Barreras de accesibilidad al dispositivo intrauterino (DIU) en el subsistema público de salud / Accessibility barriers to the intrauterine device (IUD) in the public health subsystem

INTRODUCCIÓN La Dirección de Salud Sexual y Reproductiva del Ministerio de Salud de la Nación incluye en sus estrategias la distribución y entrega gratuita de anticonceptivos y tiene como ejes prioritarios el mejoramiento de la accesibilidad al uso de métodos anticonceptivos de larga duración y la anticoncepción inmediata post evento obstétrico, que también se recomienda sea de larga duración. Sin embargo, se sigue registrando un porcentaje elevado de embarazos no planificados y, aunque el DIU fue incluido desde las primeras entregas, su utilización sigue siendo muy baja. En Argentina existe escasa información acerca de los obstáculos específicos para la utilización del DIU. OBJETIVOS Describir y analizar desde las perspectivas de las mujeres usuarias y de los/as profesionales de salud la accesibilidad al DIU en el subsistema público de salud, identificando factores objetivos y subjetivos que facilitan y/u obstaculizan dicho acceso. METODOLOGÍA Diseño cualitativo, con entrevistas a mujeres y a profesionales de tres jurisdicciones; Ciudad de Buenos Aires, Buenos Aires y Catamarca. RESULTADOS Los profesionales acuerdan con que el DIU es un método altamente costo efectivo para recomendar a las usuarias pero enumeran obstáculos institucionales para su uso. Las adolescentes, las nuligestas y la colocación post evento obstétrico les generan controversias. Las mujeres que usan o han usado DIU han tenido una experiencia muy satisfactoria que las motiva a volver a elegirlo y a recomendarlo. DISCUSIÓN La información disponible acerca del DIU está cargada de mitos y preconceptos que no condicen con la evidencia científica, pero se transforman en obstáculos al acceso. Algunos/as profesionales trabajan estos imaginarios en las consejerías y otros/as prefieren indicar otros métodos. Es necesario reforzar la capacitación de profesionales e incorporar a las obstétricas para mejorar el acceso

Atención ginecológica de lesbianas y bisexuales: notas sobre el estado de situación en Argentina / Gynecological care among lesbians and bisexual women: notes on the situation in Argentina / Cuidados ginecológicos em mulheres lésbicas e bissexuais: notas sobre a situação na Argentina

El artículo resume algunos resultados de la investigación sobre “Salud sexual y reproductiva: problemas emergentes”, cuyo objetivo fue describir las experiencias de mujeres no heterosexuales, en sus vínculos con los servicios de salud sexual y reproductiva, buscando identificar y analizar cuáles son los factores percibidos como obstaculizadores o facilitadores para su acceso. Partiendo de una estrategia cualitativa se realizaron 18 entrevistas semi-estructuradas a mujeres no heterosexuales. Como resultado encontramos que el mayor obstáculo para el acceso a servicios de salud sexual y reproductiva de mujeres no heterosexuales estriba en las “lógicas de invisibilización” que se traduce en la discriminación sentida en el marco de un contexto homo/lesbofóbico, la falta de producción teórica y la ausencia de preocupación práctica sobre relaciones sexuales entre mujeres y la invisibilidad de las lesbianas y bisexuales como colectivo...

This paper presents results from a qualitative study on emerging issues within sexual and reproductive health, in which the aim was to describe the experiences of non-heterosexual women in relation to sexual and reproductive healthcare services. The objective was to identify and analyze perceptions of obstacles and facilitators of access to healthcare services. Eighteen semi-directed interviews were conducted with non-heterosexual women. The main result was that the specific obstacle to access to sexual and reproductive healthcare among these non-heterosexual women derived from a “logic of invisibility” among this population as gynecological patients, which resulted in anticipated discrimination (sensed discrimination) within a homo/lesbophobic context; absence of theoretical production and practical interventions regarding health and sex between women; and invisibility of lesbians and bisexuals as a group...

O artigo apresenta resultados de uma pesquisa qualitativa sobre questões emergentes em saúde sexual e reprodutiva, cujo objetivo foi descrever as experiências de mulheres não heterossexuais em relação aos serviços de saúde sexual e reprodutiva. O objetivo do trabalho foi identificar e analisar as percepções de obstáculos e facilitadores do acesso aos serviços de saúde. Foram realizadas 18 entrevistas semidirigidas com mulheres não heterossexuais e os resultados principais incluíram: o obstáculo específico ao acesso à saúde sexual e reprodutiva das mulheres não heterossexuais deriva de uma “lógica da invisibilidade” dessa população como paciente ginecológica, que resulta na antecipação da discriminação (discriminação sentida) num contexto homo / lesbofóbico, na ausência de produção teórica e intervenções práticas sobre saúde e sexo entre mulheres, e na invisibilidade das lésbicas e bissexuais como coletivo...

The reproductive needs and rights of people living with HIV in Argentina: health service users' and providers' perspectives.

This article focuses on the contraceptive and reproductive experiences and needs of people living with HIV and on public health services' responses to them in Argentina. Data collected through a national survey amongst people living with HIV (N=841) and semi-structured interviews (N=89) explored the perspectives of both health-care users and HIV/AIDS program coordinators and providers. The survey revealed that 55% of women and 30% of men had had children after their HIV diagnosis and that half of those pregnancies had been unintended. At the time of the survey in 2006, 73% of men and 64% of women did not want a (new) pregnancy. The vast majority report systematic condom use, but acknowledge difficulties complying with this recommendation. Dual protection (i.e., condom use plus another method) is low among those who do not want children or another pregnancy (8% of women and 9% of men reported using it). Mostly women and heterosexual men without children either expressed their wish or were seeking to be parents. Institutional and cultural barriers to friendly and/or effective contraceptive and reproductive counselling were identified. Most physicians encourage only condom use while a minority refers patients to family planning providers or talk with them about contraception. A lack of updated information about interactions between antiretroviral drugs and hormonal contraception and/or intrauterine devices was not infrequent among providers. Users reported having being discouraged or blamed by health professionals when they revealed they wanted to have (or were expecting) a baby. Professionals and program directors' attitudes regarding reproduction range from not acknowledging people's wishes, to providing useful information or referral. Whether wanted or unexpected, parenthood is a challenge for many of the people living with HIV. Social and biomedical responses still need to be refined in order to fully respect people's rights and succeed in preventing (re)infection as well as unwanted pregnancies. Drawing on study results, recommendations to enhance the provision of adequate information and services to help people prevent unwanted pregnancies or reproduce as safely as possible are discussed.

Adolescent pregnancy in Argentina: evidence-based recommendations for public policies.

In Argentina adolescent pregnancy is still regarded as a public health problem or a "social epidemic". However, it is necessary to ask from which perspective and for whom it is a problem, and what type of problem. This article presents the findings of a large quantitative and qualitative study conducted in five Northern provinces and two metropolitan areas of Argentina in 2003-2004. Based on the results of a survey of adolescent mothers (n=1,645) and ten focus group discussions with adolescent girls and boys, it addresses the connections between school dropout, pregnancy and poverty, and makes recommendations on how to tailor health care and sexuality education to address local realities. The findings indicate a need to develop educational activities to promote safer sex and address gender power relations in programmes working with deprived communities. Sexuality education with a gender and rights perspective, and increasing accessibility to contraceptive methods for adolescent girls and boys is also crucial. Antenatal and post-partum care, as well as post-abortion care, should be improved for young women and viewed as opportunities for contraceptive counselling and provision. Male participation in pregnancy prevention and care also needs to be promoted.