Alumbramiento patológico por presencia de T de cobre en membranas ovulares. Informe de caso / Pathological delivery due to the presence of copper T in ovular membranes. Case Report

Los dispositivos intrauterinos de cobre son utilizados como métodos anticoncepcionales y es uno de los métodos más utilizados por su seguridad, reversibilidad y eficacia en la prevención de embarazos, que es superior al 97 %. Se presenta un caso de falla en la anticoncepción con dispositivos intrauterinos de cobre después de 5 años de uso en gestante de 26 años, que acudió al área de emergencias cursando con embarazo de 38 semanas y 4 días en periodo expulsivo; se obtuvo recién nacido a término sano. El periodo de alumbramiento patológico (prolongado) por presencia de dispositivo intrauterino de cobre en membranas ovulares(AU)

Copper intrauterine devices are used as contraceptive methods and are one of the most used methods due to their safety, reversibility and effectiveness in preventing pregnancy, which is greater than 97%. A case of failure in contraception with a copper intrauterine devices is presented after 5 years of use in a 26-year-old pregnant woman, who went to the emergency room with a pregnancy of 38 weeks and 4 days in the expulsive period; a healthy term newborn was obtained.The pathological (prolonged) delivery period due to the presence of copper intrauterine devices in ovular membranes(AU)

Gravidez não planejada no extremo Sul do Brasil: prevalência, tendência e fatores associados / Unplanned pregnancy in the extreme South of Brazil: prevalence, trends, and associated factors

Resumo Este estudo estimou a proporção de puérperas que não planejaram a gravidez, avaliou tendência e identificou fatores associados à sua ocorrência no município de Rio Grande-RS. Entre 01/01 e 31/12 de 2007, 2010, 2013, 2016 e 2019 entrevistadoras treinadas aplicaram questionário único e padronizado a todas as puérperas residentes neste município. Utilizou-se teste qui-quadrado para comparar proporções e regressão de Poisson com ajuste da variância robusta na análise multivariável. A medida de efeito utilizada foi razão de prevalências (RP). O estudo incluiu 12.415 puérperas (98% do total). A prevalência de não planejamento foi 63,3% (IC95%: 62,5%-64,1%). Após ajuste, as maiores RP para não planejamento da gravidez foram observadas entre mulheres de menor idade, cor da pele preta, com companheiro, maior aglomeração domiciliar, pior escolaridade e renda familiar, maior paridade e tabagistas. Houve pequeno aumento na prevalência de não planejamento da gravidez no final do período principalmente entre àquelas com maiores riscos de eventos desfavoráveis na gestação e parto. Alcançar estas mulheres nas escolas de ensino médio, empresas, serviços e profissionais de saúde, além de meios de comunicação de massa, pode auxiliar na prevenção desse tipo de gravidez.

Abstract The study aims to estimate the proportion of puerperae with an unplanned pregnancy, evaluate trends and identify factors associated with its occurrence in Rio Grande-RS, Brazil. Trained interviewers applied a single, standardized questionnaire to all puerperae residing in the municipality in 2007, 2010, 2013, 2016 and 2019. The chi-square test compared proportions and the Poisson regression with robust variance adjustment in the multivariate analysis. The prevalence ratio (PR) was the effect measure employed. The study includes 12,415 puerperae (98% of the total). The unplanned pregnancy rate was 63.3% (95%CI: 62.5%-64.1%). After adjusting, the highest PR for not planning pregnancy were observed among younger, black women, living without a partner, with more significant household agglomeration, lower schooling, and household income, multiparous and smokers. The rate of unplanned pregnancy is high and stable, with a higher propensity among women those with the highest risk of unfavorable events during pregnancy and childbirth. Reaching these women in high schools, companies, services and health professionals, in addition to the mass media, can be strategies to prevent unplanned pregnancy.

