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  • 1.
    Annborn, Anna
    et al.
    Malmö University, Faculty of Health and Society (HS).
    Finnbogadóttir, Hafrún Rafnar
    Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linneaus University, Sweden.
    Obstetric violence a qualitative interview study.2021In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 105, article id 103212Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the meaning of the concept of 'obstetric violence' to women in Sweden, who reported a negative birth experience.

    DESIGN: An inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used.

    SETTING: Three midwifery clinics in southwest Scania.

    PARTICIPANTS: Twelve women who had given birth less than three years previously and reported a negative/traumatic birth experience.

    FINDINGS: The key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as 'obstetric violence'. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape.

    KEY CONCLUSIONS: The study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to 'obstetric violence' during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth.

    IMPLICATIONS FOR PRACTICE: In order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required.

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  • 2. Arousell, Jonna
    et al.
    Carlbom, Aje
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnsdotter, Sara
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Essen, Birgitta
    Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception?: A qualitative exploration and critique of a common argument in reproductive health research2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions. Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established. Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception. Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling. (C) 2019 The Authors. Published by Elsevier Ltd.

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  • 3.
    Arvidsson, Anna
    et al.
    Department of Women’s and Children’s Health/IMCH, Uppsala University, Uppsala, Sweden.
    Vauquline, Polly
    Department of Women’s Studies, Gauhati University, Guwahati, India.
    Johnsdotter, Sara
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Essén, Birgitta
    Department of Women’s and Children’s Health/IMCH, Uppsala University, Uppsala, Sweden.
    Surrogate mother - praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers. Objective: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy. Methods: In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam. Results: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services. Conclusions: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.

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  • 4.
    Bodin, Maja
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Plantin, Lars
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Schmidt, Lone
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark..
    Ziebe, Soren
    Copenhagen Univ Hosp, Fertil Clin, Copenhagen, Denmark..
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    The pros and cons of fertility awareness and information: a generational, Swedish perspective2023In: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, Vol. 26, no 2, p. 216-225Article in journal (Refereed)
    Abstract [en]

    Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

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  • 5. Danerek, M
    et al.
    Udén, Giggi
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Sympathetic responsibility in ethically difficult situations2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 12, p. 1164-1171Article in journal (Refereed)
  • 6.
    Dejin-Karlsson, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Strobel, Ewa
    Sladkevicius, P
    Rovas, L
    De Smet, F
    Valentin, Lil
    Bishop score and ultrasound assessment of the cervix for prediction of time to start of labor and time to delivery in prolonged pregnancy2006In: Ultrasound Obstet Gynecol, Vol. 28, p. 298-305Article in journal (Refereed)
  • 7.
    Dejin-Karlsson, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Östergren, Per-Olof
    Krantz, Gunilla
    Rosvall, Maria
    Psychosocial factors at work and in the private domain and smoking during pregnancy2002Conference paper (Refereed)
  • 8.
    Denneberg, Mathilda
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Persson, Miranda
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kvinnor med endometrios och deras upplevelser av bemötandet i vården: En litteraturstudie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Endometriosis is a chronic inflammatory disease that affects one in ten women in their fertile age. Typical symptoms of endometriosis are dysmenorrhea, heavy irregular bleedings, dyspareunia and infertility. The diagnostic delay is often many years, which could cause suffering. Research of endometriosis is progressing, yet there still exists ignorance in health care and health care staff need training to be able to provide support. The theoretical frameworks used were the nursing theory by Joyce Travelbee and person-centered nursing. Aim: To illustrate how women with endometriosis experience health care encounters. Method: The literature review was performed with a qualitative approach. After the quality review ten articles remained that were included in the literature review. Results: The ten articles used in the literature review came from Sweden, Hungary, Australia, United Kingdom and the Netherlands. The data analysis generated three categories: Health care provider ́s diminishing attitude, Knowledge and information and Fertility, with six subcategories that represented different aspects of the experience in the health care encounter. The women fought several years to get a diagnosis, health care providers did not take them seriously and normalized their symptoms. The women also felt that the health care providers lacked knowledge about the disease and focused too much on fertility. Positive health care encounters were when the health care providers listened and confirmed them. Conclusion: Women mostly had negative experiences of health care encounters and lacked support from the health care staff. It is significant to raise the level of knowledge in order to reduce women’s suffering from the disease. The nurse needs to work empathically with a person-centered approach to be able to meet the women’s needs. 

