The far-reaching impact of abortion bans: reproductive care and beyond.

On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.

Essure no Brasil: desvendando sentidos e usos sociais de um dispositivo biomédico que prometia esterilizar mulheres / Essure in Brazil: unveiling senses and social uses of a biomedical device that promised to sterilize women

Resumo Denúncias graves de efeitos colaterais sofridos por mulheres em vários países (Estados Unidos, nações da Europa e Brasil) desvelaram controvérsias na difusão de um dispositivo permanente para controle reprodutivo, designado Essure, pelo laboratório farmacêutico Bayer. Este trabalho busca compreender a circulação internacional e a introdução desse artefato biomédico no Brasil, a partir de pesquisa documental em sites de agências regulatórias, do laboratório farmacêutico e da divulgação pública feita por hospitais no país, associados ao Sistema Único de Saúde, para convocarem mulheres para o procedimento. Trata-se de primeira aproximação ao tema para se inquirir sobre as condições sociais da implantação do dispositivo em usuárias desses serviços de saúde no período em que ele esteve disponível no país, de 2009 a 2017. Apresentado como um dispositivo seguro, inócuo e de fácil manejo clínico, a promessa de um objeto permanente que impediria a gravidez sem necessidade de recorrer ao método cirúrgico foi vendida pela Bayer ao staff médico como solução simples, prática e moderna de controle reprodutivo. O percurso do dispositivo no Brasil evidencia certo entusiasmo médico com a nova técnica, não acompanhado de monitoramento clínico de longo prazo, principalmente quando as mulheres passaram a demandar a sua retirada em razão de muitas sequelas e efeitos colaterais dele decorrentes.

Abstract Recently, there have been serious reports of side effects suffered by women in various countries (United States, European countries and Brazil), revealing controversies surrounding Bayer's widespread use of a permanent reproductive control device over the last decade: Essure. This article analyzes the international circulation and the introduction of this biomedical artifact in Brazil. This documentary research investigated websites of regulatory agencies, the aforementioned pharmaceutical laboratory, public disclosure made by hospitals in the country, associated with the Brazilian National Health System. This is the first approach to the subject that questions the social conditions of the implementation of Essure in users of these health services when it was available in the country, from 2009 until 2017. This permanent contraceptive method was presented as a safe and easy-to-use clinical management device. The promise of a permanent object that would prevent pregnancy without surgery was sold by Bayer to medical staff as a simple, practical and modern reproductive control solution. Its circulation in Brazil shows medical enthusiasm for the new technique, which was not accompanied by long-term clinical monitoring, even as women began to demand its withdrawal due to the many sequelae and resulting side effects.

Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone.

INTRODUCTION: Abortion is often a difficult and traumatic decision for a woman to make. Perhaps greater distress occurs when a woman commences a medical abortion but then changes her mind and wishes to keep the now-threatened pregnancy. One published case series detailed a potential method to counter/reverse the abortifacient effect of mifepristone by administering parenteral progesterone in such situations. OBJECTIVES: The present report details cases of women in similar circumstances who have been treated with progesterone. The aims were to document occurrences of where women have changed their mind after commencing medical abortion, as well as to explore some of the controversies and clinical issues surrounding their circumstances. METHODS: Women who had commenced medical abortion by ingesting mifepristone but who had not taken misoprostol independently contacted a national pregnancy support service the same day. Those meeting criteria for treatment received progesterone pessaries per vaginum for two weeks. RESULTS: Cases: 28-year-old woman, 6 weeks plus 1 day gestation; 35-year-old woman, 8 weeks plus 5 days gestation; and 27-year-old woman, 7 weeks plus 3 days gestation. Outcomes respectively were: healthy male baby delivered at 39 weeks gestation; healthy male baby delivered at term; and completed medical abortion. CONCLUSIONS: Women have changed their mind after commencing medical abortion. Progesterone use in early pregnancy is low risk and its application to counter the effects of mifepristone in such circumstances may be clinically beneficial in preserving her threatened pregnancy. Further research is required, however, to provide definitive evidence.

50 años de planificación familiar en Chile, 1965-2015: Experiencias de las primeras generaciones de mujeres urbanas usuarias del programa / 50 años de planificación familiar en Chile, 1965-2015. Experiencias de las primeras generaciones de mujeres urbanas usuarias del programa