Descripción de las personas gestantes afiliadas a OSEP que solicitan una interrupción del embarazo / Description of pregnant people affiliated to osep who request a pregnancy interruption

En 2021 entró en vigencia en Argentina la Ley N.º 27.610. El objetivo es describir características de afiliadas a OSEP que solicitaron interrupción del embarazo (SIE).Trabajo observacional descriptivo. Se analizaron las variables del 0800 del Ministerio de Salud de la Nación de todas las personas que SIE con OSEP, entre el 24/01 y 31/12/2021. Los datos fueron analizados con SPSS Statistics. Se utilizaron moda, mediana, porcentaje, tasa y el chi2. Se recibieron 427 SIE, se concretaron 330 (77,3%). Solicitaron ive: media 28,59 años. Modo 19 y 33 años. Concretaron ive: modo 22 años. 84,5% se realizó ambulatorio con misoprostol. De las SIE, 50,4% eran solteras, 43,4% trabajaba, 59,1% tenía secundario completo. Se desconoce 32,8%. De las SIE, 52,7% refirió haber estado utilizando MAC (54,2% preservativo; 37,4% anticonceptivos orales; 2,8% métodos "naturales"; 2,2% DIU). La mayor cantidad fue de zonas urbanas del Gran Mendoza. Sin embargo, se observan tasas elevadas en zonas rurales respecto de algunas zonas urbanas y más pobladas. Se observó progresión de SIE a lo largo del año. Un 11% después de SIE decidió continuar con el embarazo. Aparentemente ninguna de las variables tuvo relación con esa decisión. El MAC utilizado fue mayormente preservativo y anticonceptivos orales. Esto podría indicar falta de educación y poco acceso a métodos de larga duración. La problemática de interrupción es transversal. En base a los resultados de este trabajo, las personas sin pareja conviviente, ante un embarazo no planificado serían las que SIE. Ninguna otra variable parece actuar como determinante. Tampoco del paso de la solicitud a la interrupción efectiva o a la continuación del embarazo. Hay que aumentar la accesibilidad a MAC en zonas rurales (AU)

In 2021, Law No. 27610 entered into force in Argentina. The objective is to describe characteristics of people with OSEP who requested termination of pregnancy (PWRTP). Descriptive observational work. The variables of the 0800 of the Ministry of Health of Argentina of all the PWRTP with OSEP, between 01/24 and 12/31/2021, were analyzed. Data were analyzed with SPSS Statistics. Mode, median, percentage, rate and chi2 were used. PWRTP: 427 requests were received, 330 (77.3%) were completed. PWRTP: mean 28.59 years. Mode 19 and 33 years. People who had an abortion: mode 22 years. 84.5% were performed on an outpatient basis with misoprostol. 50.4% of the PWRTP were single, 43.4% worked, 59.1% had completed high school, 32.8% unknown, 52.7% reported having been using contraceptive methods (CM): 54.2% condoms; 37.4% oral contraceptives; 2.8% "natural" methods; 2.2% IUDs. The largest amount was from urban areas of Mendoza. However, high rates are observed in rural areas. A progression of the amount of PWRTP was observed throughout the year. 11% after requesting an abortion decided to continue with the pregnancy. Apparently none of the variables was related to that decision. The CM used were mostly condoms and oral contraceptives. This may indicate a lack of education and poor access to long-acting CM. The problem of interruption is transversal. People without a cohabiting partner, faced with an unplanned pregnancy, are the ones who RTP. No other variable seems to act as a determinant. Nor from the transition from the request to the effective interruption or continuation of the pregnancy. We must increase the accessibility to CM in rural areas (AU)

Factors Associated with Early Sexual Activity in Adolescents Residing in an Urban Area of Northeastern Mexico Who Use WhatsApp or Facebook.

Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31-16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44-5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03-2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.

One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents.

PURPOSE: Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. MATERIALS AND METHODS: We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. RESULTS: We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99-1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort. CONCLUSION: Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.