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  • 9.
    Fernlund, A
    et al.
    Skåne University Hospital; Lund University.
    Jokubkiene, L
    Skåne University Hospital; Lund University.
    Sladkevicius, P
    Skåne University Hospital; Lund University.
    Valentin, L
    Skåne University Hospital; Lund University.
    Sjöström, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Psychological impact of early miscarriage and client satisfaction with treatment: a comparison between expectant management and misoprostol treatment in a randomized controlled trial2021In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 58, no 5, p. 757-765Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare short- and long-term emotional distress (grief, anxiety, depressive symptoms) after early miscarriage in women randomized to expectant management or misoprostol treatment, and to compare satisfaction with treatment.

    METHODS: This is a randomized controlled trial (ClinicalTrials.gov ID: NCT01033903) comparing expectant management with misoprostol treatment of early miscarriage. If the miscarriage was not complete on day 31 after inclusion surgical evacuation was recommended. Main outcome measures were grief, anxiety, depressive symptoms and client satisfaction assessed by validated psychometric self-assessment instruments, i.e. Perinatal grief scale (PGS), Spielberger State-Trait Anxiety Inventory (STAI-S Form-Y), Montgomery-åsberg Depression Rating Scale Self-report version (MADRS-S) and Client Satisfaction Questionnaire (CSQ-8). There were four assessment points: the day of randomization, the day when the miscarriage was judged to be complete, and 3 months and 14 months after complete miscarriage. Analysis was by intention to treat.

    RESULTS: 90 women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment points. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had STAI-state scores >46 ("high levels of anxiety") and 9% (8/86) and 10% (9/91) had symptoms of moderate or severe depression (MADRS-S score >20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild. The median PGS score in both treatment groups was 40.0 at 3 months and 37.0 at 14 months after complete miscarriage. Four women treated with misoprostol and two women managed expectantly had PGS scores >90 (indicating deep grief) 3 months after complete miscarriage. One woman managed expectantly had PGS score >90 after 14 months. More than 85% of the participants in both groups would recommend the treatment they received to a friend.

    CONCLUSIONS: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on management of early miscarriage. This article is protected by copyright. All rights reserved.

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  • 10.
    Finnbogadottir, Hafrún
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Torkelsson, Ella
    Malmö Univ Hosp, Dept Obstet & Gynaecol, Malmö, Sweden..
    Christensen, Cecilia B.
    Malmö Univ Hosp, Dept Obstet & Gynaecol, Malmö, Sweden..
    Persson, Eva-Kristina
    Lund Univ, Dept Hlth Sci, S-22100 Lund, Sweden..
    Midwives experiences of meeting pregnant women who are exposed to Intimate-Partner Violence at in-hospital prenatal ward: A qualitative study2020In: European Journal of Midwifery, E-ISSN 2585-2906, Vol. 4, article id 35Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION Worldwide every third women is exposed to physical and/or sexual violence and pregnancy is no safe period for the women. The aim was to elucidate midwives experience of violence-exposed pregnant women who had been referred to a prenatal ward and were hospitalized. METHODS An inductive qualitative method was used with four focus-group interviews performed with sixteen midwives working at in-hospital prenatal ward. The data were analyzed with content analysis. RESULTS Three categories emerged. 'Professional area of responsibility', the midwives working at in-hospital prenatal ward considered it was the responsibility of the midwives working at antenatal care to ask routinely in order to detect violence-exposed women. Signs of help-seeking were based on the pregnant woman's behavior. Suspicion of intimate-partner violence was based on gut feeling. 'Conditions for support', the midwives strived to support pregnant women who were already identified as violence-exposed or if they had a suspicion that the pregnant woman was in a relationship where intimate-partner violence occurred. 'Barriers for giving support', both the work-place layout and routines constituted a barrier. The midwives own emotional state could affect her handling of the situation. CONCLUSIONS The midwives working in-hospital considered it the responsibility of the midwives at antenatal healthcare to identify these women. The midwives had limited experience in dealing with violence-exposed pregnant women but recognized a number of signs and symptoms that could cause suspicion. They felt uncomfortable in the situation and expressed a need for both education and an action plan.

