Consumo abusivo de álcool por mulheres rurais: o atendimento na Atenção Primária à Saúde / Abusive alcohol consumption by rural women: Primary Health Care / Consumo abusivo de alcohol por mujeres rurales: La atención en Atención Primaria de Salud

Objetivo: analisar o atendimento a usuárias de álcool, em um serviço de Atenção Primária à Saúde, na percepção das mulheres rurais. Método: estudo qualitativo, descritivo, exploratório, cujos dados foram obtidos mediante entrevistas realizadas entre março e agosto de 2018, com 23 mulheres adultas em uso abusivo de álcool, moradoras em áreas rurais de um município da região Centro Ocidental do Rio Grande do Sul. Os dados foram submetidos à Análise Temática, balizada pela teoria Bioecológica de Desenvolvimento Humano. Resultados: as abordagens em saúde estão majoritariamente centradas na medicalização e na clínica ginecológica, sem reconhecer o consumo abusivo de álcool como um problema que também acometem as mulheres. Conclusão: se faz necessário a reorientação do modelo de atenção à saúde no contexto do consumo de álcool entre mulheres rurais, por meio da restruturação de abordagens à saúde que priorizam a clínica ampliada.

Objective: to analyze care provided, in a Primary Health Care service, to rural women who use alcohol, as perceived by the women. Methods: in this exploratory, qualitative, descriptive study, data were obtained between March and August 2018, through interviews of 23 adult women who made abusive use of alcohol and lived in rural areas of a municipality in the CentreWest of Rio Grande do Sul. The data were subjected to Thematic Analysis, guided by the Bioecological Theory of Human Development. Results: health approaches focused mostly on medicalization and clinical gynecology, and not to recognize alcohol abuse as a problem that also affects women. Conclusion: it is necessary to reorient the health care model for the context of alcohol consumption among rural women, by restructuring health approaches that prioritize the expanded clinic.

Objetivo: analizar la atención brindada a usuarias de alcohol, en un servicio de Atención Primaria de Salud, en la percepción de las mujeres rurales. Métodos: estudio cualitativo, descriptivo, exploratorio, cuyos datos se obtuvieron a través de entrevistas realizadas entre marzo y agosto de 2018, junto a 23 mujeres adultas que hacían un uso abusivo de alcohol, que viven en áreas rurales de un municipio en la región centro occidental de Rio Grande do Sul. Se sometieron los datos a Análisis Temático, fundamentado sobre la Teoría Bioecológica del Desarrollo Humano. Resultados: los enfoques de salud se centran, principalmente, en la medicalización y la clínica ginecológica, sin reconocer el consumo abusivo del alcohol como un problema que también afecta a las mujeres. Conclusión: es necesario reorientar el modelo de atención de salud en el contexto del consumo de alcohol entre las mujeres rurales, a través de la reestructuración de los enfoques de salud que prioricen la clínica ampliada.

Women's labor, fertility, and the introduction of modern technology in a rural Maya village.

PIP: The introduction of mechanized technology into a rural Maya agricultural community in the mid 1970s markedly increased the technology with which maize could be ground and water collected, which in turn introduced a possible savings in the time spent working. This study investigated the response of female fertility to the introduction of this labor-saving technology. Using two proximate determinants of female fertility, the association between the advent of modern technology and changes in the age at which women give birth to their first child and the length of mothers' birth intervals was examined. Analyses showed that women begin their reproductive careers at a younger age after the laborsaving technology was introduced. Estimate of the median age at first birth from the distribution function dropped from 21.2 years before the introduction to 19.5 years after the introduction of the technology. In addition, modeling results show that the probability of a woman giving birth to her first child doubles for any age after the introduction of laborsaving technology. However, changes in birth intervals are less conclusive since the differences of smoothed probability distributions are not significant. Moreover, findings indicate that women who initiate reproduction at a younger age can potentially have longer reproductive careers and larger families.^ieng

Bolivia survey reveals disparities.