Unplanned pregnancy in Brazil: national study in eight university hospitals / Gravidez não planejada no Brasil: estudo nacional em oito hospitais universitários

ABSTRACT OBJECTIVE To estimate the prevalence of unplanned pregnancy in eight public university hospitals, distributed in the five regions that make up Brazil. METHODS A secondary analysis of a national multicenter cross-sectional study, carried out in eight public university hospitals between June 1 and August 31, 2020, in Brazil. Convenience sample including women who gave birth within sixty consecutive days and met the following criteria: over 18 years old; gestational age over 36 weeks at delivery; with a single and live newborn, without malformations. RESULTS Sample composed of 1,120 postpartum women, of whom 756 (67.5%) declared that the pregnancy had not been planned. The median prevalence of unplanned pregnancy was 59.7%. The prevalence of unplanned pregnancy across hospitals differed significantly: Campinas (54.8%), Porto Alegre (58.2%), Florianópolis (59%), Teresina (61.2%), Brasília (64.3%), São Paulo (64.6%), Campo Grande (73.9%) and Manaus (95.3%) (p < 0.001). Factors significantly associated with unplanned pregnancy were maternal age, black color, lower family income, greater number of children, greater number of people living in household, and not having a partner. CONCLUSION In the studied sample, about two thirds of the pregnancies were declared as unplanned. The prevalence of unplanned pregnancies was related to social and demographic factors and varied significantly across the university hospitals evaluated.

RESUMO OBJETIVO Estimar a prevalência de gestação não planejada (GNP) em oito hospitais públicos universitários, distribuídos nas cinco regiões que compõem o Brasil. MÉTODOS Análise secundária de um estudo transversal multicêntrico nacional, realizado em oito hospitais universitários públicos, entre 1º de junho e 31 de agosto de 2020, no Brasil. Amostra por conveniência incluindo mulheres que deram à luz em período de sessenta dias consecutivos e atenderam aos seguintes critérios: maiores de 18 anos; idade gestacional acima de 36 semanas no parto; com recém-nascido único e vivo, sem malformações. RESULTADOS Amostra composta por 1.120 puérperas, das quais 756 (67,5%) declararam que a gravidez não tinha sido programada. A mediana da prevalência de GNP foi de 59,7%. Observou-se diferença significativa na prevalência de GNP entre os hospitais: Campinas (54,8%), Porto Alegre (58,2%), Florianópolis (59%), Teresina (61,2%), Brasília (64,3%), São Paulo (64,6%), Campo Grande (73,9%) e Manaus (95,3%) (p < 0,001). Foram fatores significativamente associados a GNP a idade materna, cor negra, menor renda familiar, maior número de filhos, maior número de pessoas convivendo em casa e não ter parceiro. CONCLUSÃO Na amostra estudada, cerca de dois terços das gestações foram declaradas como não programadas. A prevalência de gestação não planejada teve relação com fatores sociais e demográficos e variou significativamente entre os hospitais universitários avaliados.

Comparison of contraceptive sales before and during the COVID-19 pandemic in Brazil.

OBJECTIVE: The aim of the study was to assess the impact of the COVID-19 pandemic on sales of modern contraceptive methods in Brazil. METHODS: Monthly sales data were analysed of short-acting reversible contraceptive methods and long-acting reversible contraceptive (LARC) methods (implants and intrauterine contraception) and COVID-19 related deaths. Contraceptive methods were grouped as follows: emergency contraception (EC); oral contraception, vaginal rings and transdermal patches; injectable contraception; LARC methods including the copper intrauterine device (Cu-IUD); and LARC methods excluding the Cu-IUD. RESULTS: Contraceptive sales showed a non-significant increase in 2020 compared with the previous year; average sales ranged from 12.8 to 13.0 million units per month. Sales of injectable contraceptives increased between March and June 2020 and EC pills between June and July 2020; the variation in sales of pills, patches and rings was not significant. Sales of the levonorgestrel-releasing intrauterine system (LNG-IUS) and the etonogestrel (ENG) implant showed three patterns: a decrease in sales between February and May 2020 (coinciding with the closure of family planning services), an increase in sales after May 2020 (coinciding with the first COVID-19-related deaths), and a further increase in sales after July 2020 (corresponding to the increasing number of deaths from COVID-19). CONCLUSION: The COVID-19 pandemic has disrupted the Brazilian health care system. Since many family planning clinics were closed, sales of most modern contraceptives fell during 2020; however, the increase in sales of the LNG-IUS and ENG implant in the private sector indicates inequitable access to modern contraceptive methods.

Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial.

This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14-19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.

RESUMEN: Este estudio evaluó la eficacia del programa COMPAS a corto plazo y a 6 meses después de la aplicación. Para la muestra inicial participaron 2.047 adolescentes de 14 a 19 años provenientes de 12 escuelas en 11 ciudades colombianas; 8 escuelas fueron aleatoriamente asignadas a la condición experimental y 6 al grupo control. Los participantes completaron autoinformes sobre variables teóricamente asociadas con comportamientos sexuales de protección. A corto plazo, el grupo experimental mostró un mayor conocimiento sobre ITS, asertividad sexual, autoeficacia e intención conductual hacia el uso del condón y actitudes más favorables hacia el VIH que el grupo de control. Después de seis meses, la mayoría de las variables psicológicas y de salud también mostraron un cambio positivo. En conclusión, el programa COMPAS es el primer programa de educación sexual que ha demostrado ser efectivo para reducir las variables mediadoras y conductuales asociadas con la reducción del riesgo sexual en Colombia.

Abordaje integral de la interrupción voluntaria del embarazo (primera entrega) / Comprehensive approach to the voluntary interruption of pregnancy (first issue)

En enero de 2021 entró en vigencia en Argentina la ley de Interrupción Voluntaria del Embarazo (IVE). Este cambio en la legislación implica una modificación sustancial de la práctica médica. En una serie de artículos, el equipo PROFAM comparte su punto de vista a través de una adaptación de su material educativo sobre la IVE. En esta primera entrega, las autoras abordan la aplicación de las cuestiones legales que determinan la práctica, la consejería general, y algunos lineamientos de cómo actuar ante la situación de un diagnóstico de embarazo inesperado. (AU)

In January 2021, the Voluntary Interruption of Pregnancy (VIP) law came into force in Argentina. This change in legislation implies a substantial modification regarding medical practice. In a series of articles, the PROFAM team shares its point of view through an adaptation of its educational material on the VIP. In this first issue, the authors address the application of the legal aspects that determine the practice, general counselling, and some guidelines on how to act when faced with a diagnosis of an unexpected pregnancy. (AU)

Abordaje integral de la Interrupción Voluntaria del Embarazo: (segunda entrega) / Comprehensive approach to the voluntary interruption of pregnancy: (second issue)

La legalización de la interrupción voluntaria del embarazo ha transformado la práctica médica con respecto a la atención de las pacientes que desean interrumpir la gestación hasta la semana 14 en Argentina. En la primera entrega, el equipo PROFAM compartió su punto de vista a través de una adaptación de su material educativo destinado, sobre todo, a aclarar los aspectos legales que hacen a la práctica cotidiana. En esta entrega se desarrolla en detalle el procedimiento para realizar un aborto farmacológico con misoprostol y mifepristona, así como las generalidades del aspirado manual endouterino. (AU)

The legalization of voluntary termination of pregnancy has transformed medical practice regarding the care of patients who wish to terminate a pregnancy up to 14 weeks in Argentina. In the first issue, the PROFAM team shared its point of view through an adaptation of its educational material aimed, above all, at clarifying the legal aspects of daily practice. In this issue, the procedure to perform a pharmacological abortion with misoprostol and mifepristone is developed in detail, as well as the generalities of manual uterine aspiration technique. (AU)

Corrigendum: Trends and Inequalities in Unplanned Pregnancy in Three Population-Based Birth Cohorts in Pelotas, Brazil.

[This corrects the article DOI: 10.1007/s00038-020-01505-0.].

