Attitudes, knowledge and practice regarding the anti-müllerian hormone test among general practitioners and reproductive specialists: A cross-sectional study.

OBJECTIVE: To describe clinicians' attitudes, knowledge and practice relating to the anti-müllerian hormone (AMH) test. DESIGN: Cross-sectional nationwide survey. SETTING: Australia. POPULATION OR SAMPLE: A total of 362 general practitioners (GPs), gynaecologists and reproductive specialists. METHODS: Clinicians were recruited through relevant professional organisations, with data collected from May 2021 to April 2022. MAIN OUTCOME MEASURES: Clinicians' attitudes, knowledge and practice relating to the AMH test, measured using multiple choice, Likert scales and open-ended items. RESULTS: Fifteen percent of GPs (n = 27) and 40% of gynaecologists and other specialists (n = 73) order at least one AMH test per month. Specialists reported raising the idea of testing most of the time, whereas GPs reported that patient request was more common. Half of clinicians lacked confidence interpreting (n = 182, 51%) and explaining (n = 173, 48%) an AMH result to their patients. Five percent (n = 19) believed the test was moderately/very useful in predicting natural conception/birth and 22% (n = 82) believed the same for predicting premature menopause, despite evidence that the test cannot reliably predict either. Forty percent (n = 144) had previously ordered the test to help with reproductive planning and 21% (n = 75) to provide reassurance about fertility. CONCLUSIONS: Clinicians reported use of AMH testing in clinical circumstances not supported by the evidence. With the proliferation of direct-to-consumer testing, efforts to support clinicians in the judicious use of testing and effectively navigating patient requests are needed.

Reproductive care in Thai women with diabetes mellitus: a descriptive cross-sectional study.

BACKGROUND: Pre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM. METHODS: This descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically. RESULTS: A total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM. CONCLUSIONS: Although highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care.

We aimed to study the knowledge, attitudes, preconception care practices, and contraceptive usage among women with diabetes mellitus (DM) who were of reproductive age. A survey was conducted among Thai women receiving DM treatment at a university hospital. The results showed that participants had limited knowledge about pregnancy planning and diabetic-related risks. Only half of them had discussed pregnancy planning with their doctors. Factors such as younger age at DM diagnosis, being non-Buddhism, being married, having higher education, and being medical personnel were associated with higher knowledge scores. Older women and those with better practice scores were more likely to use highly effective contraception. However, there was still a need for contraception in some women with DM. We concluded that there was a lack of integration between specialists in reproductive healthcare and DM therapy, and improving this coordination would enhance access to preconception care for women with DM.

Choosing Pre-conception Planning for Women/Families: Counselling and Informed Consent (Part 2) - Pre-conception Reproductive Planning, Lifestyle, Immunization, and Psychosocial Issues.

OBJECTIVE: To inform reproductive and other health care providers about pre-conception evaluation, including considerations for reproductive planning, lifestyle modification, immunization status and attitudes, and psychosocial issues. OPTIONS: This counselling information can be used for patient education and planning and possible pre-conception and/or prenatal testing. OUTCOMES: This information may allow for improved risk assessment when pre-conception counselling for individual patients and their families is used. CONSIDERATIONS FOR PRE-CONCEPTION CARE (PART 2) REGARDING PRE-CONCEPTION REPRODUCTIVE PLANNING, LIFESTYLE, IMMUNIZATIONS, AND PSYCHOSOCIAL ISSUES: CONSIDERATION FOR CARE STATEMENTS: For this review article, the Consideration for Care Statements use the Grading of Recommendations, Assessment, Development and Evaluations strength and quality principles because they are comparable for the clinician and the patient/public user. For example, "Strong" for clinicians is defined as "the recommendation would apply to most individuals. Formal discussion aids are not likely to be needed to help individuals make decisions consistent with their values and preferences." For patients/the public, "Strong" is defined as, "we believe most people in this situation would want the recommended course of actions and only a small number would not." Quality of evidence (High, Moderate, Low) is based on the confidence that the true effect lies close to that of the estimate of the effect. In addition, the Canadian Task Force on Preventive Health Care key to evidence statements and grading of recommendations are included. EVIDENCE: PubMed, Medline, and the Cochrane Database were searched until May 2017, using appropriate key words (i.e., preconception, reproductive planning, lifestyle modification, immunization risks and benefits, psychosocial pregnancy factors/issues). Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty societies. BENEFITS, HARMS, AND COSTS: The benefits for the patient and her family from receiving this pre-conception counseling would include an increased understanding of the relevant issues for both pre-conception and in early pregnancy as well as better pregnancy outcomes. Harm includes potential increased anxiety or psychological stress associated with the possibility of identifying maternal pregnancy risks.