ANTECEDENTES: En el año 1965, el Servicio Nacional de Salud chileno comenzó la ejecución directa de acciones sanitarias destinadas a implementar programas de planificación familiar, evento considerado hito fundacional que inició formalmente una política nacional de planificación familiar de carácter público y con respaldo gubernamental. OBJETIVO: Analizar la experiencia de las primeras generaciones de mujeres urbanas usuarias del programa de planificación familiar durante la década de 1960. MÉTODO: Estudio cualitativo con enfoque biográfico, realizado en 64 mujeres adultas mayores urbanas pertenecientes a las primeras generaciones usuarias del programa. Para la recolección de datos se utilizaron entrevistas con enfoque biográfico. RESULTADOS: Se identificaron cuatro dimensiones: contexto familiar y social de la sexualidad femenina en infancia y adolescencia; proyecciones frente a la maternidad; experiencia personal de la usuaria en el programa y valoraciones de la usuaria en torno al programa. El programa impulsó el ejercicio del derecho de la mujer de decidir libremente y sin presiones el número de hijos que deseaba procrear. No obstante, por ser un derecho inédito hasta ese momento, su ejercicio fue instalándose progresivamente desde una construcción cultural de maternidad que no poseía dominio sobre sus eventos reproductivos, hacia una nueva construcción cultural que reconocía incipientemente mayores grados de decisión en la propia vida reproductiva. CONCLUSIÓN: Se proponen tres perfiles tipo que ilustran las experiencias de las mujeres usuarias a partir de los componentes condición de fertilidad probada como requisito para el ingreso al programa de planificación familiar, número de hijos totales y espaciamiento entre nacimientos.

BACKGROUND: In 1965, the Chilean National Health Service began the direct implementation of sanitary measures to implement family planning programs; considered foundational milestone event formally launched a national family planning policy of public and government-backed. AIMS: To analyze the experience of the first generation of urban women users of family planning program during the 1960s. METHOD: Qualitative study with biographical approach, conducted in 64 elderly women in urban users belonging to the first generations of the program users. For data collection interviews were used to biographical approach. RESULTS: We identified four dimensions: family and social context of female sexuality in childhood and adolescence; projections toward motherhood; personal experience of the user in the program and ratings of the user around the program. The program promoted the exercise of the right of woman to decide freely and without pressure the number of children they wanted to procreate. However, being an unpublished right so far, the exercise was settled progressively from a cultural construction of motherhood did not have control over their reproductive events, to a new cultural construction incipient recognized higher levels of decision itself reproductive life. CONCLUSION: It propose three kinds profiles that illustrate the experiences of women users from components proven fertility status as a requirement for admission to the program of family planning, total number of children and birth spacing.

Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira / Motherhood behind bars: the struggle for citizens' rights and health for women inmates and their children in Brazil / La maternidad entre rejas: en búsqueda de la ciudadanía y de la salud. Un estudio sobre la legislación brasileña

Este estudo analisa as conexões entre saúde, direitos, legislação e políticas públicas a partir da pesquisa documental realizada no âmbito federal e nos estados do Rio Grande do Sul, Mato Grosso, Paraná e São Paulo, acerca das garantias legais das mulheres e seus filhos que vivem no cárcere. Busca instrumentalizar uma atuação garantista dos agentes públicos e dar visibilidade à problemática, diante das extremas vulnerabilidades e invisibilidade jurídica e administrativa da questão. Foram identificadas 33 normas legais, com pontos de tensão, como a possibilidade de prisão domiciliar e as disparidades quanto a prazos e condições de permanência das crianças no sistema penitenciário. A garantia legal constitucional do direito à amamentação é refletida nas regulamentações identificadas. Mas constatam-se ausências de outros aspectos relativos à maternidade na prisão, que se traduzem em dupla penalidade às mulheres, arbitrariamente estendida aos seus filhos. É necessária a ampliação e efetivação da regulamentação existente para prevenir e coibir as violações de direitos apontadas.

This study analyzes the links between health, rights, legislation, and public policies based on document research on legal safeguards for women and their children residing in prison. The research was conducted at the Federal level and in four States of Brazil: Rio Grande do Sul, Mato Grosso, Paraná, and São Paulo. The study aims to back measures by public agencies to guarantee such rights and to raise awareness of the problem, given the extreme vulnerability of women inmates and their children and the issue's legal and administrative invisibility. The authors identified 33 different legal provisions as points of tension, such as the possibility of house arrest and disparities in the terms and conditions for children to remain inside the prison system. Various provisions cite the Constitutional guarantee of women inmates' right to breastfeed in prison. Meanwhile, the study found gaps in other issues pertaining to motherhood in prison, expressed as dual incarceration (imprisonment arbitrarily extended to their children). It is necessary to expand and enforce the existing legislation to prevent such violations of rights.

Este estudio analiza las conexiones entre la salud, derechos humanos, legislación y políticas públicas, partiendo de una investigación documental, realizada a nivel federal y en los estados de Río Grande do Sul, Mato Grosso, Paraná y São Paulo, sobre las garantías jurídicas de las mujeres presas y sus hijos. El estudio pretende instrumentalizar una actuación garantista de los agentes públicos y dar visibilidad a esta problemática, frente a la extrema vulnerabilidad e invisibilidad jurídica y administrativa existente. Se identificaron 33 normas legales, con puntos de tensión, como la posibilidad de arresto domiciliario y disparidades en cuanto a los términos y condiciones de la estancia de los niños en el sistema penitenciario. La garantía constitucional del derecho a la lactancia materna se refleja en las regulaciones identificadas. No obstante, hay ausencias de otros aspectos de la maternidad en la cárcel, que se traduce en una doble pena para las mujeres, extendida arbitrariamente a sus hijos. Es necesaria la ampliación y ejecución efectiva de las regulación existente para prevenir y frenar las violaciones de los derechos.

