Incorporation, adaptation and rejection of obstetric practices during the implementation of the "Adequate Childbirth Program" in Brazilian private hospitals: a qualitative study.

BACKGROUND: The "Adequate Childbirth Program" (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation. METHOD: This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software. RESULTS: The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals. CONCLUSIONS: After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it's harmful.

Brazil has high Cesarean Section (CS) rates, with rates far from the ideal recommended by the World Health Organization and a model of care that does not favor women's autonomy and empowerment. In 2015, a quality improvement project, called "Projeto Parto Adequado" (PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean section, in addition to encouraging the process of natural and safe childbirth. One of the components of this project was to reorganize the model of care in hospitals to prepare professionals for humanized and safe care. The data were collected in 8 hospitals with interviews with 49 professionals, approximately two years after the beginning of the project in the hospitals. There were changes in the hospital routine and in the care of women after the project. The professionals incorporated practices such as skin-to-skin contact and breastfeeding; diet during labor; non-invasive care technologies, especially to relieve pain during labor; birth plan; pregnancy courses with guided tours in hospitals (for pregnant women and family); and analgesia for vaginal labor. There was adaptation of existing practices in hospitals to reduce CS that had no clinical indication; better monitoring of labor, favoring vaginal delivery. And finally, the professionals rejected the practice that presses the uterine fundus, for not having shown efficacy in recent studies. We can conclude that the hospitals that participated in this study have made an effort to change their obstetric model. However, specific aspects of each hospital, the organization of the health system in Brazil, and the incentive of the local administration influenced the implementation of these changes by professionals in practice.

Process of adhesion of the Adequate Childbirth Program to improve obstetric care in private hospitals in Brazil.

BACKGROUND: In 2015, a quality improvement project called "Projeto Parto Adequado-PPA" was implemented in Brazilian private hospitals to reduce unnecessary high rates of cesarean sections. This study aimed to analyze the decision-making process of managers and care leaders to adhere to the PPA. METHODS: The Healthy Birth study is evaluative research that used mixed methods to evaluate the implementation and effects of the Adequate Childbirth Program in 12 hospitals that participated in the program. Eight out of 12 hospitals were selected for a qualitative approach. We interviewed ten managers and 24 care leaders from July to October 2017. The interviews were transcripted, and data was systematized using the MaxQda software, with Thematic Content Analysis, to identify the facilitators and barriers for adherence to the Adequate Childbirth Program. We used the conceptions of the Diffusion of Innovation as an analytical reference. RESULTS: The main reasons to adhere to the Adequate Childbirth Program were the absence of other quality improvements programs in Brazilian private services using multifaceted interventions, social and market status for participating; commitment to quality of care; and the possibility of structural reforms related to the Adequate Childbirth Program implementation. In addition, inviting hospital influencers to learn about the objectives and intentions of the project before joining was considered an important strategy to motivate hospitals. CONCLUSION: Social, cultural, and economic constructs motivated adherence. The invitation strategy used by the Adequate Childbirth Program coordination, through socially respected members in Brazil, such as doctors, was highly valued by the leaders of the hospital team and encouraged adherence to the Program.

In 2015, a quality improvement program, called the "Adequate Childbirth Program" (PPA), was recommended by the National Supplementary Health Agency so that Brazilian private hospitals could, through a change in the care model, reduce unnecessary cesarean sections and stimulate the natural and safe process in childbirth. The process of adhering to the PPA was studied in this article. Ten managers and 24 assistant leaders were interviewed in 08 private hospitals in Brazil. The main reasons for joining the PPA were the absence of other quality improvement programs; for being a program considered necessary in the country's midwifery, which could increase the prestige of hospitals in the view of women and families; for proposing an improvement in the quality of care; and for stimulating of structural and ambiance reforms. Social, cultural, and economic values motivated hospital adherence. The invitation strategy used by the PPA coordination, through socially respected members in Brazil, such as medical professionals, was highly valued by the hospital's leaders and encouraged adherence to the Program.

Care at the first postnatal hour in two hospitals of the Adequate Birth Project: qualitative analysis of experiences in two stages of the Healthy Birth research.

BACKGROUND:  The Adequate Childbirth Project (PPA) is a quality improvement project that aims to enhance normal delivery and reduce cesarean sections with no clinical indication in the Brazilian supplementary health care system. This study aims to analyze the care model of the first postpartum hour in hospitals that participated in the PPA. METHODS: Qualitative analysis based on the narrative of 102 women attended at two hospitals participating in the evaluative "Healthy Birth" research that analyzed the degree of implementation and the effects of the PPA. We assessed three practices within the first hour after delivery: skin-to-skin contact, breastfeeding and appropriate clamping of the umbilical cord. Data was collected through semi-structured interviews by telephone and submitted to thematic content analysis. RESULTS: The categories that emerged from the analysis of the results were "Dimension of time and care expressed in the lived experience" and "Interferences in care in the first hour of life". In the first category, women reported that in the first hour after delivery the newborn was placed on the mother's chest, but the length of time of the newborn's stay in skin-to-skin contact was less than one hour. This experience, even in a shorter period of time, was said to be positive by the women interviewed. Two barriers were observed: interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, both separating baby from mother without observing the duration of the "golden hour". It was identified that a process of improvement of the quality of care for childbirth is underway, with a gradual incorporation of recommended practices for care in newborn's first hour of life. CONCLUSIONS: Women reported access to the three care practices at two hospitals participating in the PPA quality improvement project. All practices were valued by women as a positive experience and should be promoted. Information during antenatal care to increase women´s autonomy, review of hospital practices to reduce barriers, and support from health care providers during the first hour after birth are needed to improve the implementation of these practices and access to their health benefits.