Renegotiation, uncertainty, imagination: Assemblage perspectives on reproductive and family planning with an Inborn Error of immunity.

Advances within the new genetics expand our understanding of the scope and presentation of inherited conditions, particularly to include incompletely penetrant and variably expressive conditions. These features can complicate patients' reproductive and family planning processes, in part because they expand the possibilities of life with an inherited condition. Despite many inquiries into reproductive planning with an inherited condition, accounts of experiential knowledge and reproductive planning fail to adequately describe the uncertainties experienced by people living with incompletely penetrant and variably expressive conditions. To address this gap, we conducted a qualitative, cross-sectional study using assemblage theory to characterize the impacts of experiential knowledge on reproductive planning for individuals living with Inborn Errors of Immunity (IEI) that exhibit incomplete penetrance and variable expressivity. Eligible participants were between ages 18 and 48, with a diagnosis of either GATA2 deficiency, PIK3CD gain-of-function disorder, or CTLA4 deficiency. Using an abductive thematic approach, attention was paid to the people, ideas, and non-human objects embedded within participants' accounts of disease experience and reproductive planning. Organized around the objects of genetic diagnosis, the body, and hypothetical children, this analysis illustrates how disease can be conceptualized as an assemblage of human and non-human objects which provoke numerous actions and affective engagements in reproductive planning. These engagements include renegotiation, uncertainty, and imagination. By emphasizing the distribution of agency and action across systems, processes, and relationships, assemblage theory invites novel ways of understanding the role of experiential knowledge on reproductive planning.

Association of perinatal depression and postpartum contraception intent, choice, and actual use.

OBJECTIVES: Depression is common during pregnancy and the year following childbirth (the perinatal period). This study assessed the association of depressive symptoms and contraception decisions in perinatal individuals. STUDY DESIGN: We conducted a secondary analysis using data from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of active interventions which aimed to address perinatal depression. This analysis included 191 individuals aged 18-45 who screened positive for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥10) during pregnancy or up to 3 months postpartum. We assessed contraception intent and method choice at 1-3 months postpartum. At 5-7 months postpartum, we assessed contraceptive method used and EPDS depression scores. We used logistic regressions to examine the relationship between depression and contraceptive use/method. RESULTS: At 1-3 months postpartum, the majority of participants (76.4%) expressed an intention to use contraception. Of those, over half (53.4%) indicated a preference for higher effectiveness contraception methods. Participants with persistent depression symptoms (positive EPDS) at 5-7 months were significantly less likely to report using higher effectiveness contraceptive methods (aOR = 0.28, 95% CI = 0.11-0.70) compared to those without. Among participants with persistent depressive symptoms, 21.1% reported using a contraception method of lower effectiveness than had originally intended. CONCLUSION: Perinatal individuals with persistent depressive symptoms at 5-7 months postpartum reported greater use of less-effective contraception methods than originally planned. IMPLICATIONS: We found associations between perinatal depression and use of less effective contraception use. Provider discussions regarding contraception planning is important, particularly in those with perinatal depression symptoms.

Perceptions and Experiences With Healthcare Providers Among People Navigating Reproductive and Fertility Decisions.