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  • 11.
    Finnbogadóttir, Hafrún
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Baird, Kathleen
    Thies-Lagergren, Li
    Birth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy: a longitudinal cohort study2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Victimisation of women is encountered in all countries across the world, it damages the mental and physical health of women. During pregnancy and the postpartum period, women are at a greater risk of experiencing violence from an intimate partner. The aim of this study was to explore childbirth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy.

    METHODS: A longitudinal cohort design was used. In total, 1939 pregnant women ≥18 years were recruited to answer two questionnaires, both questionnaires were administered in the early and late stages of their pregnancy. The available dataset included birth records of 1694 mothers who gave birth between June 2012 and April 2014. Statistical analyses included descriptive statistics, T-test and bivariate logistic regression.

    RESULTS: Of 1694 mothers 38.7% (n = 656) reported a history of violence and 2% (n = 34) also experienced domestic violence during pregnancy. Women who were single, living apart from their partner, unemployed, smoked and faced financial distress were at a higher risk of experiencing violence (p = 0.001). They also had significant low scores on the SOC-scale and high EDS-scores ≥13 (p = 0.001) when compared to women without a history of violence (p = 0.001). Having a history of violence increased the woman's risk of undergoing a caesarean section (OR 1.33, 95% CI 1.02-1.70). A history of emotional abuse also significantly increased the risk of having a caesarean section irrespective of whether it was a planned or an emergency caesarean section (OR 1.50, 95% CI 1.09-2.06). Infants born to a mother who reported a history of violence, were at significant risk of being born premature < 37 weeks of gestation compared to infants born by mothers with no history of violence (p = 0,049).

    CONCLUSIONS: A history of violence and/or exclusively a history of emotional abuse has a negative impact on childbirth outcomes including caesarean section and premature birth. Therefore, early identification of a history of or ongoing violence is crucial to provide women with extra support which may have positive impact on her birth outcomes.

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  • 12.
    Håkansson, Dubravka I. G.
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Ouis, Pernilla
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Ragnar, Maria Ekstrand
    Lund University.
    Navigating the Minefield: Women's Experiences of Abortion in a Country with a Conscience Clause—The Case of Croatia2021In: Journal of International Women's Studies, E-ISSN 1539-8706, no 1, p. 166-180Article in journal (Refereed)
    Abstract [en]

    Many countries around the world have a conscience clause allowing physicians and health care providers to opt-out of performing abortions. This practice of conscientious objection to abortion care affects both healthcare providers and women's access to abortion care. In Croatia, a conscience clause was introduced in 2003. Nonetheless, women's experiences of abortion after the introduction have not been previously studied. The aim of our study was to explore women's experiences of abortion and conscientious objection in a country with a conscience clause. The study has a qualitative inductive and explorative design. We interviewed seven (7) women in Croatia with experience of an unwanted pregnancy or abortion and analyzed the interviews using thematic content analysis. Our findings revealed one overarching theme: ‘Navigating the minefield—women's experiences of abortion in a country with a conscience clause’ and three categories: ‘Experiencing abortion—to endure a vulnerable situation,’ ‘The conscientious objection in practice—causing obstacles and stigma,’ and ‘Views on abortion—socio-cultural and religious influence’. The women perceived the abortion decision as being difficult and expressed feelings of shame, guilt, and fears of being judged in line with the general attitude toward abortion in society. They described the conscientious objection as having consequences in public healthcare by limiting their access to abortion care and affecting treatment in terms of i.e. derogatory comments, limited or lacking information about the abortion procedure and/or absent contraceptive counseling post abortion. According to the women, a shift towards more conservative ideas towards abortion seem to have taken place in the Croatian society. The conscientious objection was believed to reinforce a moralizing view of sexuality, where the women’s decisions regarding abortion became a collective concern causing stigma and involuntary social alienation. The conscientious clause made the women feel they had to navigate a ‘minefield,’ where their dependency situation and vulnerability in the abortion situation were reinforced by social stigma.

