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A sense of belonging is crucial for mental health and well-being, but immigrants may find achieving a sense of belonging elusive. This study examined the relationship between sense of belonging and mental health among Finnish native, and first- and second-generation immigrant adolescents (N = 61 540) in Finland. Moreover, we estimated whether sense of belonging buffered the negative effect of experienced discrimination on mental health. Immigrants were split into two groups based on their countries of origin: Iraq, Iran, Somalia, and Afghanistan (MENAP, predominantly forced migration), and to immigrant adolescents from other countries (OCO, predominantly voluntary migration). Using structural equation modelling, we estimated the association of sense of belonging with symptoms of depression, generalized anxiety, and positive mental well-being. Finally, we conducted moderation analyses to estimate whether sense of belonging mitigated the negative effect of discrimination on mental health. Our findings revealed a strong negative link between sense of belonging and symptoms of depression, and anxiety, particularly among first-generation MENAP youth. The positive relation of sense of belonging with mental well-being was weaker among all groups, especially among first-generation. Importantly, sense of belonging buffered the negative effect of discrimination on mental health, mostly with similar estimates across groups. We discuss the possible reasons explaining the group differences and present possible actions needed for schools and mental health services in addressing the needs of immigrant youth. [ABSTRACT FROM AUTHOR]

The focus in the present study is on how experienced discrimination, being able to discuss personal matters with parents, and having someone to discuss personal worries with relate to symptoms of depression and generalized anxiety among first- and second-generation immigrant-background adolescents (aged 14–15) living in Finland. The data used was collected for the National School Health Promotion Study (2017) conducted by The Finnish Institute for Health and Welfare (N = 73,690). Mental health was assessed on the PHQ-2 (depression) and GAD-7 (generalized anxiety disorder) scales. The findings indicated that first-generation adolescents from immigrant families were significantly more likely than their second-generation counterparts to report mental-health symptoms, and they also provided worse scores on all measures examined. It was alarming that 42 per cent of the first-generation immigrant group reported that they could not discuss their personal worries with anyone, and more than one-fifth of these youth hardly ever talked about personal matters with their parents. Experienced discrimination was a slightly stronger predictor of generalized anxiety than depressive symptoms and it predicted both symptoms of depression and anxiety more prominently among first-generation immigrant adolescents compared with their second-generation counterparts. Being able to discuss personal matters with parents functioned as a protective factor with similar predictor values in both groups, whereas the possibility of having someone with whom to discuss personal worries was significantly associated to lower levels of anxiety only among first-generation immigrant adolescents. [ABSTRACT FROM AUTHOR]

Knowledge about mothers' perceptions of the quality of Finnish maternity services is limited. The aim of this cross-sectional study was to describe mothers' perceptions of the quality of Finnish maternity services, and to identify background factors associated with them. The data were collected from 1,760 mothers in autumn 2016. Descriptive statistics were used. This study is reported in accordance with STROBE. Most mothers (84%) considered the quality of the maternity services good. The mean response values for the quality of patient education (3.9), staff knowledge and skills (4.3), and hospital environment (4.3) were good. Parity and mode of childbirth were associated with perceptions of the quality of maternity services. Based on the results, development of midwifery and nursing practices should focus on sufficient pain relief, adequate duration of skin-to-skin contact, breastfeeding counselling and opportunities for mothers to reflect on their birth experience afterwards. Moreover, the study results can be used for education. Challenges for future research are presented. [ABSTRACT FROM AUTHOR]

Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not well-known among Finnish midwives. The primary aim was to increase perceived labor support as measured by BANSILQ. This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals—one regional and one central—were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the post-intervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed. [ABSTRACT FROM AUTHOR]

This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth. Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis. The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive. The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear. The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people. [ABSTRACT FROM AUTHOR]

• Older age, being married or cohabiting and being rural or semi-urban resident are protective factors to repeat termination of pregnancy. • Termination of pregnancy using medical procedure increases the risk of repeat pregnancy termination, however, considering the most recent period 2006–2015, no association was found by TOP method. • Using reliable method of contraception can lower the repeat termination of pregnancy. This study aimed to assess how factors such as sociodemographic characteristics, termination of pregnancy (TOP) related factors and contraception affect the risk of repeat TOP. This is a nationwide register-based study of 193,741 women who had TOP(s) during 1987–2015, using the Finnish Register of Induced Abortions. The risk of various factors, such as age, marital status, residence, parity, TOP related factors and contraception, was assessed separately for each repeat TOP. Cox proportional hazard model was used to estimate risk of different factors for repeat TOPs. 21% of the women having TOP had repeat TOPs during the years 1987–2015. Among women with repeat TOPs, more than 70% had one repeat TOP and the rest had two or more. Older, married and rural or semi-urban women had reduced risk of repeat TOPs. Adjusted risk for one repeat TOP was higher among parous women (HR 1.67, 95% CI 1.61–1.72). No significant risk for repeat TOP was observed by method in sub-analysis for the recent period after 2006. Women using less reliable (HR 1.14, 95% CI 1.06–1.23) and unreliable (HR 1.33, 95% CI 1.23–1.43) contraception had increased risk of repeat TOP than women using reliable contraception. Older age, being married, residing in rural or semi-urban areas and using reliable contraception were found to be protective factors for repeat TOPs whereas, parous women had higher risk for repeat TOPs. Proper counselling regarding contraception and use of reliable contraception immediately after TOP should be encouraged. [ABSTRACT FROM AUTHOR]

