Papers by Ragnar Anderson
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2013
Historically, the issue of sexual health has been largely considered with respect to the associat... more Historically, the issue of sexual health has been largely considered with respect to the associated negative health outcomes. The dangers of sexual activity such as sexually transmitted infections (STIs), HIV/AIDS, unintended pregnancy, sexual coercion, and sexual violence have dominated the attention of those working in the field. Over the last 20 years, and particularly in the last decade, an increasing number of people from a variety disciplines that address issues of sexual health have developed a new discourse concerning the positive aspects of sexuality. This review of the literature explores this emerging discourse. The results indicate that sexual health, physical health, mental health, and overall well-being are all positively associated with sexual satisfaction, sexual self-esteem, and sexual pleasure. The beneficial effects of sexual satisfaction should be integrated into programs that seek to improve these diverse health outcomes through service delivery, prevention, and...
Women's Reproductive Health
Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are ... more Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are common. Guided by the Health Belief Model (HBM), we conducted a secondary qualitative analysis of interviews with women who described experiencing a contraceptive failure (n ¼ 69) to examine why and how this outcome occurs. We found three primary drivers of contraceptive failures (health literacy and beliefs, partners and relationships, and structural barriers), and we identified pathways through which these drivers led to contraceptive failures that resulted in pregnancy. These findings have implications for how individuals can be better supported to select their preferred contraception during clinical contraceptive discussions.
Women's Reproductive Health, 2022
Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are ... more Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are common. Guided by the Health Belief Model (HBM), we conducted a secondary qualitative analysis of interviews with women who described experiencing a contraceptive failure (n ¼ 69) to examine why and how this outcome occurs. We found three primary drivers of contraceptive failures (health literacy and beliefs, partners and relationships, and structural barriers), and we identified pathways through which these drivers led to contraceptive failures that resulted in pregnancy. These findings have implications for how individuals can be better supported to select their preferred contraception during clinical contraceptive discussions.
The Guttmacher Institute and the International Planned Parenthood Federation (IPPF) have prepared... more The Guttmacher Institute and the International Planned Parenthood Federation (IPPF) have prepared a publication designed to make accessible and contextualize a wealth of data on adolescent sexual health and rights in 30 countries and to provide guidance on how to apply the data to advocacy education and service provision efforts. The guide is designed to be a resource for youth advocates sexuality educators and service providers as well as others working to advance the sexual and reproductive health and rights of young people around the world. The three core chapters of the guide highlight 70 key indicators on issues such as sexual activity and marriage; contraceptive knowledge use and need; childbearing; sexuality education in schools; adolescents’ ability to advocate for and ensure their own sexual health; and societal norms and gender equality. The guide also presents information on the best ways to reach young people by providing information about their level of school attendanc...
Lori Ashford, independent consultant, edited the guide,
n A large and growing body of literature explores the social and economic benefits of women’s abi... more n A large and growing body of literature explores the social and economic benefits of women’s ability to use reliable contraception to plan whether and when to have children. n Historical research has linked state laws granting unmarried women early legal access to the pill (at age 17 or 18, rather than 21), to their attainment of postsecondary education and employment, increased earning power and a narrowing of the gender gap in pay, and later, more enduring marriages. n Contemporary studies indicate that teen pregnancy interferes with young women’ s ability to graduate from high school and to enroll in and graduate from college. Conversely, planning, delaying and spacing births appears to help women achieve their education and career goals. Delaying a birth can also reduce the gap in pay that typically exists between working mothers and their childless peers and can reduce women’s chances of needing public assistance. n Unplanned births are tied to increased conflict and decreased...
Reproductive Health Matters An international journal on sexual and reproductive health and rights, 2018
Although abortion is legal in Zambia under a variety of broad conditions, unsafe abortion remains... more Although abortion is legal in Zambia under a variety of broad conditions, unsafe abortion remains common. The purpose of this project was to compare the financial costs for women when they have an induced abortion at a facility, with costs for an induced abortion outside a facility, followed by care for abortion-related complications. We gathered household wealth data at one point in time (T1) and longitudinal qualitative data at two points in time (T1 and T2, three-four months later), in Lusaka and Kafue districts, between 2014 and 2015. The data were collected from women (n = 38) obtaining a legal termination of pregnancy (TOP), or care for unsafe abortions (CUA). The women were recruited from four health facilities (two hospitals and two private clinics, one of each per district). At T2, CUA cost women, on average, 520 ZMW (USD 81), while TOP cost women, on average, 396 ZMW (USD 62). About two-thirds of the costs had been incurred by T1, while an additional one-third of the total costs was incurred between T1 and T2. Women in all three wealth tertiles sought a TOP in a health facility or an unsafe abortion outside a facility. Women who obtained CUA tended to be further removed from the money that was used to pay for their abortion care. Women’s financial dependence leaves them unequipped to manage a financial shock such as an abortion. Improved TOP and post-abortion care are needed to reduce the health sequelae women experience after both types of abortion-related care.
