Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review.

PROBLEM: Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises. BACKGROUND: Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances. AIM: To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care. STUDY METHODS: Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework. FINDINGS: We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice. CONCLUSION: The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review.

OBJECTIVES: The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. METHODS: Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). SYNTHESIS: Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. CONCLUSIONS: Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.

Global impacts of COVID-19 pandemic on sexual and reproductive health services: An international comparative study on primary care from the INTRePID Consortium.

OBJECTIVE: To understand how the COVID-19 pandemic has impacted sexual and reproductive health (SRH) visits. DESIGN: An ecological study comparing SRH services volume in different countries before and after the onset of the COVID-19 pandemic. SETTING: Seven countries from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) across four continents. POPULATION: Over 3.8 million SRH visits to primary care physicians in Australia, China, Canada, Norway, Singapore, Sweden and the USA. METHODS: Difference in average SRH monthly visits before and during the pandemic, with negative binomial regression modelling to compare predicted and observed number of visits during the pandemic for SRH visits. MAIN OUTCOME MEASURES: Monthly number of visits to primary care physicians from 2018 to 2021. RESULTS: During the pandemic, the average volume of monthly SRH visits increased in Canada (15.6%, 99% CI 8.1-23.0%) where virtual care was pronounced. China, Singapore, Sweden and the USA experienced a decline (-56.5%, 99% CI -74.5 to -38.5%; -22.7%, 99% CI -38.8 to -6.5%; -19.4%, 99% CI -28.3 to -10.6%; and -22.7%, 99% CI -38.8 to -6.5%, respectively); while Australia and Norway showed insignificant changes (6.5%, 99% CI -0.7 to -13.8% and 1.7%, 99% CI -6.4 to -9.8%). The countries that maintained (Australia, Norway) or surpassed (Canada) pre-pandemic visit rates had the greatest use of virtual care. CONCLUSIONS: In-person SRH visits to primary care decreased during the pandemic. Virtual care seemed to counterbalance that decline. Although cervical cancer screening appeared insensitive to virtual care, strategies such as incorporating self-collected samples for HPV testing may provide a solution in a future pandemic.

Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador

[ABSTRACT]. Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification docu- ments (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrim- ination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

[RESUMEN]. Objetivos. Describir las perspectivas de los prestadores de atención de salud sobre los obstáculos, las brechas y las oportunidades que registraron las mujeres migrantes venezolanas para acceder a los servicios de salud sexual y reproductiva (SSR) durante la pandemia de COVID-19 y cómo se vieron afectados estos servicios en Quito (Ecuador). Métodos. Se encuestó a prestadores de atención de salud que trabajan en servicios de SSR en nueve centros de salud pública de tres zonas de Quito. Se utilizó una adaptación de la encuesta sobre el instrumento de evalu- ación de la disposición operativa del paquete de servicios iniciales mínimos, disponible en el Grupo de Trabajo Interinstitucional sobre Salud Reproductiva en Situaciones de Crisis, para la recopilación de datos en Ecuador. Resultados. De las 297 personas encuestadas, 227 quedaron incluidas en el análisis. Solo el 16% de los prestadores de atención de salud estaba de acuerdo en que en el sistema de salud había discriminación con- tra las mujeres migrantes venezolanas. De estos, solo el 2,3% describió circunstancias específicas asociadas a la discriminación, como la exigencia de documentos de identidad (7,5%) y la falta de empatía o capacidad de respuesta (6,6%). La mayoría (65,2%) de las personas encuestadas manifestó que la pandemia de COVID- 19 había impactado en el uso de los servicios de SSR por parte de las mujeres de la población general y, en mayor medida, por parte de las mujeres migrantes venezolanas (56,3%) debido a sus limitaciones para acceder a los servicios de SSR, su pobreza y su vulnerabilidad. No hubo diferencias en las percepciones según el nivel de los centros de salud, excepto con respecto a la falta de insumos, la concientización sobre la discriminación y la creencia de que estas mujeres se vieron más afectadas que la población local. Conclusión. La percepción en los prestadores de atención de salud en Quito fue que, pese a ser un fenómeno que afectaba al sistema de atención de salud, la discriminación había sido poco frecuente durante la pan- demia de COVID-19. Sin embargo, se reconoció cierto nivel de discriminación hacia las mujeres migrantes venezolanas que solicitaban servicios de SSR y que este fenómeno podría estar subrepresentado.

