Impacts of attacks to female health care workers in three territories of Colombia.

BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

[Pregnancy under fifteen: The motives and redefinition of life's course]. / Embarazo en menores de quince años: los motivos y la redefinición del curso de vida.

OBJECTIVES: To interpret the motives of pregnancy in girls and the re-signification of their life's course. MATERIALS AND METHODS: In the cities of Bogota, Cali, Cartagena and Medellin, 18 life stories of adolescents under 15 years old with experience of pregnancy were made during 2012 and 2013. A phenomenological analytical framework was used to reveal the motives and meanings. RESULTS: The "because motives" and "in order to motives" of adolescents life course, are redefined by the moral control of families, couples, education and health professionals based on common sense and professional habitus. CONCLUSION: In the real "because motives" it is found that common sense assigns blame and responsibility to teens for their pregnancy. In the educational context there is a device that excludes them and promotes dropouts. In the field of health, human rights abuses are used as a control and punishment mechanism.

Embarazo en menores de quince años: los motivos y la redefinición del curso de vida / Pregnancy under fifteen: The motives and redefinition of life's course

Objetivos. Interpretar los motivos del embarazo en las adolescentes y la resignificación del curso de vida. Material y métodos. Se realizaron 18 relatos de vida de adolescentes menores de 15 años con experiencia de embarazo, en las ciudades de Bogotá, Cali, Cartagena y Medellín, durante 2011 y 2012. Se utilizó un marco analítico fenomenológico para desvelar los motivos y los significados. Resultados. Los "motivos porque" y "motivos para" del curso de vida de las adolescentes son redefinidos por el control moral de familias, parejas, profesionales de educación y salud basados en su sentido común y su habitus profesional. Conclusión. En los auténticos "motivos porque" se encuentra cómo el sentido común asigna la culpa y la responsabilidad del embarazo a las adolescentes. En el contexto educativo existe un dispositivo que excluye y promueve la deserción escolar. En el campo de la salud las violaciones a los derechos humanos se utilizan como un dispositivo de control y punición.

Objectives. To interpret the motives of pregnancy in girls and the re-signification of their life's course. Materials and methods. In the cities of Bogota, Cali, Cartagena and Medellin, 18 life stories of adolescents under 15 years old with experience of pregnancy were made during 2012 and 2013. A phenomenological analytical framework was used to reveal the motives and meanings. Results. The "because motives" and "in order to motives" of adolescents life course, are redefined by the moral control of families, couples, education and health professionals based on common sense and professional habitus. Conclusion. In the real "because motives" it is found that common sense assigns blame and responsibility to teens for their pregnancy. In the educational context there is a device that excludes them and promotes dropouts. In the field of health, human rights abuses are used as a control and punishment mechanism.

Agencia social, sexualidad y embarazo en menores de 15 años / Agency, Sexuality and Pregnancy Under Age 15 / Agência social, sexualidade e gravidez em menores de 15 anos

El embarazo adolescente tiene un alto impacto socioeconómico. El objetivo de esta investigación fue interpretar los significados de la sexualidad y el embarazo de niñas menores de 15 años con experiencia de embarazo. Se realizó un estudio cualitativo interpretativo desde el enfoque fenomenológico de Alfred Schütz sobre el sentido común. Se realizaron 18 relatos de vida con adolescentes menores de 15 años con experiencia de embarazo en las ciudades de Bogotá, Cali, Cartagena y Medellín. Los significados de la menarquia, el inicio de relaciones sexuales, la unión en pareja, el uso de anticonceptivos y la atención del parto están influenciados por la agencia moral social e institucional. La empresa moral circula por los espacios de socialización de las adolescentes: madres, padres, hogares, instituciones y profesionales del sector de la salud y educativo clasifican, de acuerdo con su sentido común, lo que está bien o es "normal" para las niñas adolescentes.

Teenage pregnancy has a high socioeconomic impact. The objective of this research was to interpret the meanings of sexuality and pregnancy of girls under 15. An interpretive qualitative study from the phenomenological approach of Alfred Schütz over common sense was carried out. 18 life stories were written with girls under 15 years who had pregnancy experiences in the cities of Bogota, Cali, Cartagena and Medellin. The meanings of menarche, the sexual onset, marriage, contraceptive use and delivery care are influenced by the social and institutional moral agency. The moral enterprise circulates through the spaces of socialization of teenagers: mothers, fathers, homes, institutions and professionals in the health and education sector which classify according to their common sense what is right or "normal" for teenage girls.