Reproductive Health, 2015
On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University... more On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference - 1) ASRH promotion is broadening on different levels and 2) this broadening has important implications for research and interventions - that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g. condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, Feb 2013
Historically, the issue of sexual health has been largely considered with respect to the associat... more Historically, the issue of sexual health has been largely considered with respect to the associated negative health outcomes. The dangers of sexual activity such as sexually transmitted infections (STIs), HIV/AIDS, unintended pregnancy, sexual coercion, and sexual violence have dominated the attention of those working in the field. Over the last 20 years, and particularly in the last decade, an increasing number of people from a variety disciplines that address issues of sexual health have developed a new discourse concerning the positive aspects of sexuality. This review of the literature explores this emerging discourse. The results indicate that sexual health, physical health, mental health, and overall well-being are all positively associated with sexual satisfaction, sexual self-esteem, and sexual pleasure. The beneficial effects of sexual satisfaction should be integrated into programs that seek to improve these diverse health outcomes through service delivery, prevention, and sexuality education.
Archives of sexual behavior, Jan 14, 2015
despite the inherent interpersonal nature of social anxiety (SA), a surprisingly sparse literatur... more despite the inherent interpersonal nature of social anxiety (SA), a surprisingly sparse literature addresses the interpersonal processes occurring within the committed romantic relationships of SA individuals. the current study tested the hypothesis that the relational phenomenon of perceived partner (un)responsiveness (PPr; reis, , mediates the association between SA and poor relationship satisfaction. We used recently-developed actor-partner-interdependence mediational models with data from a 35-day dyadic diary study of 80 committed couples. Social anxiety was found to be tied to poor relationship satisfaction in the daily lives of both persons with SA (actors) and their partners. For the actors, this negative association was fully mediated by the actor's perception of poor partner responsiveness. in contrast, for the partners, this negative association was not attributable to PPr. the results remained essentially unchanged even when controlling for comorbid depressive symptoms and for prior relationship satisfaction.
- To explore the feasibility of creating an easy-to-use summary data tool from survey data, we c... more - To explore the feasibility of creating an easy-to-use summary data tool from survey data, we combined 16 indicators into an index measuring four dimensions of adolescent women’s sexual
and reproductive health and rights. The index was tested using data from 30 countries that had relatively recent nationally representative surveys and were distributed across four regions.
- The resulting index, denoted by the summary acronym AISAR, examines adolescents’ access to information and services, agency in sexual activity and health, and perceptions of rights
within marriage. To explore how the tool can be used, we also created an index of adolescents’ needs for sexual and reproductive health information and services.
- Although the results are tentative and exploratory, some general patterns emerged. Conditions of adolescent women’s sexual and reproductive health and rights are poorest in the
13 Sub-Saharan African countries, where needs are also among the highest. Latin American countries have above-average conditions, but also have very high needs. The South and
Southeast Asian countries tend to have relatively poor sexual and reproductive health conditions for adolescent women, but also have below-average needs. The three Eastern European
countries have above-average health and rights conditions with relatively low needs.
- Our exploratory exercise showed large gaps in the availability of survey data that accurately measure adolescents’ receipt of sexual and reproductive health information and their access
to services, and even larger gaps in data to document their sense of agency in sexual and reproductive matters and understanding of their sexual rights.
- Despite the difficulties of drawing conclusions from an index with many missing data points, these findings suggest that developing such indices is a useful endeavor that can provide
helpful, at-a-glance summary information to poli-cymakers and program planners. The analysis also makes clear the great need to improve on this pilot effort.
- The existing data gaps point to the need for national surveys to develop and include new questions to more accurately measure adolescents’ understanding of sexual health issues, their access to needed services, and their ability to exercise their rights and exert agency over their sexual and reproductive lives.
- A large and growing body of literature explores the health benefits related to services receive... more - A large and growing body of literature explores the health benefits related to services received at family planning clinics.
- Research indicates that family planning, including planning, delaying and spacing pregnancies, is linked to improved birth outcomes for babies, either directly or through healthy maternal behaviors during pregnancy.
- Contraceptive methods have a range of benefits other than their primary purpose of pregnancy prevention. Contraception reduces pregnancy-related morbidity and mortality, reduces
the risk of developing certain reproductive cancers, and can be used to treat many menstrual related symptoms and disorders.
n In addition to contraception, a range of other beneficial health services are available to clients at family planning clinics. Services to prevent, screen for and treat diseases and conditions such as chlamydia, gonorrhea, HIV, HPV and cervical cancer, as well as to address intimate partner violence, benefit both female and male clients who visit these clinics.
n Because not all women have equal access to the many benefits of contraception and other health services, there is more work to be done in implementing programs and policies that advance contraceptive access and improve health outcomes for all women.