PIP: Findings from the Bolivia Demographic and Health Survey in 1998 indicate that large fertility and reproductive health disparities based on education level and geographic location still persist in the country. Despite substantial improvement in the overall education level of Bolivian women in the past 5 years, urban women are almost 5 times more likely to attend high school than rural women are. Major differences in education level also exist between provinces. Total fertility rate is at 4.2 children per woman, with women without education having more than 3 times the number of children compared to those with higher education. At such rates, rural women will have an average of 6.3 children, which are 2.5 children more than their urban counterparts. Moreover, nearly 80% of women in union know of a modern method of contraception and 45% of them are using some form of family planning. The highest levels of contraceptive use are among women with higher education and women in urban areas. There is also a notable increase in the number of women who receive assistance from a trained medical professional during delivery. Infant and child mortality rates remain among the highest in Latin America although both rates have declined since the 1994 survey findings. Infant mortality rates are still 80% higher in rural areas than urban areas.^ieng

"Fanm se poto mitan": Haitian woman, the pillar of society.

PIP: This reexamination of the status of women in Haiti opens by noting that the analysis was prompted by an acknowledgement that the past decade has given Haitian women the opportunity to make great developmental and educational progress. The analysis begins by presenting a brief social history of Haitian women, which focuses on such issues as the second-class status afforded Haitian peasants in the 19th century; the fact that household and agricultural duties curtail the education of children; the prestige assigned to marriage versus the more usual common-law unions; the social hierarchy recognized by the peasants; the survival of polygamous unions; the involvement of women in farming, marketing, and trading food; and recent attempts by rural women to gain education and organize themselves to improve the conditions of their lives. The analysis then turns to the status of rural women after they migrate to urban areas, where economic categories create the social hierarchy and Statute Law applies. This section focuses on the income-generation opportunities that were available to these women during the Duvalier regimes, on the conditions of life for the middle class, and on the use of violence by employers and the state to control women of all classes. The second part of the analysis looks at how Haitian women have been represented in literature by female and male Haitian writers and highlights the way female writers used subversive narrative techniques to create a stereotype-breaking female identity. The essay concludes that women writers are continuing to further social activism and feminist struggles.^ieng

Pride of the Maya -- basic education project for Mayan girls in bilingual and bicultural manners.

PIP: Girls Education Project, a two-year program sponsored by the Japan International Cooperation Agency (JICA), seeks to address the educational needs of Mayan girls in rural Guatemala. The program is being implemented under the framework of the Japan-US Common Agenda for Cooperation in Global Perspectives. Preliminary fieldwork revealed the importance of ensuring that entire communities, including teachers and parents, appreciate the human right of rural girls to a basic education. The project team will conduct three-day workshops in each of the four pilot states in 1997 to discuss teaching methods, materials, and curricula to promote girls' participation and improve their achievement levels. Also planned is a three-day national seminar involving governmental officials and representatives from the public and private sectors, nongovernmental organizations, professional groups, universities, and ethnic and cultural groups. The bilingual/bicultural method selected for the intervention seeks to implement basic education for Mayan girls in both Spanish and the four main Mayan languages. Another focus is to encourage the students to maintain pride in their cultural heritage.^ieng

AIDS: risk behaviors among rural Mexican women married to migrant workers in the United States.

International migration between Mexico and the United States has been acknowledged as a phenomenon that may contribute to the spread of AIDS in rural Mexico. The purpose of this study is to identify the information held by the participants regarding AIDS and to describe selected high-risk behaviors for AIDS transmission among a representative sample of rural women living in Mexico who are married to immigrant temporary workers to the United States. The women who participated in the study were married, of reproductive age, and had active sex lives with their spouses. Results revealed that most of the women interviewed had at least some knowledge about AIDS. Although some misconceptions were evident, most of the information they had was accurate. About one-third of the women felt at risk for AIDS, mostly because they doubted their husbands' fidelity, or because in the last five years they had donated blood, received a blood transfusion, or received an intramuscular or intravenous injection. The results of the study are discussed within the sociocultural context that surrounds the lives of the women interviewed.

