ABSTRACT
BACKGROUND: Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. AIM: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. METHODS: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. RESULTS: The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. CONCLUSION: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.
Subject(s)
Pregnancy in Adolescence/ethnology , Refugees/psychology , Adolescent , Anthropology, Cultural , Colombia , Female , Humans , Pregnancy , Pregnancy in Adolescence/psychologyABSTRACT
BACKGROUND: Armed conflict in Colombia has a history of 50 years that continues to this day. According to the Victims Record of Colombia, from 1985 to 2013 2.683.335 women have been victims of the armed conflict. Women have been described as the main victims of the armed conflict, especially in the Colombian cultural context that in some regions is still considered to be a 'machista' and patriarchal one. In contrast, some authors have explicitly stressed Colombian women's agency instead of positioning them only as victims. Some of them are described as 'survivors' of the war, emphasizing their impressive resistance to the outcomes of war and forced displacement. In contrast to the background of these scholarly discussions, our study focused on how displaced women living in Bogotá themselves articulate their experiences of agency and victimization. This paper will therefore explore how women, in reconstructing their life stories, expressed the tussles between victimization and agency. METHODS: We used qualitative methods conducted within an ethnographic approach. Based on ten years of experience in the neighborhood and one year of fieldwork, we collected the life stories of twenty internally displaced mothers, and ran eight workshops with them. We analyzed the narratives with a specific focus on how women expressed victimization and agency in four important periods in their life that related to the process of displacement: when they left home, when they became pregnant, when they were forced to leave their towns, and when they arrived in Bogotá. RESULTS: Participants' life stories showed how they struggled with agency during their lives. They were victims of abuse and violence during childhood and finally decided to leave their homes. They decided to have their babies despite the fact that they were abandoned by their partners and families, and after doubts about and attempts to have an abortion. Throughout the process of displacement the participants had been engaged in ambiguous relationships with armed groups. Finally they arrived in Bogotá and faced adverse circumstances but were looking for better opportunities for them and their children. CONCLUSION: The analysis of how internally displaced women narrated their life stories showed us that the concepts that dominate scholarly debates about agency, victimization and survivorship do not do justice to the life stories of the participants in our study. These stories show that changes with a major impact were loaded with ambiguity and were characterized by helplessness, lack of control and agency simultaneously. The reconstruction of these life stories goes beyond the stereotype of displaced women as only 'victims', but points also to their agency and courageous decisions they made in contexts that were not controlled by them and where support was often lacking. Instead of label them, it is important to understand the complexity of the life experiences of IDW, in order to build policies that offer them aids as victims, but also build policies and intervention programs that empower them as agents in order to support them during resettlement.
ABSTRACT
Presentamos un análisis sobre la Investigación Cualitativa (IC) en enfermería en Colombia, realizado con base en el diseño de una investigación cualitativa tipo estudio de caso, que incluyó como herramientas centrales entrevistas a informantes claves y de manera complementaria, revisión documental. Los datos se recolectaron de manera paralela entre junio y octubre de 2011. Se realizaron 19 entrevistas semiestructuradas a investigadores de universidades colombianas que han sido actores centrales en la IC en enfermería en Colombia y se revisaron 159 documentos publicados en revistas colombianas y de América Latina durante el período 1990 a 2010. El análisis interpretativo incluye como temas: los inicios de la IC en enfermería; las temáticas, abordajes y poblaciones; las contribuciones; las limitaciones y los retos para el futuro de la IC en enfermería en Colombia. A través de la práctica de la IC, las enfermeras colombianas han planteado críticas a los modelos biologicistas y positivistas hegemónicos de la investigación en salud; han realizado estudios con diversas personas y grupos poblacionales, han utilizado diversos enfoques y métodos, siendo la etnografía, la fenomenología, la teoría fundamentada y la IC los de mayor frecuencia; y han tenido limitaciones relacionadas con la calidad y el rigor, la falta de reconocimiento, la escasez de tiempo y dificultades para la financiación y la publicación. A pesar de las limitaciones, han contribuido a dar una mirada compleja y a la humanización del cuidado de enfermería y trabajan en lograr un mayor impacto de las investigaciones en las políticas y acciones sociales (AU)