OBJECTIVES: Primary healthcare providers have an important role in helping people manage their reproductive health and fertility by assessing pregnancy intentions to inform the provision of contraception and/or preconception care. This study explores how women navigating fertility decisions perceived and experienced interactions with their healthcare providers around their fertility. METHODS: We conducted in-depth interviews (N = 17) and focus groups (N = 17 groups) with 65 women aged 18 to 35 years about fertility, infertility, and reproductive planning. Two researchers coded 2 transcripts using thematic and inductive methods and met to develop a structured codebook. We then applied the codebook to the remaining transcripts. RESULTS: In all interviews and focus groups, participants discussed their interactions with healthcare providers around fertility. Three central themes emerged in the data, including a desire for more information from healthcare providers about fertility; experiences of having fertility concerns dismissed by healthcare providers (eg, ability to become pregnant when desired); and, feelings that healthcare providers lacked sensitivity in discussing fertility related issues. Notably, these themes were present, even among participants who were not trying to become pregnant or who did not wish to become pregnant. CONCLUSION: Participants wanted information about fertility from their primary healthcare providers that they felt was lacking. Moreover, participants wanted their healthcare providers to engage with them as multifaceted individuals with current needs as well as future plans regarding fertility. While healthcare providers regularly assess pregnancy intentions, they may need to make a concerted effort to address fertility concerns among both those who want to pursue pregnancy and those who do not wish to become pregnant immediately.

Receiving de novo genetic diagnoses for autism with intellectual disability: parents' views of impacts on families' reproductive decisions.

Parents of children with autism who receive genetic diagnoses of de novo variants face challenges in understanding the implications for reproductive decision-making. We interviewed 28 parents who received de novo genetic diagnoses for their child's autism and intellectual disability (ID). These genetic variants proved to have reproductive implications for not only the child's parents, but the child and his/her neurotypical siblings, aunts, uncles, and cousins. Parents had often already finished building their families but varied, overall, in whether the results had affected, or might have influenced, their reproductive decisions. Parents' views were shaped by factors related to not only genetics, but also parental age, financial considerations, competing hopes and visions for their family's future, perceived abilities to care for an additional child with similar symptoms, and the extent of the child's symptoms. Members of a couple sometimes disagreed about whether to have more children. Parents pondered, too, the possibility of preimplantation genetic testing, though misunderstandings about it arose. Children with autism vary widely in their abilities to understand the reproductive implications of genetic diagnoses for themselves. Neurotypical offspring were much relieved to understand that their own children would not be affected. While some autism self-advocates have been concerned that genetic testing related to autism could lead to eugenics, the present data, concerning de novo genetic findings, raise other perspectives. These data, the first to explore several key aspects of the reproductive implications of genetic diagnoses for this group, have important implications for future practice, education, and research-e.g., concerning various family members.

Contraceptive use in women with inherited metabolic disorders: a retrospective study and literature review.

BACKGROUND: Reproductive planning is an emerging concern for women with inherited metabolic disease (IMD). Anticipatory guidance on contraception is necessary to prevent unintended pregnancies in this population. Few resources exist to aid informed decision-making on contraceptive choice. A retrospective case-control study was performed to examine trends in reproductive planning for adolescent and adult women seen at the Children's Hospital of Philadelphia (CHOP). Literature review on contraception and IMD was performed to assess global use. RESULTS: In a cohort of 221 reproductive-aged female IMD patients, 29.4% reported routine contraceptive use. Anticipatory guidance on contraception was provided by metabolic physicians to 36.8% of patients during the study period. Contraception discussion was more likely to occur in women older than 21 years, who lived independently and were followed by gynecology. Women who received contraception counseling from their metabolic physician were 40-fold more likely to use regular contraception. Use of combined hormonal contraceptives was most commonly reported, but contraception choice varied by age and IMD. CONCLUSION: Metabolic physicians are ideally suited to provide guidance on contraception to women with IMD. Reproductive planning should be addressed routinely using shared decision-making. Contraceptives should be selected for their efficacy, effects on metabolism, and likelihood of patient adherence.

The chance of recurrence of hyperemesis gravidarum: A systematic review.

