Care for women across critical junctures during the reproductive years. Reproductive choices, pregnancy and menopause

Reproductive milestones that are specific to women can be seen as critical junctures that shape women’s lives and may offer pragmatic opportunities for care and prevention. This thesis investigates how several of these reproductive milestones can be used to improve women’s health trajectories, both during the reproductive years and in relation to later cardiovascular and renal disease. Part I examines reproductive choices. This focuses on contraceptive behaviour preceding unintended pregnancies and motivations for abortion. The studies show that women often navigate negative experiences with hormonal contraception, rely on less effective methods, and make decisions within complex relational and socioeconomic contexts. Non judgmental, personalized counselling that builds trust and acknowledges these contexts is essential. Part II explores cardiovascular risk after pregnancy complications. The thesis shows that pregnancy complications largely reveal an already adverse cardiovascular risk profile. Postpartum risk management can be strengthened through active outreach, culturally tailored follow up, and multidisciplinary care. Part III focuses on early menopause in relation to the risk of long term cardiovascular and kidney disease. Adding early menopause to currently used cardiovascular risk screening criteria did not improve the detection of women at high risk. Early menopause was not consistently associated with chronic kidney disease in the overall multiethnic population, but associations varied across ethnic groups. Overall, the thesis argues that recognizing reproductive milestones as recurring critical junctures can help align counselling, outreach, and preventive care, supporting more equitable health and wellbeing for diverse groups of women. Show more