This study aims to analyze the care model of the first postpartum hour offered by two hospitals participating in the Adequate Childbirth Project (PPA), a quality improvement project to enhance normal delivery and reduce unnecessary cesarean sections in Brazilian private hospital. It is a qualitative analysis, based on the narrative of 102 women attended at two hospitals participating in the PPA. Categories that emerged from the analysis: "First hour; dimension of time and care expressed in the lived experience" and "Interferences in care in the first hour of life". Most women expressed a chronological time of skin-to-skin contact far from the ideal recommended in the first postpartum hour; however, they valued the experience and its meaning. Two barriers were observed in this care process: the interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, without observing the duration of the "golden hour". We can conclude that women evaluated the service positively, with indications that point to the sustainability of the PPA. Information during antenatal care to increase women´s autonomy are needed to improve the implementation of these practices and access to their health benefits.

Women's voice on changes in childbirth care practices: a qualitative approach to women's experiences in Brazilian private hospitals participating in the Adequate Childbirth Project.

BACKGROUND: In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA. METHOD: Qualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the "Healthy Birth", an evaluative hospital-based research, conducted in 2017-2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement. RESULTS: The PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced. CONCLUSIONS: Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women's voices should be listened to not only during but also before and after childbirth.

In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The Adequate Childbirth Project (PPA) is a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. A qualitative study was developed in order to understand how hospitals have included the participation of women in the PPA. Based on interviews with 102 women, the present study shows that the PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient and women are not yet included as agents of change, and their voices are silenced. Hospitals and health plan operators should create strategies to engage them. Women's voices may be listened to not only during but also before and after childbirth.

Childhood leukemia: Brazilian reality in children under fifteen years.

Leukemia is among the most prevalent cancers in children and adolescents in Brazil, affecting about 75% of children's public, especially males. Therefore, the southeast region of Brazil has a higher prevalence of cases, in which from 2019 to 2022 there were 1710 leukemia cases. In addition, the average of general notifications had higher frequency in 2021 with 1761 diagnoses, with higher emphasis on the southeast region, presenting 495 cases this year. One of the goals of public entities for 2023 is to offer better quality in diagnostic services and rapid treatment of these children, since early diagnosis increases chances of cure by 90% and favorable outcomes in treatment.

[Program for Integral Assistance to Women's Health, 40 years of history: interview with Ana Maria Costa]. / Programa de Assistência Integral à Saúde da Mulher, 40 anos de uma história: entrevista com Ana Maria Costa.

The interview marks the 40th anniversary of the Programa de Assistência Integral à Saúde da Mulher (Program for Integral Assistance to Women's Health), and aims to revisit the history of this innovative health policy, the context in which it was created and the generation that took it forward, from the narrative of a key person, Ana Maria Costa, who played a leading role in the process of its creation, from conception to the elaboration of its final text. Launched in 1983, the policy was a pioneer in proposing and incorporating the principles of universality, equity and integrality, which would be the foundations of the Sistema Único de Saúde, and introducing the perspective of women's reproductive rights.

A entrevista marca os 40 anos do Programa de Assistência Integral à Saúde da Mulher e tem como objetivo revisitar a história dessa política de saúde inovadora, do contexto em que foi criada e da geração que a levou adiante, a partir da narrativa de uma pessoa-chave, Ana Maria Costa, que protagonizou o processo de sua criação, desde a concepção até a elaboração de seu texto final. Lançada em 1983, a política foi pioneira em propor e incorporar os princípios de universalidade, equidade e integralidade, que seriam os fundamentos do Sistema Único de Saúde, e introduzir a perspectiva dos direitos reprodutivos das mulheres.

Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey. / Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

Drought-heatwave nexus in Brazil and related impacts on health and fires: A comprehensive review.

Climate change is drastically altering the frequency, duration, and severity of compound drought-heatwave (CDHW) episodes, which present a new challenge in environmental and socioeconomic sectors. These threats are of particular importance in low-income regions with growing populations, fragile infrastructure, and threatened ecosystems. This review synthesizes emerging progress in the understanding of CDHW patterns in Brazil while providing insights about the impacts on fire occurrence and public health. Evidence is mounting that heatwaves are becoming increasingly linked with droughts in northeastern and southeastern Brazil, the Amazonia, and the Pantanal. In those regions, recent studies have begun to build a better understanding of the physical mechanisms behind CDHW events, such as the soil moisture-atmosphere coupling, promoted by exceptional atmospheric blocking conditions. Results hint at a synergy between CDHW events and high fire activity in the country over the last decades, with the most recent example being the catastrophic 2020 fires in the Pantanal. Moreover, we show that HWs were responsible for increasing mortality and preterm births during record-breaking droughts in southeastern Brazil. This work paves the way for a more in-depth understanding on CDHW events and their impacts, which is crucial to enhance the adaptive capacity of different Brazilian sectors.

