Global projects

Ragging, an initiation ritual in Sri Lankan universities, involves senior students harassing newcomers, leading to severe consequences such as depression, increased dropouts, and suicide. This thesis explores ragging from the perspectives of students and university affiliates and assesses the prevalence of Major Depressive Disorder (MDD) among students.

Methods included a cross-sectional survey of second- and third-year students from Medical and Technology faculties to determine the prevalence of ragging and its health consequences. Focus group discussions with students explored the social dynamics and motivations of ragging, while discussions and interviews with university staff examined their attitudes towards the practice. Another survey of second-year students from three faculties assessed the prevalence of MDD using the Patient Health Questionnaire.

Results showed that 59% of students experienced ragging, 54% reported health consequences, and most sought help from friends and family. Ragging prevalence varied by faculty and year of study. It was used to establish power and address social inequalities. Staff exhibited themes of normalization, fear of reprisal, and resistance. Additionally, 31% of students experienced MDD, with prevalence associated with ethnicity.

In many major African cities, rural-to-urban migrations lead to high unemployment, increased poverty, and significant food and shelter insecurity. By 2050, it is predicted that half of Africa's population will live in cities, exacerbating homelessness and malnutrition, especially among children. Malnutrition accounts for half of all deaths in children under five worldwide (UNICEF 2016).

The gendered roles in food procurement, especially the role of fathers in urban Africa, are insufficiently studied. This study aims to explore fathers' experiences and roles in food procurement and provision related to child nutrition in Addis Ababa through qualitative interviews and photo elicitation. Research questions focus on fathers' roles within the family, daily activities, perceptions of masculinity, and views on child nourishment. This study aims to provide a comprehensive understanding of the factors influencing child nutrition and the roles both parents play.

Somaliland

In Somaliland, our previous studies identified potential sub-optimal factors contributing to maternal near miss, mortality, and adverse perinatal outcomes. It was found that most women with near-miss conditions arrived at tertiary level hospitals in critical condition, often bypassing primary maternal and child health centers. Additionally, the need for consent from the husband or father for cesarean sections, rather than the mother herself, was perceived to delay the provision of emergency obstetric care. Poor patient-provider interaction at the care encounter further increased the risk of preventable complications and decreased trust in facility-based maternal care. The studies are also investigating the influence of consent delay for cesarean sections and the role of female circumcision on maternal and perinatal outcomes in Somaliland.

Bolivia

In Bolivia, the research focused on the factors that impede the utilization of emergency obstetric care. It was found that most women with near-miss conditions arrived at the hospital in critical condition. Additionally, poor patient-provider interaction at the care encounter increased the risk of preventable complications and decreased trust in facility-based maternal care.

Iran

The study in Iran examined the characteristics of severe maternal morbidity in the context of a middle-income country with a high influx of refugees from Afghanistan. The findings revealed that Afghan mothers face more suboptimal obstetric care compared to their Iranian counterparts due to unequal access to insurance coverage.

Guatemala

In Guatemala, the research aimed to identify factors that impede the utilization of emergency obstetric care. It was discovered that traditional birth attendants are unfamiliar with emergency obstetric care, and there is a lack of collaboration with formal care providers, which hinders the effective utilization of such services.

Rwanda

The research in Rwanda explored the potential barriers to preventable maternal mortality and partner involvement during pregnancy in a setting with a strong policy program for achieving gender equity. It was found that, even though men wish to participate during antenatal care and labor to ensure quality of care, they feel excluded from the maternal health system.

Tanzania

In Tanzania, the research investigated the effects and reasons for a high caesarean section (CS) rate in a low-resource setting. The findings indicated that CS is being overused even in some low-resource settings. Despite the improved safety of CS, it still entails high risks of severe maternal complications. Non-medical reasons for unnecessary CS include a lack of support for junior clinicians from seniors, pressure from midwives during decision-making, and fear of blame from colleagues and management in case of poor perinatal outcomes.

Iran and Tanzania

The study explored whether a criteria-based audit of obstructed labor could improve the accuracy of the decision for CS and the standard of care in settings with high maternal and perinatal mortality. It was found that transparency, auditing, and dysfunctional teamwork could contribute to the overuse of CS. Additionally, placenta previa due to earlier CS is associated with maternal near-miss morbidity.

Research on the characteristics of "near-miss" in settings with a very high rate of CS like Tehran and Dar-es-Salaam revealed that CS overuse is justified by referring to the need to “secure” the baby. This tendency was identified as a significant factor contributing to the high CS rates.

A participatory study to plan and test an educational program on GBV at the University Sri Jayewardenepura, Colombo, Sri Lanka. Studies in Sri Lanka has shown that university students have poor understanding of gender, GBV, its' prevalence, contributing factors and possible preventive measures.

An educational program was prepared and evaluated in order to later introduce a computerized or live program accessible to all students and teachers at the University Sri Jayewardenepura and other universities in Sri Lanka. Questionnaires before and after finalizing the program was analysed, as well as Focus Group discussions with teachers and students. The context specific teaching material was well-received by educators and students and they provided valuable inputs which improved the learning material.

