coexist with the concept of individuality, which is valued in a manner unique to its culture. In order to come to a deeper understanding of that dynamic, it is important to comprehend the specifics of child rearing and education within Japanese society. Based in part on the author's observational fieldwork conducted while in Japan in 1994, the thesis explicates the manner in which various core relationships exhibit the socialization of an individual that occurs within the home during a child's first few years. Furthermore, the text incorporates research in both primary and secondary historical materials. The author displays the manner in which educational issues such as the development of the Japanese education system and the dynamics of the elementary years serve to demonstrate the importance of functioning within a group. This is further clarified through an examination of elementary school texts, which also reveal underlying moral messages of profound importance in Japanese society. The seemingly contradictory issues of becoming an individual yet performing as a member of a group are pulled together by the idea that culture provides the guidance by which an individual becomes an active member of society. In Japan, individuality and group conformity are not mutually exclusive. Within the context of Japanese society, individuality is inextricably linked to group orientation.