[Intersectorial actions for health promotion in Family Health Strategy: experiences, challenges, and possibilities]. / Ações intersetoriais para promoção da saúde na Estratégia Saúde da Família: experiências, desafios e possibilidades.

Qualitative study with the purpose of analyzing intersectorial actions for health promotion in the context of the Family Health Strategy, identifying experiences, facilitating and restricting factors to the process of building partnerships. Subjects were health managers and informers from social equipment in the territory covered by a local health service in Belo Horizonte/Minas Gerais, Brazil. The results indicate the existence of a wide social network. However, intersectorial health promoting actions are still incipient. Intersectorial actions are faced with the challenge of creating communication spaces that allow the resolution of complex problems. It is concluded that intersectorial actions constitute an innovative strategy which is still under construction, and the paths of which are still being unraveled.

On the way to interrupting the gestation or not: experiences of pregnant women with anencephalic fetuses. / Nas vias de interromper ou não a gestação: vivências de gestantes de fetos com anencefalia.

Anencephaly is a malformation characterized by the total or partial absence of the brain, and Brazil records the fourth largest number of births of anencephalic fetuses in the world. Fetal anencephaly is associated with a more significant number of maternal complications. As of 2012, women with anencephalic gestation were empowered with the right to carry the pregnancy to term or terminate it, if they so desired, without any judicial authorization. Objectives: to understand the experiences of women with fetal anencephaly and to identify the determinant factors for interrupting the gestation or not. This is a qualitative study using the Life Narratives method with 12 women over 18 years old diagnosed with an anencephalic fetus, who interrupted gestation or delivery in a public maternity hospital in Rio de Janeiro. Data were collected between June and November 2016, and the process was finalized when the narrative patterns reached progressive saturation from the recurrences. The statements that emerged following floating and in-depth reading were articulated in Narrative Nuclei, and data comparative and comprehensive analysis was performed. The reports brought to light the intense experiences of these women, as well as the weaknesses existing concerning care and the pregnancy termination issue.

A anencefalia é uma malformação caracterizada pela ausência total ou parcial do encéfalo e o Brasil é o quarto colocado em número de nascimentos de fetos anencéfalos no mundo. Existe associação entre anencefalia fetal e maior número de complicações maternas. A partir de 2012 a mulher com gestação de anencéfalo poderá manter ou interromper a gestação, se assim o desejar, sem necessidade de autorização judicial. Objetivos: compreender as vivências das mulheres de fetos com anencefalia e identificar os fatores determinantes para a escolha de interromper ou não interromper a gestação. Estudo qualitativo e método das narrativas de vida, com 12 mulheres, maiores de 18 anos e com diagnóstico de feto anencéfalo, que realizaram a interrupção da gestação ou o parto em uma maternidade pública do Rio de Janeiro. A coleta dos dados foi entre junho e novembro de 2016 e encerrada quando os padrões narrativos alcançaram a saturação progressiva, a partir das recorrências. Os enunciados emergidos após leitura flutuante e aprofundada foram articulados em Núcleos Narrativos e realizada análise comparativa e compreensiva dos dados. Os relatos trouxeram à tona as vivências intensas dessas mulheres, como também as fragilidades existentes em relação ao cuidado e a problemática da interrupção da gestação.

[Medicalization of childbirth: the meanings attributed by the literature on childbirth care in Brazil]. / Medicalização do parto: os sentidos atribuídos pela literatura de assistência ao parto no Brasil.

This study analyzes the meanings attributed to the concept of the medicalization of childbirth from a narrative review of the literature in national journals published between 2000 and 2017. It is based on the more general concept of medicalization - understood as the process by which medicine broadens and consolidates its area of activity in the various sectors of society - and the different formulations of the concept conceived by twentieth-century scholars. Five categories were created that related the medicalization of childbirth with interventions, professional dispute, violation of the rights of pregnant women, the birth scenario, and the impact of the medicalization of society. In the first four categories there is a predominance of meanings that explore the interface between medicalization and humanization, considered two analytical super categories, with a predominance of a critique of the medicalized model. Setting aside this analysis model, the medicalization of childbirth category as a reflection of the medicalization of society focuses on a sense of medicalization of childbirth as part of a broader process involving different actors who are part of the care process, pointing to a possibility of more in-depth analysis in which it considers the complex connection between modern health and society.