[RESUMO]. Objetivos. Descrever as perspectivas dos profissionais de saúde sobre as barreiras, lacunas e oportunidades que as mulheres migrantes venezuelanas encontraram para acessar serviços de saúde sexual e reprodutiva (SSR) durante a pandemia de COVID-19 e como esses serviços foram afetados em Quito, Equador. Métodos. Foram entrevistados profissionais de saúde envolvidos nos serviços de SSR de nove unidades públicas de saúde de três zonas de Quito. Adaptou-se o questionário de avaliação da prontidão para oferecer o pacote de serviço inicial mínimo, disponibilizado pelo grupo de trabalho interagencial sobre saúde reprodu- tiva em situações de crise, a fim de realizar a coleta de dados no Equador. Resultados. Dos 297 respondentes, 227 foram incluídos na análise. Apenas 16% dos profissionais de saúde concordaram que havia discriminação contra mulheres migrantes venezuelanas no sistema de saúde. Desses, apenas 2,3% descreveram condições específicas associadas à discriminação, como cobrança de documen- tos de identificação (7,5%) e falta de empatia ou responsividade (6,6%). A maioria (65,2%) dos respondentes relatou que a pandemia de COVID-19 afetou o uso dos serviços de SSR por mulheres na população de modo geral. As mulheres migrantes venezuelanas foram mais afetadas (56,3%) devido ao acesso limitado a serviços de SSR e à pobreza e vulnerabilidade. Não houve diferenças de percepção entre diferentes níveis de atenção à saúde, exceto no que diz respeito à falta de insumos, sensibilização para a discriminação e crença de que as mulheres migrantes venezuelanas foram afetadas de forma mais negativa que a população local. Conclusão. Para os profissionais de saúde em Quito, a discriminação foi pouco frequente durante a pandemia de COVID-19, embora a pandemia tenha afetado o sistema de saúde. Entretanto, os profissionais reconhece- ram certo nível de discriminação contra as mulheres migrantes venezuelanas que procuram serviços de SSR, que pode estar sub-representado.

Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador / Perspectivas de los prestadores de atención de salud sobre las dificultades de acceso a los servicios de salud sexual y reproductiva de las mujeres migrantes venezolanas durante la pandemia de COVID-19 en Quito (Ecuador) / Perspectivas dos profissionais de saúde sobre as dificuldades de acesso aos serviços de saúde sexual e reprodutiva das mulheres migrantes venezuelanas durante a pandemia de COVID-19 em Quito, Equador

ABSTRACT Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

RESUMEN Objetivos. Describir las perspectivas de los prestadores de atención de salud sobre los obstáculos, las brechas y las oportunidades que registraron las mujeres migrantes venezolanas para acceder a los servicios de salud sexual y reproductiva (SSR) durante la pandemia de COVID-19 y cómo se vieron afectados estos servicios en Quito (Ecuador). Métodos. Se encuestó a prestadores de atención de salud que trabajan en servicios de SSR en nueve centros de salud pública de tres zonas de Quito. Se utilizó una adaptación de la encuesta sobre el instrumento de evaluación de la disposición operativa del paquete de servicios iniciales mínimos, disponible en el Grupo de Trabajo Interinstitucional sobre Salud Reproductiva en Situaciones de Crisis, para la recopilación de datos en Ecuador. Resultados. De las 297 personas encuestadas, 227 quedaron incluidas en el análisis. Solo el 16% de los prestadores de atención de salud estaba de acuerdo en que en el sistema de salud había discriminación contra las mujeres migrantes venezolanas. De estos, solo el 2,3% describió circunstancias específicas asociadas a la discriminación, como la exigencia de documentos de identidad (7,5%) y la falta de empatía o capacidad de respuesta (6,6%). La mayoría (65,2%) de las personas encuestadas manifestó que la pandemia de COVID-19 había impactado en el uso de los servicios de SSR por parte de las mujeres de la población general y, en mayor medida, por parte de las mujeres migrantes venezolanas (56,3%) debido a sus limitaciones para acceder a los servicios de SSR, su pobreza y su vulnerabilidad. No hubo diferencias en las percepciones según el nivel de los centros de salud, excepto con respecto a la falta de insumos, la concientización sobre la discriminación y la creencia de que estas mujeres se vieron más afectadas que la población local. Conclusión. La percepción en los prestadores de atención de salud en Quito fue que, pese a ser un fenómeno que afectaba al sistema de atención de salud, la discriminación había sido poco frecuente durante la pandemia de COVID-19. Sin embargo, se reconoció cierto nivel de discriminación hacia las mujeres migrantes venezolanas que solicitaban servicios de SSR y que este fenómeno podría estar subrepresentado.