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  • 13.
    Johnsdotter, Sara
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Female Genital Mutilation2022In: The Blackwell Encyclopedia of Sociology / [ed] J. Kalaivanthan, Chichester: Wiley-Blackwell, 2022, 2ndChapter in book (Other academic)
    Abstract [en]

    “Female genital mutilation” (FGM) or “female genital cutting” (often FGM/C) are the most widespread terms to designate nonmedical practices that alter or affect the external female genitalia. Medical consequences are often classified into immediate and long-term complications. FGM/C in some form is practiced in more than 30 countries, primarily in Africa and Asia, and there is vast variation as regards motives and age of the girls who undergo the procedure. FGM/C is illegal in Europe, North America, and Australia, and in most high-prevalence countries in Africa. Few cases of illegal FGM/C procedures have reached criminal courts in the west. A growing body of research demonstrates that cultural change regarding FGM/C attitudes and practices among migrant communities may be an important explanatory factor. Current contested issues include how the prevalent zero-tolerance approach to FGM/C is in line with the general acceptance of male circumcision, intersex surgery, and cosmetic female genital surgeries.

  • 14. Kjærgaard, Hanne
    et al.
    Olsen, Jørn
    Ottesen, Bent
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 4, p. 402-407Article in journal (Refereed)
    Abstract [en]

    Objective. To estimate the incidence of dystocia among nulliparous women without apparent co-morbidity and to examine maternal and fetal short-term outcomes after dystocia. Design. A multi-center cohort study with prospectively collected data. Setting. Nine obstetric departments with annual birth rates between 850 and 5,400. Population. Low-risk nulliparous women in term spontaneous labor with a singleton fetus in cephalic presentation. Methods. Follow-up of 2,810 nulliparas using self-administered questionnaires supplemented with clinical records. Criteria for dystocia. Cervical dilatation ≤2 cm over four hours during the first stage of labor or no descent during two hours (three hours with epidural analgesia) in the descending phase of second stage or no progress for one hour during the expulsive phase of the second stage. Inclusion took place between May 2004 and July 2005. Main outcome measures. Incidences of dystocia, maternal, and fetal outcomes. Results. The cumulative incidence of dystocia was 37% and of the diagnoses 61% were given in the second stage of labor. Women with dystocia treated by augmentation had more cesarean and ventouse deliveries, more often non-clear amniotic fluid, more post-partum hemorrhage and their children were more often given low one-minute neonatal Apgar scores as compared to women delivered without a diagnosis of dystocia. Conclusions. A dystocia incidence of 37% was found in healthy term nulliparas with no indication for induction or elective cesarean delivery. The adverse maternal and neonatal birth outcomes may be related to the cause of dystocia or to augmentation of labor and this question calls for further studies.

  • 15.
    Kolak, Mia
    et al.
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden..
    Löfgren-Mårtenson, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Hansson, Stefan R
    Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Malmö, Sweden.
    Rubertsson, Christine
    Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Agardh, Anette
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden.
    Immigrant women's perspectives on contraceptive counselling provided by midwives in Sweden - a qualitative study2022In: Sexual and reproductive health matters, ISSN 2641-0397, Vol. 30, no 1, article id 2111796Article in journal (Refereed)
    Abstract [en]

    Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women's health at both individual and societal levels. This study explored immigrant women's perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife's professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.

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  • 16. Kruljac, M.
    et al.
    Finnbogadottir, Hafrún
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bobjer, J.
    Giraldi, A.
    Fugl-Meyer, K.
    Giwercman, A.
    Symptoms of sexual dysfunction among men from infertile couples: prevalence and association with testosterone deficiency2020In: Andrology, ISSN 2047-2919, E-ISSN 2047-2927, Vol. 8, no 1, p. 160-165Article in journal (Refereed)
    Abstract [en]