Este estudo analisa os sentidos atribuídos ao conceito de medicalização do parto a partir de uma revisão narrativa de literatura em periódicos nacionais publicados entre 2000 e 2017. Parte-se da concepção mais geral sobre medicalização ­ entendida como o processo pelo qual a medicina amplia e consolida a sua área de atuação nos diversos campos da sociedade ­ e das diferentes formulações do conceito concebidas por estudiosos do século XX. Foram construídas cinco categorias que relacionaram medicalização do parto com: intervenções, disputa profissional, violação de direitos das gestantes, cenário do parto e reflexo da medicalização da sociedade. Nas quatro primeiras categorias encontramos um predomínio de sentidos que exploram uma interface entre medicalização e humanização, constituindo-se como duas supercategorias analíticas, com um predomínio de uma crítica ao modelo medicalizado. Fugindo a este modelo de análise, a categoria medicalização do parto como reflexo da medicalização da sociedade se concentra em torno de um sentido de medicalização do parto como parte de um processo mais amplo que envolve diferentes atores que seriam copartícipes no processo de assistência, apontando para uma possibilidade de análise mais aprofundada em que considera a complexa conexão entre saúde e sociedade moderna.

Programa de Assistência Integral à Saúde da Mulher, 40 anos de uma história: entrevista com Ana Maria Costa / Program for Integral Assistance to Women's Health, 40 years of history: interview with Ana Maria Costa

Resumo A entrevista marca os 40 anos do Programa de Assistência Integral à Saúde da Mulher e tem como objetivo revisitar a história dessa política de saúde inovadora, do contexto em que foi criada e da geração que a levou adiante, a partir da narrativa de uma pessoa-chave, Ana Maria Costa, que protagonizou o processo de sua criação, desde a concepção até a elaboração de seu texto final. Lançada em 1983, a política foi pioneira em propor e incorporar os princípios de universalidade, equidade e integralidade, que seriam os fundamentos do Sistema Único de Saúde, e introduzir a perspectiva dos direitos reprodutivos das mulheres.

Abstract The interview marks the 40th anniversary of the Programa de Assistência Integral à Saúde da Mulher (Program for Integral Assistance to Women's Health), and aims to revisit the history of this innovative health policy, the context in which it was created and the generation that took it forward, from the narrative of a key person, Ana Maria Costa, who played a leading role in the process of its creation, from conception to the elaboration of its final text. Launched in 1983, the policy was a pioneer in proposing and incorporating the principles of universality, equity and integrality, which would be the foundations of the Sistema Único de Saúde, and introducing the perspective of women's reproductive rights.

Direitos sexuais e direitos reprodutivos na percepção de: mulheres privadas de liberdade / Sexual rights and reproductive rights in the perception of: women deprived of freedom / Derechos sexuales y derechos reproductivos percibidos por: mujeres privadas de libertad

Objetivo: analisar a percepção de mulheres privadas de liberdade quanto aos seus direitos sexuais e direitos reprodutivos. Método: pesquisa descritiva, com abordagem qualitativa. Foram realizadas entrevistas com mulheres que estavam vivenciando a gestação (9) e o puerpério (4), em duas unidades prisionais do Rio de Janeiro. O método de análise foi o Hermenêutico dialético. Resultados: foram elencadas duas categorias: 1) Violações institucionais como infração dos direitos sexuais e dos direitos reprodutivos e 2) Contradições entre a possibilidade de exercer os direitos e as limitações impostas pelo sistema carcerário. Conclusão: as violações que essas mulheres sofrem, não estão restritas a elas. A luta pelos direitos das mulheres é um movimento constante. Os avanços são significativos, contudo, há amarras reais que impedem que as mulheres usufruam seus direitos sexuais e seus direitos reprodutivos, mesmo que eles existam no plano legal e normativo

Objective: analyze the perception of women deprived of liberty regarding their sexual rights and reproductive rights. Method: descriptive research, with a qualitative approach. Interviews were conducted with women who were experiencing pregnancy (9) and the puerperium (4), in two prison units in Rio de Janeiro. The analysis method was the dialectic hermeneutic. Results: two categories were listed: 1) Institutional violations as infractions of sexual rights and reproductive rights and 2) Contradictions between the possibility of exercising rights and the limitations imposed by the prison system. Conclusion: the violations that these women suffer are not restricted to them. The fight for women's rights is a constant movement. The advances are significant, however, there are real obstacles that prevent women from enjoying their sexual rights and their reproductive rights, even though they exist in the legal and normative plan

Objetivos: respecto a sus derechos sexuales y derechos reproductivos. Método: investigación descriptiva, con un enfoque cualitativo. Las entrevistas fueron realizadas a mujeres en situación de embarazo (9) y de puerperio (4), en dos unidades penitenciarias de Río de Janeiro. El método de análisis fue la hermenéutica dialéctica. Resultados: se han dividido en dos categorías: 1) Violaciones institucionales como la infracción de los derechos sexuales y los derechos reproductivos y 2) Contradicciones entre la posibilidad de ejercer los derechos y las limitaciones impuestas por el sistema carcelario. Conclusión: las violaciones que sufren estas mujeres no se limitan a ellas. La lucha por los derechos de la mujer es un movimiento constante. Los avances son significativos, sin embargo, existen ataduras reales que impiden a las mujeres disfrutar de sus derechos sexuales y sus derechos reproductivos, aunque existan a nivel legal y normativo

Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II / Itinerarios para el cuidado de la salud de mujeres en situación de abortamiento: aspectos metodológicos del estudio cualitativo de la encuesta Nacer en Brasil II / Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

Saúde, reprodução e sexualidade nos tempos da COVID-19: memórias incorporadas das mulheres no Brasil / Health, reproduction and sexuality in times of COVID-19: embodied memories of women in Brazil / Salud, reproducción y sexualidad en los tiempos de COVID-19: memorias encarnadas de las mujeres en Brasil

Objetivo: compreender como a pandemia de COVID-19 afetou a vida e a saúde das mulheres, com ênfase nos aspectos da saúde sexual e reprodutiva, e refletir sobre os direitos sexuais e reprodutivos e a justiça reprodutiva no contexto da crise sanitária. Metodologia: utilizou-se questionário online com 113 perguntas objetivas e uma questão aberta para comentários. De 8.313 mulheres que responderam ao questionário, 1.838 relataram suas vivências durante a pandemia na questão aberta. Esse material passou por técnicas de análise narrativa e temática e de construção de memória. Resultados: evidenciou-se a ampliação das dificuldades de acesso a serviços de saúde, em especial de saúde sexual e reprodutiva; o aprofundamento das iniquidades na divisão sexual do trabalho, com sobrecarga de trabalho doméstico e profissional; a insegurança econômica; o tensionamentos das relações afetivo-sexuais e maior exposição à violência; e importantes repercussões na saúde psicoemocional. Todos esses aspectos afetaram as experiências de saúde e adoecimento; a vida sexual; e os planos e experiências reprodutivas nos primeiros anos de pandemia. Conclusão: no Brasil, na sobreposição da emergência sanitária com a crise democrática de direitos, fatos sociais e fatos fisiológicos se misturam e se totalizam na experiência histórica e material do corpo sexual e reprodutivo das mulheres, seguindo as linhas de força das precariedades e injustiças de gênero, de raça e de classe. Os relatos das mulheres contribuem para a construção de uma memória coletiva ­não necessariamente unívoca e linear ­da pandemia. Memórias que podem não apenas ilustrar o momento presente, como contribuir para o entendimento e enfrentamento de crises semelhantes futuras.

Objective: this study seeks to comprehend the impact of the COVID-19 pandemic on women's lives and health, with a particular focus on sexual and reproductive health, andto reflect on sexual and reproductive rights and reproductive justice within the context of the health crisis.Methods:employing an online questionnaire featuring 113 objective questions and one open-ended question for free comments, the study gathered responses from 8,313 women. Out of these, 1,838 utilized the open question to articulate their experiences during the pandemic. The collected material underwent analysis using narrative and thematic approaches, along with memory construction techniques.Results:the findings indicate heightened challenges in accessing health services, particularly for sexual and reproductive health. The pandemic deepened inequities in the sexual division of labor, leading to increased domestic and professional workloads, economic insecurity, elevated tensions in affective-sexual relationships, greater exposure to violence, and notable repercussions on psycho-emotional health. These factors collectively influenced women's health/illness experiences, sexual lives, and reproductive plans during the initial years of the pandemic. Conclusion: the intersection of the health crisis with a democratic crisis in rights has intertwined social and physiological factors into the historical and material experiences of women's sexual and reproductive bodies. These experiences follow the trajectories of gender, race, and class-based precariousness and injustices. Women's accounts contribute to the construction of a collective memory of the pandemic that is not necessarily uniform or linear. Beyond illustrating the present moment, these memories aid in understanding and addressing similar crises in the future.

Objetivo: comprender cómo la pandemia de COVID-19 afectó la vida y la salud de las mujeres, con énfasis en aspectos de salud sexual y reproductiva y reflexionar sobre los derechos sexuales y reproductivos y la justicia reproductiva, en el contexto de la crisis sanitaria. Metodología:se utilizó un cuestionario online con 113 preguntas objetivas y una pregunta abierta para comentarios libres al final. De 8.313 mujeres que respondieron el cuestionario, 1.838 relataron sus experiencias durante la pandemia, en este espacio abierto. Este material fue analizado mediante técnicas análisis de narrativa y temática y de construcción de memoria. Resultados: hubo aumento de las dificultades para acceder a los servicios de salud, especialmente de salud sexual y reproductiva, profundización de las inequidades en la división sexual del trabajo, con sobrecarga de trabajo doméstico y profesional, inseguridad económica, tensiones en las relaciones afectivo-sexuales y mayor exposición. a la violencia, e importantes repercusiones en la salud psicoemocional. Todos estos aspectos afectaron las experiencias de salud/enfermedad, la vida sexual, los planes y experiencias reproductivas, en los primeros años de la pandemia. Conclusión: en Brasil, en el solapamiento de la crisis sanitaria con la crisis democrática y de derechos, hechos sociales y hechos fisiológicos se mezclan y totalizan en la experiencia histórica y material de los cuerpos sexuales y reproductivos de las mujeres, siguiendo las líneas de fuerza de la precariedad y las injusticias. de género, raza y clase. Las narrativas de las mujeres contribuyen a la construcción de una memoria colectiva ­no necesariamente unívoca y lineal ­ de la pandemia. Memorias que no sólo pueden ilustrar el momento presente, sino que también contribuyen a comprender y afrontar crisis futuras similares.

