Unwanted caesarean sections among public and private patients in Brazil: prospective study.

OBJECTIVE: To assess and compare the preferences of pregnant women in the public and private sector regarding delivery in Brazil. DESIGN: Face to face structured interviews with women who were interviewed early in pregnancy, about one month before the due date, and about one month post partum. SETTING: Four cities in Brazil. PARTICIPANTS: 1612 pregnant women: 1093 public patients and 519 private patients. MAIN OUTCOME MEASURES: Rates of delivery by caesarean section in public and private institutions; women's preferences for delivery; timing of decision to perform caesarean section. RESULTS: 1136 women completed all three interviews; 476 women were lost to follow up (376 public patients and 100 private patients). Despite large differences in the rates of caesarean section in the two sectors (222/717 (31%) among public patients and 302/419 (72%) among private patients) there were no significant differences in preferences between the two groups. In both antenatal interviews, 70-80% in both sectors said they would prefer to deliver vaginally. In a large proportion of cases (237/502) caesarean delivery was decided on before admission: 48/207 (23%) in women in the public sector and 189/295 (64%) in women in the private sector. CONCLUSIONS: The large difference in the rates of caesarean sections in women in the public and private sectors is due to more unwanted caesarean sections among private patients rather than to a difference in preferences for delivery. High or rising rates of caesarean sections do not necessarily reflect demand for surgical delivery.

[Tuberculosis treatment adherence in Pelotas, Brazil, from the patient's perspective]. / Adesão à terapêutica da tuberculose em Pelotas, Rio Grande do Sul: na perspectiva do paciente.

This study deals with adherence to tuberculosis treatment among men and women as well as the disease's links and consequences vis-à-vis life styles and treatment outcomes. The ethnographic study was a component of the Tuberculosis Epidemiological Control Project in the city of Pelotas and aimed to identify the reasons patients failed to complete treatment. Direct ethnographic observations and semi-structured interviews were used. Use of the term "adherence" is justified by the concern for extending to other fundamental factors in addition to the patient's own individual responsibility. This approach fostered an understanding of views towards disease, social dynamics among the various protagonists involved in the disease process, and treatment. Some of the factors considered in adherence to treatment were: socio-demographic characteristics, cultural factors, popular beliefs, the cost-benefit relationship, physical and chemical aspects of the drugs, the physician-patient relationship, and level of family participation in treatment.

[Blood, fecundity, and contraceptive usage]. / Sangre, fertilidad y practicas anticonceptivas.

PIP: This work describes ethnographic and other evidence that lower class women in southern Brazil believe that the fertile period is simultaneous with or closely related to the menstrual period. Ethnographic reports from both rural and urban areas in southern Brazil, materials on the folklore of the area, and findings of an ongoing study of four lower class neighborhoods served by community health services indicate that nearly all lower class adults of both sexes believe that conception is possible if not most likely during the menstrual period. Menstrual blood is not viewed as actually a part of women, but as a fluid which remains in the uterus after fertilization or otherwise as something dirty that must be eliminated. The cultural model of the female body includes notions of opening to allow elimination of the menstrual fluid, closing after its departure, and states of wetness and heat. Numerous informants reported cases in which women became pregnant while using IUDs or in the interval between 21-day packets of oral contraceptive (OC) pills. The fact that OCs reduce the menstrual flow is viewed as problematic, because blood that should be eliminated is apparently retained. The IUD, which causes long menstrual periods and intermenstrual bleeding, is also viewed with suspicion since it appears impossible to prevent pregnancy when there is actually greater flow. Irregular and incorrect use of OCs and very limited acceptance of IUDs may be factors in the growing demand for female sterilization and in the very high rates of illegal abortion.^ieng