    Background This case control study aimed to investigate whether symptoms of sexual dysfunction are more common in males from infertile couples than in the general population and to explore whether symptoms of sexual dysfunction are associated to hypogonadism. Objectives Participants were 165 subfertile men in infertile heterosexual relationships, 18-50 years of age, with sperm concentrations < 15 x 10(6)/mL. The controls were 199 men from a population-based group, matched for age. Material and methods Logistic regression was applied in order to calculate odds ratios (ORs) for seven different symptoms of sexual dysfunction. In a multivariate model, we tested independent effects of infertility and primary as well as secondary hypogonadism. Results Statistically significant association between subfertility and symptoms of sexual dysfunction was found for lack of ability to control ejaculation (OR 2.2, 95% CI: 1.2-4.2). For hypogonadism, statistical significance was seen both in relation to low sexual interest/desire for sex (OR 2.3, 95% CI: 1.0-5.5) and for being worried about the size or shape of the penis (OR 3.6, 95% CI: 1.3-9.5). These associations remained statistically significant in males with primary but not those with secondary hypogonadism. Discussion Our study showed that men from infertile couples have an increased risk of symptoms of sexual dysfunction and this risk is linked to androgen deficiency. Conclusion Assessment of reproductive hormone levels and sexual function should routinely be done in this group of males.

  • 17. Larsson, Anna-Karin
    et al.
    Crang Svalenius, Elizabeth
    Marsal, Karel
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Parental level of anxiety, sense of coherence and state of mind when choroid plexus cysts have been identified at a routine ultrasound examination in the second trimester of pregnancy: a case control study2009In: Journal of Psychosomatic Obstetrics and Gynecology, ISSN 0167-482x, Vol. 30, no 2, p. 95-100Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to compare parents' experience of a routine ultrasound examination in the second trimester, when a choroid plexus cyst/cysts (CPC) were found (Study group; n = 22), with matched controls where no fetal deviations were identified (Control group, n = 66). All the parents had participated in a larger cohort study. The instruments used for measuring anxiety were STAI-state/trait, sense of coherence (SOC) and Parents' Expectations, Experiences, Reactions to an Ultrasound examination during pregnancy (PEER-U, State of Mind Index). Regarding the SOC and STAI-state/trait no significant differences were found between the cases and controls or within the respective group before and after the ultrasound examination. The cases had an increase in anxiety (more anxious) as measured by the instrument PEER-U after the examination, while the controls showed a significant better level of State of Mind Index (less anxious) after the examination, compared to before. Therefore PEER-U can be a more reliable instrument when studying state of mind (anxiety) in connection with ultrasound examinations, and as it is specific for this situation it does not appear to be time dependent.

  • 18. Larsson, Anna-Karin
    et al.
    Crang Svalenius, Elizabeth
    Marsal, Karel
    Ekelin, Maria
    Nyberg, Per
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Parents’ Worried State of Mind When Fetal Ultrasound Shows an Unexpected Finding2009In: Journal of ultrasound in medicine, ISSN 0278-4297, E-ISSN 1550-9613, Vol. 28, no 12, p. 1663-1670Article in journal (Refereed)
    Abstract [en]

    Objective. Most parents yearn for a second-trimester ultrasound examination and feel excitement about it, but some also worry about what the examination will show. According to prior research, using only generic instruments or specific questionnaires, anxiety decreases when the ultrasound findings are normal. The aim of this study was to compare parents’ worry (Parents’ Expectations, Experiences, and Reactions to Ultrasound [PEER-U] State of Mind Index) and sense of coherence before and after a routine second-trimester ultrasound examination when it showed normal or abnormal findings. Methods. A 1-year cohort study was performed at a Swedish university hospital. A total of 2049 parents who had their second-trimester ultrasound examinations there filled in a questionnaire consisting of 2 parts before and after the examinations. Results. Parents with normal ultrasound findings were less worried than parents with abnormal findings. The group with normal findings also showed less worry after the examination than before. A sex analysis showed similar patterns. Conclusions. Parents with abnormal ultrasound findings are more worried and anxious. The new instrument, the PEER-U State of Mind Index, not only measures parents’ worry but can also expose what influences their ultrasound examination experience.