Cervical cancer narratives: invoking 'God's will' to re-appropriate reproductive rights in present-day Romania.

Drawing from ethnographic fieldwork in contemporary Southern Romania, this paper scrutinises local moralities governing some women's refusal to enrol in free reproductive healthcare initiatives targeting cervical cancer through primary and secondary prevention (human papillomavirus [HPV] vaccination and Papanicolaou [Pap] testing, respectively). Women backed up their rejection of participation in official reproductive care programmes by mentioning 'God's will' as the ultimate trigger of cervical cancer. They withheld their own and their daughters' bodies from biomedical intervention and used discursive references to divine logic to imbue their refusal with moral legitimacy. However, 'God's will' is not a mere rhetorical device, since it has a correlate in many of these women's embodied reproductive experiences. As this paper argues, religious narratives, far from stripping ordinary citizens of their reproductive choices, constitute the medium through which they display individual agency. In fact, invoking 'God's will' empowers Romanian women to challenge state control and it enables them to re-appropriate their bodies by making a counter-intuitive, yet bold, choice.

Comparative study on sexual and reproductive health of adolescents with and without aids: is there a difference in knowledge between the two groups? / Estudo comparativo sobre a saúde sexual e reprodutiva dos adolescentes com e sem aids: há diferença de conhecimento entre os dois grupos?

Currently we are facing the challenge to deal with the first generation of adolescents HIV+, infected by vertical transmission. This is new, and creates the need to improve attention to self-care and knowledge on sexual and reproductive health. Issues like the exercise of sexuality, contraception, pregnancy, sexually transmitted diseases (STD), are not enough debated among professionals, families and adolescents, despite their importance, concerning the affective and sexual discoveries typical of that age. Objective: To assess and compare the knowledge among adolescents HIV+ and HIV-, the guidance received on sexual and reproductive health and their sexual behavior, in order to better assist an integral health attention. Methods: A prospective, quali-quantitative, observational, analytical and cross-sectional study that took place during one year at the public hospital of an university in Curitiba, interviewing 61 adolescents HIV+ and 61 adolescents HIV- after their outpatient attendance. A questionnaire with objective multi-choice questions, as well as open-ended questions thought to stimulate free narratives was the base of data acquisition. Statistical analysis have considered the adolescents HIV+ and HIV- matched by age, gender and education. To evaluate differences on continuous variables, Student'st-test for normal distribution and Mann-Whitney test for asymmetric distribution were the tools. For categorical variables: Fisher exact tests and chi-square of Pearson. The analysis of answers for the openended questions was based on categorization of semantic equivalence. Significance level of 5% for all tests. Main variables of study in the amount enough to allow comparisons have driven the sample estimation, with less than 5% of significance level and minimum test power of 95%. Results: The study showed that adolescents don't have good enough knowledge about reproductive health in both groups (p=0.01). They have initiated sexual activity at about 15 years old, they report using condoms, but not the habit of picking them up. The group of HIV + have expressed more opinions about the sexual and reproductive rights, they have received less guidance on emergency contraception (p<0.001); they "hook-up" and dated less than HIV- group. Conclusion: The lack of knowledge of adolescents on reproductive health is greater than about sexual health and both groups reported the habit of not getting condoms. The HIV+ group had more opinions about sexual and reproductive rights, received less guidance on emergency contraception, "hooked-up" and dated less than the HIV- group. The knowledge about sexual rights and sexuality, and the guidance provided to both groups of teenagers, didn't seem to be adequate to make protective sexual attitudes preventing STD.