In this article, we present an analysis of the Qualitative Research (QR) in nursing in Colombia, which was based on a qualitative case study design that included key informants interviews complemented by document review. Data were collected in a parallel manner between June and October 2011. We conducted 19 semi-structured interviews with researchers of Colombian universities that have been central actors in the QR nursing in Colombia and we reviewed 159 documents published by Colombian nursing researchers between 1990 and 2010 mainly in Colombian and Latin American journals. The interpretative analysis that we present include the following themes: the beginnings of QR in nursing in Colombia; the topics, approaches and populations; and finally, the contributions, limitations, and challenges for the future. Through their practice on QR Colombian nurses have raised criticisms of the hegemonic positivist and biologists models of health research studies; they have conducted research studies with various individuals and population groups; they have used different approaches and methods such as ethnography, phenomenology, grounded theory, among the ones with higher frequency; they have had limitations related to the quality and rigor, lack of recognition, lack of time, and difficulties in funding and publications. Despite these limitations, Colombian nurses conducting QR have helped to give a complex look and humanization of nursing care and currently work in achieving greater impact of their research on policies and social action (AU)
Subject(s)
Humans , Male , Female , Nursing , Qualitative Research , Nursing Research , Education, Nursing , ColombiaABSTRACT
El propósito de este artículo es resaltar la importancia de desarrollar investigaciones que, yendo más allá de describir las diversas prácticas y conocimientos de las comunidadesindígenas, revelen las inequidades e injusticias sociales que ellos viven. Laargumentación se basa en tres momentos investigativos: un estudio cualitativo realizado durante 1992 y 1993 con indígenas colombianos en diferentes regiones del país; una investigación documental sobre investigaciones en salud realizadas en Colombia de 1935 a 1996, con poblaciones indígenas y afrocolombianas, y una revisión de lainvestigación reciente sobre la salud de los indígenas colombianos. En la primera partedel artículo se plantea una revisión de los conceptos de justicia social y equidad enel contexto de la Declaración de Alma Ata y del marco de los determinantes socialesde la salud. A continuación se analiza la situación de los indígenas en Colombia en lainvestigación realizada sobre la salud de los pueblos indígenas en Colombia y en cincoproblemas críticos en la relación entre salud indígena y equidad: la tierra: propiedad,violencia y migración forzada; recursos y medio ambiente: pobreza y posesiones; poder:autodeterminación, abuso y dependencia; identidad: discriminación y reconocimiento;situación de salud: tradición y modernidad. Mi intención al analizar el caso colombianoes dar elementos para la comprensión de los problemas de salud de poblaciones indígenasen otros contextos. Se concluye con algunas recomendaciones sobre accionesglobales y locales en salud indígena...
The purpose of this article is to highlight the importance of developing different researchwhich, beyond the description of the different practices and knowledge of theindigenous communities, reveal the inequalities and social injustices that they live in.The argument is based on three moments of research: a qualitative study conductedduring 1992 and 1993 with the indigenous peoples of Colombia from different regionsof the country. A documentary research on health carried out in Colombia from 1935to 1996, with the indigenous and Afro-Colombian population, and a review of the recentresearch on the health of the indigenous peoples from Colombia. The first partof the article presents a review of the concepts of social justice and equity, within thecontext of the Declaration of Alma-Ata and the framework of the social determinantsof health. Then, an analysis of the situation of the indigenous peoples in Colombia ismade -from the research on their health-, and five critical issues between indigenoushealth and equity are taken into account: land: property, violence and forced migration.Resources and Environment: poverty and possessions. Power: self determination,abuse and dependence. Identity: discrimination and recognition. Health status:tradition and modernity. I intend to analyze the Colombian case in order to provideelements to the understanding of the health problems of the indigenous peoples inother contexts. The article concludes with some recommendations on global and localactions in indigenous health...
