Ethnic differences in factors associated with the use of contraception among 20- to 44-year-old women in Estonia and St. Petersburg, Russia

BackgroundThe aim of this study was to explore factors associated with contraception among 20- to 44-year-old women in different ethnic groups in two Eastern European countries.Study DesignData on sexually experienced women in need of contraception taken from population-based cross-sectional surveys, conducted in Estonia (n=1680) and in St. Petersburg (n=798), were analyzed. Factors associated with contraception nonuse or the use of unreliable contraceptive methods were explored using multivariate logistic regression analysis.ResultsThe age-standardized prevalence rate of contraception nonuse or the use of unreliable contraceptive methods was high (27.3% among Estonian-speaking women in Estonia, 39.9% and 42.5% among Russian-speaking women in Estonia and in St. Petersburg, respectively). Age, economic subsistence, high-risk sexual behavior and smoking did not correlate with contraception nonuse or the use of unreliable contraceptive methods among Russian-speaking women in Estonia and in St. Petersburg; this was in contrast to Estonian-speaking women in Estonia. Previous childbirth and abortion reduced the risk of contraception nonuse or the use of unreliable contraceptive methods among Estonian-speaking women in Estonia (adjusted odds ratio, 0.50; 95% confidence interval [CI], 0.31?0.81) but elevated the risk among Russian-speaking women in St. Petersburg (1.99; 1.17?3.40). Abortion, not previous childbirth, was associated with an increased risk among Russian-speaking women in Estonia (2.94; 1.25?6.95).ConclusionsThe importance of different risk factors associated with contraceptive use varies between different ethnic groups. Cross-national comparisons are essential for the design of public health policies that decrease the burden of sexual ill health.     

Men's perceptions of women's reproductive health in South Sudan

This paper draws on a qualitative study (n = 52) and applies a political ecology of health framework to examine men's perceptions of women's reproductive health in South Sudan. The findings suggest that political practices of place making configure men's views of women's reproductive roles in this new nation state. In particular, masculinity intertwines with fears of losing traditional culture, and with lingering concerns about sovereignty to underpin men's deep aversion to modern family planning methods. In addition, the use of tribal militia to control territory and leverage political power places women's reproduction at the centre of South Sudan's post-secession politics. Improving health in such a fragile environment may require more than rebuilding the health infrastructure and guaranteeing financial access to health care.     

Abortion and Contraception: Attitudes of South African University Students

Despite the availability of contraception, the rates of abortion among young women in South Africa continue to increase. We designed a study to examine young people's attitudes about abortion and contraception. One hundred and eighty-eight South African university students (97 females and 91 males) completed the survey. While we found moral objections to abortion for the sample as a whole, females showed stronger support for availability of abortion and women's autonomy compared with males. The respondents acknowledged the importance of contraception at a personal and general level, but more than 40% of them believed that women who use contraception are promiscuous. Females expressed difficulty with usage more frequently than males and indicated that they would not consider sexual intercourse if contraception were not available. For health care workers involved in counseling young people about their sexual and reproductive choices, the challenge lies in promoting a culture of equal rights and respect for women's reproductive freedom.     

Beyond “toxic bodies”: Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto,Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a “high-risk environmental area” in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond “toxic bodies”.     

Kathy Pan,sticks and pummelling: Techniques used to induce abortion by Burmese women on the Thai border

Forced migrants face particular reproductive health problems. Migrant Burmese women in Thailand often need to work to support themselves and their families, and mistimed and unwanted pregnancies are a common problem. They have limited access to culturally appropriate reproductive health services and no access to safe elective abortion. They are at risk of deportation or at least harassment by Thai authorities if they travel. They use traditional methods such as herbal medicines, and employ lay midwives to provide pummelling and stick abortions to end their pregnancies. This ethnographic study used various methods to collect data over 10 months in Tak Province, Thailand. The authors describe the women's motives and means of ending their pregnancies and some of the difficulties in obtaining reliable modern methods of contraception. This study highlights the need for reproductive health care for displaced populations.     

