ABSTRACT
Background: During the COVID-19 pandemic, the Uruguayan government decided to call for an attitude of responsible freedom of the population and created an Honorary Scientific Advisory Group (GACH). The intention was to report the scientific evidence available on the health situation with transparency and technical independence and to recommended interventions. This paper aims (1) to analyze the strategy to combat the COVID-19 pandemic used in Uruguay from the perspective and principles of person-centered medicine (PCM), (2) to report and examine from a broad perspective the policy regarding health authorities, scientific evidence and population, and (3) to discuss the importance of mental health and behavioral monitoring for identifying vulnerable groups that require special attention and care. Methods: Retrospective and narrative analysis of the creation of a socioeconomic and behavioral observatory [OSEC], critical evaluation of key data collection on population mental health, and assessment of the influence of OSEC in the context of the pandemic in Uruguay. T-test was used to assess mean differences of mental health trends in the general population using GHQ-12 panel data. The article presents the results obtained on the country's mental health data through the analysis of a helpline consultations and a digital panel survey of a representative sample of the Uruguayan population. Screening instruments were used, which allowed for an identification of risk groups. Results: The evidence shows the impact of the pandemic on the emotional distress of the population, indicating that the population discomfort decreased significantly when the pandemic situation began to improve. In addition, differences according to socioeconomic status and age groups were observed, showing that the most disadvantaged had significantly higher levels of emotional distress than those of the middle and upper class, at all times of analysis. Conclusions: Apparently, it is possible to extend the principles of beneficence, autonomy, and justice applied at the individual level to the level of collective health policies. This is essential to achieve the active participation of the population in their self-care and to promote greater and more transparent communication with the health and scientific fields. It is also necessary to adopt a holistic, biopsychosocial perspective, which makes it possible to identify the vulnerable sectors of society and the areas in which special attention is required.
ABSTRACT
This article presents the main characteristics and achievements of Uruguay's National and Intersectoral Strategy for Prevention of Adolescent Pregnancy, implemented from 2016 to 2020. This strategy was implemented in a context in which unintentional adolescent pregnancy continues to be a major social problem for Uruguay and the Region, necessitating comprehensive, sustained, and evidence-based public policies. In Uruguay, adolescent fertility rates have remained high for over a decade. In addition to intersectoral action by government and civil society, the strategy received scientific assistance from the academic community, and technical and financial cooperation from regional and international organizations. Its actions and measures were adopted based on a socio-ecological vision, with cultural sensitivity, a gender-transformative approach, and a human rights perspective. Major barriers include social norms that value maternity as the main life project for women living in poverty, gender stereotypes (pregnancy as the exclusive responsibility of adolescent girls, without involving adolescent boys), the stigma of abortion, a lack of sexual and reproductive health services, and resistance to raising the visibility of pregnancy in girls under 15 years of age who are victims of structural and family violence. It is necessary to ensure the continuity of public policies--adjusted to a gender and human-rights approach--that take into account new scenarios such as the one imposed by the COVID-19 pandemic.
Este artigo apresenta os principais aspectos e os resultados da Estratégia Nacional e Intersetorial para Prevenção da Gravidez na Adolescência, implementada no Uruguai entre 2016 e 2020. A gravidez não intencional na adolescência persiste como uma questão social importante no Uruguai e na Região, exigindo políticas públicas com base em evidências científicas que sejam abrangentes e permanentes. A fecundidade na adolescência no Uruguai tem se mantido elevada há mais de uma década. Além da ação intersetorial do governo e da sociedade civil, a estratégia aprovada recebeu orientação científica de entidades acadêmicas, e cooperação técnica e financeira de organismos regionais e internacionais. As ações e as medidas da estratégia foram elaboradas a partir de uma visão socioecológica, com sensibilidade cultural e enfoque transformador de gênero e uma perspectiva de direitos humanos. Entre as barreiras mais importantes enfrentadas estão as normas sociais que valorizam a maternidade como principal projeto de vida para a mulher que vive em situação de pobreza, os estereótipos de gênero (a gravidez é vista como responsabilidade exclusiva da adolescente, sem envolver o parceiro adolescente), o estigma do aborto, a oferta insuficiente de serviços de saúde sexual e reprodutiva, e a resistência a dar visibilidade à gravidez de menores de 15 anos que são vítimas de violência estrutural e intrafamiliar. É necessário garantir a continuidade das políticas públicas que incorporem uma perspectiva de gênero e direitos humanos, e que sejam adaptadas aos novos cenários da pandemia de COVID-19.
ABSTRACT
BACKGROUND: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15â 144, 7.0%) compared to before COVID-19 measures (1469 of 15â 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10â 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.