PIP: Studies have found that migration and return migration between Mexico and the US among temporary migrant workers contributes to the spread of HIV/AIDS among Mexico's poor, especially in rural communities. The available information about the sexual practices of migrant workers in and out of Mexico is, however, very limited. Indeed, the authors were able to find just one report dealing with the sex practices of seasonal migrant workers in the US. That report describes seasonal migrant workers as maintaining an active, but largely unprotected bisexual life with fellow workers or prostitutes while in the US. Returning home, typically once per year, they tend to have unprotected sexual intercourse with their wives. 100 rural Mexican women of mean age 35.9 years living in Mexico and a mean educational attainment of 5.2 years of schooling, with an average of 5 children, who had been married for an average of 16.2 years to immigrant temporary workers to the US were interviewed to learn what information they had regarding AIDS and which high-risk behaviors they had for the transmission of HIV. The women had active sex lives with their spouses. Most of the women interviewed had at least some knowledge about AIDS. Although the women held some misconceptions, they had mostly accurate AIDS-related information. Approximately one-third of the women felt at risk for AIDS, mostly because they doubted their husbands' fidelity, or because in the last five years they had donated blood, received a blood transfusion, or received an intramuscular or intravenous injection. Study results are discussed.

Risk factor analysis of peri-neonatal mortality in rural Guatemala.

Peri-neonatal mortality is a serious health problem in Guatemala, especially in rural areas where most deliveries occur at home and are overseen by traditional birth attendants (TBAs) who function in the role of midwives. The three aims of the work reported here were to identify important predictors of peri-neonatal mortality within a rural area of Guatemala; to assess the effects of traditional and modern health care providers on such mortality; and to find ways of identifying high-risk women who might benefit from transfer to a hospital or clinic. For these purposes a case-control study was conducted of 120 women in the rural department of Quetzaltenango who had lost their babies from the 20th week of pregnancy through the 28th day of life. These women and 120 controls were interviewed in their homes by trained physicians, using questionnaires in Spanish or the appropriate Indian dialect, and the results were analyzed through a series of statistical tests. It was found that the complications of pregnancy and delivery with the greatest statistical significance were prematurity, malpresentation, and prolonged labor. Population-based attributable risks of these complications demonstrated that they accounted for significant proportions of the observed peri-neonatal mortality. While these conditions cannot be eliminated, within the rural Guatemalan context it appears that early referral of women with these complications to more specialized care settings could result in improved delivery outcomes.

Improving NGO collaboration in AIDS prevention in rural Haiti.

PIP: Zanmi Lasante (Health Friends), a nongovernmental organization (NGO) based in rural Haiti, provides an example of the effective role NGOs can play in acquired immunodeficiency syndrome (AIDS) prevention. The group has produced a video, "Chache Lavi, Detwi Lavi," based on the true story of a rural woman who became infected when she migrated to Port-au-Prince to seek employment. The video illustrates the association between human immunodeficiency virus (HIV) and broader social issues such as peasants' access to land, political upheaval, and unequal gender relationships. To promote collaboration, Save the Children established the NGO Coalition for the Prevention of AIDS and Sexually Transmitted Diseases (STDs) in the Central Plateau. Women, particularly adolescent females, are the coalition's target population. Activities have included literacy and income generation training for women, development of algorithms for STD treatment without laboratory diagnosis, a training course for health professionals on STD services and counseling, training of trainers workshops, and preparation of informational materials. The 10 participating NGOs and private voluntary organizations meet quarterly to share information and evaluate programs.^ieng

Women farmers in Central America: myths, roles, reality.

PIP: In Central America, women's productive roles are negated by the widely held belief that women do not work in agriculture or do so only temporarily for reasons of poverty. Working as unpaid laborers, working seasonally in cash crops, and engaging in informal sector activities off the farm, women are not seen as agricultural producers or full-time wage laborers. That notion is enhanced by rural women, who tend not to describe themselves as producers. Women farmers are therefore invisible and deprived of social and legal recognition and protection. Recent studies, however, have found that women throughout Central America have played a long-standing role in agriculture as permanent, not temporary, workers. Official statistics indicate that almost 20% of rural households are headed by women who are fully responsible for agricultural production. Indeed, there are villages in Central America inhabited solely or mainly by widows and single women and their children. Despite the growing body of evidence on women's true productive role in Central American societies, their agricultural roles still remain largely invisible in government census and labor statistics. The author discusses barriers to opportunity and supporting women farmers in Central America.^ieng

Responding to the real needs of women.

PIP: INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.^ieng

[Female sexuality as perceived by rural women]. / Sexualidade feminina na percepcao da mulher do campo.