Reproductive Health and Bodily Integrity in Tanzania

Several policy initiatives support the empowerment of women to improve their reproductive health. Little is known, however, about the inverse effect that reproductive health might have on women's empowerment. Women are pressured to conform to their reproductive role, and an inability to do so might affect their empowerment, including control over their own body. Using a panel dataset of 504 married women in Northern Tanzania, we find that women who experienced a pregnancy loss show more tolerant views of partner violence and that child mortality lowers their perceived control over the sexual relationship with their spouse. The number of living children did not affect bodily integrity. These results confirm that women's bodily integrity is partly dependent on the ability to fulfill their reproductive role. They strengthen the case for policies and programs that improve women's reproductive health and underline the importance of counselling after pregnancy or child loss.     

Ethnophysiology and Contraceptive Use Among Low-Income Women in Urban Brazil

Distrust and dissatisfaction with contraceptive methods among low-income Brazilian women contributes to incorrect contraceptive use, harmful health risks, and an extensive reliance on surgical sterilization. Data from ethnographic fieldwork in a low-income neighborhood in urban Brazil illustrate that women's concerns regarding contraception make sense in the context of their general health and illness beliefs and their understanding of reproductive physiology. Women interpret and experience biomedical concepts and contraceptive methods (such as “hormones” and oral contraceptives, respectively) according to an ethnophysiology of fecundity, menstruation, and conception. These popular representations of reproduction embody social relations and local experience and therefore persist despite the influence of biomedical models. Recognition of this ethnophysiology and greater emphasis on culturally appropriate counseling and education among health care professionals will improve women's experience and effective use of reversible contraception.     

Narratives of risk: Women at midlife,medical 'experts' and health technologies

The 'management' of midlife women's bodies is becoming an increasingly important focus for both themselves and medical 'experts'. Health technologies play a major part in this process, given health promotion messages about their usefulness for maintaining and enhancing the quality of life. But how do individual women interpret such messages? This paper explores the factors that impact upon health decision making in relation to a group of these technologies. In particular, we examine how related risks are assessed by women themselves and jointly with health professionals, in the clinical context. Drawing upon literature from the sociology of the body and embodiment, debates about risk and feminist research on the menopause, we argue that midlife needs to be understood as an embodied experience and that women's decisions about technology-based health interventions need to be contextualised. The paper draws upon research data from interviews with individual women and health professionals, and recordings of clinical consultations which relate to the specific technologies of HRT, bone densitometry and breast screening. The data reveal the emergence of two major risk narratives within consultations and interviews, health risks and social risks. We conclude that the health decisions and practices of both lay women and health professionals reflect a complex mixture of expert knowledge and advice, and embodied cultural experience.     

Women's health theorizing: a call for epistemic action

The women's health community is challenged by global social and economic pressures. In order to ensure the salience of their empirical and theoretical research, women's health researchers are struggling with an analysis of what has successfully typified women's health and a critical awareness of the pressures that will mark its future. For many researchers, this has provoked a quest for new women's health paradigms to inform and spur action regarding the future of women's health. Re-theorizing women's health cannot be successful in the absence of an analysis of the epistemological orientation of women's health research. However, little has been done to examine these epistemological roots. This paper examines the historic epistemological foundation of women's health research in order to facilitate an understanding of the theoretical and conceptual underpinnings of women's health. This review is intended to guide future epistemic action necessary to advance the field of women's health research and highlight current efforts that may support work in this field.     

Contraceptive practice of women with opiate addiction in a rural centre

ABSTRACT: This study aimed to explore the contraceptive practices of women in methadone treatment for opiate use in rural New South Wales and the reasons for those practices. Demographic characteristics, including age, marital status, sexual activity and contraceptive use, of all 23 women on a rural methadone program were documented. A smaller subgroup of seven women was interviewed using a semi-structured qualitative technique and issues around contraception explored in more depth. The study found that women who did not use contraception often had a low perceived risk of pregnancy for a variety of reasons including past infertility, menstrual irregularities and effect of drugs. The women had concerns about, and often felt guilty about, the effect of drug use on their children. They also had concerns about the side-effects of contraception. The study has implications for education and counselling of women when they enter drug treatment programs. Problems associated with opiate use are not just restricted to metropolitan areas but are part of rural health.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

I’m a young student,I’m a girl … and for some reason they are hard on me for smoking: The role of gender and social context for smoking behaviour