RESUMO Objetivos. Descrever as perspectivas dos profissionais de saúde sobre as barreiras, lacunas e oportunidades que as mulheres migrantes venezuelanas encontraram para acessar serviços de saúde sexual e reprodutiva (SSR) durante a pandemia de COVID-19 e como esses serviços foram afetados em Quito, Equador. Métodos. Foram entrevistados profissionais de saúde envolvidos nos serviços de SSR de nove unidades públicas de saúde de três zonas de Quito. Adaptou-se o questionário de avaliação da prontidão para oferecer o pacote de serviço inicial mínimo, disponibilizado pelo grupo de trabalho interagencial sobre saúde reprodutiva em situações de crise, a fim de realizar a coleta de dados no Equador. Resultados. Dos 297 respondentes, 227 foram incluídos na análise. Apenas 16% dos profissionais de saúde concordaram que havia discriminação contra mulheres migrantes venezuelanas no sistema de saúde. Desses, apenas 2,3% descreveram condições específicas associadas à discriminação, como cobrança de documentos de identificação (7,5%) e falta de empatia ou responsividade (6,6%). A maioria (65,2%) dos respondentes relatou que a pandemia de COVID-19 afetou o uso dos serviços de SSR por mulheres na população de modo geral. As mulheres migrantes venezuelanas foram mais afetadas (56,3%) devido ao acesso limitado a serviços de SSR e à pobreza e vulnerabilidade. Não houve diferenças de percepção entre diferentes níveis de atenção à saúde, exceto no que diz respeito à falta de insumos, sensibilização para a discriminação e crença de que as mulheres migrantes venezuelanas foram afetadas de forma mais negativa que a população local. Conclusão. Para os profissionais de saúde em Quito, a discriminação foi pouco frequente durante a pandemia de COVID-19, embora a pandemia tenha afetado o sistema de saúde. Entretanto, os profissionais reconheceram certo nível de discriminação contra as mulheres migrantes venezuelanas que procuram serviços de SSR, que pode estar sub-representado.

Escola sem partido e conservadorismo moral: instrumentalização da religião, sexualidade e gênero / School without party and moral conservatism: the instrumentalization of religion, sexuality and gender / Escuela sin partido y conservadurismo moral: la instrumentalización de la religión, sexualidad y género

Este artigo tem por objetivo identificar e discutir alguns estratagemas psicológicos utilizados por movimentos conservadores e autoritários recentemente difundidos no Brasil - em especial, pelo Movimento Escola sem Partido -, em relação a temas como sexualidade e gênero, que atualmente foram incluídos como essenciais à formação escolar. Com esse propósito, empenhamo-nos em compreender a perspectiva cultural em que se apoiam e o modo como a articulam, ideologicamente, para inviabilizar o debate sobre eles. A partir da análise dos Projetos de Lei 246/2019 e 1859/2015, identificamos estratégias conservadoras que, autoritariamente, deslegitimam sua inclusão na formação escolar. Dentre elas, pareceu-nos urgente investigar a instrumentalização da religião, pois favorece a subordinação da crença religiosa, sobretudo associada ao conservadorismo moral imbricado na tradição cristã brasileira, ao discurso político autoritário. Assim como os movimentos fascistas que, nos Estados Unidos da década de 1930, reivindicavam um ordenamento autoritário e opressor da sociedade por meio do apelo a conteúdos religiosos instrumentalizados para esse fim, atualmente, o discurso religioso também é utilizado como forma de suscitar adesão ao conservadorismo social e político e de justificar preconceitos arraigados. Constatamos que a instrumentalização da religião é uma forma de justificar a permanência de valores conservadores na escola e na sociedade, bem como de reiterar o modelo de família heterossexual monogâmica e a ordem patriarcal. Por meio de estratagemas como esses, os movimentos conservadores e autoritários, articulados em função da negação da diversidade sexual e de gênero, impedem que a escola se constitua como espaço democrático e diverso.(AU)

This paper identifies and discusses the psychological ploys employed by recent conservative and authoritarian movements in Brazil, particularly the School without Party movement, against topics like sexuality and gender, which are currently included as essential to school education. To do so, we sought to understand their cultural basis and how they are ideologically articulated to prevent school debate around these topics. By analyzing Bills 246/2019 and 1859/2015, we identified some conservative strategies that authoritatively delegitimize their inclusion in school education. Chief among them is the instrumentalization of religion, since it favors subordinating religious belief, mainly associated with traditional Christian moral conservatism, to authoritarian political discourse. Similar to the fascist movements in the 1930s United States that claimed an authoritarian and oppressive ordering of society by appealing to religious content, religious speech is currently instrumentalized to encourage social and political conservatism adherence and to justify deep-seated prejudices. Religion instrumentalization is used to justify upholding conservative values at school and in society, as well as to reiterate the monogamous heterosexual family model and patriarchy. Through such ploys, authoritarian and conservative movements, articulated around denying sexual and gender diversity, prevent the school from becoming a democratic and diverse environment.(AU)

Este artículo tiene por objetivo identificar y discutir algunas de las estratagemas psicológicas que utilizan los movimientos conservadores y autoritarios, difundidas recientemente en Brasil, en particular por el Movimiento Escuela sin Partido, con relación a temas como sexualidad y género, que actualmente se incluyeron en la formación escolar. Con este propósito, se pretende comprender la base cultural en la que se han apoyado y cómo la articulan ideológicamente para hacer inviable el debate sobre ellas. A partir de análisis de los Proyectos de Ley 246/2019 y 1859/2015, se identificaron estrategias conservadoras que, autoritariamente, deslegitiman la inclusión de estos temas en la formación escolar. Entre ellas, parece urgente analizar la instrumentalización de la religión, porque favorece la subordinación de la creencia religiosa al discurso político autoritario, sobre todo asociada al conservadurismo moral presente en las vertientes del cristianismo brasileño. Al igual que los movimientos fascistas en los Estados Unidos en los años 1930 que reivindicaban una planificación autoritaria de la sociedad mediante un llamado a contenidos religiosos instrumentalizados, actualmente se utiliza el discurso religioso como forma de promover la adhesión al conservadurismo social y político y de justificar los prejuicios. Se constata que la instrumentalización de la religión es un modo de justificar la permanencia de valores conservadores en la escuela, así como de confirmar el modelo de familia heterosexual monógama y el orden patriarcal. Estos estratagemas que son utilizados por los movimientos conservadores y autoritarios, articulados en función de la negación de la diversidad sexual y de género, impiden que la escuela sea democrática y diversa.(AU)

