Birgitta Rubenson

Reasoning and deciding PMTCT-adherence during pregnancy among women living with HIV in Kenya

This study explores type identities among rural and urban slum women on antiretroviral therapies who become pregnant. Narrative structuring was chosen to develop type narratives that illustrate how rural and urban women handle their HIV-infection and how they reason and decide about PMTCT-adherence during pregnancy and childbirth. Women in rural areas described their lives as ‘secure and family controlled’. This gave the women security and predictability in life, but also meant that it was difficult to keep secrets about HIV infection. For women in the urban slum area the narratives were a tale of the uncertain and hard to predict reality in the slum, but also about self-reliance and decisiveness. They portrayed themselves as ‘vulnerable and striving to survive’ thus managing a tough situation without long-term solutions. We conclude that pregnancy poses different social challenges in rural and urban areas affecting how women choose to manage their adherence to PMTCT, which is also affected by HIV stigma and lack of disclosure.

Young Sex-Workers in Ho Chi Minh City Telling Their Life Stories

In this study the life stories of 22 sex-workers (age 15-18 years) in Vietnam are organized into three thematic narratives depicting how the girls presented their lives. Poverty, lack of job alternatives and the responsibility to share in the support of their families led the girls into prostitution. Strong family ties gave many girls connectedness; earning a well-needed income provided them with purpose and meaning; and the need for self-sufficiency forced the girls to manage and protect their lives. For some, a history of abuse led to victimization and rendered them powerless. While many of their human rights were violated, it was the disrespect for their dignity that hurt most.

Security lies in obedience - Voices of young women of a slum in Pakistan

BackgroundExisting literature shows that young people, especially women, have poor knowledge about sexuality and reproductive health. Many of the difficulties young women experience are related to beliefs and expectations in society making them more vulnerable to reproductive ill health. The objective of this study was to explore how young women living in a slum in Islamabad are prepared for marriage and how they understand and perceive their transition to marriage and the start of sexual and childbearing activity.MethodsTwenty qualitative interviews and three focus group discussions were conducted with young women residing in a slum of Islamabad. Content analysis was used to explore how the participants represented and explained their situation and how decisions about their marriage were made.ResultsThe main theme identified was security lies in obedience. The two sub-themes contributing to the main theme were socialization into submissiveness and transition into adulthood in silence. The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan.ConclusionThe study demonstrates how, in a culture of silence around sexuality, young womens socialization into submissiveness lays the foundation for the lack of control over the future reproductive health that they experience.

Testing together challenges the relationship': Consequences of HIV Testing as a couple in a High HIV prevalence setting in Rural South Africa

Objective We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention. Methods This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples. Findings Learning about each other’s status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised. Conclusions Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women’s vulnerability and their lack of decision-making power.

The care of corporal punishment: Conceptions of early childhood discipline strategies among parents and grandparents in a poor and urban area in Tanzania:

This study investigates conceptions of early childhood discipline strategies discussed in focus groups with parents and grandparents in a poor urban area in Tanzania. A grounded theory analysis suggested a model that included four discipline strategies related to corporal punishment: to beat with care, to treat like an egg, as if beating a snake and the non-care of non-beating. In order to develop strategies to prevent corporal punishment in the home in accordance with the UN recommendation and article 19 in the Convention on the Rights of the Child, the power of caregiving needs further investigation.

Who am I? Where am I? Experiences of married young women in a slum in Islamabad, Pakistan

BackgroundIn Pakistan, 16% of the women aged 15–19 years are married. Many get married shortly after they attain menarche. This study explores the preparedness for and actual experiences of married life (inter-spousal relationship, sexual activity and pregnancy) among adolescent women.MethodsAmong married adolescent women residing in a slum of Islamabad ten were selected with the help of a community health worker and interviewed qualitatively till saturation was reached. They were interviewed three times at different occasions. Narrative structuring was used to explore how the participants represented their background, social situation, decision making and spousal communication and how they explained, understood and managed married life and bore children.ResultsTwo categories identifying the respondents as either submissive-accepting or submissive-victims emerged. The married young women who belonged to the accepting group lived under compromised conditions but described themselves as satisfied with their situation. They were older than the other group identifying themselves as victims. However, none of the respondents felt prepared for marriage. Women belonging to the victimized group experienced physical and verbal abuse for their inability to cope with the duties of a wife, caretaker of the home and bearer of children. Their situation was compounded by the power dynamics within the household.ConclusionKnowledge about sexuality could prepare them better for the future life and give them more control of their fertility. Adolescent development and life skills education need to be addressed at a national level. There is need for innovative interventions to reach out and provide support to young women in disadvantaged homes.