PIP: The themes of sex, gender, and women's health have been analyzed by various sciences. Medical and public health literature report on clinical aspects and epidemiology of risks affecting women, especially those of the reproductive process. The sexual division of labor means that the natural function of the woman is not considered economically productive in contrast to men. Women tend to be concentrated in lower grades of the remuneration scale, prestige, and autonomy, a phenomenon called the feminization of poverty. The construction of genders in the perspective of health means that being a man or a woman produces sexual differences in attitude and activities, which bring about specific risks for health and differentiation in the levels of access to health resources. On the macro level institutionalized sex differences manifest themselves in the high prevalence of malnutrition among girls in Latin America, the 2-3 times higher rate of depression among women, the high incidence of mortality among women from cancer, and the abuse of medical technology such as cesareans and hysterectomies. The Program of Integrated Assistance in Women's Health was conceived for the prevention and diagnosis of cervical uterine cancer, breast cancer, sexually transmitted diseases, and access to and choice of contraceptive methods.^ieng

New horizons for Mexico's women.

PIP: In Mexico, a rural woman's sole worth lies in her ability to have children. Her husband's status in the community also rests on this ability. Family planning and enjoyment of sex by a woman are taboo. Physical abuse of women by men is accepted and common. Education of young girls and women, which leads to increase self-esteem and trust in outsiders, is necessary to begin the process that will allow rural women to take control of their lives and their relationships with men. This process is the adoption of family planning practices.^ieng

[Lactation and amenorrhea in women from the rural and urban areas of Yucatan]. / Lactancia y amenorrea en mujeres de las áreas rural y urbana de Yucatán.

Influence of environment and lactation patterns on amenorrhea duration and frequency of ovulation before the first menstrual bleeding postpartum are studied on a group of 100 women (half rural, half from urban areas). All subjects studied were highly motivated to breastfeed for prolonged periods. Results show a more prolonged amenorrhea, although not statistically significant, in those women from the rural zone. Ovulation frequency before the first vaginal bleeding was 14% none ovulated before six months.

PIP: 100 women in Yucatan, Mexico, participated in a longitudinal and prospective study of the influence of lactation patterns and rural or urban residence on the duration of amenorrhea and the frequency of ovulation before the first postpartum menstrual period. 50 women from the city of Merida and 50 from nearby villages were followed until their first postpartum menstruation. The women were of lower socioeconomic status and aged 20-31 years. All had breast fed at least two older children and none used contraception before the first postpartum menstruation. 25 women in each residence group practiced exclusive breast feeding in the first months and 25 mixed bottle and breast feeding. The women kept records of the number of nursing episodes or bottles given, and collected 24-hour urine samples weekly beginning in the fourth postpartum month for urinary pregnanediol determination. Monthly blood samples were obtained before and after nursing to measure prolactin levels. Ten of the 100 women withdrew before completion of the study. The women in all four subgroups were very similar in age, education, and family size. The average duration of amenorrhea was 10.58 months for the 49 rural women and 8.02 months for the 44 urban women, but the difference was not statistically significant. The 11.02 month duration of amenorrhea of the exclusively breast feeding mothers was significantly longer than the 7.34 months of the partially breast feeding group. At six months postpartum, nine exclusively breast feeding and 22 partially breast feeding mothers had resumed menstruation. 75 of the women (88.3%) resumed menstruation within one year. 13 women (14.4%) ovulated before the first menstruation, with an average duration of amenorrhea of 9.8 months. None of the women became pregnant before the first menstruation. Prolactin levels were significantly lower in the women who ovulated before the first menstruation.

[Rural women. Public health workshop of the Centro de Investigaciones en Psicologia Social]. / Mujer rural. Taller de salud publica del Centro de Investigaciones en Psicologia Social.

PIP: Mexico's peasant sector is undergoing great change as a result of the insertion of capitalist relations into areas that were previously remote. The traditional peasant subsistence economy has been displaced, and peasants have been forced to adopt a series of new strategies for survival, entailing proletarianization or selling of labor. Women in the community of San Nicolas Zoyapetlayoca, in the municipio of Tepeaca, have lived in a situation of poverty and precariousness for some time. Most of the population historically depended on the neighboring haciendas for their livelihood. Women and children also worked there, mistreated and without social protection. The lands that were distributed after the Revolution are insufficient to support the community, and most families must look elsewhere for employment. Incomes are insufficient to cover all the necessities of education, health, nutrition, and other aspects of life. Most women are educated no farther than the primary level. They spend most of their time preparing food, carrying water, washing clothes, caring for their children, and in other domestic chores. Some women work for wages as laborers, factory workers, or domestics. Rural women are disadvantaged by poor working conditions, insufficient education, low levels of health and nutrition, limited participation in social and political life, poor housing and lack of services, and frequently by their own attitudes of traditionalism or fatalism.^ieng

Prevalence and determinants of caesarean section in Jamaica.