Asociación de la violencia obstétrica, control prenatal y embarazo no planeado con la prematurez / Association of obstetric violence, prenatal control, and unplanned pregnancy with prematurity

Resumen La prematurez (PM) neonatal es un problema mayor de salud pública en el mundo, debido a su frecuencia de presentación y los años de vida potencialmente perdidos; además, es la principal causa de muerte en menores de cinco años. Entre las consecuencias negativas de la PM están las discapacidades del aprendizaje, visual y auditiva. Múltiples son los factores asociados a la PM; algunos pueden ser detectados y modificados de forma oportuna en las consultas prenatales y también, en las preconcepcionales. Por otro lado, la PM no es solamente responsabilidad del prestador de los servicios de salud, sino también del sistema de salud, el cual, debe otorgar los recursos mínimos necesarios para monitorear y mantener a la embarazada en un estado óptimo de salud para evitarla, y en caso de presentarse, debe contar con la infraestructura hospitalaria básica que permita la viabilidad del producto y evitar su muerte. Aunado a lo anterior, se debe de considerar la responsabilidad de la paciente y su pareja, debido a que en ellos recae la obligación de llevar un estilo de vida saludable y acudir a las consultas preconcepcionales y control prenatal.

Abstract Neonatal prematurity (MP) is a major public health problem in the world, due to its presentation frequency and the years of life potentially lost; In addition, it is the main cause of death in children under five years of age. Among the negative consequences of MP are learning, visual and hearing disabilities. There are multiple factors associated with MP; some can be detected and modified in a timely manner in prenatal consultations and in preconception. On the other hand, MP is not only responsibility of the health service provider, but also of the health system, which must grant the minimum resources necessary to monitor and maintain the pregnant woman in an optimal state of health to avoid it, and if it occurs, the hospital must have the basic infrastructure that allows the viability of the product and prevents its death. In addition, the responsibility of the patient and her partner must be considered since they are obliged to lead a healthy lifestyle and attend preconception consultations and prenatal care.

Prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast / Prevalência e fatores associados à gravidez não planejada em uma capital do Nordeste Brasileiro

Abstract Objectives: to analyze the prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast. Methods: a cross-sectional study nested to a hospital birth cohort with a probable sample of 5,110 puerperal women. Associated factors were analyzed using a hierarchical theoretical model in three levels: distal (women's socioeconomic and demographic characteristics), intermediate (reproductive characteristics, maternal habits and BMI), and proximal level (partner's characteristics). Multivariate Poisson regression analysis was performed. Results: the prevalence of unplanned pregnancy was 68.1% (CI95%=66.8-69.4). Multivariate analysis showed association with black skin color/race (PR=1.03; CI95%=1.01- 1.07), mother's age group up to 19 years old (PR=1.09; CI95%=1.06-1.12) and 20 to 24 years old (PR=1.04; CI95%=1.01-1.07), not living with partner (PR=1.09; CI95%=1.07- 1.11), highest number of people in the household: 5 people (PR= 1.10; CI95%=1.08-1.13) and 3 to 4 (PR=1.08; CI95%=1.05-1.10), number of ≥4 children (PR=1.09; CI95%=1.06- 1.13) and 2 or 3 children (PR=1.03; CI95%=1.02-1.05), alcohol consumption (PR=1.03; CI95%=1.01-1.05), malnourished pre-pregnancy BMI (PR=1.03; CI95%=1.01-1.06) and partner's low schooling (5 to 8 years) (PR=1.03; CI95%=1.01-1.07). Prior abortion was inversely associated with planned pregnancy (PR=0.95; CI95%=0.93-0.97). Conclusions: the prevalence of unplanned pregnancy was high and was associated with socioeconomic and demographic characteristics that reflect on the combination of the complex inequalities that impact women and their partners

