Suchergebnisse

School-based sexuality education makes teachers important gatekeepers of students' access to information about sexual and reproductive health and rights. The school setting has the potential to reach large numbers of students. However, teachers' professional identities may go beyond, differ from or even conflict with the qualities required of sexuality educators. To gain a better understanding of the role of professional identity in the delivery of school-based sexuality education, this study used cultural schema theory to study teachers' professional identities, and how these motivate them to provide sexuality education. In-depth interviews were conducted with 40 sexuality education teachers at secondary schools in Kampala, the capital of Uganda. Sexuality education lessons were observed to validate the findings from the interviews. Results identified five cultural schemas of professional identity: (i) upholder of ethics and regulations; (ii) authority figure; (iii) counsellor and guide; (iv) role model; and (v) guardian. The study concludes that teachers' cultural schemas of professional identity motivate them to adhere to moral discourses of abstinence and sexual innocence. To support teachers in taking more comprehensive approaches to sexuality education, it is important that they receive adequate teacher training and support from the Ugandan government, the school administration and the wider community.

School-based sexuality education makes teachers important gatekeepers of students' access to information about sexual and reproductive health and rights. The school setting has the potential to reach large numbers of students. However, teachers' professional identities may go beyond, differ from or even conflict with the qualities required of sexuality educators. To gain a better understanding of the role of professional identity in the delivery of school-based sexuality education, this study used cultural schema theory to study teachers' professional identities, and how these motivate them to provide sexuality education. In-depth interviews were conducted with 40 sexuality education teachers at secondary schools in Kampala, the capital of Uganda. Sexuality education lessons were observed to validate the findings from the interviews. Results identified five cultural schemas of professional identity: (i) upholder of ethics and regulations; (ii) authority figure; (iii) counsellor and guide; (iv) role model; and (v) guardian. The study concludes that teachers' cultural schemas of professional identity motivate them to adhere to moral discourses of abstinence and sexual innocence. To support teachers in taking more comprehensive approaches to sexuality education, it is important that they receive adequate teacher training and support from the Ugandan government, the school administration and the wider community.

SummaryIn India, nearly one million women of childbearing age are infected with HIV. This study sought to examine the biological effect of HIV on the fertility of HIV-infected Indian women. This is relevant for the provision of pregnancy-related counselling and care to the infected women, and for estimating the HIV prevalence among women and children. The study used retrospectively collected data from the National Family Health Survey (2005–2006) and applied a matched case control study design to compare the effect of HIV on conception, pregnancy rates and pregnancy outcomes among HIV-infected (N=69) and HIV-non-infected (N=345) women, both unaware of their HIV status. Pregnancy rates and pregnancy outcomes were compared through non-parametric statistical tests, whereas the effect of HIV on fecundity was studied by analysing the interval between last two pregnancies using Cox regression. The pregnancy rate was observed to be lower among HIV-infected than HIV-non-infected women (RR=0.77). The difference, however, was not statistically significant (p=0.064). There was also no statistically significant difference in the interval between last two pregnancies (p=0.898). Significantly higher number of pregnancies among HIV-infected women resulted in termination because of miscarriage or stillbirths (p=0.004). Therefore, while providing clinical care and counselling to infected women, the possibility of adverse pregnancy outcomes should be considered. Due to the higher rate of adverse pregnancy outcomes, attendance of HIV-infected women at antenatal clinics might be greater, which could lead to overestimation of HIV prevalence derived from antenatal care surveillance sites.

The Ugandan government has been criticised on several grounds for its abstinence-only policies on sexuality education directed towards young people. These grounds include the failure to recognise the multiple realities faced by young people, some of whom may already be sexually active. In the study reported on this paper, students' perceptions of relationships and sexual practices were analysed to obtain an understanding of how young people construct and negotiate their sexual agency in the context of abstinence-only messages provided in Ugandan secondary schools and at the wider community level. Ten in-depth interviews and six focus group discussions were conducted with students aged 15–19 years (N = 55) at an urban co-educational secondary school. Data were transcribed verbatim and analysed using grounded theory. Findings show that students engage in sexual activity despite their belief that contraception is ineffective and their fears for the consequences. Students' age, gender, financial capital and perceived sexual desire further increase risk and vulnerability. To improve their effectiveness, school-based sexuality education programmes should support students to challenge and negotiate structural factors such as gender roles and sociocultural norms that influence sexual practices and increase vulnerability and risk.