The prevalence and determinants of primary caesarean section in Jamaica were estimated from a survey of women aged 14-49 years. Among 2328 women reporting 2395 live hospital births during the period January 1984 to May 1989, the prevalence of caesarean section was 4.1%. Repeat caesarean sections accounted for 1.3% of the hospital births during that period. Of the medical complications studied, prolonged labour and/or cephalopelvic disproportion carried the highest risks of primary caesarean section, followed by breech presentation, maternal diabetes, a high birth-weight baby, maternal hypertension, and a low birth-weight baby. The risk of primary caesarean section increased with maternal age, decreased with parity, was higher for urban than for rural residents, and was higher for births in private versus government hospitals.

PIP: Researchers analyzed data on 2395 hospital births which occurred to 2328 14-49 year old women between January 1984 and May 1989 living in 7 parishes of Jamaica to determine the prevalence and factors of cesarean section. The primary cesarean section rate for the 5.5-year period was 4.1% which is lower than the rates of some developing countries and of some developed countries such as the US. The repeat cesarean section rate was 1.3%. Cephalopelvic disproportion and/or prolonged labor (abnormal labor) accounted for 17.4% of all primary cesarean sections. Abnormal labor carried the greatest risk of primary cesarean section (logistic regression model beta=1.9). Other delivery complications which posed considerable risk of cesarean section included breech presentation (beta=1.68), maternal diabetes (beta=0.84), maternal hypertension (beta=0.47), large birth weight infant (beta=0.4), and low birth weight infant (beta=-0.15). These complications made up 22.3%, 7.1%, 7.4%, and 5.3% of all primary cesarean sections, respectively. Nonmedical determinants of primary cesarean section included 30-year old women (beta=1.04), 1-2 births (beta=-1.27), urban residence (beta=0.75), and delivering in a private hospital (beta=0.59). 5.3% of 30-year old mothers underwent a cesarean section compared with 3.8% of 30-year old mothers. 5.2% of women of parity 1-2 had a cesarean section whereas only 2.3% of those of parity =or 3 did. Urban mothers were more likely to have a cesarean section than were rural mothers (5.4% vs. 3.3%). 7.6% of mothers delivering at a private hospital underwent a cesarean section compared with 3.9% of those delivering at a government hospital. Well-designed studies of infant mortality in Jamaica can determine whether the country can attain low levels of early infant mortality while keeping its current low rate of cesarean section.

Psychosocial factors associated with teenage pregnancy in Jamaica.

The self-esteem and perceived maternal care and control of 134 Jamaican schoolgirls and 108 pregnant adolescents and teenage mothers were compared. The girls were 14 through 17 years of age, from working-class backgrounds, and living in rural and urban areas. Adapted versions of the Coopersmith Self-Esteem Inventory and the Parental Bonding Instrument were administered. Results indicated that the two groups did not differ in perceived maternal care and control. However, the self-esteem of urban schoolgirls was significantly higher than that of their once-pregnant counterparts. This was also true of the total sample. Urban teenagers without father figures were nearly 2.7 times more likely to have been pregnant than were those living with adult male relatives. Thus, father-figure absence and low self-esteem may combine as risk factors for teenage pregnancy in urban Jamaica.

The rural market: a unique communication medium.