Infertilidade, justiça reprodutiva e pandemia de COVID-19: reflexões sobre acesso e barreiras / Infertility, reproductive justice and the COVID-19 pandemic: reflections on access and barriers / Infertilidad, justicia reproductiva y la pandemia de COVID-19: reflexiones sobre acceso y barreras

Objetivo: refletir sobre o acesso a serviços de saúde para infertilidade e reprodução humana assistida durante o período da pandemia de COVID-19, na perspectiva da justiça reprodutiva. Metodologia: utilizou-se dados do inquérito online da pesquisa Pandemia de COVID-19e práticas reprodutivas de mulheres no Brasil, que obteve 8.313 respostas de mulheres residentes em todas as regiões do país, de 18 anos ou mais. O questionário autoaplicável circulou entre julho e outubro de 2021, contendo questões fechadas e abertas. A análise descritiva das respostas objetivas de 242 mulheres que referiram buscar atendimento para infertilidade contou com o cálculo de frequências simples das variáveis. Já os textos escritos nos espaços abertos do questionário foram submetidos à análise temática. Resultados: o estudo verificou a existência de barreiras institucionais e não institucionais para os cuidados da infertilidade, ambas incrementadas pela pandemia. Conclusão: recomenda-se a efetivação de política pública que garanta acesso pleno a todas as pessoas, haja vista que o tratamento para infertilidade e reprodução assistida tende a se restringir a mulheres cisgênero, de camadas médias e altas, mais escolarizadas e majoritariamente brancas.

Objective: to critically examine access to health services for infertility and assisted human reproduction during the COVID-19 pandemic, emphasizing the perspective of reproductive justice. Methods: data for analysis were derived from the online survey titled COVID-19 Pandemic and Women's Reproductive Practices in Brazil, garnering 8,313 responses from women aged 18 years or older residing in all regions of the country. The self-administered questionnaire circulated from July to October 2021 and comprised both closed and open-ended questions. Descriptive analysis of the objective responses obtained from 242 women actively seeking infertility care involved the calculation of simple frequencies for relevant variables. Responses provided in the open-ended sections of the questionnaire underwent thematic analysis. Results: revealed the presence of both institutional and non-institutional barriers to infertility care, with a notable exacerbation during the pandemic. Conclusion: given that infertility and assisted reproduction treatment predominantly cater to cisgender women from middle and upper socio-economic strata, characterized by higher education levels and mostly white, there is a compelling need for the implementation of public policies that ensure equitable access for all individuals.

Objetivo: reflexionar sobre el acceso a los servicios de salud para la infertilidad y la reproducción humana asistida durante el período de la pandemia de COVID-19, desde la perspectiva de la justicia reproductiva. Metodología: se utilizaron datos de la encuesta en línea de la Pandemia de COVID-19y prácticas reproductivas de las mujeres en Brasil, que obtuvo 8.313 respuestas de mujeres residentes en todas las regiones del país, con edad igual o superior a 18 años. El cuestionario autoaplicado circuló entre julio y octubre de 2021, conteniendo preguntas cerradas y abiertas. El análisis descriptivo de las respuestas objetivas de 242 mujeres que relataron buscar atención por infertilidad implicó el cálculo de frecuencias simples de las variables. Los textos escritos en los espacios abiertos del cuestionario fueron sometidos a análisis temático. Resultados:el estudio verificó la existencia de barreras institucionales y no institucionales para la atención de la infertilidad, ambas aumentadas por la pandemia. Conclusión: se recomiendala implementación de una política pública que garantice el pleno acceso a todas las personas, dado que el tratamiento de la infertilidad y reproducción asistida tiende a estar restringido a mujeres cisgénero de clase media y alta, con mayor educación y en su mayoría blancas.

Encaminhamento dos usuários com alterações renais ao nefrologista pela Estratégia Saúde da Família: estudo transversal / Referral of users with kidney disorders by the Family Health Strategy to the nephrologist: a cross-sectional study / Derivación de usuarios con trastornos renales al nefrólogo por la Estrategia Salud de la Familia: estudio transversal

Objetivo: analisar os encaminhamentos de usuários de risco ao desenvolvimento da doença renal crônica para serviço especializado de nefrologia pelas equipes da Estratégia de Saúde da Família. Método: estudo transversal, com coleta de dados dos prontuários de usuários diagnosticados com diabetes e hipertensão arterial, acompanhados na atenção primária no município do Rio de Janeiro, em março de 2021. O protocolo de pesquisa obteve a aprovação em Comitê de Ética. Resultados: a solicitação de creatinina sérica foi identificada em 96% dos prontuários, mas tal realidade foi diferente junto aos demais exames. Quanto aos estágios, o mais indicado para encaminhamento foi o 3B compreendendo 37%, seguido pelo estágio 4 que abrange 33% da amostra. Conclusão: sendo uma doença de curso insidioso, o acompanhamento laboratorial deve ser realizado continuamente. É inquestionável o papel da Atenção Primária, porém diante dos desafios evidenciados é importante considerar novas estratégias para melhor efetivação das ações e integralidade do cuidado na rede.

