Factors influencing sexual and reproductive health among adolescents in Lao PDR.

BACKGROUND: Adolescents are particularly vulnerable to poor sexual and reproductive health outcomes. In addition, Lao PDR has the highest teenage pregnancy rate in southeast Asia and a high maternal mortality ratio. OBJECTIVE: This study aimed to provide a comprehensive exploration of factors that influence SRH knowledge, attitudes, and practices of adolescents in Bokeo Province, Lao PDR. METHOD: Data from the Adolescent Girl Situation Analysis cross-sectional study, collected in 2018 using a mixed-method approach with 837 adolescents aged 10-19, and key informant interviews, were analysed. Regression analyses were used to identify predictors of modern contraception knowledge, autonomy, gender-based violence, sexual activity, and contraception use. This was complemented with qualitative thematic content analysis. RESULTS: Adolescents living in two rural districts had lower sexual and reproductive health knowledge compared to urban district residents. Findings showed misconceptions about the birth control pill, a belief that sex education is important, but that the current teaching quality is problematic. There was a strong positive association between knowledge and autonomy. In the two rural districts, residents were more likely to lack autonomy. Marriage was described as an autonomous decision, yet 40.4% lacked autonomy regarding marriage. Among sexually active adolescents, 35.2% used contraception. Boys and girls were said to be equal, yet education access and gender roles favoured boys. Additionally, violence was more justified by husbands against their wives. CONCLUSION: The study helps to understand the views and perceptions of adolescents and key informants on gender equality and gender-based violence. Three main areas require more effort and greater investment to improve adolescent sexual and reproductive health: knowledge and use of contraceptives, gender inequality, and autonomy. There is poor knowledge of contraceptive methods, indicating a need to further integrate comprehensive sexual education, introduced in primary school, and to increase investment in training and monitoring teachers.

Perceptions of non-Western immigrant women on having breast cancer and their experiences with treatment-related changes in body weight and lifestyle: A qualitative study.

BACKGROUND: The number of non-Western immigrants with breast cancer in the Netherlands has increased over the past decades and is expected to triple by 2030. Due to insufficient representation in clinical studies, it is unclear what the specific experiences and needs of these women are. Understanding how culture and religion affect these women's experience of breast cancer and how they deal with chemotherapy and treatment-related changes in body weight and lifestyle is crucial for health care professionals to be able to provide effective support. METHODS: A qualitative study was conducted using semi-structured interviews with 28 immigrant women with a history of breast cancer treated with chemotherapy. RESULTS: Women often associated breast cancer with taboo, death or bad luck. Religion offered these women guidance, strength and meaning to the disease, but also limited the women to openly talk about their disease. Women perceived lifestyle factors to have little influence on the development and treatment of cancer. After treatment, however, their thinking changed and these lifestyle factors became of paramount importance to them. They realised that they missed out on information about managing their own diet, exercise and body weight and were eager to share their experiences with other women in their culture with newly diagnosed breast cancer. CONCLUSION: Women became aware during and after breast cancer treatment that it was difficult for them to actively deal with their illness under the influence of their culture and religion. Based on their own experiences and acquired knowledge, they would like to give advice to newly diagnosed women on how to deal with breast cancer within their own culture and religion. Their recommendations could be used by mosques, churches, support groups and health care professionals, to ensure interventions during breast cancer treatment meet their religious and cultural needs and thus improve their quality of life.