A sociedade está enfrentando o desafio de lidar com a primeira geração de adolescentes HIV+, infectados por transmissão vertical. Isso cria a necessidade de melhorar a atenção ao autocuidado e o conhecimento sobre saúde sexual e reprodutiva. Questões como sexualidade, contracepção, gravidez e doenças sexualmente transmissíveis (DST) são pouco debatidas entre profissionais, famílias e adolescentes, apesar de sua importância diante das descobertas afetivas e sexuais típicas dessa idade. Objetivo: Avaliar e comparar o conhecimento de adolescentes HIV+ e HIV- e as orientações recebidas sobre saúde sexual e reprodutiva, seus comportamentos sexuais, visando auxiliar na Atenção Integral à Saúde. Métodos: Estudo prospectivo, quali-quantitativo, observacional, analítico e transversal, realizado por um ano em hospital público de uma universidade de Curitiba, entrevistando 61 adolescentes HIV+ e 61 adolescentes HIV-, após seu atendimento ambulatorial. Foi elaborado questionário com perguntas objetivas de múltipla escolha e perguntas abertas, para estimular a livre narrativa sobre as temáticas. Foram pareados por idade, gênero e escolaridade. Para avaliar as diferenças em variáveis contínuas, foram utilizados os testes t de Student, para distribuição normal, e de Mann-Whitney, para distribuição assimétrica; para variáveis categóricas, os testes exato de Fisher e do χ2 de Pearson. A análise das respostas para as perguntas abertas baseou-se na categorização de equivalência semântica. Para os testes, foi considerado um nível mínimo de significância de 5%. A amostra foi estimada considerando as principais variáveis do estudo, sendo suficiente para as comparações um nível de significância inferior a 5%, com poder de teste mínimo 95%. Resultados: O estudo mostrou que ambos os grupos de adolescentes não têm conhecimento suficiente sobre saúde reprodutiva (p=0,01), iniciaram atividade sexual com cerca de 15 anos, relataram uso de preservativos, mas não o hábito de buscá-los. O grupo HIV+ expressou mais opiniões sobre os direitos sexuais e reprodutivos, recebeu menos orientações sobre contracepção de emergência (p<0,001), "ficou" e namorou menos que o grupo HIV-. Conclusão: O desconhecimento dos adolescentes sobre a saúde reprodutiva é maior do que sobre a saúde sexual e ambos os grupos disseram não ter o hábito de adquirir preservativos. O grupo HIV+ expressou mais opiniões sobre os direitos sexuais e reprodutivos, recebeu menos orientações sobre contracepção de emergência, "ficou" e namorou menos que o grupo HIV-. O conhecimento sobre direitos sexuais e sexualidade e as orientações fornecidas, para ambos os grupos de adolescentes, não pareceram ser suficientes para atitudes sexuais protetivas diante das DST.

Promoción de derechos sexuales y reproductivos en adolescentes de Bucaramanga, Floridablanca y Lebrija -Colombia / Promotion of sexual and reproductive rights in adolescents of Bucaramanga, Floridablanca and Lebrija - Colombia

Introducción: la educación para la sexualidad en el ámbito escolar, es una forma de promover la salud, y es obligatoria conforme a la legislación vigente para el sector educativo. Sin embargo no hay suficiente formación docente para abordarla de manera apropiada y asegurar resultados favorables para las y los jóvenes; por ello se diseñó e implementó un programa para docentes, orientado a promover la salud sexual y reproductiva en adolescentes con perspectiva de derechos y de género. Metodología: se realizó revisión y articulación de materiales educativos, levantamiento de línea de base, desarrollo del proceso formativo con docentes, asistencia técnica y acompañamiento a docentes y levantamiento de línea de resultados utilizando los mismos instrumentos y población de la línea de base. Resultados: se trabajó en 5 instituciones educativas, con 142 docentes y 80 grupos de estudiantes correspondientes a 2.735. Luego del proceso realizado, se encontraron modificaciones favorables en el conocimiento y manejo de los temas de sexualidad, derechos sexuales y reproductivos y habilidades para la vida en docentes y estudiantes. Conclusión: realizar un proceso de educación para la sexualidad desde la promoción de la salud en el ámbito escolar con enfoque de DSR y HpV permite la apropiación de información y herramientas pedagógicas y didácticas a docentes para que a su vez sean trabajadas con estudiantes, aportando fortalezas para su vida, modificando el enfoque biologicista desde el que usualmente se ha abordado el tema de la sexualidad. Salud UIS 2012; 44 (3): 13-23.

Introduction: the education for sexuality within the scholar context is a way to promote health and it is mandatory according to the current legislation. However, there is not enough teacher training to approach this subject properly to assure positive results in youngsters. Hence, a program for teachers to promote sexual and reproductive health in teenagers was designed and implemented. This program was created within framework of rights and gender and was based on three types of teaching materials. Methodology: the program was developed in the next phases: revision and articulation of teaching materials, definition of a base line, development of the training process with teachers, technical assistance and support to teachers, construction of a line of results using the same instruments and target population from the base line. Results: the program was developed in 5 educational institutions, with 142 teachers and 2.735 students divided in 80 groups. After the program implementation, it was found favorable changes in teachers and students in their knowledge of sexuality, sexual and reproductive rights, and their way to handle these issues. They also showed a general improvement of their life skills. Conclusion: to develop a process of education for sexuality from the promotion of health in the scholar context (with sexual and reproductive rights and life skills approaches), facilitates the appropriation of information and pedagogical and didactic tools for teachers, and for their work with students, strengthening their life skills and modifying the biologicist approach, from which the topic of sexuality is usually addressed. Salud UIS 2012; 44 (3): 13-23.