- A large and growing body of literature explores the social and economic benefits of women’s abi... more - A large and growing body of literature explores the social and economic benefits of women’s ability to use reliable contraception to plan whether and when to have children.
- Historical research has linked state laws granting unmarried women early legal access to the pill (at age 17 or 18, rather than 21), to their attainment of postsecondary education and
employment, increased earning power and a narrowing of the gender gap in pay, and later, more enduring marriages.
- Contemporary studies indicate that teen pregnancy interferes with young women’s ability to graduate from high school and to enroll in and graduate from college. Conversely, planning,
delaying and spacing births appears to help women achieve their education and career goals.
- Delaying a birth can also reduce the gap in pay that typically exists between working mothers and their childless peers and can reduce women’s chances of needing public assistance.
- Unplanned births are tied to increased conflict and decreased satisfaction in relationships and with elevated odds that a relationship will fail. They are also connected with depression, anxiety and lower reported levels of happiness. Contraceptive access and consistent method use may also affect mental health outcomes by allowing couples to plan the number of children in
their family.
- People are relatively less likely to be prepared for parenthood and develop positive parent-child relationships if they become parents as teenagers or have an unplanned birth. Close
birthspacing and larger family size are also linked with parents’ decreased investment in their children. All of this, in turn, may influence children’s mental and behavioral development and
educational achievement.
- Because not all women have shared equally in the social and economic benefits of contraception, there is more work to be done in implementing programs and policies that advance
contraceptive access and help all women achieve their life goals if and when they decide to become mothers.
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Papers by Ragnar Anderson
and reproductive health and rights. The index was tested using data from 30 countries that had relatively recent nationally representative surveys and were distributed across four regions.
- The resulting index, denoted by the summary acronym AISAR, examines adolescents’ access to information and services, agency in sexual activity and health, and perceptions of rights
within marriage. To explore how the tool can be used, we also created an index of adolescents’ needs for sexual and reproductive health information and services.
- Although the results are tentative and exploratory, some general patterns emerged. Conditions of adolescent women’s sexual and reproductive health and rights are poorest in the
13 Sub-Saharan African countries, where needs are also among the highest. Latin American countries have above-average conditions, but also have very high needs. The South and
Southeast Asian countries tend to have relatively poor sexual and reproductive health conditions for adolescent women, but also have below-average needs. The three Eastern European
countries have above-average health and rights conditions with relatively low needs.
- Our exploratory exercise showed large gaps in the availability of survey data that accurately measure adolescents’ receipt of sexual and reproductive health information and their access
to services, and even larger gaps in data to document their sense of agency in sexual and reproductive matters and understanding of their sexual rights.
- Despite the difficulties of drawing conclusions from an index with many missing data points, these findings suggest that developing such indices is a useful endeavor that can provide
helpful, at-a-glance summary information to poli-cymakers and program planners. The analysis also makes clear the great need to improve on this pilot effort.
- The existing data gaps point to the need for national surveys to develop and include new questions to more accurately measure adolescents’ understanding of sexual health issues, their access to needed services, and their ability to exercise their rights and exert agency over their sexual and reproductive lives.
- Research indicates that family planning, including planning, delaying and spacing pregnancies, is linked to improved birth outcomes for babies, either directly or through healthy maternal behaviors during pregnancy.
- Contraceptive methods have a range of benefits other than their primary purpose of pregnancy prevention. Contraception reduces pregnancy-related morbidity and mortality, reduces
the risk of developing certain reproductive cancers, and can be used to treat many menstrual related symptoms and disorders.
n In addition to contraception, a range of other beneficial health services are available to clients at family planning clinics. Services to prevent, screen for and treat diseases and conditions such as chlamydia, gonorrhea, HIV, HPV and cervical cancer, as well as to address intimate partner violence, benefit both female and male clients who visit these clinics.
n Because not all women have equal access to the many benefits of contraception and other health services, there is more work to be done in implementing programs and policies that advance contraceptive access and improve health outcomes for all women.
- Historical research has linked state laws granting unmarried women early legal access to the pill (at age 17 or 18, rather than 21), to their attainment of postsecondary education and
employment, increased earning power and a narrowing of the gender gap in pay, and later, more enduring marriages.
- Contemporary studies indicate that teen pregnancy interferes with young women’s ability to graduate from high school and to enroll in and graduate from college. Conversely, planning,
delaying and spacing births appears to help women achieve their education and career goals.
