RESUMEN
O gênero é um dos fatores associados à Insegurança Alimentar (IA). Apesar das pessoas em grupos minoritários de gênero estarem expostos a fatores potenciais de risco para IA, não temos dados em larga escala sobre estes grupos. Isso acontece devido à forma com que o gênero é classificado em pesquisas populacionais (i.e., homem e mulher), deixando populações transgênero "ocultas" em uma classificação binária. Nesta tese, propomos explorar as relações entre experiências minoritárias de gênero e a vulnerabilidade à IA. Dessa forma, investigamos a associação de fatores alimentares, nutricionais, sociais, econômicos e de preconceito com a IA na literatura científica, por meio de uma revisão sistemática, e um grupo de pessoas transgênero, por meio de um estudo transversal. Em nossa revisão, o desenho de estudo mais utilizado foi o transversal e o menos utilizado foi o etnográfico. Imagem corporal e controle de peso foram os temas predominantes (n = 25), seguidos por segurança alimentar e nutricional (n = 5), estado nutricional (n = 5), assistência nutricional à saúde (n = 1) e visões êmicas de alimentação saudável ( = 1). Em nosso estudo transversal, nossos resultados mostraram que as dificuldades de compra de alimentos na comunidade transgênero são anteriores à pandemia de COVID-19, mas que as medidas restritivas adotadas também impactaram o acesso geral a alimentos de qualidade. No entanto, as principais explicações para o IF foram renda e emprego. Concluímos que excluir diversidade de gênero em pesquisas sobre insegurança alimentar possivelmente tem deixado de revelar demandas importantes para a população transgênero. Nesta tese, apresentamos as relações compreendidas até o momento entre a IA na população transgênero, bem como os possíveis desafios e estratégias alternativas para superação. Esperamos que, assim, possamos apoiar políticas de alimentação e nutrição e sistemas de vigilância, bem como pesquisadores em todo o mundo a compreender a diversidade oculta nos estudos de IA (AU).
Gender is one of the factors associated with Food Insecurity (FI). Although people in gender minority groups are exposed to potential risk factors for FI, we do not have large-scale data on these groups. This is due to how gender is classified in population surveys (i.e., male and female), leaving transgender populations "hidden" in binary classification. In this thesis, we propose to explore the relationships between minority gender experiences and vulnerability to FI. In this way, we investigated the association of food, nutritional, social, economic, and prejudice factors with AI in the scientific literature, using a systematic review, and a group of transgender people, using a cross-sectional study. In our review, the most often used study design was cross-sectional, the least frequently used study design was ethnographic. Body image and weight control were predominant themes (n = 25), followed by food and nutrition security (n = 5), nutritional status (n = 5), nutritional health assistance (n = 1), and emic visions of healthy eating ( = 1). In our cross-sectional study, our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for FI were income and employment. We conclude that excluding gender diversity in research on food insecurity has possibly failed to reveal essential demands for the transgender population. This thesis presents the relationships understood so far between FI in the transgender population and possible challenges and alternative strategies for overcoming them. We hope that in doing so, we can guide food and nutrition policies and surveillance systems, as well as researchers around the world, to understand the hidden diversity in AI studies (AU).
Asunto(s)
Humanos , Masculino , Femenino , Identidad de Género , Equidad de Género , Inseguridad Alimentaria , Factores Socioeconómicos , Distribución de Chi-CuadradoRESUMEN
RESUMO Este relato situa-se no campo do protagonismo das mulheres Médicas de Família e Comunidade (mMFC) e em sua articulação nacional por meio do Grupo de Trabalho Mulheres na Medicina de Família e Comunidade (GT-MMF), fundado em 2016 no bojo da Sociedade de Medicina de Família e Comunidade (SBMFC), entidade científica que representa a especialidade no País. Descreve a organização do I Encontro do GT-MMFC, em 2019, intitulado 'Liderança feminina em saúde' e discute seus desdobramentos, com foco na equidade de gênero nos domínios: profissional, acadêmico, de gestão, de ensino e pesquisa; assim como na própria instituição, a SBMFC. O artigo se debruça, ainda, sobre questões relacionadas com as causas de mulheres no âmbito da especialidade e da medicina. O evento foi aberto a estudantes e profissionais de outras áreas e ofertou discussões contemporâneas, como: protagonismo feminino; autocuidado; interseccionalidades; maternidade e trabalho; inserção da mulher e diferenças de gênero na política. O Encontro reuniu mulheres de quatro regiões do Brasil, aprofundou as relações e o apoio interpares e permitiu a ampliação das pautas para o fortalecimento da consciência de gênero e sua influência no cotidiano das mMFC, na sua prática acadêmica, científica, assistencial e de gestão.