O propósito deste artigo é salientar a importância de desenvolver pesquisas que, indoalém de somente descrever as diferentes práticas e conhecimentos das comunidadesindígenas, também revele as iniquidades e injustiças sociais que eles vivem. A argumentaçãobaseia-se em três momentos investigativos: um estudo qualitativo realizadodurante 1992 e 1993 com indígenas colombianos em diferentes regiões do país; umainvestigação documental sobre pesquisas sobre saúde feitas na Colômbia de 1935 a1996, com populações indígenas e afro-colombianas, e uma revisão da pesquisa recentesobre a saúde dos indígenas colombianos. Na primeira parte do artigo é apresentadauma revisão dos conceitos de justiça social e equidade no contexto da Declaração deAlma Ata e do entorno dos determinantes sociais da saúde. Posteriormente é analisadaa situação dos indígenas na Colômbia na pesquisa feita sobre a saúde dos povosindígenas na Colômbia e em cinco problemas críticos na relação entre saúde indígenae equidade: a terra: propriedade, violência e migração forçada; recursos e meio ambiente:pobreza e posses; poder: autodeterminação, abuso e dependência; identidade:discriminação e reconhecimento; situação de saúde: tradição e modernidade. Minhaintenção ao analisar o caso colombiano é dar elementos para a compreensão dos problemasde saúde das populações indígenas em outros contextos. Conclui-se com algumasrecomendações sobre ações globais e locais em saúde indígena...
Subject(s)
Socioeconomic Factors/analysis , Social Justice/classification , Health of Indigenous Peoples , ColombiaABSTRACT
A la luz de la relación entre ciencia y solidaridad en el contexto de enfermería, se afirma que el saber científico y la investigación deben tener como una de sus intenciones primordiales el propiciar la integración social y la solidaridad. Con este fin, se plantea una reflexión conceptual y de experiencias en cinco momentos. En el primero se retoma un concepto de cuidado de enfermería, entendido como interacción y coordinación de accionescon las personas con quienes trabajamos, a fin de resaltar un tipo de cuidado de enfermería orientado a la integración social. En el segundo se reconstruyen los conceptos de solidaridad e integración social, propuestos por Jürgen Habermas. En el tercero, asumiendo que la diversidad y el poder son fuerzas que afectan la solidaridad y la integración social, se analiza la estrecha relación entre verdad y poder, a partir de MichelFoucault, y se resalta el papel de intérpretes de la diversidad de la antropología médica y la enfermería transcultural. En la siguiente parte, se narran algunas experiencias sobreel trabajo de investigación e intervención que viene realizándose con niñas y niños que viven migración parental en Colombia, las cuales articulan los elementos discutidos enlos momentos anteriores. Finalmente, se plantean algunas ideas sobre cómo nuestro quehacer investigativo puede y debe contribuir a la solidaridad y a la integración social...
In the context of the relationship between science and solidarity in nursing, I affirm that solidarity and social integration should be main purposes of scientific knowledgeand research. To this end, I develop a reflection about concepts and experiences in five parts. In the first, I propose a concept of nursing care understood as interaction andcoordination of actions with the people with whom we work; this in order to highlight a nursing care aimed at social integration. Then, I reconstruct the concepts of social solidarity and social integration proposed by Jürgen Habermas. Then, assuming thatdiversity and power are forces that affect solidarity and social integration, I analyze the close relationship between truth and power from Michel Foucault and highlight the role that medical anthropology and transcultural nursing have played as interpreters of thediversity. In the next part, I narrate some experience son research and intervention that we have been doing with children experiencing parental migration in Colombia which articulate the elements discussed in the previous parts. Finally, I raise some ideas onhow I think our research can and should contribute to solidarity and social integration...