This methodological paper systematically describes the steps towards exploring client-perceived barriers to enroll in the National Health Insurance Scheme in Ghana. To respond to the stagnating enrollment rate and to provide evidence-based information for developing policy and practice, the request for this study was made by the insurance authority. We adopted a Participatory Action Approach (PAA) and employed a linked trajectory of qualitative and quantitative methods to inquire deeply into clients' motives and assumptions, and the root causes of these barriers, while transferring learning among multiple stakeholders in the system: the client, the healthcare provider, and the insurer. Data were collected in 2011 and 2012 among clients in their local communities in two regions in Ghana. Clients were participants in the research, expressing and sharing their emic perspectives and commonly shared opinions with the other stakeholders. This paper explores the contribution of the PAA to healthcare and health insurance studies. We claim that the PAA is a necessary approach for the study of a complex situation such as the health insurance context in Ghana as well as for the facilitation of learning and facilitate democratic decision-making. Making multidisciplinary stakeholders, including clients, part of the research contributes to finding solutions that are acceptable to different stakeholders. Our study contributes to PAA methodology knowledge and provides new insights on combining qualitative and quantitative research methods. We propose this as a model to be used within action research that can also be applied in other contexts outside of Africa.

This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N=560), were analysed. Directly standardized overall and parity-specific pregnancy rates were compared among HIV infected women before and after coming to know about their HIV status. The age- and parity-standardized pregnancy rates and age-standardized parity-specific pregnancy rates were statistically significantly lower after knowing about HIV status as compared to before the HIV status was known. Analysis of parity-specific rates suggested lower likelihood of HIV infected women to progress to higher parity. The clear behavioural impact of HIV on fertility observed should be taken into account while estimating HIV infected pregnant women in the country. Ensuring access to information and services for PMTCT to HIV infected couples is essential to support informed reproductive decision making among them.

This methodological paper systematically describes the steps towards exploring client-perceived barriers to enroll in the National Health Insurance Scheme in Ghana. To respond to the stagnating enrollment rate and to provide evidence-based information for developing policy and practice, the request for this study was made by the insurance authority. We adopted a Participatory Action Approach (PAA) and employed a linked trajectory of qualitative and quantitative methods to inquire deeply into clients' motives and assumptions, and the root causes of these barriers, while transferring learning among multiple stakeholders in the system: the client, the healthcare provider, and the insurer. Data were collected in 2011 and 2012 among clients in their local communities in two regions in Ghana. Clients were participants in the research, expressing and sharing their emic perspectives and commonly shared opinions with the other stakeholders. This paper explores the contribution of the PAA to healthcare and health insurance studies. We claim that the PAA is a necessary approach for the study of a complex situation such as the health insurance context in Ghana as well as for the facilitation of learning and democratic decision-making. Making multidisciplinary stakeholders, including clients, part of the research contributes to finding solutions that are acceptable to different stakeholders. Our study contributes to PAA methodology knowledge and provides new insights on combining qualitative and quantitative research methods. We propose this as a model to be used within action research that can also be applied in other contexts outside of Africa.

ABSTRACTThe article examines the independent effect of religious minority status on fertility at two levels i.e. cross‐country level of India and Bangladesh and intra‐country level (district) of India. Demographic and health survey data from India (2005–2006) and Bangladesh (2006–2007) are used for the cross‐country comparison and the census of India (2001) for the intra‐country comparison. Minority status is operationalised first as an interaction between country and religion, and second through a religion‐based concentration index. This article finds empirical support for the independent effect of religious minority status on fertility at the cross‐country (India and Bangladesh) and intra‐country (districts of India) level. This article contends that high fertility among religious minorities is a result of vulnerability due to socio‐economic disadvantageous position of minorities in India and Bangladesh. Copyright © 2011 John Wiley & Sons, Ltd.

Background: People's decision to enroll in a health insurance scheme is determined by socio-cultural and socioeconomic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people's perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice. Method: We conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012. Results: While social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers' clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009,.000 and .000 respectively). Conclusion: Social capital can motivate clients to enroll in health insurance. ...