‘Gender’ is defined by WHO as ‘the socially constructed roles, behaviour, activities and attributes that a particular society considers appropriate for men and women’. The distinct roles and behavior may give rise to gender inequality, which are differences between men and women that systematically favor one group. Such inequalities build up the foundation for gender related issues such as gender-based violence (GBV), social, economic and health inequalities between men and women. Partner violence is the most frequent form of GBV in societies, and efforts are made to get evidence-based interventions. The Government in Sri Lanka has adopted several policies around GBV and calls for service points to provide care to abused women. GBV among ever married women and intimate partner violence (IPV) in Sri Lanka is estimated to be between 20 – 60%.

The aim of the study was to explore male future leaders perception on GBV. The study design was qualitative, content analysis using focus group discussion (FGD) with last year male medical students and last year male students from management faculty. Four categories emanated: Fixed gender roles, Violence not accepted but exists, causes of violence, how to prevent violence against women

Research in Nicaragua focused on the individual, psychosocial, and socio-environmental factors influencing adolescents' decision-making around sexual activity, including contraceptive use in a rural community. The study also examined how adolescent girls experience the transition to motherhood in the rural community of Tololar. Findings revealed that despite the challenges of becoming a teenage mother, many young women expressed positive feelings about motherhood. Some participants indicated that their newfound responsibility as teenage mothers provided them with a sense of purpose in life. There is considerable evidence that adolescence is a period of overwhelming changes and challenges, exposing adolescents to high-risk behaviors. However, adolescents from rural Nicaragua embraced positive thoughts around access to sex education, sexual health care, and opportunities for healthier relationships. These findings aim to enhance understanding of the different expressions of adolescents' sexual and reproductive health.

India

Research in India aims to create a patient-centered health system that caters to reproductive health needs and increases access to medical abortion and contraception services among women living in low-resource settings. Despite the Millennium Development Goals (MDG) agenda, inadequate care options force life-threatening solutions to unwanted pregnancy. Findings indicate that Indian women prefer reversible contraceptive methods post-abortion rather than sterilization. Additionally, simplified follow-up using a low-sensitivity pregnancy test two weeks post early medical abortion is as effective, acceptable, and feasible as in-clinic follow-up by a doctor. Surrogacy in India is seen as a reproduction method that fulfills cultural expectations of parenthood, as having an "own child," though it also involves complex views of the surrogate mother and moral qualms related to transnational surrogacy.

Rwanda

In Rwanda, the research focuses on potential barriers to preventable severe maternal morbidity and partner involvement during early pregnancy in a low-resource setting with a strong policy program aimed at improving women's health. Despite the MDG agenda, inadequate care options force life-threatening solutions to unwanted pregnancy. The findings highlight the need for strategies to increase partner involvement and improve maternal health outcomes in the context of Rwanda's robust policy framework.

Sweden

The research in Sweden examines the construction of parenthood and surrogate motherhood in relation to the use of transnational surrogates in Sweden and India. Surrogacy in India fulfills cultural expectations of parenthood but involves complex views of the surrogate mother and moral qualms. The exploitation of surrogate mothers is defied in the context of transnational surrogacy, pointing to the nuanced and multifaceted nature of surrogacy practices.

Nicaragua

The study in Nicaragua aims to understand the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status and stigma. Findings indicate that although seven out of ten Men who have Sex with Men (MSM) and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common. MSM have a better understanding of HIV transmission than men and women of the general population. These insights are crucial for designing targeted interventions to reduce HIV transmission and stigma in Nicaragua.

Infertility often creates social and financial problems because of the importance of having children to secure the support in old age and ensure the continuation of the lineage. Especially women suffer from not being able to bear children and childlessness carries social stigma. Even though infertility treatment can be found within the public health care system in India it is in a very small scale and difficult to access. ART is mainly provided to a high cost in private clinics, and there has been a rapid increase of clinics. Many clinics also provide surrogacy but the service is in large part used by childless couples outside of India. The enormous increase in ART clinics providing surrogacy also means that they are no longer located only in big cities, but have spread all over India even to places where they lack basic health care facilities.

Assam is one of seven North-East states in India and borders Bhutan and Bangladesh. Assam is considered to be one of the poorest states in India. Reproductive health care is in many ways insufficient and no government hospital has a department for In-vitro-fertilization (IVF). The study has a qualitative approach and is focusing on different perspectives of the issues on options to parenthood in Assam. Special emphasize is on surrogacy as a solution to childlessness. The study is carried out in collaboration with Gauhati University, Assam, The Department of Women's studies.

Maternal mortality remains high in India, particularly in Rajasthan. Despite the legalization of abortion in 1971, access to safe abortion services is inadequate, contributing to 8-18% of maternal deaths and significant morbidity. Low contraceptive use and limited awareness of reproductive health exacerbate these issues. This project aims to simplify medical abortion, making it more acceptable and affordable for women and healthcare providers. Combining medical abortion with contraceptive counseling may increase post-abortion contraceptive use and encourage women to seek further reproductive health services from the public system.

A randomized control trial in rural and urban Rajasthan will evaluate the efficacy, safety, and acceptability of a simplified medical abortion regimen. This study addresses the unique challenges of low-resource settings, such as limited infrastructure and low literacy. Additionally, it will investigate post-abortion contraceptive use and barriers to accessing safe abortion services. The study will also explore young women's reproductive choices and partner involvement outside the trial context.