Around 1 % of pregnancies develop Hyperemesis Gravidarum (HG), causing high physical and psychological morbidity. Reports on HG recurrence rate in subsequent pregnancies vary widely. An accurate rate of recurrence is needed for informed reproductive decision making. Our objective is to systematically review and aggregate reported rates for HG subsequent to index pregnancies affected by HG. We searched databases from inception as per the protocol registered on PROSPERO. No language restrictions were applied. Inclusion was not restricted based on how HG was defined; reports of severe NVP were included where authors defined the condition as HG. We included descriptive epidemiological, case control and cohort study designs. Eligibility screening was performed in duplo. We extracted data on populations, study methods and outcomes of significance. A panel of patients reviewed the results and provided discussion and feedback. Quality was assessed with the JBI (2017) critical appraisal tool independently by two reviewers. We performed the searches on 1st November 2019. Our search yielded 4454 unique studies, of which five (n = 40,350 HG cases) matched eligibility criteria; One longitudinal and four population-based cohort studies from five countries. Follow-up ranged from 2 to 31 years. Definition of HG and data collection methods in all the studies created heterogeneity. Quality was low; studies lacked valid and reliable exposure, and/or follow-up was insufficient. Meta-analysis was not possible due to clinical and statistical heterogeneity. This systematic review found five heterogeneous studies reporting recurrence rates from 15 to 81%. Defining HG as hospital cases may have introduced detection bias and contribute to clinical heterogeneity. A prospective longitudinal cohort study using an internationally agreed definition of HG and outcomes meaningful to patients is required to establish the true recurrence rate of HG.

Uso de métodos contraceptivos durante a pandemia da COVID-19 / Use of contraceptive methods during the COVID-19 pandemic

Objetivo: Análise do uso de métodos contraceptivos no período da pandemia. Método: Trata-se de um estudo transversal, descritivo, exploratório, aprovado pelo Comitê de Ética em Pesquisa envolvendo Seres Humanos (número 3.146.657). Foram entrevistadas via chamada telefônicas colaboradoras que retiraram contraceptivos em 01/01/2020 à 30/07/2020, excluídas os menores de 18 anos de idade; cadastro incompleto e residência fora da área de abrangência da Unidade Básica de Saúde Aquiles Stenghel (Londrina ­ Paraná). Resultados: Elaboraram-se tabelas descritivas com as respostas obtidas. Notou-se que quatro colaboradoras não usavam nenhum contraceptivo no momento da entrevista, e oito haviam trocado de métodos contraceptivos. Todas referiram conhecer pelo menos um contraceptivo e tê-lo utilizado em algum momento. Conclusão: O anticoncepcional injetável, apesar dos efeitos indesejáveis mencionados, continuou sendo o mais usado por entre a maioria delas, e observou-se um desuso da camisinha. Ficou evidente a necessidade de ampliar o olhar para as especificidades das mulheres, em especial as que estão em contexto de vulnerabilidades.(AU)

Objective: Analyze the use of contraceptive methods during the pandemic. Method: This is a cross-sectional, descriptive, exploratory study, approved by the Ethics Committee for Research involving Human Beings (number 3,146,657). Women, who collected contraceptives in the period between 01/01/2020 to 07/30/2020, over 18 years old, with complete registration and resident in the coverage area of the Basic Health Unit Aquiles Stenghel (Londrina ­ Paraná) were interviewed by the researchers by telephone. Results: Descriptive tables were created with the interview responses obtained. It was noted that four collaborators were not using any contraceptive at the time of the interview, and eight had changed contraceptive methods. All participants reported being familiar with at least one contraceptive and having used it at some point. Conclusion: Injectable contraceptives, despite the aforementioned undesirable effects, continued to be the most widely used method among the participants, and there was a lack of use of condoms. It is evident that women especially those who are in a vulnerability context need a bit more of pharmacy assistance in order to guarantee correct contraceptives use and its efficiency.(AU)

Objetivo: Análisis del uso de métodos anticonceptivos durante la pandemia. Método: Estudio transversal, descriptivo y exploratorio, aprobado por el Comité de Ética para la Investigación con Seres Humanos (número 3.146.657). Se entrevistó por llamada telefónica a mujeres que tomaron anticonceptivos entre el 01/01/2020 y el 30/07/2020; no se incluyeron menores de 18 años; registro incompleto y residencia fuera de la zona de captación de la Unidad Básica de Salud Aquiles Stenghel (Londrina ­ Paraná). Resultados: Con las respuestas obtenidas se elaboraron tablas descriptivas. Se observó que cuatro colaboradoras no utilizaban ningún anticonceptivo en el momento de la entrevista y ocho habían cambiado de método anticonceptivo. Todas declararon conocer al menos un anticonceptivo y haberlo utilizado en algún momento. Conclusión: El anticonceptivo inyectable, a pesar de los efectos indeseables mencionados, siguió siendo el más utilizado entre la mayoría de las colaboradoras, y se observó desuso del preservativo. Se puso de manifiesto la necesidad de profundizar en las particularidades de las mujeres, especialmente las que se encuentran en contextos vulnerables.(AU)