Resumo Objetivos: analisar a prevalência e fatores associados à gravidez não planejada em uma capital do Nordeste brasileiro. Métodos: estudo transversal aninhado à coorte de nascimento hospitalar com amostra probabilística de 5.110 puérperas. Fatores associados foram analisados utilizando-se modelo teórico hierarquizado em três níveis: distal (caracteristicas socioeconômicas e demográficas da mulher), intermediário(caracteristicas reprodutivas, hábitos maternos e IMC), e nível proximal (características do companheiro). Realizou-se análise de regressão multivariada de Poisson. Resultados: a prevalência de gravidez não planejada foi de 68,1% (IC95%= 66,8-69,4). A análise multivariada mostrou associação com cor/raça preta (RP=1,03; IC95%= 1,01-1,07), faixa etária da mãe até 19 anos (RP=1,09; IC95%= 1,06-1,12) e 20 a 24 anos (RP=1,04; IC95%= 1,01-1,07), não residir com o companheiro (RP=1,09; IC95%= 1,07-1,11), maior o número de pessoas no domicílio: 5 pessoas (RP= 1,10; IC95%= 1,08-1,13) e de 3 a 4 (RP=1,08; IC95%= 1,05-1,10), número de ≥4 filhos (RP=1,09; IC95%= 1,06-1,13) e 2 ou 3 filhos (RP=1,03; IC95%= 1,02-1,05), uso de álcool (RP=1,03; IC95%= 1,01-1,05), IMC pré-gestacional desnutrido (RP=1,03; IC95%= 1,01-1,06) e baixa escolaridade (5 a 8 anos) do companheiro (RP=1,03; IC95%= 1,01-1,07). O aborto prévio associou-se inversamente com gravidez planejada (RP=0,95; IC95%= 0,93-0,97). Conclusões: foi elevada a prevalência de gravidez não planejada, e esteve associada a características socioeconômicas e demográficas que refletem a combinação de complexas desigualdades que impactam mulheres e seus parceiros.

Zika virus public health crisis and the perpetuation of gender inequality in Brazil.

BACKGROUND: In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS: We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS: Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION: Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.

Maternal sensitivity in interactions with their 2-month-old infants in Rio de Janeiro - Brazil.

This paper reports on a study of maternal sensitivity in 22 primiparous women and their infants from Rio de Janeiro, Brazil. Sociodemographic risk was assessed through an interview, and videotaped naturalistic home observations were used to assess maternal sensitivity, and its relation with warmth, verbal and physical engagement, and camera awareness. A K-means cluster analysis was performed to examine patterns of risk in relation to maternal sensitivity. Compared to the 15 mothers with higher sensitivity scores, the seven mothers with lower sensitivity scores were characterized by lower educational levels, lower income, lower age, slum residence, unplanned and unwanted pregnancies, and later onset of prenatal care. Whether father was resident did not appear to distinguish between the lower and higher sensitivity groups. The pattern of social-contextual risk for Brazilian mothers showing less sensitive caregiving to their infants provide direction for future research in this cultural context.

Maternal sensitivity in interactions with their 2-month-old infants in Rio de Janeiro - Brazil.

This paper reports on a study of maternal sensitivity in 22 primiparous women and their infants from Rio de Janeiro, Brazil. A semi-structured interview was conducted about sociodemographic risk, as and videotaped home observations to assess maternal sensitivity, and its relation with warmth, verbal and physical engagement, and camera awareness. A K-means cluster analysis was performed to examine patterns of risk in relation to maternal sensitivity. Compared to the 15 mothers with higher sensitivity scores, the seven mothers with lower sensitivity scores were characterized by lower educational levels, lower income, lower age, living in a slum, unplanned and unwanted pregnancies, and later onset of prenatal care. Whether father was resident did not appear to distinguish between the lower and higher sensitivity groups. The pattern of social-contextual risk for Brazilian mothers showing less sensitive caregiving to their infants provide a clear direction for future research in this cultural context.

Perfil epidemiológico das gestações não planejadas em um hospital de referência no oeste do Paraná / Epidemiological profile of unplanned pregnancies in a reference hospital in the west of Paraná