PIP: In January 1990, the Health Secretary asked the Technologies for Primary Health Care (PRITECH) project to facilitate access to the many small villages with 500 people in Mexico since PRITECH had assisted the diarrhea disease control program. 1st PRITECH had Ministry of Health staff train trainers which would eventually spread the information to the rural areas. This strategy was effective only for those people who did not live in remote areas. The same reasons for remote people being at high risk of disease also limited this strategy: isolation, lack of education, limited diets, lack of access to services, and limited fluency in Spanish. PRITECH hired a local consulting organization, CICLOPE, to develop a new strategy. CICLOPE limited its activities to the states of Hidalgo and Vera Cruz for 8 months. 1st CICLOPE staff provided proper diarrhea management training including emphasis on oral rehydration therapy (ORT) to rural health auxiliaries. They used a gourd painted to look like an infant with holes and other modifications to depict the workings and results of diarrheal dehydration. The staff then sent the auxiliaries to their own communities to use the gourd dolls to teach mothers about ORT and correct diarrhea management. The staff conducted follow-up activities to monitor the auxiliaries' progress. This training approach allowed the auxiliaries to realize the abilities of the mothers and their active role in learning. The auxiliaries conducted the training at markets where women living in remote areas came weekly. The local radio announced market day events in which the auxiliaries participated and aired dramas about diarrhea management. CICLOPE staff and the auxiliaries sat up a booth at these markets to promote proper diarrhea management. They used a flip chart, comic books, a lottery game, and entertainment to impart education messages.^ieng

[Plasma clearance of ethanol and its excretion in the milk of rural women who consume pulque]. / Depuración plasmática de etanol y su excreción en la leche de mujeres rurales que consumen pulque.

Women from rural areas of the central plateau of Mexico drink during pregnancy and lactation a mild alcoholic beverage called pulque as a galactogogue. Ethanol present in milk could have a harmful effect on growth and development of breast-fed children. The purpose of this study was to quantify the ethanol consumed as pulque by eleven lactating rural women as well as its clearance rate in blood and milk. Mothers were separated in two groups depending upon the ethanol ingested in a single dose of pulque 0.21 +/- 0.08 g/kg of body weight (group A) and 0.44 +/- 0.11 g/kg (group B). Maximal concentration of ethanol was reached in milk at 60 minutes and almost equaled that in plasma. Both groups showed a similar clearance pattern regardless of the volume of pulque ingested. Clearance rates between groups were different: ethanol concentration in milk at 60 min were 8.4 +/- 3.0 mg/dL for group A and 26.2 +/- 7.0 mg/dL for group B. Two hours later ethanol levels were 3.6 +/- 3.4 mg/dL and 23.3 +/- 9.4 mg/dL respectively. Clearance rates were slower in mothers showing the highest concentration of ethanol in milk. The present data demonstrate that there is no differential elimination of ethanol in maternal blood and milk following ingestion of a moderate amount of pulque during lactation. The amount of ethanol received by infants through milk is relatively low and therefore it is unlikely to have harmful effects on them. Pulque consumption adds about 350 kcal/day to the customary dietary intake of these lactating women.

PIP: This work assessed the quantity of ethanol consumed in pulque, a mildly alcoholic beverage from the maguey cactus, and its clearance rate in the blood and milk of 11 rural women in the state of Mexico. 27% of women in the rural and semirural areas of central Mexico drink pulque with their meals. Pulque is believed to stimulate milk production in lactating women. The 11 women lived in the community of San Mateo Capulhuac. All exclusively breast fed their infants, who ranged in age from 3-12 months. On the study day the women breakfasted on tortillas, beans, soup and tea, accompanied by their usual quantity of pulque. During the study, samples of milk and blood were taken from the women at 60, 90, and 120 minutes after 1st ingestion of pulque. The volume of pulque consumed was measured and a sample was saved to determine the ethanol content. Mature pulque showed little variation in ethanol concentration or in total carbohydrates, independently of temperature or duration of storage. The average concentration of ethanol in pulque produced in San Mateo Capulhuac was 3.08 + or - 1.09 g/dL, with a minimum of 1.35 and a maximum of 4.70. The 11 mothers were divided into 2 groups depending on whether the maximum concentration of ethanol quantified in their blood and milk was less than 20 mg/dL (group A) or greater than 20 (group B). The mothers in group A had younger infants, lower body weights, and smaller volumes of pulque ingested on average than the mothers in group B. The average dose of ethanol ingested with pulque was .21 + or - .08 g/kg body weight for group A and .44 + or - .22 g/kg of body weight for group B. concentrations of ethanol in the blood were similar to those in milk for both groups at 60, 90, and 120 minutes. The maximum ethanol concentration occurred 60 minutes after ingestion. Maximum concentrations of ethanol in milk were 8.4 + or - 3.0 mg/dL for group A and 26.2 + or - 7.0 mg/dL for group B, slightly lower than the maximal plasma concentrations in each group. Ethanol levels in blood and milk of group A declined rapidly, with 63% of the ethanol disappearing from the blood and 52% from the milk at 120 minutes. At 120 minutes the ethanol concentration had declined by only 5.5% in the blood and 11% in the milk of group B. Pulque contributes about 350 kcal per day to these women, who have daily caloric intakes averaging 2100 kcal. The relatively small amount of ethanol taken in by infants through milk is unlikely to have harmful effects.

