[Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil]. / Entre saúde e aprimoramento: a engenharia do corpo por meio de cirurgias plásticas e terapias hormonais no Brasil.

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Entre saúde e aprimoramento: a engenharia do corpo por meio de cirurgias plásticas e terapias hormonais no Brasil / Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

Resumo Este estudo explora as margens da medicina, em que práticas de saúde e aprimoramento se confundem. Ele é baseado no trabalho de campo desenvolvido no contexto de dois projetos de pesquisa distintos no Brasil sobre cirurgia plástica e terapias de hormônio sexual. Há uma significativa sobreposição clínica dessas duas terapias. Ambas estão disponíveis nos sistemas de saúde público e privado de tal forma que revelam a dinâmica de classes subjacente à medicina brasileira. Essas terapias também têm uma dimensão experimental enraizada no contexto normativo do Brasil e nas expectativas da sociedade em relação à medicina como forma de controlar a saúde reprodutiva e sexual da mulher. O uso medicinal experimental desses tratamentos está associado a um uso experimental “social”: as mulheres os adotam em resposta a pressões, ansiedades e aspirações no âmbito profissional e na vida pessoal. Argumenta-se aqui que essas técnicas experimentais estão se tornando moralmente autorizadas como um controle rotineiro da saúde da mulher, integradas aos tratamentos predominantes de obstetrícia e ginecologia, e sutilmente confundidas com práticas de cuidados pessoais que são vistas no Brasil como essenciais para atingir uma forma de feminilidade moderna.

Abstract This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil’s regulatory context and societal expectations placed on medicine as a means for managing women’s reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women’s health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Entre saúde e aprimoramento: a engenharia do corpo por meio de cirurgias plásticas e terapias hormonais no Brasil / Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

Este estudo explora as margens da medicina, em que práticas de saúde e aprimoramento se confundem. Ele é baseado no trabalho de campo desenvolvido no contexto de dois projetos de pesquisa distintos no Brasil sobre cirurgia plástica e terapias de hormônio sexual. Há uma significativa sobreposição clínica dessas duas terapias. Ambas estão disponíveis nos sistemas de saúde público e privado de tal forma que revelam a dinâmica de classes subjacente à medicina brasileira. Essas terapias também têm uma dimensão experimental enraizada no contexto normativo do Brasil e nas expectativas da sociedade em relação à medicina como forma de controlar a saúde reprodutiva e sexual da mulher. O uso medicinal experimental desses tratamentos está associado a um uso experimental “social”: as mulheres os adotam em resposta a pressões, ansiedades e aspirações no âmbito profissional e na vida pessoal. Argumenta-se aqui que essas técnicas experimentais estão se tornando moralmente autorizadas como um controle rotineiro da saúde da mulher, integradas aos tratamentos predominantes de obstetrícia e ginecologia, e sutilmente confundidas com práticas de cuidados pessoais que são vistas no Brasil como essenciais para atingir uma forma de feminilidade moderna. (AU)

The unintended consequences of sex education: an ethnography of a development intervention in Latin America.

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention--and of the larger global field of adolescent sexual and reproductive health--is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of 'open communication,' its participants more often used the term 'confianza' (trust). This norm was defined in ways that might--or might not--include revealing information about sexual activity. Questioning public health assumptions about parent-teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge.

Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil.

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Can medicine be aesthetic? Disentangling beauty and health in elective surgeries.

This article analyzes tensions between aesthetics and health in medicine. The blurring of distinctions between reconstructive and cosmetic procedures, and the linking of plastic surgery with other medical treatments, have added to the legitimacy of an emerging "aesthetic medicine." As cosmetic surgeries become linked to other medical procedures with perceived greater medical necessity, health and aesthetics become entangled. One consequence is that medical needs are magnified while perceptions of the risks of surgery are minimized. Drawing on ethnographic work on plastic surgery, as well as other studies of obstetrics and cosmetic surgery, I illustrate this entanglement of health and aesthetics within the field of women's reproductive health care in Brazil. I argue that while it would be difficult to wholly disentangle aesthetics and health, analysis of how risk-benefit calculations are made in clinical practice offers a useful critical strategy for illuminating ethical problems posed by aesthetic medicine.

Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua.

OBJECTIVES: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. METHODS: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. RESULTS: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. CONCLUSIONS: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

"Almost invisible scars": medical tourism to Brazil.

Along with a handful of other nations in the developing world, Brazil has emerged as a top destination for medical tourism. Drawing on the author's ethnographic fieldwork in plastic surgery wards, this article examines diverse factors - some explicitly promoted in medical marketing and news sources, others less visible - contributing to Brazil's international reputation for excellence in cosmetic plastic surgery. Brazil's plastic surgery residency programs, some of which are housed within its public health system, attract overseas surgeons, provide ample opportunities for valuable training in cosmetic techniques, and create a clinical environment that favors experimentation with innovative techniques. Many graduates of these programs open private clinics that, in turn, attract overseas patients. High demand for Brazilian plastic surgery also reflects an expansive notion of female health that includes sexual realization, mental health, and cosmetic techniques that manage reproduction. Medical tourism is sometimes represented as being market-driven: patients in wealthier nations travel to obtain quality services at lower prices. This article ends by reflecting on how more complex local and transnational dynamics also contribute to demand for elective medical procedures such as cosmetic surgery.