Reflexiones acerca del desempeño del ministro de Salud de Colombia en el manejo de la pandemia de COVID-19, la salud sexual y reproductiva, y la salud pública / Reflections on the performance of the Colombian Minister of Health regarding the management of the COVID-19 pandemic, sexual and reproductive health and public health

Objetivos: hacer una evaluación crítica de la gestión del ministro de Salud en ejercicio al terminar el gobierno de Iván Duque en el manejo de la pandemia, la salud sexual y reproductiva, y la salud pública en Colombia. Materiales y métodos: a partir de la descripción de situaciones problemáticas enfrentadas en ese periodo se presenta evidencia sobre los resultados de la gestión que, sumados a la opinión del autor, proveen un balance de la gestión realizada. Conclusiones: la gestión del ministro de Salud fue deficiente en el manejo de la pandemia y, en especial, en su atención a la salud sexual y reproductiva, y la salud pública.

Objectives: To offer a critical assessment of the incumbent Health Minister's performance at the end of the Ivan Duque administration regarding the management of the pandemic, sexual and reproductive health, and public health in Colombia. Material and methods: Based on the description of challenges faced during this time period, we present evidence regarding performance results which, together with the author's opinion, offer an assessment of the work done. Conclusions: The Health Minister's performance in managing the pandemic fell short, in particular as concerns sexual and reproductive health, as well as public health.

Incorporando la bioética ambiental a los cuidados materno-perinatales para disminuir los riesgos de la pan-sindemia en el proceso reproductivo / Incorporating environmental bioethics to maternal perinatal care to reduce the risks of pan-syndemic in the reproductive process / Incorporando a bioética ambiental ao cuidado perinatal materno para reduzir os riscos de pan-sindemia no processo reprodutivo

Antecedentes: Hasta el momento actual, el abordaje bioético de los cuidados materno-perinatales se proyecta desde la visión integral de la salud bio - psico - social, la perspectiva de derechos humanos y el enfoque de género. En general, no se ha incorporado a los cuidados materno-perinatales la bioética ambiental, que surge de la perspectiva de la salud ambiental; integrando la ética global, la perspectiva de la consiliencia, el derecho al ambiente saludable y la ética ambiental. La actual situación de crisis global por la combinación de la Pandemia COVID 19 y la Sindemia Global, que caracterizaremos como Pan-sindemia, incrementa los riesgos y daños en el proceso reproductivo, sobre todo en las poblaciones vulneradas en sus derechos. Justificación: Es necesario minimizar el efecto de la Pan-sindemia en el proceso reproductivo. En la agenda global, la humanidad debe revertir las causas que provocan la Pan-sindemia. Mientras tanto, los profesionales y equipos de salud deben reformular su rol a la hora de los cuidados materno-perinatales, incorporando a la clínica el derecho a un ambiente saludable para la reproducción. Perspectivas: Las modificaciones en la práctica clínica de los equipos de salud sexual y reproductiva deben orientarse a: - incorporar la bioética ambiental a los cuidados materno-perinatales desde la formación hasta la práctica clínica - desarrollar un abordaje integral de los grandes síndromes obstétricos perinatales, la prematurez y la restricción de crecimiento, para minimizar el impacto de la Pan-sindemia en el proceso reproductivo humano.

Background: Until now, the bioethical approach to maternal perinatal care is projected from the integral vision of bio-psycho-social health, the perspective of Human Rights and the gender perspective. In general, environmental bioethics, which arises from the perspective of environmental health has not been incorporated into maternal-perinatal care with global ethics, the perspective of consilience, the right to a healthy environment and environmental ethics. The current global crisis situation due to the combination of the COVID 19 Pandemic and the Global Syndemic, characterized as Pan Syndemic, increases the risks and damages in the reproductive process, especially in populations violated in their rights. Justification: It is necessary to minimize the effect of the Pan Syndemic on the human reproductive process. On the global agenda, humanity must reverse the causes of the Pan Syndemic. Meanwhile, health professionals and teams must reformulate their role when it comes to maternal-perinatal care, incorporating into the clinic the right to a healthy environment for reproduction. Perspectives: Modifications in the clinical practice of sexual and reproductive health teams should be aimed at: incorporate environmental bioethics into maternal perinatal care from training to clinical practice; develop a comprehensive approach to major perinatal obstetric syndromes, prematurity and fetal growth restriction, to minimize the impact of the Pan Syndemic on the human reproductive process.