ABSTRACT This report is situated in the scope of Female Family Physicians' protagonism and their national organization through the Women's Working Group on Family and Community Medicine, which was founded in 2016 under the Brazilian Society of Family and Community Medicine, a scientific entity that represents this medical specialty in the country. It describes the organization of the first Meeting of this Working Group, in 2019, named 'Female Leadership in Health' and discusses its unfoldings, focusing on gender equity in spheres such as: professional, academic, management, educational, and research, as well as permeating the institution itself. This article also focuses on women's issues surrounding both the specialty and medicine in general. The event welcomed students and professionals from other fields and offered contemporary debates, for example: female protagonism, self-care, intersectionality, maternity and work, participation of women in politics, and gender inequities. The Meeting gathered women from four regions of Brazil, deepened peer bonds and support, and enabled the expansion of the agenda of gender consciousness and its influence in women family physicians' daily life in their experience in management, university, science, and assistance.
RESUMEN
The vast majority of women in Mexican prisons have several mental health disorders and addictions, as well as problems obtaining access to treatment for this type of problems. These women's personal background and prison conditions reflect the unresolved problems of the country, such as education and illiteracy, access to health and housing and inequity in the justice systems. The literature has shown that substance abuse affects female prisoners to a greater extent than other women, and that their disadvantaged socio-economic status makes them more likely to engage in and continue substance abuse. Other aspects that exacerbate this vulnerability are their low educational attainment, lack of job skills, and exposure to stigmatization and discrimination in addition to the physical and psychological consequences of addictive behavior. One aspect that has been internationally acknowledged is that gender inequities make women's health more vulnerable, particularly that of female prisoners, since they have greater health deficits and more treatment barriers. International literature has shown that female users of psychoactive substances in general face more barriers than men in seeking or continuing treatment. Research has also shown that the most common personal barriers in women are denial, shame and guilt. Likewise, women's anxiety and depressive disorders tend to be more prevalent and severe, which in turn prevents them from seeking help when they have substance abuse problems. The most common family-related barriers are the difficulty of attending treatment due to family, partner or childcare obligations, pregnancy or fear of losing custody of their children. The main barriers faced by women regarding treatment institutions are the insensitivity or inadequate training of the staff that work there, prejudice and negative attitudes towards women, lack of information on available treatment and extremely long waiting lists. As a result of the above, the aim of this study is to document the barriers to the treatment of addictions of female prisoners, a disadvantaged group that has rarely been studied in Mexico, in order to understand certain aspects related to this population's access to treatment and continuation of the latter. The design used for this research is an ex post facto, descriptive, non-experimental, cross-sectional field study. The sample consisted of 213 women, chosen for convenience, who met the following criteria: alcohol and drug users, ages 18 to 65, able to read and write and with no psychiatric disorders or handicaps that would prevent the interview. The women that participated in this study were drawn from two Mexico City prisons: the Centro Preventivo Femenil Oriente, which houses women that have been accused, tried and sentenced, and the Centro de Readaptación Social Femenil Tepepan, where the inmates are women who have been sentenced and also have psychiatric problems. The ethical care observed included informing the interviewees of the objectives of the study, voluntary participation, confidential handling of the information and the use of witnesses, as well as guaranteeing participants the right to abandon the study and not to answer questions they found uncomfortable. The instrument was designed as a semi-structured interview with 242 questions covering various areas including Allen's Questionnaire on Treatment Barriers. It can be self-administered by the respondents, has internal consistency, construct and content validity and was adapted by Romero (2002). Some of the respondents had to have the questionnaire read out to them because of their low educational attainment. This questionnaire consists of 41 items, 30 of which are divided into three categories: 1. characteristics