Aim: to describe the expectations to and knowledge of antenatal screening of expecting parents, and their experiences concerning the first-trimester screening scan. Design: survey study with a consecutive sampling method. Setting: two hospital districts in Finland, namely the capital area and Eastern Finland. Together these two districts include the six different municipal units in which the first-trimester screening scans discussed in the study were done during spring 2015. Participants: 1037 participants: 654 pregnant women and 346 partners. Measurements and findings: the survey was based on an electronic questionnaire containing 29 questions. Almost all the pregnant women involved had received information on screenings during antenatal care, but only 20% reported a good level of familiarity with the various screening methods. Of the respondents, around 30% of the partners and 26% of all participants with lower education considered their knowledge to be poor. Around 30% of nulliparous respondents reported a need for further information. The experiences of the first-trimester screening scans were generally positive, though some of the partners felt they were treated too impersonally. Parents were well informed during the scan. Key conclusions: the expectations of the antenatal screening of the parents-to-be were realistic, even for those whose knowledge of antenatal screening by their own estimation inadequate. Nulliparous and highly-educated respondents would have needed more counselling. For all respondents the first trimester screening scan generally reinforced the sense of becoming a parent. Implications for practice: new ways to provide information on antenatal screening are needed. In particular, there should be a focus on making the information more understandable and accessible both to pregnant women and to partners. The results of this study could be used in developing such means of providing such information during antenatal care and services in ultrasound units. The results would also be helpful for improving professional skills of the medical personnel performing the scans, and for providing information on them. [ABSTRACT FROM AUTHOR]

Background: Medically assisted reproduction (MAR) can negatively impact women's mental health, particularly when the treatments do not result in a live birth. While the number of women relying on MAR to conceive has grown rapidly, our knowledge about the mental health effects before, during, and after treatment is limited.Objective: To understand the long-term association between medically assisted reproduction and mental health outcomes for women before, during and after their treatments, and according to whether the treatment resulted in a live birth or not.Study Design: Using Finnish register data for the period 1995-2018 we estimated the probability of psychotropic purchases (antidepressants, anxiolytics, hypnotics and sedatives) for three groups of women who: 1) gave birth after natural conception (NC), 2) gave birth after MAR treatments (MAR+), or 3) underwent MAR but remained childless (MAR-). We followed women for up to 12 years before and 12 years after the reference date which corresponded to the conception date for women who had a first live birth either after a natural or a MAR conception, or the date of the last MAR treatment for women with no live birth by the end of 2017. We estimated linear probability models before and after the adjustment for socio-demographic characteristics.Results: The results show that women who did not have a live birth after undergoing MAR treatments purchased more psychotropics than women who gave birth after conceiving naturally or through MAR, and that these differences did not attenuate over time. 12 years after the reference date 17.73% (95% CI: 16.82-18.63) of MAR- women purchased psychotropics, versus 11.11% of NC (95% CI: 10.98-11.26) and 12.17% (95% CI: 11.65-12.69) of MAR+ women. In addition, women who conceived naturally and through MAR had very similar psychotropic use patterns from three years before conception to four years after, and over the long term. Adjustment for women's socio-demographic characteristics did not change the results.Conclusions: The similarities in psychotropic purchases of women who had a live birth, whether naturally or through MAR, suggest that the higher psychotropic use among women who remained childless after undergoing MAR were likely driven more by involuntary childlessness than by treatment-related stress. The results highlight the importance of counselling for women undergoing MAR treatments, especially if their attempts to conceive are unsuccessful. [ABSTRACT FROM AUTHOR]

We compared the reasons for postponing first birth in the three neighbouring areas of St Petersburg (Russia), Estonia and Finland. Data from three population-based surveys among women aged 18-44 years in St Petersburg (response rate 67%); Estonia (54%) and Finland (63%) in the early 2000s were used and analysed with logistic regressions. Childbearing intentions and reasons for postponing parenthood differed between both study areas and age groups. The proportion of women aged 35-44 still planning to have children was highest in Estonia. In the two post-Soviet areas, job insecurity increased postponement intentions among women aged 18-34 years. Enrolment in education was an important reason for postponement among women below 35 years in Estonia and aged 25-34 years in St Petersburg. In Finland, poor economic situation in the youngest age group and desire to advance a career among all women were important reasons to postpone birth. The importance of prolonged education and job insecurity for the timing of births in St Petersburg and Estonia suggests that governments should improve family policy measures to encourage childbearing among the young. In Finland policies to support the reconciliation of family and career and to increase permanent employment could promote parenthood among well-educated women. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe the trends and determinants of cesarean section (CS) delivery rates in rural China. Study Design: Data on rural primiparous women aged 15-49 years (n = 10,754) were obtained from 3 nationwide representative surveys in 1993, 1998, and 2003. The CS rate per 100 births and odds ratios by women''s background characteristics were calculated with the use of logistic regression. Results: The CS rate increased from 1% in 1991 to 17% in 2002. After age adjustment, CS was most common among more educated women, who lived in Eastern China, who had high household income and health insurance, who used antenatal care, and who gave birth at a high-level hospital. Conclusion: This development over the 10-year period may indicate very high CS rates in the near future; the epidemic of the use of CS that has been observed in urban China is likely to occur also in rural China. Further studies on the reasons and consequences of such excessive use of operative delivery are needed. [Copyright &y& Elsevier]