Despite considerable population declines, smoking has become increasingly socially stratified, a trend that emerges as salient when examining smoking according to gender. However, there is a dearth of comparative research with regard to smoking inequalities among men and women. The goal of this exploratory study was to examine how three elements of the social context (identity, body, agency) are gendered and the way in which they differentially shape men's and women's smoking practices. In-depth qualitative interviews were conducted with 23 adult smokers living in Toronto and Montréal, Canada stratified by socio-economic position and gender. Our results show that: (1) women express considerable dissonance between gender identities and smoking behaviour, whereas men's gender identities seem to reinforce smoking behaviour; (2) women's smoking was tied to gendered representations of the body, with the fear of weight gain factoring into their smoking maintenance, whereas concern about the body was absent among men; (3) women suggested wanting, but not having agency over their smoking behaviour while men suggested having agency but little urgency to quit smoking. Our exploratory study points to the possibility that gender remains important for shaping smoking practices among adult smokers and that smoking among some women may be characterised by a greater sense of dissonance and tension than among some men. Addressing gender inequalities in the health discourse surrounding smoking may help reduce the current gender disparities in smoking patterns.     

Gender,caring work,and the embodiment of kufungisisa: Findings from a global health intervention in Shurugwi District,Zimbabwe

This paper analyses the findings from qualitative interviews conducted as part of a cross-disciplinary pilot study into the efficacy of the Friendship Bench for promoting mental health amongst rural women living in Shurugwi District, Zimbabwe. Informed by UNICEF's nurturing care framework, the pilot study hypothesised that women's caring capabilities would be enhanced if a cost-effective intervention could be found for those suffering from common mental disorders (CMD), locally referred to as kufungisisa. Focusing on the women's accounts of their embodiment of kufungisisa, the paper further highlights the important role that gender plays in women's experience of common mental health disorders. More critically, it identifies the ways in which patriarchal social relations may be reinforced through the spaces of global health interventions such as the one reported on here. The paper concludes with a moment of self-reflection. Specifically, it poses the question that our paper, and the global health intervention it reports upon, would look very different if the women's experiences of kufungisisa were considered not only as they appear in the present but at the intersection of social and spatial relations that have much longer histories.     

Consistent and Inconsistent Contraception Among Young Women: Insights from Qualitative Interviews

Qualitative interviews with young women attending community colleges were used to address why women who do not desire pregnancy vary in how consistently they use contraception. Based on our analysis of the women's sexual histories, we argue that five factors are key to promoting or discouraging consistent use of contraception: efficacy (women's ability to put an intention to contracept into practice), the actions and attitudes of male partners, being in a long‐term relationship, whether women experience side effects, and misinformation or erroneous reasoning about pregnancy risk. Variations in how these factors combine at different times in women's lives explain much about their patterns of contraceptive consistency.     

Women's health: women's voices

This paper presents the results of an exploratory study into the health concerns of women in South Wales. The objective was to obtain information on the way in which women view their own health and the health issues that concern them. The research design replicated a study carried out in Canada by one of the authors. Sixty-five women were interviewed using a structured interview schedule. The core question on the interview schedule took respondents through a list of 68 health and social problems. They were asked to indicate whether they had been worried about or had experienced any of these problems in the previous 6 months. The results support the findings of the Canadian research that reproductive health is not central to women's health concerns. On the contrary, among the most frequently mentioned problems were tiredness, stress, headaches and arthritis. The most frequently mentioned social problem was worrying about money. Women linked their health concerns with other problems such as unemployment, problems combining child care and paid employment and worrying about money. These problems created stress and, in turn, stress either led directly to ill health or else helped to foster ‘unhealthy’ life styles. Women were aware of the possibly harmful effects on health of smoking or drinking, for example, but resorted to them in order to cope with their stressful lives. One of the main conclusions of the study is that it is essential to incorporate women's health concerns into the policy-making process. Women's main health concerns are related to the stressful nature of their lives and, particularly in South Wales, to poverty and unemployment. So-called unhealthy lifestyles are often a response to stress and enable women to cope. This needs to be taken into consideration by health promoters. Finally, more research is required into women's health concerns and their understanding of health and illness.     

Climate change,women's workload in smallholder agriculture,and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.     

Self-Efficacy and Rural Women's Performance of Breast and Cervical Cancer Detection Practices

Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women ( N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.