Avaliação da implementação da assistência ao planejamento reprodutivo em três municípios do Estado do Rio de Janeiro entre 2005 e 2007 / An evaluation of the implementation of family planning assistance in three municipalities in the State of Rio de Janeiro, Brazil, between 2005 and 2007

OBJETIVOS: avaliar a implementação das ações de assistência ao planejamento reprodutivo (PR) em três municípios fluminenses e os aspectos contextuais. MÉTODOS: pesquisa avaliativa realizada entre 2005-2007. Foram realizadas entrevistas com gestores e profissionais de saúde, observação de serviços e análise de documentos. Para análise do grau de implementação do programa foi desenvolvida matriz de avaliação com três componentes - assistência, educação e gerenciamento - e estabelecidos padrões e critérios. Fontes orais e documentais possibilitaram análise do contexto de implementação. RESULTADOS: a implementação do PR no município metropolitano está avançada e nos municípios do interior é incipiente. Atividades educativas apresentaram maior conformidade com critérios do que atividades clínico-assistenciais. Irregularidade de métodos contraceptivos, problemas na oferta de contracepção cirúrgica, ausência de atenção à infertilidade e à saúde reprodutiva masculina foram aspectos frágeis. Existem equipes multiprofissionais, mas há necessidade de capacitação. No município metropolitano, o gerenciamento do programa é ponto forte, mas nos demais é débil. CONCLUSÕES: o grau de implementação da assistência ao PR se relacionou com desigualdades geopolíticas entre os municípios e aspectos do contexto institucional do SUS - pouca integração da rede assistencial e regionalização limitada. O estudo pode contribuir para institucionalização da prática de monitoramento e avaliação das ações de assistência ao planejamento reprodutivo.

OBJECTIVES: to evaluate the implementation of family planning (FP) assistance in three municipalities in the State of Rio de Janeiro, Brazil, along with contextual factors. METHODS: the evaluation was carried out between 2005 and 2007. Interviews were conducted with health workers and managers, the provision of services was observed, and documents consulted. The degree of implementation of the program was assessed by developing an evaluation matrix comprising three components - assistance, education and management - and standards and criteria were established. Oral and documentary sources of information allowed for analysis of the context to the implementation to be carried out. RESULTS: the implementation of FP in the metropolitan municipality was at an advanced stage and in the rural municipalities in its initial stages. Educational activities conformed better to the established criteria than clinical care. Weaknesses included irregular methods of contraception, problems with the availability of contraceptive surgery, the lack of infertility care and male reproductive health. The teams include a range of different professionals, but there is a need for further training. In the metropolitan municipality, program management is a strong point, but in the others management falls short of expectations. CONCLUSIONS: the degree of implementation of FP care is related to geopolitical inequalities and contextual factors associated with the Brazilian National Health System-lack of integration of care networks and limited regionalization. This study may help to encourage institutionalization of the practice of monitoring and evaluating family planning assistance.

Estrategias de prevención en la salud de la mujer / Strategies for women preventive health

En este capítulo revisaremos cuatro importantes hitos en la salud preventiva de la mujer.Veremos las recomendaciones actuales de manejo del embarazo y atención del parto con los derechos de la mujer y las prácticas médicas recomendadas.Analizaremos los derechos reproductivos de la mujer y el viraje hacia la anticoncepción hormonal. El cáncer cervicouterino sigue siendo una patología prevalente y veremos como los programas de prevención son exitosos y analizaremos la nueva vacuna para virus papiloma. Finalmente revisaremos 2 tópicos de la mujer climatérica: la salud cardiovascular y la salud ósea

In this chapter we review four major milestones in women's preventive health. We will see the current recommendations for management of pregnancy and delivery care to the rights of women and medical practices recommended. Analyze the reproductive rights of women and the shift to hormonal contraception. Cervical cancer remains a prevalent disease and we will see how prevention programs are successful and we should analyze the new papillomavirus vaccines. Finally we will review two topics of climacteric women: cardiovascular health and bone health

Desejo de maternidade entre mulheres com HIV/AIDS / Maternity desire of among women with HIV/AIDS / Deseo de maternidad entre mujeres con VIH /SIDA

O objetivo do presente estudo é analisar as percepções de mulheres com HIV AIDS sobre o desejo de maternidade. Trata-se de estudo qualitativo realizado com mulheres soropositivas para HIV no município de Jequié (BA). Foram realizadas entrevistas com mulheres em idade reprodutiva que estavam sendo acompanhadas pelo Centro de Referência DST/AIDSdo município. Para análise das falas, utilizou-se a técnica de análise de conteúdo temática. Os resultados desvelaram que a maternidade configura-se como o desejo das mulheres e não é abalada sob o signo da infecção pelo HIV. Um grupo das mulheres entrevistadas, mesmo desejando ter filhos, revelou não mais pretender tê-los. Os principais motivos apontados sãoos preconceitos sociais da doença e o medo de transmitir o vírus aos bebês. As mulheres demonstraram relativo conhecimento com relação às medidas preventivas para a transmissão vertical. O não aleitamento materno é apontado como medida de maior dificuldade de ser seguida pelas mães. Os serviços de saúde não oferecem assistência adequada às mulheres. Sugere-se uma ampliação da atenção à saúde da mulher e o desenvolvimento de educação permanente para os profissionais de saúde, especialmente nas questões subjetivas do processo saúde doença cuidado.