Até o momento, a abordagem bioética da atenção materna perinatal se projeta a partir da visão integral da saúde biopsicossocial, da perspectiva dos direitos humanos e da perspectiva de gênero. De modo geral, a bioética ambiental não foi incorporada à assistência materno-perinatal que surge na perspectiva da saúde ambiental; integrando a ética global, a perspectiva da consiliência, o direito ao ambiente saudável e a ética ambiental. A atual situação de crise global devido à combinação da Pandemia COVID 19 e da Sindemia Global, que caracterizaremos como Pan-sindêmica, aumenta os riscos e danos no processo reprodutivo, especialmente em populações cujos direitos são violados. Justificação: É necessário minimizar o efeito da Pan-sindemia no processo reprodutivo. Na agenda global, a humanidade deve reverter as causas que causam a Pan-sindemia. Nesse ínterim, os profissionais e equipes de saúde devem reformular seu papel no que se refere à assistência materno-perinatal, incorporando à clínica o direito a um ambiente saudável para a reprodução. Panorama: As modificações na prática clínica das equipes de saúde sexual e reprodutiva devem ter como objetivo: - incorporar a bioética ambiental ao cuidado perinatal materno, desde o treinamento até a prática clínica - desenvolver uma abordagem abrangente para as principais síndromes obstétricas perinatais, prematuridade e restrição de crescimento, para minimizar o impacto da Pan-sindemia no processo reprodutivo humano.

Disruptions to the procurement of medical abortion medicines during COVID-19: a scoping review.

OBJECTIVES: This scoping review aimed to systematically search, retrieve and map the extent and characteristics of available literature on the evidenced disruptions to medical abortion (MA) medicine procurement caused by the COVID-19 outbreak. DESIGN: Scoping review using Arksey and O'Malley's methodology and Levac et al's methodological enhancement with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. DATA SOURCES: PubMed, Embase, PMC, Science Direct, the Cochrane Library and Google Scholar were searched from January 2020 to April 2022. ELIGIBILITY CRITERIA: We included articles in English that: (1) contained information on MA medicines; (2) included descriptions of procurement disruptions, including those with examples, characteristics and/or statistics; (3) documented events during the COVID-19 pandemic; and (4) presented primary data. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened search results, performed a full-text review of preliminarily included articles and completed data extraction in a standard Excel spreadsheet. Extracted data from was compared for validation and synthesised qualitatively. RESULTS: The two articles included are unpublished grey literature demonstrating evidence of short-lived disruptions in sexual and reproductive health commodity procurement, including MA medicines, in sub-Saharan Africa during the early months of the pandemic. Findings from the two included grey literature articles show that in sub-Saharan contexts, emergency preparedness, stockpiling, adaptations and flexibility of key actors, including donors, alleviated COVID-19 disruptions allowing for resumption of services within weeks. CONCLUSION: There is a need for increased empirical evidence of MA procurement challenges to understand which barriers to MA procurement may persist and impact continuity of supply while others can fuel resilience and preparedness efforts at the country and subregional levels. The lack of evidence from social marketing organisations and their networks is a significant gap as these actors constitute a vital artery in the distribution of MA commodities in low-income and middle-income countries.

Systematization of initiatives in sexual and reproductive health about good practices criteria in response to the COVID-19 pandemic in primary health care in Chile.

Introduction The COVID- 19 pandemic discontinued sexual and reproductive health care in Chile and the world. The national focus on hospital care led primary care teams to respond in natural and diverse ways. Understanding the factors involved in this process may improve future responses from the judgment of good practices. Therefore, this study aimed to identify and systematize sexual and reproductive health initiatives raised by primary care teams in response to the COVID- 19 pandemic in Chile. Methods We systematically evaluated initiatives and practices in sexual and reproductive health in prima-ry care between June 2020 and November 2021. This study was developed in three methodological phases: a review of documents, a collection of experiences through an electronic instrument sent to the 29 health services in Chile, and in-depth interviews. According to best practice criteria, mapping and characterizing the initiatives and critical discourse analysis of narratives and interviews were carried out. Results Forty-one initiatives from 19 health services were identified, mainly from the South Central macro zone and urban areas. In these areas, care was recognized. These practices were relevant, aligned with their objectives, rapidly implemented, and used novel strategies through new technologies. However, these initiatives had little intercultural relevance or evaluation. Perceived success was related to motivation, leadership, and institutional and community resilience. The adaptability of initiatives emerged as a new need and criterion of analysis. Conclusion The lessons learned from these initiatives invite us to consider health care teams' mental health, their relationship with the community, the use of new technologies, the evaluation of practices considering satisfaction, cross- cutting approaches, and their adaptability. In all, these aspects may improve primary care response in sexual and reproductive health to new crises.

Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.

Sistematización de iniciativas en salud sexual y reproductiva según criterios de buenas prácticas en repuesta a la pandemia COVID-19 en la atención primaria en Chile / Systematization of initiatives in sexual and reproductive health about good practices criteria in response to the COVID-19 pandemic in primary health care in Chile

Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.

Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.

Access to contraception during the Covid-19 pandemic: barriers and perspectives / Acesso à contracepção durante a pandemia de Covid-19: barreiras e perspectivas

Abstract Background The SARS-CoV-2 pandemic, which started in December 2019, was declared by the World Health Organization (WHO) as an international public health emergency in January 2020, with an impact on access to sexual and reproductive health services for women. Objective To discuss contraception in the pandemic context, based on current public policies and the world and Brazilian scenario. Method This is an opinion article, which describes the barriers and possible solutions for access to qualified sexual and reproductive health care for women. Results Relevant topics were explored, such as: the change in the logistics of services, the reduction in the number of consultations, the difficulty in importing contraceptives, the lack of trained professionals, and the bureaucratization of access to contraceptives methods. The use of telemedicine and the strengthening of Primary Health Care are considered strategies to guarantee access and change the reality of women. Conclusion In this context, it is necessary to maintain the actions of sexual and reproductive planning services to prevent injuries from unplanned pregnancies and increase maternal morbidity and mortality.

Resumo Introdução A pandemia por SARS-CoV-2, iniciada em dezembro de 2019, foi declarada pela Organização Mundial da Saúde (OMS) como emergência de saúde pública internacional em janeiro de 2020, com impacto sobre o acesso a serviços de saúde sexual e reprodutiva para as mulheres. Objetivo Discutir a contracepção no contexto pandêmico, a partir das políticas públicas vigentes e do cenário mundial e brasileiro. Método Trata-se de um artigo de opinião, onde se descreve as barreiras e possíveis soluções para o acesso à assistência de saúde sexual e reprodutiva qualificada para as mulheres. Resultados Explorou-se temas relevantes como: mudança na logística dos serviços, redução do número de consultas, dificuldade na importação de contraceptivos, falta de profissionais capacitados, burocratização do acesso a métodos contraceptivos. O uso da telemedicina e o fortalecimento da Atenção Primária à Saúde são consideradas estratégias para garantia do acesso e modificação da realidade das mulheres. Conclusão Faz-se necessário nesse contexto, a manutenção das ações dos serviços de planejamento sexual e reprodutivo para prevenir agravos provenientes de gestações não planejadas e aumento na morbimortalidade materna.

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa

Objectives: To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. Design: A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. Setting: The Economic Community of West African States (ECOWAS). Participants: Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Interventions: Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. Results: The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. Conclusions: This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.

Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde / Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care

SILVEIRA, L. M. Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde. 2022. 96p. Dissertação (Mestrado em Enfermagem) - Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, 2022. Introdução: A contracepção após o parto é estratégia essencial para prevenir gestações não planejadas e garantir o intervalo interpartal recomendado, visto que engravidar em um espaço de tempo menor do que 12 meses aumenta os riscos maternos, neonatais e infantis. Sabe-se ainda que características sociodemográficas e assistenciais podem influenciar o início precoce ou tardio de métodos contraceptivos (MC) após o parto. Objetivos: Verificar se as características sociodemográficas e assistenciais estão associadas ao tempo até o início do uso de contraceptivos no primeiro ano após o parto em usuárias da Atenção Primária à Saúde. Metodologia: Estudo longitudinal, do tipo coorte prospectiva, de gestantes e puérperas cuja linha de base foi aninhada a um projeto multicêntrico de abrangência nacional e Belo Horizonte foi um centro colaborador. Contou com amostra de 236 mulheres na linha de base, 108 na primeira onda e 68 na segunda onda. As entrevistas da linha de base foram realizadas presencialmente com as gestantes. As entrevistas da linha de base foram interrompidas devido à pandemia de COVID-19. O seguimento deu-se por meio de ligações telefônicas, 6 meses após o parto e 1 ano após o nascimento do bebê. Foram analisados os tipos de MC iniciados e calculado o tempo até o início dos mesmos segundo características sociodemográficas e assistenciais. A fração de mulheres que permaneceram sem usar o método contraceptivo ao longo do primeiro ano após o parto foi calculada usando a estimativa de Kaplan Meier. O teste log-rank foi utilizado para analisar se havia diferença entre os grupos (p<0,05). O Modelo de Riscos Proporcionais de Cox com cálculo do risco relativo (RR) não ajustado e ajustado e seus intervalos de 95% de confiança (IC95%) foi usado para estimar os determinantes sociodemográficos e assistenciais associados ao início do uso de métodos. Resultados: Das 108 mulheres, mais de 90% relataram utilizar algum MC, sendo o injetável o mais utilizado (25,9%), seguido das camisinhas (25,0%), das pílulas (23,2%) e do DIU (13,0%). Mais de 48% das mulheres iniciaram o uso de MC 40 dias após o parto. Ou seja, os outros 50% iniciaram após e outras nem iniciaram. A mediana do tempo até o início do MC foi: 39,5 dias (IC95%: 32,1-44). Essa mediana foi menor para mulheres com idade igual ou maior que 35 anos (12,5 dias; IC95%: 0,5-37,3), pardas/pretas (22 dias; IC95%: 4,1-54,1) e que recebiam bolsa família (33 dias; IC95%: 20,3-67,4). Observou ainda que as mulheres que iniciaram o uso de MC mais rapidamente receberam orientações na maternidade (23 dias; IC95% 7,1-42,6) ; foram atendidas por enfermeiros (32 dias; IC95%: 0,71-48,3), e realizaram mais de 6 consultas de pré-natal (33 dias; IC95%: 27,4-41,0). Após ajuste de todas as variáveis, a idade das mulheres e o número de consultas de pré-natal (PN) foram determinantes do início de uso de MC. Mulheres mais jovens (18 até 34 anos) se associaram ao início mais tardio do uso de MC e o maior número de consultas PN ao início mais rápido do uso de MC. Conclusão: Apesar da alta prevalência do uso de MC, persistem desigualdades sociodemográficas e assistenciais em relação ao tempo até o início da contracepção após o parto, como também, uma insegurança contraceptiva. Ressalta-se a necessidade de uma política de promoção do uso de MC eficazes nesse período para reduzir os desfechos adversos associados ao curto intervalo interpartal e os riscos relacionados a ocorrência de gestações pouco espaçadas. Descritores: Planejamento Familiar; Anticoncepção; Período Pós-Parto; Intervalo entre os nascimentos; Saúde da Mulher; Saúde Sexual e Reprodutiva; Enfermagem.