  • 19. Larsson, Anna-Karin
    et al.
    Crang-Svalenius, Elizabeth
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Information for better or for worse: interviews with parents when their foetus was found to have choroid plexus cysts at a routine second trimester ultrasound2009In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 30, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to gain a theoretical understanding of parents' experiences and handling of the situation, when their foetus was diagnosed as having choroid plexus cysts, at a routine second trimester ultrasound examination. Nine couples and one mother were interviewed using one open question. Analysis method was Grounded Theory. The main concern was anxiety and the core category became need for knowledge. The other categories were frightening and confusing, judging risk and making a choice and comforting. The parents felt information during the ultrasound examination was insufficient. The time delay between the diagnosis and the doctor's appointment was also often criticized. Most of the parents in this study wanted to know what can be diagnosed by ultrasound, even if there is a small risk that the child will have a malformation or chromosome abnormality. However, when the diagnosis is made, they need adequate information, otherwise unnecessary anxiety arises. By giving sufficient information without days of delay, anxiety can hopefully be minimized. Some written information was also requested. It is of utmost importance that the staff use the same terminology and the correct name of the soft marker to the parents.

  • 20. Larsson, Anna-Karin
    et al.
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Care during pregnancy and childbirth in Sweden: perspectives of lesbian women2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 6, p. 682-690Article in journal (Refereed)
    Abstract [en]

    Objective to explore the views and experiences of care of lesbian women during pregnancy and childbirth. Design, setting and participants a qualitative study of 18 lesbian women in southern Sweden. Findings valid text units were formed through categorisation into four main categories: recognition of sexual orientation; openness; relationships within the homosexual family; and different encounters and attitudes within the health-care system. The interviewed women were positive about their care during pregnancy and childbirth. However, as in studies regarding women's experiences of care in general, lesbian women raised concerns about postnatal care, parent education and the structure of the patient records with no place for the female partner. Key conclusions and implications for practice confirmation of parenthood was important, especially for the co-parent. The participants in this study felt that when they were open about their sexuality, this was met with an openness that they felt was confirming about their homsexuality. It is important for health-care providers not to make assumptions about women's sexuality.

  • 21.
    Mattsson, Kristina
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
    Nilsson-Condori, Emma
    Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Vassard, Ditte
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Schmidt, Lone
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Ziebe, Søren
    The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
    Jöud, Anna
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
    Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study2021In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 116, no 2, p. 505-513, article id S0015-0282(21)00127-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey.

    DESIGN: Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434).

    INTERVENTION(S): None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity.

    CONCLUSION(S): Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.

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  • 22. Persson, Eva
    et al.
    Dykes, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Important variables for parents' postnatal sense of security: evaluating a new Swedish instrument (the PPSS instrument)2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 4, p. 449-460Article in journal (Refereed)
    Abstract [en]

    Objective to evaluate dimensions of both parents’ postnatal sense of security the first week after childbirth, and to determine associations between the PPSS instrument and different sociodemographic and situational background variables. Design evaluative, cross-sectional design. Participants and settings 113 mothers and 99 fathers with children live born at term, from five hospitals in southern Sweden. Measurements and findings mothers and fathers had similar feelings concerning postnatal sense of security. Of the dimensions in the PPSS instrument, a sense of midwives’/nurses’ empowering behaviour, a sense of one's own general well-being and a sense of the mother's well-being as experienced by the father were the most important dimensions for parents’ experienced security. A sense of affinity within the family (for both parents) and a sense of manageable breast feeding (for mothers) were not significantly associated with their experienced security. A sense of participation during pregnancy and general anxiety were significantly associated background variables for postnatal sense of security for both parents. For the mothers, parity and a sense that the father was participating during pregnancy were also significantly associated. Key conclusions and implications for practice more focus on parents’ participation during pregnancy as well as midwives’/nurses’ empowering behaviour during the postnatal period will be beneficial for both parents’ postnatal sense of security.