Reproductive Planning and the Choice of Long-acting Reversible Contraceptive Primary to Health: A Cross-Sectional Study / Planejamento reprodutivo e a escolha do contraceptivo de longa permanência na atenção primária à saúde: um estudo transversal

Abstract Objective Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). Methods This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). Results Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). Conclusion It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

Resumo Objetivo Avaliar as diversas perspectivas que envolvem a escolha dos LARCs, as problemáticas relacionadas a esse processo e as consequências da escolha do método na vida das mulheres no centro de Atenção Primária à Saúde (APS) em Sousas, distrito de Campinas, SP. Métodos Trata-se de um estudo transversal analítico, realizado no Centro de Saúde de Sousas. Os dados foram coletados através da análise de prontuários e de entrevistas das mulheres residentes em Sousas, que inseriram o dispositivo intrauterino (DIU) de cobre (D) entre abril de 2021 a abril de 2022 ou o implante de etonogestrel (I) de maio a dezembro de 2022. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciência Médicas da Universidade Estadual de Campinas (UNICAMP). Resultados O motivo da escolha: por indicação médica (D: 52%; I: 100%), pela facilidade (D: 71%; I: 67%) e pela eficácia (D: 55%; I: 100%). Da indicação por profissionais de saúde (D: 65%; I: 100%). E melhora das características clínicas: humor (D: 77%; I: 67%), índice de massa corporal (IMC; D: 52%; I: 33%) e libido (D: 84%; I: 67%). Conclusão Sugere-se que as mulheres tendem a escolher LARCs quando orientadas pelo seu médico ou por profissionais de saúde da APS e optam pelos LARCs pela facilidade do uso e baixa taxa de falhas. Destaca-se como os LARC's podem interferir positivamente em aspectos que perpassam a contracepção, como o IMC, libido e estado de humor.

Prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast / Prevalência e fatores associados à gravidez não planejada em uma capital do Nordeste Brasileiro

Abstract Objectives: to analyze the prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast. Methods: a cross-sectional study nested to a hospital birth cohort with a probable sample of 5,110 puerperal women. Associated factors were analyzed using a hierarchical theoretical model in three levels: distal (women's socioeconomic and demographic characteristics), intermediate (reproductive characteristics, maternal habits and BMI), and proximal level (partner's characteristics). Multivariate Poisson regression analysis was performed. Results: the prevalence of unplanned pregnancy was 68.1% (CI95%=66.8-69.4). Multivariate analysis showed association with black skin color/race (PR=1.03; CI95%=1.01- 1.07), mother's age group up to 19 years old (PR=1.09; CI95%=1.06-1.12) and 20 to 24 years old (PR=1.04; CI95%=1.01-1.07), not living with partner (PR=1.09; CI95%=1.07- 1.11), highest number of people in the household: 5 people (PR= 1.10; CI95%=1.08-1.13) and 3 to 4 (PR=1.08; CI95%=1.05-1.10), number of ≥4 children (PR=1.09; CI95%=1.06- 1.13) and 2 or 3 children (PR=1.03; CI95%=1.02-1.05), alcohol consumption (PR=1.03; CI95%=1.01-1.05), malnourished pre-pregnancy BMI (PR=1.03; CI95%=1.01-1.06) and partner's low schooling (5 to 8 years) (PR=1.03; CI95%=1.01-1.07). Prior abortion was inversely associated with planned pregnancy (PR=0.95; CI95%=0.93-0.97). Conclusions: the prevalence of unplanned pregnancy was high and was associated with socioeconomic and demographic characteristics that reflect on the combination of the complex inequalities that impact women and their partners

