Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde / Provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil: perceptions of public health services managers and professionals

A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.

This study describes the perceptions of public health services managers and professionals concerning provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil. The study adopted a qualitative approach in four municipalities (counties), where semi-structured interviews were conducted with 26 health professionals and health services managers involved in the provision of surgical sterilization. The interviewees identified difficulties in scheduling visits at Outpatient Family Clinics or Reference Centers (APF/CR), and the number of available surgeries in the accredited hospitals was insufficient. They emphasized the lack of physical infrastructure and human resources for conducting family planning activities in the primary health units as well as in the APF/CR.They also criticized the legal criteria for authorizing surgical sterilization, and mentioned adaptations to make them more appropriate to the each municipality's situation. According to the health services managers and professionals, despite the efforts, meeting the demand for surgical sterilization in the Campinas Metropolitan Area was jeopardized by its centralization in the APF/CR, which in practice had to cover the gap in family planning activities in each municipality's primary care units.

District-level religious composition and adoption of sterilization in India.

This paper examined the influence of religion on the adoption of female sterilization, using data from the 1992/93 Indian National Family Health Survey. The influence of religion at both individual and district levels was examined, and a multi-level modelling methodology was used for assessing community variations in the influence of religion on the adoption of sterilization. Individual religion was a strong predictor of the decision to adopt sterilization, and residence in a district in which more than 20% of the people were Muslims significantly lowered the odds of adoption of sterilization. There was more variation in the adoption of sterilization between districts for Muslim women and women from minority religious groups. The results demonstrate the influence of community conservatism on the choice of contraceptive methods and point to the mediating effects that community characteristics can have on access to sterilization services for women from religious minority sub-groups.

Show, no show and sterilzation

The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.

Factores psicológicos que inciden en la toma de decisión de la esterilización quirúrgica y probables cambios posteriores / The psychological factors that affect the making of a decision for surgical sterilization and the likely later changes

The practice of female surgical sterilization in Panama during the past decades, motivated the realization of this study, to determine the factors which caused women to use this permanent contraceptive method, and to see if regrets later occurred after that decision, in the sterilized women. A sample of 151 women were selected, between the ages of 28 and 45 years, concurrently pregnant and with 2 or more living children at the moment of the study. Psychological tests were applied during three different phases (pre-operatively and subsequently 12 and 24 months, post operatively). Results showed that female sterilization did not cause long term complications, and amongst the majority of women conforming the sample, a stable psychological profile was found up to 24 months after the interventions, with a significant improvement in the last evaluation of the social adaptation variable, in comparison to the pre-operative assessment

Pattern of depressive disorder among the permanent sterilized women.

A prospective study was done on 100 permanent sterilized women (age 21 to 40 years) attending two model family planning clinics of Dhaka. By using DSM III-R criteria for major depressive episode, 19 were found to have depressive disorder. Among them 3 were severe, 8 were moderate and rest 8 were mild according to HRSD score. The average number of children in postligated depressive group was 5 in number. Almost all the depressives had considerable life events one year before ligation and relationship problem was the most frequent event. The time of occurrence of depressive disorder was within 2-3 months after ligation in 42.11% of the depressives. Only 2 cases of the depressives were getting psychiatric treatment which indicates lack of awareness about the existence of depression among postligated women.

Consideraciones psicológicas en la esterilización quirúrgica / Psychologic considerations in surgery sterilization

Seguimiento de 161 casos; sometidos a esterilización quirúrgica entre 1982 y 1984. Análisis de los factores psicológicos que repercuten en el pronóstico de la intervención, que nos permita prevenir las complicaciones observadas en el período post-operatorio