This study aims at analyzing the perceptions of women with HIV/AIDS on the desire of maternity. This is a qualitative study conducted with HIV positive women in the municipality of Jequié BA. Women in reproductive age that were being monitored by the Reference Center of DST AIDS were interviewed. The method of content analysis of the speeches was used. The results showed that maternity is configured construed as the women desire and it is not affected under the sign of the infection by HIV. A group of the interviewed women, despite their desire to to have children. revealed they no longer intend to have them. The main reasons presented are the social prejudices about the disease and the fear of transmitting the virus to the babies. The women demonstrated relative knowledge regarding preventive measures for vertical transmission. The prohibition to breastfeed babies is pointed as the most difficult measure to adhere to. Health services don?t offer women an appropriate assistance. We suggest the broadening of attention to women?s health and the permanent qualification of healthprofessionals, especially in the subjective issues of health-disease-care process.

El objetivo de este estudio es analizar las percepciones de las mujeres con VIH /SIDA sobre el deseo de la maternidad. Se trata de un estudio cualitativo realizado con mujeres seropositivas al VIH en Jequié (BA). Se realizaron entrevistas con mujeres en edad reproductiva que estaban siendo acompañadas por el Centro de Referencia de ETS / SIDA en la ciudad. Para el análisis de los discursos, se utilizó la técnica de análisis de contenido temático. Los resultados revelan que la maternidad se configura como el deseo de las mujeres y no es afectada por el signo de infección por el VIH. Un grupo de mujeres entrevistadas, incluso deseando tener hijos, reveló la no pretensión de querer tenerlos. Las principales razones mencionadas son los prejuicios sociales de la enfermedad y el miedo de transmitir el virus a los bebés. Las mujeres manifestaron relativo conocimiento con relación a las medidas de prevención de la transmisión vertical. La no lactancia materna es mencionado como la medida que ofrece mayor difícultad para ser seguida por las madres. Los servicios de salud no ofrecen una asistencia adecuada a las mujeres. Se sugiere una ampliación de la atención a la salud de la mujer y al desarrollo de la educación continua para los profesionales de la salud, especialmente en las cuestiónes subjetivas del proceso salud enfermedad atención

A ligadura das artérias uterinas e ovarianas no manejo do sangramento pós-parto / Management of postpartum hemorrhage by ligature of the uterine and ovarian arteries

O sangramento pós-parto é causa importante de mortalidade materna no Brasil e no restante do mundo. A sua prevenção inclui o manejo ativo do terceiro período do parto. O tratamento medicamentoso mediante o uso de ocitocina, prostaglandinas e metilergonovina é a primeira escolha, sendo eficaz na maioria das vezes. Nos raros casos em que haja necessidade cirúrgica deve-se preservar o futuro reprodutivo. Existem várias técnicas cirúrgicas que mantêm a fertilidade. No Brasil, as principais escolas preconizam o uso da histerectomia puerperal como resolução dos casos de sangramento pós-parto. Os autores relatam um caso de sangramento pós-cesariana, que foi controlado com a ligadura das artérias uterinas e ovarianas. Descrevem e ilustram essa técnica de execução simples e com poucas complicações, tendo como objetivo divulgar a técnica entre os obstetras brasileiros.

Postpartum hemorrhage is a major cause of maternal mortality in Brazil and the world over. Its prevention includes active management of the third stage of childbirth. Drug treatment through the use of oxytocin, prostaglandin, and methylergonovin is the first choice and is effective in most cases. In the rare cases in which surgery is needed the reproductive future should be preserved. There are many surgical techniques which maintain fertility. In Brazil, the main schools recommend the use of puerperal hysterectomy for management of the cases of postpartum bleeding. The authors report a case of post-caesarian bleeding, which was controlled by ligation of the uterine and ovarian arteries. They describe and illustrate this technique of simple execution and few complications, in order to publicize this technique among Brazilian obstetricians.

Implementação da iniciativa unidade básica amiga da amamentação: educação continuada e prática profissional / Implementation of breastfeeding-friendly primary care initiative: continued education and practical professional / Implementación de la iniciativa unidad básica amiga de la amamantación: educación continuada y práctica profesional

As Unidades de Atenção Básica a Saúde tem um papel fundamental nas ações de aleitamento materno. O objetivo deste estudo foi avaliar as contribuições do curso de educação continuada proposto pela Iniciativa Unidade Básica Amiga da Amamentação (IUBAAM) para a prática da equipe materno-infantil. Pesquisa qualitativa descritiva realizada em Unidade Básica de Saúde, na cidade de São Carlos-SP, no período de março a agosto de 2006, envolvendo quatro profissionais. Para a coleta de dados foi utilizada a entrevista individual e a observação. A análise dos dados teve como base a análise de conteúdo. A formação dos profissionais em aleitamento materno pareceu ser insuficiente para a atuação deles nesta temática. O curso foi avaliado como um momento importante de aprendizagem e de compartilhar conhecimentos. Verificou-se que há uma tentativa de mudar a prática individual, já a implementação dos grupos de apoio a mães e gestantes foi a atividade mais difícil de ser viabilizada. Apesar de trazer contribuições importantes para a prática profissional, o curso de capacitação não consegue provocar grandes mudanças nas atitudes dos profissionais e nas rotinas da unidade. O estudo aponta a necessidade de acompanhamento do processo de implementação dos passos propostos pela IUBAAM e sua avaliação.