Objective: to examine referrals of users at risk of developing chronic kidney disease by the Family Health Strategy teams to a specialized nephrology service. Method: in this cross-sectional study, data were collected in March 2021 from the medical records of users diagnosed with diabetes and high blood pressure, and monitored in primary care in Rio de Janeiro city. The research protocol was approved by the ethics committee. Results: serum creatinine was requested in 96% of the medical records, but the situation was different with the other exams. Referral was indicated most often at stage 3B (37% of the sample), followed by stage 4 (33%). Conclusion: as the course of this disease is insidious, laboratory monitoring must be carried out continuously. The role of Primary Care is unquestionable, but in view of the challenges highlighted, it is important to consider new strategies for more effective action and comprehensive care in the system.

Objetivo: analizar la derivación de usuarios con riesgo de desarrollar enfermedad renal crónica a un servicio especializado de nefrología por parte de los equipos de la Estrategia Salud de la Familia. Método: estudio transversal, con recolección de datos de las historias clínicas de usuarios con diagnóstico de diabetes e hipertensión arterial, cuyo seguimiento se realizó en la atención primaria de la ciudad de Rio de Janeiro, en marzo de 2021. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: la solicitud de creatinina sérica fue identificada en el 96% de las historias clínicas, pero esa realidad fue diferente a los demás análisis. En cuanto a las etapas, la más indicada para la derivación fue la 3B que comprende el 37%, seguida de la etapa 4 que abarca el 33% de la muestra. Conclusión: al ser una enfermedad de curso insidioso, el seguimiento de laboratorio debe realizarse de forma continua. El rol de la Atención Primaria es incuestionable, sin embargo, frente a los desafíos señalados, es importante considerar nuevas estrategias para una mejor implementación de las acciones y la atención integral en la red.

Ações de enfermagem na prevenção da pneumonia associada à ventilação mecânica: Uma revisão integrativa / Acciones de enfermería en la prevención de la neumonía asociada a la ventilación mecánica: Una revisión integrativa / Nursing actions in the prevention of mechanical ventilation associated pneumonia: An integrative review

OBJETIVO: Objetivou-se identificar medidas de prevenção realizadas pela equipe de enfermagem para prevenir pneumonia associada à ventilação mecânica. MÉTODO: Trata-se de revisão integrativa da literatura norteada pela questão: quais as medidas de prevenção de pneumonia associada à ventilação mecânica utilizadas na assistência de enfermagem ao paciente adulto? A busca foi realizada durante o mês de dezembro de 2020, sem recorte temporal,nas bases: Cumulative Index toNursingandAllied Health Literature; Web of Science; Base de Dados em Enfermagem; Literatura Latino-Americana e do Caribe em Ciências da Saúde. Utilizando os Descritores em Ciências da Saúde: "Pneumonia associada à ventilação mecânica"; "Cuidados de enfermagem"; "Pacote de assistência ao paciente". RESULTADOS:Encontrou-se 1.864 estudos, desses 16 compuseram a amostra final. As medidas mais utilizadas são: elevação da cabeceira do leito, higiene oral e reajuste diário do nível de sedação.CONCLUSÃO:São medidas de baixo custo financeiro e que se mostraram eficazes na prevenção direta(AU)

OBJECTIVE: Objective to identify preventive measures carried out by the nursing team to prevent pneumonia associated with mechanical ventilation. METHOD: This is an integrative review of the literature focused on the question: what are the preventive measures for pneumonia associated with mechanical ventilation used in nursing care of adult patients? The search was carried out during the month of December 2020, in the bases: Cumulative Index to Nursing and Allied Health Literature; Web of Science; Database in Sickness; Latin American and Caribbean Literature in Health Sciences. Using the Describers in Health Sciences: "Pneumonia associated with mechanical ventilation"; "Sick care"; "Pacote of assistance to the patient". RESULTS: 1,864 studies were found, 16 of which were composed in the final sample. The most used measures are: elevation of the head of the bed, oral hygiene and daily readjustment of the level of sedation. CONCLUSION: There are low financial cost measures that will be effective in direct prevention.(AU)

OBJETIVO: Objetivou-se identificar medidas de prevenção realizadas pela equipo de enfermagem para prevenir pneumonia associada à ventilación mecânica. MÉTODO: Trata-se de revisão integrativa da literatura norteada pela questão: ¿cuálessonlas medidas de prevención de neumoníaasociada a laventilaciónmecánica utilizada enlaasistencia de enfermagem ao paciente adulto? Una búsqueda realizada durante o más de diciembre de 2020, nas bases: Cumulative Index toNursingandAllied Health Literature; Web de laCiencia; Base de Dados en Enfermagem; Literatura Latino-Americana e do Caribe em Ciências da Saúde. Utilizando os Descritores em Ciências da Saúde: "Pneumonia associada à ventilação mecânica"; "Cuidados de enfermagem"; "Paquete de asistencia al paciente". RESULTADOS: Encontrou-se 1.864 estudos, desses 16 compuseram a amostra final. Las medidas más utilizadas son: elevação da cabeceira do leito, higiene oral y reajuste diário do nível de sedação. CONCLUSÃO: São medidas de baixo custo financeiro e que se muestraneficaces na prevenção direta.(AU)

