ABSTRACT
Analisam-se as estratégias reprodutivas de duas coortes de mulheres que viveram seu período reprodutivo em diferentes estágios de evolução de uma região de fronteira agrícola na Amazônia brasileira. Entende-se por estratégia reprodutiva a adoção de determinado comportamento reprodutivo e contraceptivo segundo as possibilidades e adversidades oferecidas no contexto da fronteira. O objetivo é avaliar as mudanças nessa estratégia ao longo do processo de desenvolvimento desse tipo de fronteira. As distintas condições socioeconômicas que os estágios de desenvolvimento da fronteira oferecem tornariam as estratégias reprodutivas diferenciadas, influenciando as decisões das mulheres que viveram seu período reprodutivo nas fases iniciais ou nas mais avançadas da fronteira. Foram realizadas entrevistas semiestruturadas em Machadinho d'Oeste, Rondônia, com 60 mulheres. Os resultados apontam que, contrariamente ao referido na literatura, não haveria uma relação direta entre uso da terra e o número de filhos. O comportamento reprodutivo de cada coorte se relaciona mais à infraestrutura de serviços de saúde sexual e reprodutiva e às condições socioeconômicas individuais e da fronteira. Para ambos os grupos, porém, a união e a maternidade são precoces e existem elevada falha contraceptiva e alta proporção de laqueadura.
We analyze the reproductive strategies of two cohorts of women whose reproductive period was experienced in different stages of the agricultural frontier evolution in the Brazilian Amazon. Reproductive strategy consists of certain reproductive and contraceptive behaviors adjusted to the possibilities and adversities offered in the context of the frontier. We evaluate changes in reproductive and contraceptive strategies throughout the development process of the agricultural frontier. The different conditions throughout the development stages offered by the frontier would trigger different reproductive strategies, thus decisions would be different for women that lived their reproductive period during initial or more advanced stages of the frontier. We carried out semi-structured interviews with 60 women in Machadinho d'Oeste, Rondônia. Despite what the literature claims, the results indicate that there is no direct relationship between land use and number of children. Rather, the reproductive behavior of each cohort is related to the infrastructure of sexual and reproductive health services and to individual and frontier socioeconomic conditions. Despite the differences, union and childbearing occur at young ages in either stage, with a reasonable proportion of pregnancy due to contraceptive failure as well as a high rate of female surgical sterilization.
Se analizan las estrategias reproductivas de dos cohortes de mujeres que vivieron en diferentes etapas de evolución de una región de frontera agrícola en la Amazonia brasileña. Se entiende por estrategia reproductiva la adopción de ciertos comportamientos reproductivos y anticonceptivos de acuerdo a las posibilidades y adversidades del contexto de la frontera. Se busca evaluar los cambios en las mencionadas estrategias en la medida en que evoluciona una región de este tipo. Las diferentes condiciones socioeconómicas por las que pasa la frontera agrícola durante este proceso diferenciarían a las estrategias reproductivas al influir en las decisiones tomadas por las mujeres que vivieron su período reproductivo en las primeras o en las fases más avanzadas de la frontera. Se realizaron entrevistas semiestructuradas en Machadinho d'Oeste, Rondônia, a sesenta mujeres, cuyos resultados muestran —a diferencia de lo que señala la literatura— que no habría relación directa entre el uso de la tierra y el número de hijos. El comportamiento reproductivo de cada cohorte está más relacionado con la infraestructura de los servicios de salud sexual y reproductiva y con las condiciones socioeconómicas individuales y fronterizas. No obstante, para ambos grupos, la unión y la maternidad son precoces, se observan alta falla anticonceptiva y alta proporción de esterilización.