Objetivo: Delinear o perfil epidemiológico das gestações não planejadas em um hospital na cidade de Toledo-PR, comparando características socioeconômicas, uso de métodos contraceptivos, adesão ao pré-natal e desfechos maternos e fetais, entre as gestações planejadas e não planejadas. Métodos: Foram realizadas entrevistas com puérperas, por meio da aplicação de questionário criado especificamente para este estudo. Realizaram-se análise descritiva e comparação por análise bivariada. Foi considerado o nível de significância de 5%. Resultados: O total de participantes entrevistadas foi de 327. A prevalência de gestações não planejadas foi de 51,6% (n = 169). Do total, 10,3% (n = 34) eram adolescentes. As partic ipantes com gestações não planejadas apresentaram 0,4 gestação a mais (p = 0,004); 68% (n = 98) desse grupo era não branca (p = 0,009); 60,9% (n = 103) eram casadas ou em união estável; 17,2% (n = 29) possuíam renda até um salário mínimo (p = 0,007); 50,3% (n = 85) não utilizavam métodos contraceptivos. A proporção de anemia entre as gestações não planejadas foi de 8,3% (n = 14), enquanto nas planejadas foi de 1,9% (n = 3) (p = 0,02). Conclusão: As participantes cujas gestações não são planejadas são multíparas, mais jovens e não brancas, possuem menor renda e escolaridade, maior proporção de não casadas e maior prevalência de anemia gestacional. A intenção da gestação não apresentou influência sobre o concepto ou desfechos puerperais. Para alterar esse perfil, são primordiais aconselhamento reprodutivo individualizado e medidas de saúde pública voltadas a métodos contraceptivos eficazes.(AU)

Objective: To outline the epidemiological profile of unplanned pregnancies in a hospital in the city of Toledo/Paraná, comparing socioeconomic characteristics, use of contraceptive methods, adherence to prenatal care and maternal and fetal outcomes among planned and unplanned pregnancies. Methods: Interviews were conducted with puerperal participants, through the application of a form designed by the authors. A descriptive analysis was done and the data were compared between groups through a bivariate analysis. The significance level was set at 5%. Results: The total number of interviewed participants was 327. The incidence of unplanned pregnancies was 51.6% (n = 169). Of the total, 10.3% (n = 34) were adolescents. Participants with unplanned pregnancies averaged 0.4 more pregnancies (p = 0.004), 68% (n = 98) of this group were non-white (p = 0.009); 60.9% (n = 103) married or in a stable relationship; 17.2% (n = 29) had an income of up to 1 minimum wage (p = 0.007); 50.3% (n = 85) did not use contraceptive methods. The proportion of anemia among unplanned pregnancies was 8.3% (n = 14), while in planned pregnancies, it was 1.9% (n = 3) (p = 0.02). Conclusion: Participants whose unplanned pregnancies occur, are multiparous, younger and non-white, they have lower income and education access, higher proportion of unmarried women and gestational anemia. The intention of the pregnancy does not influence the conceptus or postpartum outcomes. To change this profile, individualized reproductive counseling and public health measures aimed at more effective contraceptive methods are essential.(AU)

Pregnancy planning does not interfere with child development in children aged from 11 to 23 months old / La planificación del embarazo no interfiere con el desarrollo infantil de los niños de 11 a 23 meses / Planejamento da gravidez não interfere no desenvolvimento infantil de crianças de 11 a 23 meses

Objective: to analyze the correlation between child development and pregnancy planning and other associated aspects. Method: a cross-sectional study conducted with 125 mother-child dyads, the children aged from 11 to 23 months old and attending daycare centers located in socially disadvantaged areas. Child development according to domains was assessed using the Ages & Stages Questionnaire-BR and pregnancy planning was evaluated through the London Measure of Unplanned Pregnancy. The mothers were interviewed at their homes and non-parametric tests were used for data analysis. Results: 17.6% of the pregnancies were unplanned, 24.8% were planned and 57.6% were ambivalent. Inadequate development in the different domains ranged from 21% to 40% and was not associated with pregnancy planning. However, the "communication" domain was associated with Bolsa Família and the "personal/social" and "communication" domains, with gender; while "personal/social", "broad motor coordination" and "fine motor coordination" were domains related to the child's age. Conclusion: no correlation between pregnancy planning and child development was observed; however, the low frequency of planned pregnancies and the high percentages of inadequate child development show the need to invest in the training of health professionals, both for contraceptive care and preconception health and for the promotion of child development, especially in socioeconomically disadvantaged contexts.

