RESUMO
INTRODUCCION: Las políticas de salud sexual y reproductiva (SSR) deben tener en cuenta la anticoncepción quirúrgica (AQ) y la accesibilidad a la SSR de mujeres lesbianas y bisexuales. Estos dos temas ponen en agenda cuestiones de sexualidad no reproductiva.OBJETIVO: Analizar estas dos cuestiones emergentes para conocer la accesibilidad: a) de mujeres y varones a la AQ (ligadura de trompas y vasectomía), b) de mujeres no heterosexuales a la SSR. Conocer las experiencias de usuarios y profesionales, investigar cómo y en qué medida favorecen u obstaculizan la accesibilidad las concepciones de sexualidad, género, ideológico-políticas, éticas y religiosas, y relevar factores que afectan la accesibilidad.METODOS: El estudio se realizó en áreas urbanas de Buenos Aires y Mendoza, con un diseño exploratorio-descriptivo y un enfoque cualitativo basado en entrevistas a usuarios, profesionales y referentes.RESULTADOS: Se verificaron barreras para la ligadura y vasectomía: aplicación incompleta de la ley, trabas implícitas, privilegio de determinados perfiles de mujeres (multíparas, con riesgo alto para la salud frente a un nuevo embarazo, etc.), falta de asesoramiento, falta de integración de los servicios de urología con los programas de SSR, valores de género rígidos y mitos sobre femineidad y virilidad relacionados con la inhabilitación a la procreación de modo permanente. Se verificaron barreras para el acceso de lesbianas y mujeres bisexuales, relacionadas con la heteronormatividad imperante en el sistema de salud y con ideas y presupuestos por parte de las mujeres en relación con el cuidado de su salud y los vínculos en materia de prevención y atención dentro del sistema.CONCLUSIONES: Los presupuestos heteronormativos, que privilegian la inseparabilidad entre sexualidad y reproducción, obstaculizan la accesibilidad a la SSR cuando los métodos rompen de manera permanente con la posibilidad de procrear o cuando la sexualidad es per se no reproductiva.
INTRODUCTION: Policies on sexual and reproductive health (SRH) should take into account surgical contraception and accessibility to SRH for lesbians and bisexual women.OBJECTIVE: To study the accessibility: a) of women and men to surgical contraception, b) of non-heterosexual women to SRH, within the frame of these two emerging issues. The study also aimed to describe the experiences of users and professionals, to analyze how and to what extent conceptions of sexuality, gender, ethics, politics and religion favor or hinder accessibility, and to identify factors influencing accessibility.METHODS: The study was conducted in urban areas of Buenos Aires and Mendoza. The exploratory-descriptive design followed a qualitative approach, based on in-depth interviews to users, professionals and officers.RESULTS: The study identified barriers to female and male surgical contraception: incomplete implementation of law, implicit obstacles, privilege for certain profiles of women (with multiple children, high risk, etc.), lack of counseling, lack of integration of urology services to SRH, rigid gender values and myths about feminity and virility related with permanent contraceptive methods. The study also showed barriers for lesbians and bisexual women. They were related to heteronormative values and practices prevailing within the health system, and to ideas and presuppositions of these women about self-care and reproductive health prevention/care.CONCLUSIONS: The heteronormative values, which claim there is no separation between sexuality and reproduction, hinder accessibility when contraceptive methods are permanent and when sexuality is per se non-reproductive.