SILVEIRA, L. M. Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care. 2022. 96p. Dissertation (Master in Nursing) ­ School of Nursing, Federal University of Minas Gerais, Belo Horizonte, 2022. Introduction: The postpartum contraception is an essential strategy to prevent unplanned pregnancies and ensure the recommended interpregnancy interval, since becoming pregnant in a period of time of less than 12 months increases maternal, neonatal and infant risks. It is also known that sociodemographic and health assistance characteristics can influence the early or late initiation of contraceptive methods (CM) after the giving birth. Objective: To verify whether sociodemographic and assistance characteristics are associated with the time until the initiation of contraceptive use in the first year after giving birth in users of Primary Health Care service. Methods: Longitudinal, prospective cohort type of study of pregnant and postpartum women whose baseline was nested in a nationwide multicenter project and Belo Horizonte was a collaborative center. It had a sample of 236 women at baseline, 108 in the first wave and 68 in the second wave. The baseline interviews were conducted face-to-face with pregnant women. The baseline interviews were discontinued due to the COVID-19 pandemic. The follow-up was conducted through phone calls, 6 months after they gave birth and 1 year after the baby's birth. The types of CM that were initiated were analyzed, and the time until the initiation was calculated according to sociodemographic and assistance characteristics. The fraction of women who remained not using a contraceptive method throughout the first year after giving birth was calculated using Kaplan Meier estimation. The log-rank test was used to analyze if there was a difference between the groups (p<0.05). The Cox Proportional Risk Model with unadjusted and adjusted relative risk (RR) calculation and its 95% confidence intervals (95% CI) was used to estimate the sociodemographic and assistance determinants associated with the beginning of the use of methods. Results: Out of the 108 women, over 90% reported using some CM, with the injectable one being the most commonly used (25.9%), followed by condoms (25.0%), pills (23.2%) and IUD (13.0%). More than 48% of women started using CM 40 days after giving birth. This means the other 50% started after and others did not start at all. The median time to the start of CM was: 39.5 days (95%CI: 32.1-44). This average was lower for women aged 35 years or older (12.5 days; 95%CI: 0.5-37.3), brown/black (22 days; 95%CI: 4.1-54.1) and receiving family allowance (33 days; 95%CI: 20.3-67.4). It was also noted that women who started using CM more quickly received orientation at the maternity hospital (23 days; 95%CI 7.1-42.6); were seen by nurses (32 days; 95%CI: 0.71-48.3), received, and had more than 6 prenatal visits (33 days; 95%CI: 27.4-41.0). After the adjustment of all variables, women's age and the number of prenatal (PN) appointments were determinants of the beginning of CM use. Younger women (18 up to 34 years old) were associated with a later beginning of CM use, and more prenatal visits were associated with a faster beginning of CM use. Conclusion: Despite the high prevalence of CM use, sociodemographic and assistance inequalities persist regarding the time until the beginning of contraception after delivery, as well as contraceptive insecurity. We emphasize the need for a policy to promote the use of effective CM in this period to reduce the adverse outcomes associated with the short intrapartum interval and the risks related to the occurrence of poorly spaced pregnancies. Keywords: Family Planning; Contraception; Postpartum Period; Interval between births; Women's Health; Sexual and Reproductive Health; Nursing.

Eastern Mediterranean Health Journal [2021; Vol.27, Issue 12] / [المجلة الصحية لشرق المتوسط [2021; المجلد 27 , العدد 12

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

COVID-19 and inequities in the Americas: lessons learned and implications for essential health services

[ABSTRACT]. The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.

