"We are always asked; 'where are you from?'": Chilean women's reflections in midlife about their health and influence of migration to Sweden

Aim: This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences. Method: Three focus group discussions (FGDs) were performed with 21 middle-aged Chilean women (40-60 years) who had lived in Stockholm for at least 15-20 years. In-depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape-recorded and transcribed data. Findings: Three main themes emerged from the data: (i) Chilean women's reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They conn

ORIGINAL RESEARCH ARTICLES - Safe Motherhood Perspectives and Social Support for Primigravidae Women in Lusaka, Zambia

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care. (Afr J Reprod Health 2003; 7[3]: 29-40

Safe Motherhood Perspectives and Social Support for Primigravidae Women in Lusaka, Zambia

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care. (Afr J Reprod Health 2003; 7[3]: 29–40) RÉSUMÉ Perspectives de la maternité sans risque et l'appui social pour les femmes primigestes à Lusaka, Zambie Les objectifs visés par la maternité sans risque de profiter du service des sage-femmes traditionnels bien habileté au moment de l'accouchement n'ont pas été atteints en Zambie. Presque toutes (93%) les femmes zambiennes enceintes vont à la consultation prénatale, quoique seules 43% accouchent dans des maternités. Cette étude a été menée pour explorer comment la primigeste zambienne à bas risque se prépare pour la grossesse y compris l'usage du contraceptif, le contenu des soins prénatals, les préparatifs pour la naissance et le niveau de l'appuie social. Deux cent quatre-vingt dix primigestes qui ont fréquenté la consultation prénatale au Centre Hospitalier Universitaire (CHU) de Lusaka, Zambie ont été interviewées à l'aide d'un guide d'interview structuré. L'âge moyen des femmes était de 20,7ans; 41% d'elles étaient des adolescentes. Le groupe adolescent était remarquablement moins scolarisé (p < 0,0000). Au total, 78% n'avaient jamais utilisé aucune méthode contraceptive. Les sources principales d'information en matières sexuelles et de la santé reproductive étaient des amis et les médias. Il n'y avaient que 2% des femmes qui s'étaient renseignées sur les questions sexuelles et la santé reproductive auprès du personnel médical. Presque la moitié n'ont pas voulu la grossesse. Soixante-trois pour cent des femmes avaient eu leur première visite à la consultation prénatale au cours du deuxieme trimestre. Il n'y avait aucun préparatif prénatal des femmes pour la parturition et leur rôle de parent. Quatre-vingt-cinq pour cent parmi les femmes enceintes avaient identifié la personne qui leur serviraient comme appui social au cours de la grossesse et pendant l'accouchement. Les résultats ont montré que les préparatifs pour le rôle de parent avait été accordé une faible priorité en ce qui concerne les soins prénatals. Comme approche de la santé reproductive intégrée, nous proposons que les cours soient organisés pour les parents et qu'un réseau d'appui social soit utilisé et fasse partie des soins. (Rev Afr Santé Reprod 2003; 7[3]: 29–40

Chilean midwives and midwifery students' views of women's midlife health-care needs

Objective: to determine Chilean midwives' views with regard to Chilean women's health-care needs in midlife. The aim was also to explore Chilean midwifery students' views on the clinical care provided to women in midlife. Design: a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis. Setting: 10 different primary health care (PHC) centres in Santiago, Chile. Participants: 22 midwives, working in PHC clinics and 13 (n=13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago. Findings: the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence

“I Am Happy that God Made Me a Boy”: Zambian Adolescent Boys\' Perceptions about Growing into Manhood