Assuntos
Homossexualidade Feminina , Saúde Reprodutiva , Esterilização Tubária , Vasectomia , Acessibilidade aos Serviços de Saúde , Argentina , Saúde PúblicaRESUMO
INTRODUCCION: Las políticas de salud sexual y reproductiva (SSR) deben tener en cuenta la anticoncepción quirúrgica (AQ) y la accesibilidad a la SSR de mujeres lesbianas y bisexuales. Estos dos temas ponen en agenda cuestiones de sexualidad no reproductiva.OBJETIVO: Analizar estas dos cuestiones emergentes para conocer la accesibilidad: a) de mujeres y varones a la AQ (ligadura de trompas y vasectomía), b) de mujeres no heterosexuales a la SSR. Conocer las experiencias de usuarios y profesionales, investigar cómo y en qué medida favorecen u obstaculizan la accesibilidad las concepciones de sexualidad, género, ideológico-políticas, éticas y religiosas, y relevar factores que afectan la accesibilidad.METODOS: El estudio se realizó en áreas urbanas de Buenos Aires y Mendoza, con un diseño exploratorio-descriptivo y un enfoque cualitativo basado en entrevistas a usuarios, profesionales y referentes.RESULTADOS: Se verificaron barreras para la ligadura y vasectomía: aplicación incompleta de la ley, trabas implícitas, privilegio de determinados perfiles de mujeres (multíparas, con riesgo alto para la salud frente a un nuevo embarazo, etc.), falta de asesoramiento, falta de integración de los servicios de urología con los programas de SSR, valores de género rígidos y mitos sobre femineidad y virilidad relacionados con la inhabilitación a la procreación de modo permanente. Se verificaron barreras para el acceso de lesbianas y mujeres bisexuales, relacionadas con la heteronormatividad imperante en el sistema de salud y con ideas y presupuestos por parte de las mujeres en relación con el cuidado de su salud y los vínculos en materia de prevención y atención dentro del sistema.CONCLUSIONES: Los presupuestos heteronormativos, que privilegian la inseparabilidad entre sexualidad y reproducción, obstaculizan la accesibilidad a la SSR cuando los métodos rompen de manera permanente con la posibilidad de procrear o cuando la sexualidad es per se no reproductiva.
INTRODUCTION: Policies on sexual and reproductive health (SRH) should take into account surgical contraception and accessibility to SRH for lesbians and bisexual women.OBJECTIVE: To study the accessibility: a) of women and men to surgical contraception, b) of non-heterosexual women to SRH, within the frame of these two emerging issues. The study also aimed to describe the experiences of users and professionals, to analyze how and to what extent conceptions of sexuality, gender, ethics, politics and religion favor or hinder accessibility, and to identify factors influencing accessibility.METHODS: The study was conducted in urban areas of Buenos Aires and Mendoza. The exploratory-descriptive design followed a qualitative approach, based on in-depth interviews to users, professionals and officers.RESULTS: The study identified barriers to female and male surgical contraception: incomplete implementation of law, implicit obstacles, privilege for certain profiles of women (with multiple children, high risk, etc.), lack of counseling, lack of integration of urology services to SRH, rigid gender values and myths about feminity and virility related with permanent contraceptive methods. The study also showed barriers for lesbians and bisexual women. They were related to heteronormative values and practices prevailing within the health system, and to ideas and presuppositions of these women about self-care and reproductive health prevention/care.CONCLUSIONS: The heteronormative values, which claim there is no separation between sexuality and reproduction, hinder accessibility when contraceptive methods are permanent and when sexuality is per se non-reproductive.
Assuntos
Acessibilidade aos Serviços de Saúde , Esterilização Tubária , Homossexualidade Feminina , Saúde Reprodutiva , Vasectomia , Argentina , Saúde PúblicaRESUMO
This article focuses on the contraceptive and reproductive experiences and needs of people living with HIV and on public health services' responses to them in Argentina. Data collected through a national survey amongst people living with HIV (N=841) and semi-structured interviews (N=89) explored the perspectives of both health-care users and HIV/AIDS program coordinators and providers. The survey revealed that 55% of women and 30% of men had had children after their HIV diagnosis and that half of those pregnancies had been unintended. At the time of the survey in 2006, 73% of men and 64% of women did not want a (new) pregnancy. The vast majority report systematic condom use, but acknowledge difficulties complying with this recommendation. Dual protection (i.e., condom use plus another method) is low among those who do not want children or another pregnancy (8% of women and 9% of men reported using it). Mostly women and heterosexual men without children either expressed their wish or were seeking to be parents. Institutional and cultural barriers to friendly and/or effective contraceptive and reproductive counselling were identified. Most physicians encourage only condom use while a minority refers patients to family planning providers or talk with them about contraception. A lack of updated information about interactions between antiretroviral drugs and hormonal contraception and/or intrauterine devices was not infrequent among providers. Users reported having being discouraged or blamed by health professionals when they revealed they wanted to have (or were expecting) a baby. Professionals and program directors' attitudes regarding reproduction range from not acknowledging people's wishes, to providing useful information or referral. Whether wanted or unexpected, parenthood is a challenge for many of the people living with HIV. Social and biomedical responses still need to be refined in order to fully respect people's rights and succeed in preventing (re)infection as well as unwanted pregnancies. Drawing on study results, recommendations to enhance the provision of adequate information and services to help people prevent unwanted pregnancies or reproduce as safely as possible are discussed.