Resumo Objetivos: analisar a prevalência e fatores associados à gravidez não planejada em uma capital do Nordeste brasileiro. Métodos: estudo transversal aninhado à coorte de nascimento hospitalar com amostra probabilística de 5.110 puérperas. Fatores associados foram analisados utilizando-se modelo teórico hierarquizado em três níveis: distal (caracteristicas socioeconômicas e demográficas da mulher), intermediário(caracteristicas reprodutivas, hábitos maternos e IMC), e nível proximal (características do companheiro). Realizou-se análise de regressão multivariada de Poisson. Resultados: a prevalência de gravidez não planejada foi de 68,1% (IC95%= 66,8-69,4). A análise multivariada mostrou associação com cor/raça preta (RP=1,03; IC95%= 1,01-1,07), faixa etária da mãe até 19 anos (RP=1,09; IC95%= 1,06-1,12) e 20 a 24 anos (RP=1,04; IC95%= 1,01-1,07), não residir com o companheiro (RP=1,09; IC95%= 1,07-1,11), maior o número de pessoas no domicílio: 5 pessoas (RP= 1,10; IC95%= 1,08-1,13) e de 3 a 4 (RP=1,08; IC95%= 1,05-1,10), número de ≥4 filhos (RP=1,09; IC95%= 1,06-1,13) e 2 ou 3 filhos (RP=1,03; IC95%= 1,02-1,05), uso de álcool (RP=1,03; IC95%= 1,01-1,05), IMC pré-gestacional desnutrido (RP=1,03; IC95%= 1,01-1,06) e baixa escolaridade (5 a 8 anos) do companheiro (RP=1,03; IC95%= 1,01-1,07). O aborto prévio associou-se inversamente com gravidez planejada (RP=0,95; IC95%= 0,93-0,97). Conclusões: foi elevada a prevalência de gravidez não planejada, e esteve associada a características socioeconômicas e demográficas que refletem a combinação de complexas desigualdades que impactam mulheres e seus parceiros.

Planejamento reprodutivo e os fatores limitantes para participação masculina: uma revisão integrativa / Reproductive planning and the limiting factors for male participation: an integrative review / La planificación reproductiva y los factores limitantes de la participación masculina: una revisión integradora

Objetivo: identificar o que tem sido retratado na literatura acerca da participação dos homens no planejamento reprodutivo e os fatores intervenientes a inserção masculina nos serviços de saúde. Método: trata-se de uma revisão integrativa, realizada no período de setembro de 2018, com artigos científicos completos nas bases de dados SciELO, BVS e BDENF, publicados em português (nacionais e internacionais), no período de dez anos (2008-2018). Foram analisados 10 artigos, no qual, 100% destes apresentam uma abordagem qualitativa, com maior parcela publicada no ano de 2014 (50%) e realizada no Brasil (90%). Resultados: evidenciou-se que as questões de gênero e masculinidade estiveram mais associadas as principais dificuldades para a participação e inserção dos homens no PR, como a persistência de uma desigualdade de papeis sociais entre o homem e a mulher, historicamente construída por uma cultura patriarcal, no qual, a mulher é tida como a única responsável pelos cuidados de reprodução e dos filhos. Conclusão: para uma maior adesão masculina ao PR, é necessário que os serviços se tornem mais apropriados para homens, como já acontece em algumas regiões brasileiras com a flexibilização de horários das unidades, além de capacitar os profissionais para trazer os homens para junto das equipes de saúde, incentivando a desmistificação dos preconceitos, com a finalidade de contribuir para uma participação mais efetiva.

Objective: to identify what is portrayed in the literature about the participation of men in reproductive planning and the factors involved in male insertion in health services. Method: this is an integrative review, carried out in the period of September 2018, with complete scientific articles in the SciELO, BVS and BDENF databases, published in Portuguese (national and international), in the period of ten years (2008-2018). 10 articles were analyzed, in which 100% of them have a qualitative approach, most of them published in 2014 (50%) and carried out in Brazil (90%). Results: it became evident that gender and masculinity issues were more associated with the main difficulties for the participation and insertion of men in public relations, such as the persistence of an inequality of social roles between men and women, historically built by a culture. patriarchal, in which the woman is considered solely responsible for the care of reproduction and children. Conclusion: for greater male adherence to PR, services need to be more suitable for men, as is already the case in some Brazilian regions with the flexibility of the units' schedules, in addition to training professionals to bring men to the teams. health, promoting the demystification of prejudices, in order to contribute to a more effective participation.