Objetivo: analizar la relación entre el desarrollo infantil y la planificación del embarazo y otros aspectos asociados. Método: estudio transversal realizado con 125 díadas madre e hijo de 11 a 23 meses, que concurren a guarderías infantiles ubicadas en zonas socialmente desfavorables. El desarrollo infantil de acuerdo con los dominios se evaluó mediante el Ages & Stages Questionnaire-BR y la planificación del embarazo mediante la London Measure of Unplanned Pregnancy. Las madres fueron entrevistadas en sus domicilios y se utilizaron pruebas no paramétricas para el análisis de los datos. Resultados: se registró que 17,6% de los embarazos no fue planificados, 24,8% fue planificado y 57,6% ambivalente. El desarrollo inadecuado en los diferentes dominios osciló entre el 21% y el 40% y no estaba asociado con la planificación del embarazo. Sin embargo, el dominio "comunicación" se asoció con Bolsa Familia; los dominios "personal/social" y "comunicación" con el sexo; mientras que los dominios "personal/social", "coordinación motora gruesa" y "coordinación motora fina" estaban relacionados con la edad del niño. Conclusión: no se observó relación entre la planificación del embarazo y el desarrollo infantil, sin embargo, la baja frecuencia de embarazos planificados y los altos porcentajes de desarrollo infantil inadecuado demuestran que es necesario invertir en la capacitación de los profesionales de la salud, tanto para la atención sobre anticoncepción y salud preconcepcional, como para la promoción del desarrollo infantil, especialmente en contextos socioeconómicos desfavorables.

Objetivo: analisar a relação entre desenvolvimento infantil e planejamento da gravidez e outros aspectos associados. Método: estudo transversal conduzido com 125 díades mãe-criança de 11 a 23 meses de idade, frequentadoras de creches localizadas em áreas socialmente desfavoráveis. O desenvolvimento infantil segundo domínios foi avaliado com aplicação do Ages & Stages Questionnaire-BR e o planejamento da gravidez por meio do London Measure of Unplanned Pregnancy. Mães foram entrevistadas nos domicílios e utilizou-se testes não paramétricos para análise dos dados. Resultados: verificou-se 17,6% de gravidez não planejada, 24,8% foram planejadas e 57,6% ambivalentes. O desenvolvimento inadequado nos diferentes domínios variou de 21-40% e não teve associação com o planejamento da gravidez. No entanto, o domínio "comunicação" associou-se com Bolsa Família; os domínios "pessoal/social" e "comunicação" com sexo; ao passo que "pessoal/social", "coordenação motora ampla" e "coordenação motora fina" foram domínios relacionados com a idade da criança. Conclusão: não foi observada relação entre o planejamento da gravidez e o desenvolvimento infantil, porém, a baixa frequência de gestações planejadas e os elevados percentuais de inadequado desenvolvimento infantil mostram a necessidade de se investir na capacitação dos profissionais de saúde, tanto para a atenção em contracepção e saúde pré-concepcional, quanto para a promoção do desenvolvimento infantil, especialmente em contextos socioeconômicos desfavoráveis.

Trends and inequalities in unplanned pregnancy in three population-based birth cohorts in Pelotas, Brazil.

OBJECTIVES: To assess time trends in unplanned pregnancy, stratified by sociodemographic status, reproductive history, and inequalities in family income and women's skin color, in Pelotas, Brazil. METHODS: Data from mothers of participants of the 1993 (N = 5264), 2004 (N = 4243), and 2015 (N = 4268) Pelotas birth cohorts were analyzed. Unplanned pregnancy was investigated in the perinatal period, with tests to assess changes over time among different sociodemographic and reproductive history subgroups and inequalities as a function of family income and skin color. RESULTS: The prevalence of unplanned pregnancy was 62.7% (3299/ 5264), 65.9% (2794/ 4243), and 52.2% (2226/ 4268) in the 1993, 2004, and 2015 cohorts, respectively. Black or brown women and women of lower socioeconomic status had a higher prevalence of unplanned pregnancy in all cohorts. The overall rate of unplanned pregnancy decreased over time in most subgroups. Inequality as a function of family income and skin color increased during the time frame of assessment. CONCLUSIONS: The prevalence of unplanned pregnancies decreased in the period analyzed, but it is still unjustifiably high. Efforts aimed at reducing unplanned pregnancy are vital and will require special attention to the most vulnerable groups.

Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study.

OBJECTIVE: To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. METHODS: A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. RESULTS: The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. CONCLUSION: Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.