A gravidez na adolescência tem impacto socioeconómico elevado. O objetivo desta pesquisa foi o de interpretar os significados da sexualidade e gravidez para meninas menores de 15 anos com experiência em gravidez. Estudo qualitativo interpretativo desde o enfoque fenomenológico de Alfred Schütz sobre o senso comum foi realizado. Fizeram-se 18 relatos de vida com adolescentes menores de 15 anos com experiência de gravidez nas cidades de Bogotá, Cali, Cartagena e Medellín. Os significados da menarca, o início de relações sexuais, a união em casal, o uso de contraceptivos e a assistência do parto são influenciados pela agência moral social e institucional. A empresa moral circula pelos espaços de socialização das adolescentes: mães, pães, famílias, instituições e profissionais do setor da saúde e educativo classificam, segundo o seu senso comum, aquilo que vai dar certo ou é "normal" para as meninas adolescentes.

[Meanings of sexuality and reproductive health in adolescents from Bogota]. / Significaciones de la sexualidad y salud reproductiva en adolescentes de Bogotá.

OBJECTIVE: To describe and understand the meanings that adolescents give to sexuality and how they are created and influence adolescents' reproductive health and sexual practices. MATERIAL AND METHODS: The research was conducted in three different regions within Bogoá city. Twenty focus groups were selected and 20 life stories of boys and girls between 10 and 14 years old were transcribed. From inductive and deductive categorization of the transcripts of the oral histories, an interpretative analysis was carried out in order to generate concepts and relations that comprise plausible hypotheses about the meanings that circulate in the adolescents' symbolic universe. RESULTS: There are notable differences between the meanings that boys and girls give to sexuality, the ways in which such meanings are created, and the factors that contribute to its configuration. These findings imply dissimilar constructions related with reproductive and sexual health risks. CONCLUSIONS: The cultural constructions resulting from sexual differences that is, gender suggest the meanings that are given to sexuality in the groups studied and define ways of interacting with the social environment. Girls relate sexuality with reproduction and they experience it as negative. For boys, the possibility of a positive and pleasant experience of sexuality exists, marked by a context that encourages having sexual relations as a way of maintaining manhood.

Significaciones de la sexualidad y salud reproductiva en adolescentes de Bogotá / Meanings of sexuality and reproductive health in adolescents from Bogota

OBJETIVOS: Describir y comprender los significados que tiene la sexualidad en los adolescentes , y cómo se construyen e influyen en sus prácticas sexuales y salud reproductiva. MATERIAL Y MÉTODOS: La investigación se llevó a cabo en tres zonas de la ciudad de Bogotá. Se seleccionaron 20 grupos focales y se tomaron 20 relatos de vida de adolescentes mujeres y varones entre 10 y 14 años. Mediante la categorización deductiva e inductiva de las transcripciones de los discursos verbales, se procedió a un análisis de tipo interpretativo para generar conceptos y relaciones que configuran hipótesis plausibles sobre las significaciones que circulan en el universo simbólico adolescente. RESULTADOS: Existen diferencias en los significados que tienen los varones y las mujeres sobre la sexualidad, la forma en que los construyen y los agentes que contribuyen a su conformación. Estos hallazgos suponen articulaciones distintas en relación con los riesgos en salud sexual y reproductiva CONCLUSIONES: La construcción cultural que se hace de la diferencia sexual -el género- marca los significados que se dan a la sexualidad en los grupos estudiados y establece formas de interactuar con su entorno social. Las mujeres relacionan la sexualidad con el ejercicio reproductivo y la viven como una experiencia negativa. Para los varones existe la posibilidad positiva y placentera de la sexualidad, enmarcada en un contexto que los impulsa a tener relaciones sexuales como forma de sustentar su masculinidad.

OBJECTIVE: To describe and understand the meanings that adolescents give to sexuality and how they are created and influence adolescents' reproductive health and sexual practices. MATERIAL AND METHODS: The research was conducted in three different regions within Bogotá city. Twenty focus groups were selected and 20 life stories of boys and girls between 10 and 14 years old were transcribed. From inductive and deductive categorization of the transcripts of the oral histories, an interpretative analysis was carried out in order to generate concepts and relations that comprise plausible hypotheses about the meanings that circulate in the adolescents' symbolic universe. RESULTS: There are notable differences between the meanings that boys and girls give to sexuality, the ways in which such meanings are created, and the factors that contribute to its configuration. These findings imply dissimilar constructions related with reproductive and sexual health risks. CONCLUSIONS: The cultural constructions resulting from sexual differences that is, gender suggest the meanings that are given to sexuality in the groups studied and define ways of interacting with the social environment. Girls relate sexuality with reproduction and they experience it as negative. For boys, the possibility of a positive and pleasant experience of sexuality exists, marked by a context that encourages having sexual relations as a way of maintaining manhood.