Objetivo: identificar lo retratado en la literatura sobre la participación de los hombres en la planificación reproductiva y los factores involucrados en la inserción masculina en los servicios de salud. Método: se trata de una revisión integradora, realizada en el período de septiembre de 2018, con artículos científicos completos en las bases de datos SciELO, BVS y BDENF, publicados en portugués (nacional e internacional), en el período de diez años (2008-2018). Se analizaron 10 artículos, en los cuales el 100% de ellos tienen un enfoque cualitativo, la mayoría publicados en 2014 (50%) y realizados en Brasil (90%). Resultados: se evidenció que las cuestiones de género y masculinidad estaban más asociadas a las principales dificultades para la participación e inserción de los hombres en las relaciones públicas, como la persistencia de una desigualdad de roles sociales entre hombres y mujeres, históricamente construida por una cultura. patriarcal, en el que la mujer es considerada la única responsable del cuidado de la reproducción y los hijos. Conclusión: para una mayor adherencia masculina a la RP, los servicios deben ser más adecuados para los hombres, como ya ocurre en algunas regiones brasileñas con la flexibilidad de los horarios de las unidades, además de capacitar a los profesionales para traer hombres a los equipos. salud, promoviendo la desmitificación de los prejuicios, para contribuir a una participación más efectiva.

Preconception care and reproductive planning in primary care.

Preconception care is designed to identify and reduce biomedical, behavioral, and social risks to the health of a woman or her baby before pregnancy occurs. Few women present requesting preconception care; however, 1 in 10 US women of childbearing age will become pregnant each year. As primary care physicians (PCPs) care for reproductive-aged women before, between, and after their pregnancies, they are ideally positioned to help women address health risks before conception, including optimizing chronic conditions, to prevent adverse pregnancy and longer-term health outcomes. PCPs can help women make informed decisions both about preparing for pregnancy and about using effective contraception when pregnancy is not desired.

A vivência da gestante em planejamento reprodutivo na atenção primária à saúde / The pregnant woman's experience of reproductive planning in primary health care

Resumo: Introdução: O planejamento reprodutivo se insere como requisito primordial para a assistência de saúde integral à mulher, e tem como objetivo oferecer maior liberdade e autonomia à sua trajetória reprodutiva. Esse serviço, no Sistema Único de Saúde (SUS), é assegurado pela Constituição Federal, e na Lei no 9.263. Preferencialmente deve ser oferecido na Atenção Primária à Saúde (APS), e a oferta dos serviços de planejamento reprodutivo contribui para a redução da morbimortalidade materna e infantil, na medida em que reduz o número de gestações não desejadas e de abortos induzidos. Além disso, os profissionais de saúde promovem nas mulheres a possibilidade de planejar a sua gestação, contribuindo para que vivenciem uma maternidade mais segura. Objetivo: Descrever a vivência da gestante em planejamento reprodutivo na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa qualitativa e descritiva. O estudo foi conduzido em um município da região metropolitana de Curitiba/PR, no período de março a junho de 2022. Os critérios de inclusão foram: gestantes com idade mínima de 18 anos, e que utilizavam os serviços das unidades de saúde da família (USFs) do município, no mínimo havia 1 ano. A coleta de dados foi por meio de entrevistas com 22 gestantes; a análise se deu com base nos passos sugeridos por Creswell e com o apoio do software Iramuteq para organização dos dados. Resultados: Identificaram-se três categorias: 1 - "O planejamento da gestação a partir da vivência das gestantes", que mostrou que as gestações aconteceram de forma planejada e não planejada; 2 - "A vivência do planejamento reprodutivo antes e após a gestação", onde foi abordado como as gestantes vivenciaram o planejamento reprodutivo, fosse diante de uma gravidez planejada ou não planejada, e qual era o planejamento reprodutivo que elas pretendiam vivenciar no futuro; 3 - "A percepção do planejamento reprodutivo para as gestantes", que permitiu identificar o conhecimento das gestantes sobre os métodos contraceptivos e onde buscou-se compreender o significado do conceito de planejamento reprodutivo para as participantes. Considerações finais: Ao conhecer a vivência do planejamento reprodutivo das gestantes na APS, foi possível observar que, apesar de estes serviços serem ofertados, apresentam fragilidades nas ações de concepção e contracepção. Ficou evidente que as gestantes não tinham o hábito de buscar esse serviço, e demostraram um baixo conhecimento sobre o conceito de planejamento reprodutivo. Isto posto, são necessárias ações de melhoria na capacitação dos profissionais de saúde, a fim de que estejam preparados para fornecer um cuidado de qualidade, condizente com as necessidades de saúde reprodutiva das mulheres. Ações educativas do setor da saúde em conjunto com as escolas, bem como as famílias, por meio da inserção de ações educativas nas mídias sociais, são estratégias que podem ser implementadas a fim de melhorar o conhecimento das pessoas sobre a importância de planejar a sua vida reprodutiva, e que lhes permitam realizar escolhas livres e informadas.