The Health Basic Attention Units are extremely important in actions involving maternal breast-feeding. The objective of this study was to evaluate the contributions of the continued education course proposed by the ?Breastfeeding-Friendly Primary Care Initiative? (IUBAAM in Portuguese) for the practices of the maternal-infantile team.Descriptive qualitative research conducted in the Health Basic Unit, in the city of São Carlos-SP, from March to August of 2006, involving four professionals. For the data collection the next procedures were followed: individual interviews and observation. Data analysis was content-based. The professionals? formation in maternal breast-feeding showed to be insufficient for their performance in the thematic. The course was evaluated as an important moment for learning and sharing knowledge. An attempt for changing individual practices was verified, however the implementation of support groups for mothers and expectant mothers was the most difficult activity to render feasible. Despite of the important contributions for professional practices, the qualification course, by itself, did not bring great changes in the attitudes of the professionals or in the routines of the health unit. The study points out the need of accompaniment of the implementation process of the steps considered by the IUBAAM and its evaluation.

Las Unidades de Atención Básica de Salud tienen un papel fundamental en las acciones de lactancia materna. El objetivo de este estudio fué evaluar las contribuciones del curso de educación continuada propuesto por la Iniciativa Unidad Básica Amiga de la Amamantación (IUBAAM) para la práctica de los profesionales de salud del equipo materno-infantil. Investigación cualitativa descriptiva realizada en una Unidad Básica de Salud, de la ciudad de São Carlos-SP, entre marzo y agosto de 2006, envolviendo cuatro profesionales. Para la colecta de los datos fué utilizada la entrevista individual y la observación. El análisis de los datos tuvo como base el análisis del contenido. La formación de los profesionales en lactancia materna pareció insuficiente para la actuación de ellos en el tema. El curso fué evaluado como un momento importante de aprendizaje y de compartillar conocimientos. Se verificó una tendencia para el cambio de la práctica individual; la implementación de los grupos de apoyo para madres y embarazadas fué la actividad mas difícil de viabilizar. A pesar de traer contribuciones importantes para la práctica profesional, el curso en sí no consigue provocar grandes cambios en las actitudes de los profesionales y en las rutinas de la unidad. Este estúdio apunta la necesidad de una propuesta que promueva el acompañamiento del proceso de implementación de los pasos propuestos por la IUBAAM y su evaluación.

Salud Sexual y Reproductiva: Hacia una Hermenéutica de la Sospecha. Caso Venezuela / Sexual and Reproductive Health: Toward an hermeneutics of suspicion. Venezuela Case

El presente ensayo intenta abordar desde una perspectiva hermenéutica un tema de relevante importancia: Los derechos sexuales y reproductivos. Dos miradas conforman el cuerpo del trabajo: La primera relacionada con la Contextualización del objeto de estudio la cual tiene como finalidad ubicar la temática en Venezuela, sus especificidades y sus marcas ideológicas. Los derechos sexuales y reproductivos, establecen el reconocimiento del derecho de todas las personas a decidir libre y responsablemente el número y el espaciamiento de los hijos, y a contar con la información y servicios adecuados que le faciliten el ejercicio de esos derechos. Derecho a una educación sexual veraz, científica y oportuna, que apunte hacia un ejercicio pleno y responsable de la sexualidad. Derecho a condiciones de igualdad de hombres y mujeres a fin de que tomen decisiones responsables y con conocimiento de causa que garanticen su calidad de vida, y repartición equitativa de los compromisos que se derivan del ejercicio de los roles de género, de la sexualidad y la reproducción, sin ninguna discriminación. Derecho a la seguridad sexual y reproductiva, incluido el derecho a estar libres de violencia y coacción sexual. Abordar la temática en torno a la salud sexual y reproductiva en Venezuela, obliga revisar aspectos que tienen que ver con la situación poblacional en el país y los modelos de desarrollo, así como las evidencias en torno a la mortalidad materna, el embarazo precoz y la planificación familiar. Una segunda mirada se centrara sobre los desafíos que tiene que asumir el estado Venezolano a fin de dar cumplimiento a los diferentes acuerdos sucritos y donde se establece entre otras cosas la garantía plena del derecho a la salud y la calidad de vida, la equidad de género y los derechos sexuales y reproductivos.