Adolescence is a period of transition during which a person is neither considered a child nor an adult. As little is known about adolescent boys\' perceptions, norms, role models and gender relations that influence their male identity and behaviour, this qualitative study was conducted. Data were drawn from seven FGDs and twelve mails of adolescent boys (15–19 years old) residing in two townships outside Lusaka and Kitwe in Zambia. Findings show that growing up to a man entails a certain level of ambiguity and contradictory perceptions in terms of supposedly appropriate social and sexual behaviour but indicates a few alternatives. Based on the findings, we recommend that the information gap, misconceptions and anxiety among boys regarding their male identity should be addressed. The respondents suggested that an educational programme that will pay due attention to their needs and answer their questions should be designed and implemented with active involvement of male adolescent peers. (Afr J Reprod Health 2003; 7[1]: 49–62) Résumé  “Je suis content que le bon Dieu m\'ait créé un garçon”: les perceptions des adolescents mâles zambiens sur le procès d\'atteindre l\'âge l\'homme. L\'adolescence est une période de transition pendant laquelle l\'on n\'est considéré ni comme un enfant ni comme un adulte. Nous avons entrepris cette étude parce qu\'on connaît très peu de choses sur les perceptions des adolescents mâles, leurs normes, leurs modèles et les rapports entre les sexes qui influent sur leur identité et comportement masculins. Nous avons reculli des données des 7 DGCs et de douze courriers des garçons adolescents (15–19) qui habitaient dans deux municipalités hors de Lusaka et Kituve en Zambie. Les résultats ont montré que le procès d\'atteindre l\'âge d\'homme implique une certaine ambiguité et des perceptions contradictoires sur le plan du comportement sexuel et social soi-disant approprié. L\'étude a proposé des alternatifs. En nous fondant sur les résultats, nous proposons que les problèmes du manque d\'information, des idées fausses et de l\'inquiétude chez les garçons à l\'égard de leur identité masculine soient abordés. Les interrogés ont proposé qu\'un programme éducatif qui s\'occuperait de leurs besoins et qui répondrait à leurs questions soit conçu et réalisé avec la participation active des pairs adolescents mâles. (Rev Afr Santé Reprod 2003; 7[1]: 49–62) Key Words: Adolescents, gender, male identity, role models, sexuality, Zambi

Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg

Abstract Background There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory. The present study investigated the effect of different maternity home practices in St. Petersburg, Russia, as well as of physiological breast engorgement and maternal mood, on milk production in primi- and multiparous women on day four. The amount of milk was studied in relation to the duration of "nearly exclusive" breastfeeding. Methods 176 mother-infant pairs were randomised into four groups according to an experimental two-factor design taking into account infant location and apparel. Data were recorded in the delivery ward at 25–120 minutes postpartum and later in the maternity ward. Group I infants (n = 37) were placed skin-to-skin in the delivery ward while Group II infants (n = 40) were dressed and placed in their mother's arms. Both groups later roomed-in in the maternity ward. These infants had the possibility of early suckling during two hours postpartum. Group III infants (n = 38) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in. Group IV infants (n = 38) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward. Equal numbers per group were either swaddled or clothed. Episodes of early suckling were noted. Number of breastfeeds, amount of milk ingested (recorded on day 4 postpartum) and duration of "nearly exclusive" breastfeeding were recorded. Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being "low/blue". Results On day four, multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule (7 times a day; Group III). In contrast, there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on demand (Groups I, II and IV), although multiparas had higher numbers of feedings than primiparas. In addition during the first three days postpartum, multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling "low/blue" than primiparous mothers. Early suckling was shown to positively affect milk production irrespective of parity. Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not (284 and 184 ml respectively, SE = 14 and 27 ml, p = 0.0006). Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling, intensity of breast engorgement and number of breastfeeds on day 3 were most important. Intensity of feeling "low/blue" was negatively related to amount of milk ingested. The significant factor for multiparous women was early suckling. Similar results were obtained in Groups III and IV; however, in primiparous mothers, engorgement was the most important factor and in multiparous women it was rooming-in. Amount of milk produced on day 4 was strongly correlated to a duration of "nearly exclusive" breastfeeding (p Conclusion The present data show that ward routines influence milk production. As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors, further research is needed.</p