Abstract: Introduction: Reproductive planning is a primary requirement for comprehensive health care for women and aims to offer greater freedom and autonomy in their reproductive trajectory. This service, in the Unified Health System (SUS) is guaranteed by the Federal Constitution and Law n°. 9.263. It should preferably be offered in Primary Health Care (APS), and the availability of reproductive planning services contributes to reducing maternal and child morbidity and mortality by reducing the number of unintended pregnancies and induced abortions. In addition, health professionals promote the ability of women to plan their pregnancy, contributing to a safer motherhood. Objective: To describe the experience of pregnant women in reproductive planning in Primary Health Care. Method: This is a qualitative and descriptive research. The study was conducted in a municipality in the metropolitan region of Curitiba/PR, from March to June 2022. The inclusion criteria were: pregnant women with a minimum age of 18 years and who used the health services of the family health units (USFs) of the municipality for at least 1 year. Data collection was through interviews with 22 pregnant women; and the analysis was based on the steps suggested by Creswell and with the support of the Iramuteq software for data organization. Results: Three categories were identified: 1 - "The planning of pregnancy from the experience of pregnant women," which showed that the pregnancies occurred in a planned and unplanned manner; 2 - "The experience of reproductive planning before and after pregnancy", where it was addressed how pregnant women experienced reproductive planning, whether in front of a planned or unplanned pregnancy, and what was the reproductive planning they intend to experience in the future; 3 - "The perception of reproductive planning for pregnant women" which allowed us to identify the knowledge of pregnant women about contraceptive methods and where we sought to understand the meaning of the concept of reproductive planning for the participants. Final considerations: By knowing the experience of reproductive planning for pregnant women in APS, it was possible to observe that, despite these services being offered, they present weaknesses in conception and contraception actions. it was evident that pregnant women did not have the habit of seeking this service, and they demonstrated a low knowledge about the concept of reproductive planning. Therefore, improvement actions are necessary in the training of health professionals so that they are prepared to provide quality care in line with women's reproductive health needs. Educational actions by the health sector in conjunction with schools, as well as families, through the insertion of educational actions in social media, are strategies that can be implemented to improve people's knowledge about the importance of planning their reproductive life, and to allow them to make free and informed choices.

Direitos sexuais e reprodutivos: influências dos materiais educativos impressos no processo de educação em sexualidade / Sexual and reproductive rights: influences of printed educational materials in the process of education in sexuality

Com o objetivo de analisar a influência dos materiais educativos impressos na aprendizagem e promoção da saúde sexual e reprodutiva, foi realizada uma pesquisa qualitativa em 6 unidades de saúde no município de Jequié (BA) por meio de entrevistas com 6 enfermeiros(as) e 12 usuárias do planejamento reprodutivo, além de observação sistemática. Após a triangulação, os dados foram analisados segundo a técnica de análise de conteúdo. Evidenciou-se que, quando os materiais educativos impressos estão associados à comunicação horizontal entre profissionais e usuários(as) e metodologias mais diversificadas, respeitando as especificidades do público-alvo, é possível alcançar aprendizagem e autonomia.

In order to analyze the influence of printed educational material on learning and promotion of sexual and reproductive health, this qualitative study was conducted in 6 public primary healthcare facilities in the city of Jequié (BA) through interviews with 6 nurses and 12 users of reproductive planning services, and a systematic observation. After triangulation, the data were analyzed using the technique of content analysis. It was evidenced that when printed educational material is associated with horizontal communication between the professionals and the users and more diverse methodologies related to the specificities of the target audience, it is possible to achieve learning and autonomy.