A body ... for whom?

PIP: An opinion pole was conducted by the Mexican Health Department in 1988 to determine the problems facing women in terms of sexuality and reproductive activity. 1481 women from the Northeast, Bajio, and Southeast regions were included. The data showed that women feel they have more right to make decisions concerning motherhood and less when it comes to deciding when the couple is having sex. 31% of the women felt that it is the man who should decide when to have sex, while only 14% felt it is the man who should decide when to have children. 81% of the women with secondary school or higher education felt that both members of a couple have to decide when to have sex, compared with 45% of uneducated women. There is a 73% difference between urban and rural women when it comes to the decision that sexual relationships should be made by the couple. There is a 66% difference between women who have experience with contraception and those who have not concerning this type of decision. Uneducated rural women with a large number of children who have never used contraception are least likely to decide on the number of children, while 91% of higher educated women felt that it was a decision for the couple. 78% of urban women compared with 54% of rural women felt the same way. Another difference between urban and rural women is the value of the sex act. For urban women it is seen as having an affectionate value while rural women are more likely to associate the sex act with pregnancy.^ieng

[Contraceptive practice in Mexico: two five-year periods, two different patterns (1976-1977 to 1987)]. / La practica anticonceptiva en Mexico: dos quinquenios, dos patrones diferentes (1976-1977 a 1987).

PIP: This work uses data from the 1976-77 Mexican Fertility Survey, the 1982 National Demographic Survey, and the 1987 National Fertility and Health Survey to analyze fertility and contraceptive behavior among Mexican women in the 2 5-year periods from 1976-82 and 1982-87. The proportion of fertile-aged women in union using a method increased from 41.6% in 1976-77 to 58.8% in 1982 and 61.4% in 1989. The most significant gains in use of the more effective methods as in contraceptive prevalence occurred in the 1st 5-year period. The proportion of women sterilized increased from 3.73% in 1977 to 16.6% in 1982 and 21.7% in 1987, equivalent to increases over the 2 5-year periods of 345.7% and 30.7%. Female sterilization was the only method whose use increased constantly over the period. Use of the IUD was almost unchanged between 1977-82, while use of oral contraceptives and injectables both declined from 1982 to 1987 after increasing over the preceding 5 years. Contraceptive usage increased intensely in all subgroups of women studied between 1976-82, but in the 2nd period from 1982 to 1987 contraceptive usage declined significantly in some subgroups. Contraceptive prevalence among women in urban and metropolitan areas increased systematically after 1977. Rural women increased their use from 22.5% in 1977 to 48.6% in 1982. 5 years later the proportion of rural users had declined to 45.3% although it was still well above the level of 1976-77. The most significant increase in contraceptive usage among illiterate women and those with primary educations occurred from 1976 to 1982. In 1987 women with primary and higher levels of education demonstrated increases in contraceptive usage compared with 1982, but contraceptive usage among illiterate women declined from 40.8% in 1982 to 28.9% in 1987. Data from the 3 surveys demonstrate low but increasing rates of use among women 15-19 years old, who may be in the process of developing a new fertility pattern characterized by longer birth intervals. Women in the middle reproductive years had higher rates of use showing little change from 1982 to 1987 and unlikely to show great change in the future due to their already high level. Women aged 40-44 showed systematic increases in use from 1976 to 1987, but women aged 45-49 increased their use only from 32.6% in 1977 to 39.0% in 1987. The declines in age differentials in contraceptive prevalence from 1982 to 1987 demonstrate that age is losing weight as an explanatory factor. Between 1976-77 and 1982, women of all parities increased their contraceptive usage substantially. Women with 3 or fewer children continued to increase their usage through 1987, but usage among women with 4 or more children actually declined between 1982-87. The results suggest that a small proportion of rural, less educated, and high parity women may have returned to their former patterns of uncontrolled fertility. Nevertheless, fertility differentials were much smaller in 1987 than in 1976-77.^ieng