This essay is an attemtp to address from a hermeneutic point of view a relevant theme such as: The sexual and reproductive rights. Two standpoints det as framework: The first related to contextualization of the object of study which aims to locate the subject in Venezuela, their specific and their ideological brands. Sexual and Reproductive stipulate the recognition of the right of all individuals to decide freely and responsibly the number and spacing of children and to have adequate information and services that will facilitate the exercise of those rights. Right to an accurate sex education, scientific and timely, it points towards a full and responsible exercise of sexuality.The right to equal men and women to take responsible decisions and knowingly to ensure their quality of life, and equitable sharing of the commitments arising from the exercise of gender roles, sexuality and playing without any discrimination. The right to sexual and reproductive security, including the right to be free from violence and sexual coercion. Addressing the issues around sexual and reproductive health in Venezuela, forced to revise aspects that deal with the situation in the country population and development models, as well as evidence on maternal mortality, early pregnancy and family planning. A second look would focus on the challenges that must assume the Venezuelan state in order to implement the various agreements which stipulate the full guarantee of the health right and quality of life, gender equity and sexual and reproductive rights.

From HIV prevention to reproductive health choices: HIV/AIDS treatment guidelines for women of reproductive age.

In South Africa, the private sector has responded to the HIV epidemic by providing treatment in the form of highly active antiretroviral therapy (HAART). The private sector has paved the way for policy and treatment regimens, while the public sector has reviewed health-systems capacity and the political will to provide treatment. The paradigm of prevention of mother-to-child transmission of HIV (PMTCT) has led the way as a clear evidenced-based method of treatment and prevention in South Africa. In sub-Saharan Africa, the HIV epidemic is feminised as a growing proportion of infections occurs among women or affects women. While access to HIV treatment has been contested in South Africa, women's sexual and reproductive health has been neglected. This paper is a reflection and critical review of current practice. Many HIV-positive women desire to choose to have a child, while the best choice of contraception for women on HAART is not well understood. In some areas there are reports of women being forced to accept injectable contraceptives. Some women who learn of their HIV-positive status during pregnancy may want to choose to terminate their pregnancy. There is a clear absence of HIV/AIDS-treatment guidelines for women of reproductive age, including options for HAART and options regarding fertility intentions. A range of other sexual and reproductive health areas (relevant to both the public and private health sectors) are neglected; these include depression and anxiety, violence against women, HIV-testing practices, screening for cervical cancer, and vaccination. Given the narrow focus of HAART, it is important to expand HIV treatment conceptually, by applying a broader view of the needs of working women (and men), and so contribute to better HIV prevention and treatment practices. There is a need to move from an HIV/AIDS-care maternal-health paradigm to one that embraces women's sexual and reproductive health and rights.

International program confronts myths.

PIP: The concept of reproductive rights (RR) is being attacked in an ultra-conservative backlash based on myth and misinformation. One such myth, that supporters of RR favor coercive population control measures, is the exact opposite of the truth. A second myth, that reproductive health (RH) is a euphemism for abortion, ignores the many facets of RH addressed by a holistic approach to RH needs in the areas of family planning, maternal and child health care, sexuality, infertility, prevention and treatment of sexually transmitted diseases, detection and treatment of reproductive tract cancer, and female genital mutilation. The third myth, that only radical feminists and anti-family interests support women's reproductive choice, fails to recognize the broad support among women and men worldwide for the RR movement. A fourth myth, that emergency (postcoital) contraception is a form of abortion, defies the physical reality that emergency contraception prevents pregnancy by interrupting the process of implantation that leads to pregnancy. Finally, the myth that promoting reproductive freedom neglects the real needs of women in developing countries denies the fact that women have identified RH needs as a major concern and that RR are promoted as part of a holistic approach to attaining full gender equality and equity.^ieng

Women's health issues cause controversy in European Union.

PIP: Women's health issues will be raised in the European Parliament in September, when members return from vacation. Nel van Dijk, Dutch Green party deputy, produced a report to the plenary for the assembly's Committee on Women's Rights; in the report, committee members urge action by the European Union (EU) and list recommendations for member-state governments. The report is in response to a publication by the European Commission, in May 1997, of a statistical survey developed from national data. The resolution by van Dijk urges EU-wide legalization of abortion in certain circumstances based on the final decision of the woman involved. In a motion for resolution by the Parliament, the committee was concerned that the Commission had dealt only summarily with the different situations regarding abortion in the member states and that it had not dealt with backstreet abortions. Originally, the report was slated for a session when attendance was poor, the closing Friday session before the July plenary's closing. Sufficient support was mustered from the floor of the assembly to move the report to an earlier point on the agenda; however, those opposed to the report managed to send it back to committee. Currently, the EU is acting on limited powers conferred by the 1992 Maastricht Treaty with regard to coordination of health policy in EU states. The van Dijk report details demands regarding EU research, information programs, and other initiatives concerning tampon-related toxic shock syndrome, osteoporosis, breast and cervical cancer, depression, hormonal treatments, female genital mutilation, and eating disorders. Sexual harassment and violence against women are also included; these are not covered by the Treaty. The report may be stalled indefinitely due to legislative business ahead of the June 1999 Euro-elections.^ieng