À luz da relação entre ciência e solidariedade no contexto da enfermagem, afirma-se que o conhecimento científico e a investigação devem ter como uma de suas principaisintenções a promoção da integração social e solidariedade. Para esse fim proponhese uma reflexão conceitual e experiências em cinco etapas. Na primeira, acolhe-se o conceito de enfermagem, entendida como a interação e coordenação de atividades com pessoas com quem trabalhou, para destacar um tipo de cuidados de enfermagem que visam à integração social. Em seguida, reconstroem-se os conceitos de solidariedade e integração social propostos por Jürgen Habermas. Então, assumindo que a diversidadee poder são as forças que afetam a solidariedade e integração social, é discutida a relação estreita entre a verdade e o poder de Michel Foucault e o destaque do papel de intérpretes da diversidade da antropologia médica e de enfermagem transcultural. Na próxima parte, narram-se algumas experiências em pesquisa e intervenção no trabalho feito com crianças vítimas de migração dos pais na Colômbia, que articulou os elementos discutidos nos momentos anteriores. Finalmente, levantam-se algumas idéias sobre como o trabalho de pesquisa pode e deve contribuir para a solidariedade e integração social...
Subject(s)
Nursing Care , Transcultural Nursing , Nursing Research , Nursing TheoryABSTRACT
Este artículo presenta el análisis de un taller participativo realizado con estudiantes, docentes y funcionarios del Programa Salud al Colegio, en noviembre de 2007. El taller fue realizado en la Pontificia Universidad Javeriana durante el Congreso Internacional de Salud Escolar en el Marco de la Atención Primaria en Salud y la Garantía del Derecho a la Educación, el cual fue convocado y financiado por la Secretaría de Salud y la Secretaría de Educación de la Alcaldía Mayor de Bogotá. Luego de una breve descripción del programa Salud al Colegio, se reseñan los antecedentes, objetivos y metodología del taller, así como las voces de los participantes que incluyen: sus conceptos sobre salud y calidad de vida, las contribuciones, los retos y amenazas del programa y, finalmente, algunas recomendaciones...
This brief article, presents the analysis of a participatory workshop conducted with students, teachers, and health officials of the Programa Salud al Colegio (School Health Program), in November 2007. The workshop was held at the Pontificia Universidad Javeriana during the International Congress of School Health within the Framework of the Primary Health Care and ensuring the Right to Education, which was convened and funded by the Secretariat of Health and the Secretariat of Education of Bogota. After a brief description of the Programa Salud al Colegio, presents the background, objectives and methodology of the workshop and the voices of participants, which include: their concepts of health and quality of life; contributions, challenges and threats of the program, and finally some recommendations...
Neste breve artigo apresenta-se a análise de um workshop participativo junto com estudantes, professores e funcionários do Programa Saúde para à Escola, feito em novembro de 2007. O workshop foi desenvolvido na Pontifícia Universidade Javeriana, durante o Congresso Internacional de Saúde Escolar no Âmbito da Atenção Primária à Saúde e a Garantia e do Direito à Educação, por convite e financiamento das secretarías Municipais de Saúde e Educação da Prefeitura de Bogotá. Após da breve descrição do programa referido, apresentam-se o contexto, objetivos e metodologia do workshop e as vozes dos participantes, incluindo nelas, os seus conceitos sobre saúde e qualidade de vida, contribuições, desafios e ameaças do programa e, no final, algumas recomendações...
Subject(s)
Child Welfare , Quality of Life , Health PromotionABSTRACT
La relación de la enfermería con la cultura y con la antropología es de larga data. Estudiantes y profesionales durante su formación y en la práctica cotidiana en hospitales, centros ambulatorios y comunidades, utilizan conceptos como cultura, valores, prácticas, creencias o estilos de vida y herramientas metodológicas como entrevistas a profundidad, observación participante y grupos focales, provenientes todos ellos de la tradición disciplinar de la antropología. La cultura como lente de mirada es como lo propone Leininger "se trata de lograr que los conocimientos y la práctica de enfermería tengan una base cultural y una conceptualización, una planificación y una aplicación basadas en la cultura".