of treatment services, 2. beliefs, feelings or thoughts, and 3. socio-environmental aspects. Each category also includes an open question to discover other types of barriers not included in the three categories. The results yielded the following socio-demographic profile of the interviewees: 45.5% were in the 28 to 40 year age group; and had had 6 or less years' education (41.3%) or completed junior high school (36.2%). The majority were single (48.6%) or common law (21.6%), while 50.7% had children under the age of 18. Certain other characteristics of this sample such as depression, violence and alcohol and drug use have been reported in other studies. Of the total group of women that had received treatment at some time in their lives, 52.6% (n = 112) mentioned some type of barrier to treatment for addictions. A total of 29.1% (n = 62) of these women mentioned some type of barrier to treatment for alcohol use, while 44.1 % (n = 94) cited some type of barrier to treatment for drug use. Lastly, 39.2% (n = 44) mentioned some type of barrier to treatment for both types of consumption. An analysis of the treatment sub-scale by socio-demographic variable showed greater difficulty in obtaining treatment among women ages 28 to 40 and among those with children under 18. Statistically significant differences were observed regarding the type of offense (robbery) and availability of treatment. As for the beliefs, feelings and thoughts sub-scale, statistically significant differences were found among women with children under 18 and those finding it hard to abandon consumption. The sub-scale related to situational aspects, such as rejection from friends, proved to be the main barrier to enter treatment and was statistically significant among single women. The results of this study pose challenges to the health and mental health service sector regarding the timely treatment and rehabilitation of marginalized women. Likewise, acknowledging gender inequities is crucial when it comes to designing health promotion strategies. Without this perspective, their effectiveness could be jeopardized and gender inequalities actually exacerbated.
La gran mayoría de las mujeres recluidas en las prisiones de México presentan una gran cantidad de trastornos de salud mental y adicciones, así como dificultades para acceder al tratamiento para este tipo de problemas. Los antecedentes personales y las condiciones de reclusión de estas mujeres reflejan los problemas no resueltos del país como son educación y analfabetismo, acceso a la salud, vivienda e inequidad en los sistemas de procuración de justicia. En la bibliografía se ha señalado que el abuso de sustancias afecta a las mujeres presas en mayor medida que a otras mujeres y que su situación socioeconómica desfavorable las hace más susceptibles de incidir y prevalecer en la conducta de abuso de sustancias. Otros aspectos que acentúan esta vulnerabilidad son el bajo nivel educativo, las pocas habilidades para el trabajo, la exposición a la estigmatización y la discriminación, además de las consecuencias físicas y psicológicas de la conducta adictiva. Un aspecto reconocido internacionalmente es que las inequidades de género vulneran de manera particular la salud de las mujeres, lo cual es aún más evidente en las mujeres presas, pues presentan mayores déficits en su salud y mayor número de barreras al tratamiento. Se ha documentado en la bibliografía internacional que las usuarias de sustancias psicoactivas en general se enfrentan a un mayor número de barreras que los hombres para buscar o seguir un tratamiento. Por lo anterior, el objetivo del estudio es documentar las barreras al tratamiento de adicciones de mujeres en prisión, una población desfavorecida poco estudiada en México a fin de entender algunos aspectos relacionados con el acceso a tratamientos de esta población y su permanencia en ellos. El diseño utilizado para esta investigación corresponde a un estudio de campo transversal no experimental, descriptivo, ex post facto. La muestra se conformó de 213 mujeres, seleccionadas por conveniencia, con los siguientes criterios: usuarias de alcohol y drogas, edad de 1 8 a 65 años, que supieran leer y escribir, sin trastorno psiquiátrico o discapacidad que impidiera la entrevista. Las mujeres que participaron en este estudio se seleccionaron de dos prisiones de la Ciudad de México: el Centro Preventivo Femenil Oriente, donde se encuentran mujeres indiciadas, procesadas y sentenciadas, y el Centro de Readaptación Social Femenil Tepepan, donde se encuentran mujeres sentenciadas y con problemas psiquiátricos. Los cuidados éticos observados en el estudio fueron: información de los objetivos a las entrevistadas, participación voluntaria, confidencialidad de la información, empleo de testigos, así como el derecho de abandonar el estudio y de no responder aquellas preguntas que les resultasen incómodas. El instrumento empleado tuvo un formato de entrevista semiestructurada con 242 preguntas que abarcan diversas áreas, entre ellas, el <