Vasectomy within the public health services in Campinas, São Paulo, Brazil.

OBJECTIVE: To describe some of the characteristics of men who underwent a vasectomy in the public health network of Campinas, São Paulo, Brazil. METHODS: A descriptive study including 202 men randomly selected from a list of all the men vasectomized between 1998 and 2004 in the public health network. RESULTS: Most of the men were 30 years of age or older when vasectomized, had completed elementary school and had two or more children of both sexes. Most of the men came from the lowest income segment of the population: 47.6% in 1998-1999 and 61.3% in 2003-2004. Although the men knew various contraceptive methods, 51.2% reported that their partners were using combined oral contraceptives at the time of surgery. Most men initially sought information on vasectomy at health-care clinics where care was provided by a multidisciplinary team; most received counselling, however, 47.9% of the men waited more than 4 months for the vasectomy. CONCLUSIONS: The profile of the vasectomized men in this study appears to indicate that the low-income population from Campinas, São Paulo, Brazil has access to vasectomy; however, the waiting time for vasectomy reveals that difficulties exist in obtaining this contraceptive method in the public health service.

Contraceptive methods with male participation: a perspective of Brazilian couples.

OBJECTIVE: To assess the perspectives of couples who requested vasectomy in a public health service on the use of male participation contraceptive methods available in Brazil: male condoms, natural family planning/calendar, coitus interruptus and vasectomy. METHODS: A qualitative study with semi-structured interviews was held with 20 couples who had requested vasectomy at the Human Reproduction Unit of the Universidade Estadual de Campinas, Brazil. Data analysis was carried out through thematic content analysis. FINDINGS: The couples did not, in general, know any effective contraceptive options for use by men and/or participating in their use, except for vasectomy. The few methods with male participation that they knew of were perceived to interfere in spontaneity and in pleasure of intercourse. Men accepted that condom use in extra-conjugal relations offered them protection from sexually transmitted diseases; that their wives might also participate in extra-marital relationships was not considered. DISCUSSION: The few contraceptive options with male participation lead to difficulty in sharing responsibilities between men and women. On the basis of perceived gender roles, women took the responsibility for contraception until the moment when the situation became untenable, and they faced the unavoidable necessity of sterilization. CONCLUSIONS: Specific actions are necessary for men to achieve integral participation in relation to reproductive sexual health. These include education and discussions on gender roles, leading to greater awareness in men of the realities of sexual and reproductive health.

The opinion of Brazilian women regarding vaginal labor and cesarean section.

OBJECTIVES: The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. METHODS: Six hundred and fifty-six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. RESULTS: Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C-section-only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). CONCLUSIONS: Apparently, pain and women's perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.

Laqueadura tubaria nos servicos de saude do Estado de Sao Paulo / Tubal ligation in health services of Sao Paulo State

Com objetivo de avaliar algumas das atividades desenvolvidas pelo Programa de Assistencia Integral a Saude da Mulher (PAISM), no Estado de Sao Paulo, foram entrevistadas em seus domicilios 3.703 mulheres de baixa renda com idade entre 15 e 49 anos: 2.021 na area metropolitana e 1.682 no interior. Este trabalho apresenta resultados referentes a adequacao do uso da laqueadura. Verificou-se que, de todas as mulheres entrevistadas, 17,9 por cento na area metropolitana e 25,9 por cento no interior estavam laqueadas. Constatou-se que a cirurgia foi realizada mais precocemente no interior que na area metropolitana (53 por cento comparada com 44 por cento na faixa de 20-29 anos de idade). A maioria das mulheres foi esterilizada por ocasiao de uma cesarea (72,2 por cento), pagou pela laqueadura (69,5 por cento) e combinou sua realizacao com o medico durante o pre-natal (86,9 por cento).