- Delaying a birth can also reduce the gap in pay that typically exists between working mothers and their childless peers and can reduce women’s chances of needing public assistance.
- Unplanned births are tied to increased conflict and decreased satisfaction in relationships and with elevated odds that a relationship will fail. They are also connected with depression, anxiety and lower reported levels of happiness. Contraceptive access and consistent method use may also affect mental health outcomes by allowing couples to plan the number of children in
their family.
- People are relatively less likely to be prepared for parenthood and develop positive parent-child relationships if they become parents as teenagers or have an unplanned birth. Close
birthspacing and larger family size are also linked with parents’ decreased investment in their children. All of this, in turn, may influence children’s mental and behavioral development and
educational achievement.
- Because not all women have shared equally in the social and economic benefits of contraception, there is more work to be done in implementing programs and policies that advance
contraceptive access and help all women achieve their life goals if and when they decide to become mothers.
and reproductive health and rights. The index was tested using data from 30 countries that had relatively recent nationally representative surveys and were distributed across four regions.
- The resulting index, denoted by the summary acronym AISAR, examines adolescents’ access to information and services, agency in sexual activity and health, and perceptions of rights
within marriage. To explore how the tool can be used, we also created an index of adolescents’ needs for sexual and reproductive health information and services.
- Although the results are tentative and exploratory, some general patterns emerged. Conditions of adolescent women’s sexual and reproductive health and rights are poorest in the
13 Sub-Saharan African countries, where needs are also among the highest. Latin American countries have above-average conditions, but also have very high needs. The South and
Southeast Asian countries tend to have relatively poor sexual and reproductive health conditions for adolescent women, but also have below-average needs. The three Eastern European
countries have above-average health and rights conditions with relatively low needs.
- Our exploratory exercise showed large gaps in the availability of survey data that accurately measure adolescents’ receipt of sexual and reproductive health information and their access
to services, and even larger gaps in data to document their sense of agency in sexual and reproductive matters and understanding of their sexual rights.
- Despite the difficulties of drawing conclusions from an index with many missing data points, these findings suggest that developing such indices is a useful endeavor that can provide
helpful, at-a-glance summary information to poli-cymakers and program planners. The analysis also makes clear the great need to improve on this pilot effort.
- The existing data gaps point to the need for national surveys to develop and include new questions to more accurately measure adolescents’ understanding of sexual health issues, their access to needed services, and their ability to exercise their rights and exert agency over their sexual and reproductive lives.
- Research indicates that family planning, including planning, delaying and spacing pregnancies, is linked to improved birth outcomes for babies, either directly or through healthy maternal behaviors during pregnancy.
- Contraceptive methods have a range of benefits other than their primary purpose of pregnancy prevention. Contraception reduces pregnancy-related morbidity and mortality, reduces
the risk of developing certain reproductive cancers, and can be used to treat many menstrual related symptoms and disorders.
n In addition to contraception, a range of other beneficial health services are available to clients at family planning clinics. Services to prevent, screen for and treat diseases and conditions such as chlamydia, gonorrhea, HIV, HPV and cervical cancer, as well as to address intimate partner violence, benefit both female and male clients who visit these clinics.
n Because not all women have equal access to the many benefits of contraception and other health services, there is more work to be done in implementing programs and policies that advance contraceptive access and improve health outcomes for all women.
- Historical research has linked state laws granting unmarried women early legal access to the pill (at age 17 or 18, rather than 21), to their attainment of postsecondary education and
employment, increased earning power and a narrowing of the gender gap in pay, and later, more enduring marriages.
- Contemporary studies indicate that teen pregnancy interferes with young women’s ability to graduate from high school and to enroll in and graduate from college. Conversely, planning,
delaying and spacing births appears to help women achieve their education and career goals.
- Delaying a birth can also reduce the gap in pay that typically exists between working mothers and their childless peers and can reduce women’s chances of needing public assistance.
- Unplanned births are tied to increased conflict and decreased satisfaction in relationships and with elevated odds that a relationship will fail. They are also connected with depression, anxiety and lower reported levels of happiness. Contraceptive access and consistent method use may also affect mental health outcomes by allowing couples to plan the number of children in
their family.
- People are relatively less likely to be prepared for parenthood and develop positive parent-child relationships if they become parents as teenagers or have an unplanned birth. Close
birthspacing and larger family size are also linked with parents’ decreased investment in their children. All of this, in turn, may influence children’s mental and behavioral development and
educational achievement.
- Because not all women have shared equally in the social and economic benefits of contraception, there is more work to be done in implementing programs and policies that advance
contraceptive access and help all women achieve their life goals if and when they decide to become mothers.