Controle tecnológico do corpo e da vida: cesariana entre mulheres usuárias do setor privado / Control tecnológico del cuerpo y la vida: cesariana entre mujeres usuarias del sector privado / Technological control of the human body and life: c-section among women private sector users

Resumo O artigo analisa os sentidos que a ideia de controle do corpo e da vida adquire nos discursos acerca da decisão sobre o parto, a partir das falas de mulheres que realizaram cirurgia cesariana em maternidades privadas da região metropolitana do Rio de Janeiro e do município de São Paulo. A abordagem teórico-metodológica é da análise das práticas discursivas e produção de sentidos. Dor, integridade corporal, controle dos riscos, estética do parto e os tempos (social e reprodutivo) são acionados como elementos contidos no ideário de controle que circunda a cesárea como uma prática de nascimento. Esse controle seria exercido em redes de interações entre mulheres, familiares, profissionais, objetos tecnológicos médicos e não médicos e instituições.

Resumen El artículo analiza los sentidos que la idea de control del cuerpo y de la vida adquiere en los discursos acerca de la decisión sobre el parto a partir de las palabras de mujeres que realizaron cirugía cesárea en maternidades privadas de la región metropolitana de Río de Janeiro y del municipio de São Paulo. El enfoque teórico-metodológico es del análisis de las prácticas discursivas y la producción de sentidos. El dolor, integridad corporal, control de los riesgos, estética del parto y los tiempos (social y reproductivo) son accionados como elementos contenidos em el ideario de control que circunda la cesárea como una práctica de nacimiento. Este control se ejerceren redes de interacción entre mujeres, familiares, profesionales, objetos tecnológicos médicos y no médicos, e instituciones.

Abstract This paper analyses the way that the idea of control of body and life gets in the discourse about the decision on childbirth from the speech of women who underwent cesarean surgery in private hospitals in the metropolitan area of Rio de Janeiro and São Paulo. The theoretical-methodological approach is the analysis of discursive practices and the production of meanings. Pain, body integrity, risk control, birth aesthetics and times (social and reproductive) are triggered as elements contained in the control idea that surrounds cesarean delivery as a birth practice.This control would be exercised in interaction networks among women, family, professional, medical and non-medical technological objects, and institutions.

"De mão-em-mão tramando redes e normas: a vida social das pílulas anticoncepcionais, a partir de suas bulas" / "From hand to hand plotting networks and norms: The social life of contraceptive pills through their patient information leaflet "

Resumo Com o objetivo de descortinar aspectos da vida social das pílulas anticoncepcionais, o artigo analisou o conteúdo de suas bulas publicados no guia de medicamentos Dicionário de Especialidades Farmacêuticas (DEF), entre 1971 e 1990. Procuramos explorar os discursos veiculados nesses dispositivos - a quem se dirigiam, o que propunham e que efeitos pretendiam - e compreender como contribuíram e o que nos revelaram sobre o seu percurso biográfico. As bulas se comportaram como importantes veículos de intercomunicação entre os atores que participaram da trajetória desses medicamentos, desde sua produção pela da indústria farmacêutica, até chegarem às suas consumidoras finais, as mulheres, passando também por médicos, enfermeiros, farmacêuticos, donos e balconistas de farmácias e transitando entre consultórios, serviços de saúde, entidades de planejamento familiar, estabelecimentos comerciais, lares e bolsas femininas. Nessa enorme cadeia de associações produzidas pelas pílulas, as bulas contribuíram para a geração de um mínimo denominador comum que permitiu a normalização e naturalização das práticas de controle da fecundidade hormonal e para a formação do mercado - não só no sentido econômico, mas em sentido sociológico, como redes de interações e trocas, onde circularam bens que agregaram a um só tempo valores econômicos, simbólicos e normativos.

Abstract In order to uncover aspects of social life of pharmaceutical pills and based on the theoretical-methodological perspective of the drugs biography, this paper analyzes the instructions of their leaflets, published in the Dictionary of Pharmaceutical Specialties (DEF), between 1971 and 1990. It seeks to explore the speeches conveyed in papers that accompanied the packaging of the "medicine pill" - to whom they were headed, what they proposed and what social effects they intended - and to understand their participation in the set of associations that allowed the stabilization of oral contraceptives in Brazil. Leaving the pharmaceutical laboratories, the patient information leaflet transited among physicians, nurses, pharmacists, owners and shopkeepers of pharmacies and women, passing from hand to hand, in offices, health services family planning entities, pharmacy counters, medical departments of companies, households and women's bag. They were the important intercommunication vehicles between these actors and in the big chain of associations produced by contraceptive pills, the patient information leaflets contributed to a minimum common denominator that allowed to return a normal and natural control practices of hormone-mediated fecundity and the formation of the fertility control pill market, where goods were giving movement to add economic, symbolic and normative values at the same time.