Subject(s)
Humans , Women , Amazonian Ecosystem , Reproductive Behavior , Evaluation Studies as Topic , Fertility , Border Areas , BrazilABSTRACT
Background: Adolescents are at the peak of growth velocity and warrant special consideration as they undergo enormous psychological, physical as well as cognitive changes. The Government of India implemented friendly adolescent reproductive and sexual health (ARSH) clinics to improve healthcare services all over the country. However, there is lack of information on the sustainability of the programme.Methods: Community workers and public health workers from randomly selected twenty sub centres for intervention from West Tripura district and control from the adjacent Khowai district were selected. Knowledge prior and post intervention at both sites of the health workers was assessed by a self-administered questionnaire on 0 day, at 3, 6 and 12 months. Difference of knowledge score was analysed by paired t-test.Results: The mean knowledge score significantly differed at pre-intervention and immediately post intervention (p<0.01). The knowledge score was sustained even after 12 months of intervention among public (14.63±3.01) and community health workers (12.53±2.91). However, at the control site, a gradual decrease was noted over duration of 12 months. Intervention also considerably increased the utilization of ARSH clinics by both male and females in comparison to previous year’s data.Conclusions: The intervention and increased sustainability of acquired knowledge over 12 months seem to enhance the capacity for the adolescent clinics. Therefore, training the health workers to manage various sexual and reproductive health issues along with creating a friendly environment for adolescents is indispensable in the present setting.
ABSTRACT
Resumo O artigo aborda alguns resultados da pesquisa Uma investigação socioantropológica no âmbito das farmácias: posição de farmacêuticos e balconistas sobre a contracepção de emergência, uma pesquisa mais ampla, realizada entre 2012 e 2014, com o objetivo de conhecer as concepções e práticas dos farmacêuticos e balconistas sobre a comercialização da contracepção de emergência no país. A coleta de dados entre os farmacêuticos se deu por meio de um questionário on-line, anônimo e autoaplicado, disponível na Plataforma DataSUS/FormSUS, e a divulgação do estudo contou com apoio de órgãos de classe da categoria profissional em foco. Obteve-se a participação voluntária de 383 farmacêuticos, 74,5% pertencentes ao sexo feminino e 25,5%, ao masculino, e a maioria (78,1%) afirmou que os consumidores costumam apresentar dúvidas sobre a contracepção de emergência e seu uso, e procuram os profissionais para saná-las. A maior parte dos entrevistados (88,4%) já buscou informações a respeito da contracepção de emergência, e uma parcela significativa deles (49,9%) desconhece sua distribuição no Sistema Único de Saúde (SUS). O atendimento farmacêutico às consumidoras é problematizado, tendo em vista a importância de incluir esse profissional no debate público nacional sobre o tema e de valorizar sua atuação clínica em farmácias e drogarias. São discutidas, por fim, a questão do uso racional de medicamentos e as possíveis contribuições das ciências sociais ao tema.
Abstract The article addresses results from a broader survey entitled "A socio-anthropological investigation about drugstores: position of pharmacists and clerks on emergency contraception", carried out from 2012 to 2014. The purpose of this study is to understand pharmacists and clerks' conceptions and practices about the commercialization of emergency contraception in Brazil. The data was collected through an anonymous, self-administered on-line questionnaire available on the DataSUS/FormSUS Platform, and the disclosure of the study had the Brazilian pharmaceutical societies support. 383 pharmacists participated voluntarily (n=383), from which 74.5% were female and 25.5% were male. Most interviewees (78.1%) said that consumers usually have questions about emergency contraception and its use, and they often seek the professionals to clarify them. Most of them (88.4%) have already sought information about the emergency contraception, and a significant proportion of pharmacists (49.9%) do not know about their distribution in the Brazilian National Health System (SUS). The pharmaceutical service to emergency contraception users is problematized, considering the importance of including these professionals in the Brazilian public debate on the subject and valuing their clinical performance in pharmacies and drugstores. Furthermore, we discuss the rational use of medicines and the contributions of social sciences to the subject.