  • 23.
    Sjöblom, Ingela
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Edberg, Anna-Karin
    Nordström, Berit
    A qualitative study of women´s experinces of home birth in Sweden2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 4, p. 348-355Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to illuminate the experiences of women who have given birth at home. METHODS: a descriptive design with a qualitative approach based on interviews with 12 women. The text was analysed using a phenomenological-hermeneutic method. FINDINGS: giving birth at home meant preserved authority and autonomy whereby the women themselves ruled the situation. The women's experiences of giving birth at home can be divided into three themes, with internal variations viewed as sub-themes. The main themes were as follows: 'having faith in one's own competence'; 'choosing support on one's own terms'; and 'being at home'. The experience embraced an earthly dimension, represented by reliance on inherent natural forces, and an existential, spiritual dimension, represented by faith in life itself, expressed in terms of the sacredness of giving birth, a heavenly experience, and wisdom about life itself. CONCLUSION: the experience of giving birth at home seems to differ from findings of studies focusing on the experience of giving birth in hospital. A reasonable goal for maternity care in hospital could, however, be that all women should have the opportunity to give birth on their own terms in a supportive and calm environment, surrounded by people who can assist if needed.

  • 24.
    Wahlberg, Anna
    et al.
    Uppsala Univ, Uppsala, Sweden..
    Johnsdotter, Sara
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Selling, Katarina Ekholm
    Uppsala Univ, Uppsala, Sweden..
    Källestål, Carina
    Uppsala Univ, Uppsala, Sweden..
    Essen, Birgitta
    Uppsala Univ, Uppsala, Sweden..
    Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants - a cross-sectional study in Sweden2017In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, no S2, p. 8-8, article id III:8Article in journal (Other academic)
  • 25.
    Wangel, Anne-Marie
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Stenzelius, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Sexual Function and Depressive Symptoms in Middle-Aged Women with Long-Lasting Type 1 Diabetes: A Cross-Sectional Study2021In: Journal of Nursing & Healthcare, ISSN 2475-529X, Vol. 6, no 2Article in journal (Refereed)
    Abstract [en]

    Background & aim: Women and men with diabetes, type 1 (T1D) and type 2 (T2D) develop complications in small and large blood vessels as well as in nerve pathways over time. In men, erectile dysfunction is a well-documented complication. However, sexual dysfunction in women with different types of diabetes is less studied. Sexual dysfunction is associated with lowered health-related quality of life and depression. The aim of the study was to investigate self-reported sexual function and signs of depression in middle-aged women with long-lasting T1D. 

    Methods: A cross-sectional questionnaire study including the Female Sexual Function Index (FSFI) and the Patient Health Questionnaire (PHQ-9) together with background questions was designed. The sample was women aged 45-66 with T1D for at least 15 years, identified from clinical medical records at four hospitals in southern Sweden. Descriptive statistical analysis of background factors, depression, and self-reported sexual dysfunction, as well as correlation and regression analysis, are presented. 

    Results: A total of 212 women completed the questionnaire, mean age 54.1 (SD: 5.83), mean years with T1D 36.2 (SD: 11.42). Almost half of the women had sexual dysfunction (45.2%; FSFI < 26.55, max 36) and the mean full score was 23.73 (SD: 10.57). The FSFI domains are desire, arousal, lubrication, orgasm, satisfaction and pain. Symptoms of depression measured by PHQ-9 were reported by 39.8%. A low FSFI was significantly associated with severe depression (p<0.001). 

    Conclusions: Problems with sexual dysfunction and depression in middle-aged women with long-lasting T1D are common and may be unreported unless addressed in clinical care. Nurses could start asking women about problems with lubrication and vaginal pain in relation to sexual activity. Lubricants or local estrogen therapy could prevent those problems. Routinely assessing depressive status is equally important in improving quality of life for women with T1D. 

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  • 26.
    Åkeflo, Linda
    et al.
    The Sahlgrenska Academy, University of Gothenburg.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Dunberger, Gail
    Ersta Sköndal Bräcke University College.
    Skokic, Viktor
    The Sahlgrenska Academy, University of Gothenburg.
    Arnell, Amanda
    The Sahlgrenska Academy, University of Gothenburg.
    Bergmark, Karin
    The Sahlgrenska Academy, University of Gothenburg.
    Sexual health and wellbeing after pelvic radiotherapy among women with and without a reported history of sexual abuse: important issues in cancer survivorship care2021In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 29, p. 6851-6861Article in journal (Refereed)
    Abstract [en]

    AIMS: Sexual abuse is a women's health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing.

    METHODS: Using a study-specific questionnaire, data were collected during 2011-2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing.

    RESULTS: In the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24-3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001).

    CONCLUSIONS: Our findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.

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