[RESUMEN]. La pandemia de COVID-19 ha acentuado las desigualdades sociales, económicas y relacionadas con la salud, que afectan desproporcionadamente a las personas en situación de vulnerabilidad. Esta población incluye grupos étnicos que se enfrentan a la discriminación y obstáculos para el acceso a la atención integral de salud. La pandemia de COVID-19 ha expuesto estas desigualdades de salud, y las interrupciones de los servicios esenciales de salud han ampliado aún más las brechas en el acceso a la atención de salud. Las enfermedades no transmisibles son más prevalentes en los grupos que han sufrido un mayor impacto de los determinantes sociales de la salud deficientes y se han asociado con una mayor probabilidad de presentar un cuadro grave de COVID-19 y una mayor mortalidad. Asimismo, se proyecta que las interrupciones en la prestación de servicios esenciales de salud para las enfermedades no transmisibles, la salud mental, las enfermedades transmisibles como la infección por el VIH, la tuberculosis y la malaria, y los servicios de salud maternoinfantil (como la salud sexual y reproductiva) incrementen los resultados deficientes en materia de salud. Otros retos son una mayor frecuencia de la violencia interpersonal y la inseguridad alimentaria. Los países de la Región de las Américas han respondido a las interrupciones causadas por la pandemia con la prestación de servicios de salud mediante la telemedicina y otras soluciones digitales, y la aceleración de las intervenciones de apoyo de los servicios sociales. A medida que la vacunación contra la COVID-19 crea la oportunidad de superar la pandemia, los países deben fortalecer su atención primaria de salud y sus servicios de salud esenciales a fin de garantizar la equidad, para que la Región logre la cobertura universal de salud en cumplimiento de los Objetivos de Desarrollo Sostenible.

[RESUMO]. A pandemia de COVID-19 exacerbou as disparidades sociais, econômicas e as relacionadas à saúde, que afetam de maneira desproporcional as pessoas que vivem em situação de vulnerabilidade. Essas populações incluem grupos étnicos que enfrentam discriminação e barreiras para o acesso à atenção integral à saúde. A pandemia de COVID-19 expôs essas disparidades, e as interrupções nos serviços essenciais de saúde ampliaram ainda mais as lacunas no acesso aos cuidados de saúde. As doenças não transmissíveis são mais prevalentes entre os grupos mais afetados por determinantes sociais da saúde deficientes e estão associadas a um aumento na probabilidade de doença grave pela COVID-19 e mortalidade mais elevada. Prevê-se que as interrupções na prestação de serviços essenciais de saúde para doenças não transmissíveis, saúde mental, doenças transmissíveis como HIV, tuberculose e malária, bem como dos serviços de saúde materno-infantil (incluindo saúde sexual e reprodutiva) também aumentem os desfechos adversos de saúde. Outros desafios são o aumento da frequência da violência interpessoal e insegurança alimentar. Os países das Américas responderam às interrupções causadas pela pandemia com a prestação de serviços de saúde por meio da telemedicina e outras soluções digitais, e a aceleração de intervenções de apoio dos serviços sociais. À medida em que a vacinação contra a COVID-19 oferece a oportunidade de superar a pandemia, os países devem fortalecer a atenção primária à saúde e os serviços essenciais de saúde com o objetivo de garantir a equidade, para que a região atinja a cobertura universal de saúde em cumprimento aos Objetivos de Desenvolvimento Sustentável.

COVID-19 and Sexual and Reproductive Health Care: Findings From Primary Care Providers Who Serve Adolescents.

PURPOSE: Among U.S. primary care physicians who delivered sexual and reproductive health (SRH) services to adolescents before the COVID-19 pandemic, we examine (1) changes in availability of in-person SRH services; (2) changes in accessibility and utilization of SRH services; and (3) use of strategies to support provision of SRH services during the pandemic. METHODS: Data were from the DocStyles provider survey administered September-October 2020. Descriptive analyses were restricted to family practitioners, internists, and pediatricians whose main work setting was outpatient and whose practice provided family planning or sexually transmitted infection services to ≥ one patient aged 15-19 years per week just before the COVID-19 pandemic (n = 791). RESULTS: Among physicians whose practices provided intrauterine device/implant placement/removal or clinic-based sexually transmitted infection testing before the COVID-19 pandemic, 51% and 36% indicated disruption of these services during the pandemic, respectively. Some physicians also reported reductions in walk-in hours (38%), evening/weekend hours (31%), and adolescents seeking care (43%) in the past month. At any point during the pandemic, 61% provided contraception initiation/continuation and 44% provided sexually transmitted infection services via telehealth. Among these physicians, about one-quarter reported confidentiality concerns with telehealth in the past month. There were small increases or no changes in other strategies to support contraceptive care. CONCLUSIONS: Findings suggest disruption of certain SRH services and issues with access because of the pandemic among primary care providers who serve adolescents. There are opportunities to enhance implementation of confidential telehealth services and other service delivery strategies that could help promote adolescent SRH in the United States.