Subject(s)
Humans , Male , Female , Pharmaceutical Services , Unified Health System , Reproductive Health Services , Contraception, Postcoital , Reproductive Health , Professional PracticeABSTRACT
Background: Adolescents are a heterogeneous, vulnerable, and sexually active group. Geographical and educational health disparities exist among urban, rural, and slum adolescents and among out-of-school and school-going adolescents, respectively. Adolescent reproductive and sexual health (ARSH) services should be implemented in a manner to minimize health inequities among them. Objectives: To ascertain the extent of awareness and utilization of ARSH services provided under reproductive and child health(RCH) program among adolescents in Chandigarh. Materials and Methods: A crosssectional study was conducted among 854 adolescents (402 household, 200 out-of-school, and 252 school-going adolescents) in Chandigarh using pretested validated interview schedule on awareness and utilization of adolescent reproductive and sexual health services from February to April 2011 in North Indian Union Territory of Chandigarh. Ordinal regression analysis was done to study the association of socio-demographic variables with awareness and utilization of ARSH. Results: Awareness about contraception and health services was significantly less among rural (12.7% and 1.1%, respectively) adolescents as compared to slum (17.9% and 4.6%, respectively) and urban adolescents (33.5% and 7.8%, respectively) (P < 0.05). Out-ofschool adolescents were utilizing the preventive [odds ratio (OR) 0.39, P < 0.001] and curative services significantly lesser (OR = 0.54, P < 0.001) and had higher substance abuse (OR = 4.26, P= 0.006). Awareness was significantly associated with older age of adolescents (OR = 4.4,P < 0.001), poor education of father (OR = 0.5, P = 0.002), rural area (OR = 0.56, P = 0.001), and out-of-school status (OR = 0.35, P < 0.001). Conclusion: Awareness and utilization of ARSH services was inequitable and was more among urban and school-going adolescents. Educational status was the most important factor affecting it.
ABSTRACT
En la práctica clínica, el conflicto por la objeción de conciencia emerge al confrontarse el derecho del profesional objetor a la libertad de conciencia y el derecho de las personas a la atención en salud, oportuna, de calidad y sin discriminación. Frente a una objeción resulta imprescindible considerar la existencia de requisitos y límites, descartando su utilización para eludir la responsabilidad profesional o como forma encubierta de prácticas discriminatorias. Mediante un estudio exploratorio, cualitativo, se analizaron los principales significados y aspectos bioéticos relacionados con la objeción de conciencia profesional en la atención de salud sexual y reproductiva de adolescentes de la Región Metropolitana, en Santiago de Chile. Los resultados evidencian que, en la medida que se establezcan las bases éticas y legales para resguardar los derechos fundamentales, basados en el respeto por la dignidad de todos los involucrados, podremos lograr un real entendimiento entre las partes que a menudo entran en conflicto respecto de esta materia.
In clinical practice, the conflict due to conscientious objection arises when confronting the right of professional objection to free conscience and the right of persons to health care on time, with quality and without discrimination. When facing an objection is indispensable to consider the existence of requirements and limits, ruling out its use to evade professional responsibility or as a way to hide discriminatory practices. Using an exploratory, qualitative study, the main meanings and bioethical issues related to professional conscientious objection were analyzed in sexual and reproductive health care of adolescents of Metropolitan Region in Santiago of Chile. The results show that, in the extend that ethical and legal basis safeguard fundamental rights, based in the respect for the dignity of all involved, we may achieve a real understanding between the stakeholders that often enter into conflict with respect to this issue.
Na prática clínica, o conflito pela objeção de consciência emerge ao confrontar-se o direito do profissional objetor à liberdade de consciência e o direito das pessoas à atenção em saúde oportuna, de qualidade e sem discriminação. Frente a uma objeção resulta imprescindível considerar a existência de requisitos e limites, descartando a sua utilização para eludir a responsabilidade profissional ou como forma encoberta de práticas discriminatórias. Mediante um estudo exploratório, qualitativo, se analisaram os principais significados e aspectos bioéticos relacionados com a objeção de consciência profissional na atenção à saúde sexual e reprodutiva de adolescentes da Região Metropolitana, em Santiago do Chile. Os resultados evidenciam que, na medida que se estabelecem as bases éticas e legais para resguardar os direitos fundamentais, baseados no respeito pela dignidade de todos os envolvidos, poderemos lograr um real entendimento entre as partes que com frequência entram em conflito a respeito desta matéria.