Marriage decision making, spousal communication, and reproductive health among married youth in Pakistan

Abstract Background: Married young women’s reproductive needs are a challenge in traditional Pakistani society. The decisions regarding family planning and pregnancy are controlled by the family, often involving complex negotiations. The current study was undertaken to explore how young married women’s involvement in the arrangements surrounding their marriage is associated with their ability to negotiate sexual and reproductive health decisions in marriage. Objective: The study explores the associations between young women’s involvement in their marriage arrangements and their ability to negotiate for contraceptive use and fertility decisions. Methodology: A subset of 1,803 married young women aged 15–24 years was drawn from a nationally representative adolescent and youth survey conducted in Pakistan in 2001–2002 by the Population Council. Regression models were fitted to outcomes: reported agreement with spouse on the number of children to have, current use of contraceptives, intention to use contraceptives in the future, and the time elapsed between marriage and first contraceptive use. Key covariates of interest were variables that measure the involvement of young women in their marriage: (a) having a say in selection of spouse, (b) having met him prior to marriage, and (c) whether he was related to respondent’s family. Other factors explored were respondents’ mobility outside of household, social role, and decision making in their homes. Results: Having a say in the selection of a spouse was significantly associated with agreement with spouse over number of children to have, intention to use contraceptives, and the time between marriage and first contraceptive use. These relationships existed after controlling for education, socioeconomic status, mobility outside of house, and decision making in the home. Discussion: Women who had decision-making freedom in their parental home carried this ability with them into marriage in their new home and were better able to negotiate about their fertility.

Child domestic servants in Hanoi. Who are they and how do they fare

Child labour has been receiving much attention and the opinions of what is “ thebest interest of the child” and what is possible to achieve go wide apart.Children themselves and organizations working with them have very differentviews on the causes for and consequences of child work and what should bedone about it (Woodhead, 1999).The Convention on the Rights of the Child (CRC) prohibits economicexploitation of children and their involvement in work that could be harmfulor that interferes with their education. It also requires States Parties to regulateages for admission to and conditions for employment. The Labour Code ofVietnam from 1994 states: “ A labourer must be at least 15 years old . . .” butit also provides for a number of occupations, which are accepted for childrenand not considered harmful.Domestic service is a common occupation of teenage girls all around theworld (Black, 1997). For girls, for whom education is not a realistic option, itis one of few opportunities available to earn a well-needed income. In thedebate it has been highlighted as a form of invisible child labour with greatrisks of being harmful (Blagbrough, 1999; UNICEF, 1999). The girls spendmost, if not all their time, con”ned within the walls of the employer’ s housewith few opportunities to meet others (Black, 1997). In some countries they may be very young and with little or no contact with their families(Blanchet, 1996; Janak, 2000). The risks for physical, sexual and psychologi-cal abuse and exploitation are obvious, since the girls are left to the mercy oftheir employer’ s families. At the same time domestic service is widelyaccepted. In many western countries a system of “ au pair” has been developed,in which young people can combine language studies abroad with domestic

'Keeping healthy in the backseat': How motherhood interrupted HIV treatment in recently delivered women in Kenya.

Although there is a large body of literature related to the experiences of motherhood and aspects of the change that it brings about, how the experience of motherhood affects the healthcare of women with chronic illness is less documented. This study explores how motherhood in newly delivered HIV-infected mothers in Kenya interrupted their antiretroviral treatment (ART). Qualitative interviews were performed with 26 mothers on ART in a rural or urban area. The data were organised and interpreted using content analysis. The study found that adherence to ART was influenced by contextual differences in socio-cultural expectations and family relationships. Urban life enabled women to make decisions on their own and to negotiate challenges that were often unpredictable. Women in rural areas knew what was expected of them and decisions were normally not for them to make alone. The women in Busia and Kibera had difficulties combining adherence with attaining the socio-cultural definition of good mothering. Lack of support from health providers and weak healthcare systems contributed to inadequate stocks of HIV drugs and inaccessibility of HIV-related care. From the data, we developed the main theme ‘keeping healthy in the backseat’ and the two sub-themes ‘regaining self-worth through motherhood’ and ‘mother first – patient later.’ We suggest that motherhood is context-specific and follows socio-cultural practises, which made it difficult for the women in Kenya to follow ART instructions. There is a need to reassess HIV-related services for mothers on ART in order to give them a better chance to stay on treatment and satisfy their aspiration to be ‘good mothers.’ Context-specific HIV-treatment policies are necessary for ensuring adherence and successful treatment outcomes.

‘As a man I felt small’: a qualitative study of Ugandan men’s experiences of living with a wife suffering from obstetric fistula

Abstract The effects of obstetric fistula surpass the individual woman and affect husbands, relatives, peers and the community at large. Few studies have documented the experiences of men who live with wives suffering from fistula. In this study, our objective was to understand how fistula affects these men’s lives. We conducted 16 in-depth interviews with men in central and western Uganda. We used thematic narrative analysis and discuss our findings based on Connell’s theory of hegemonic masculinity. Findings show that the men’s experiences conflicted with Ugandan norms of hegemonic masculinity. However, men had to find other ways of explaining their identity, such as portraying themselves as small men but still be responsible, caring husbands and fathers. The few individuals who married a second wife remained married to the wife with the fistula. These men viewed marriage as a lifetime promise before God and a responsibility that should not end because of a fistula. Poverty, love, care for children and social norms in a patriarchal society compelled the men to persevere in their relationship amidst many challenges.