CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Na lÃgica da Reforma PsiquiÃtrica, mulheres portadoras de transtorno mental devem ter acesso à atenÃÃo bÃsica no campo do Planejamento Familiar (PF). Desta forma, estabeleceu-se a tese de que o matriciamento à uma estratÃgia que favorece a promoÃÃo do PF de mulheres com transtorno mental pelas equipes da EstratÃgia SaÃde da FamÃlia (ESF). Objetivou-se analisar o matriciamento como estratÃgia para efetivar o planejamento familiar de mulheres portadoras de transtorno mental; identificar condutas de enfermeiros e de mÃdicos frente Ãs demandas de planejamento familiar de mulheres com transtorno mental na atenÃÃo bÃsica, bem como possÃveis fatores que interfiram no atendimento neste nÃvel de atenÃÃo; verificar percepÃÃes da equipe de saÃde do CAPS a respeito de demandas de mulheres portadoras de transtorno mental no campo do planejamento familiar; e investigar contribuiÃÃes de profissionais dos CSF e do CAPS que venham a favorecer o atendimento ao planejamento familiar de mulheres com transtorno mental no sistema de saÃde. Estudo do tipo descritivo-exploratÃrio e convergente assistencial, desenvolvido em onze CSF e um CAPS de Fortaleza-CE. A coleta de dados ocorreu em duas etapas. Na primeira, ocorreram entrevistas com 42 profissionais (enfermeiros e mÃdicos) dos CSF e com 8 profissionais do CAPS; e na segunda houve o exercÃcio do matriciamento. Os dados foram organizados no SPSS e pela tÃcnica de anÃlise de conteÃdo de Bardin. Parte das condutas profissionais nos CSF mostrou-se adequadas: importÃncia à atenÃÃo ao PF, preocupaÃÃo com interaÃÃo medicamentosa e com cuidado materno; indicaÃÃo de MÃtodos Anticoncepcionais (MAC) que nÃo exija controle feminino; corresponsabilidade do parceiro no PF; vigilÃncia ao abuso sexual; atendimento sem discriminaÃÃo; e inadequadas: atendimento restrito ao quadro psicopatolÃgico, conduta inadequada ao PF de portadora de esquizofrenia. Os fatores a interferir nas condutas profissionais foram restrita variedade de MAC; rotina de prescriÃÃo mÃdica do anticoncepcional hormonal, inseguranÃa tÃcnica para atender aos casos. As demandas de PF apresentadas pelos profissionais do CAPS foram: lidar com a paciente sexualmente ativa; com pacientes susceptÃveis à violÃncia sexual e à gravidez; pacientes com depressÃo e que fazem uso de carbonato de lÃtio. ContribuiÃÃes dos participantes incluÃram: reduÃÃo do nÃmero de famÃlias por equipe da ESF; nÃmero suficiente de agentes comunitÃrios; capacitaÃÃo dos profissionais em saÃde mental; disponibilizaÃÃo dos MAC; apoio matricial; envolvimento da famÃlia; administraÃÃo supervisionada dos contraceptivos. O exercÃcio de matriciamento ocorreu por meio de duas reuniÃes: na primeira foram apresentados os resultados da pesquisa; e na segunda, por meio, de um caso clÃnico, os participantes discutiram seis aspectos para a efetivaÃÃo do PF de mulheres portadoras de transtorno mental: integraÃÃo equipes dos CSF e do CAPS; levantamento dos aspectos reprodutivos e sexuais na histÃria clÃnica inicial; encaminhamento da paciente com descriÃÃo detalhada; intervenÃÃo mÃdica conjunta dos CSF e do CAPS na prescriÃÃo de MAC e anticonvulsivantes; apresentaÃÃo das pacientes para os novos profissionais, no caso de troca de equipe; e contracepÃÃo supervisionada. Por fim, confirmou-se a tese de que o matriciamento à uma estratÃgia que favorece a promoÃÃo da assistÃncia ao PF de mulheres com transtorno mental pelas equipes da ESF.

Objetivo: descrever as características dos homens submetidos à vasectomia na rede pública do Município de Campinas, SP, e investigar a sua percepção quanto às conseqüências da esterilização em algumas áreas de sua vida e as relações entre as circunstâncias da cirurgia e essas conseqüências. Procedimentos metodológicos: estudo descritivo, com um componente qualitativo e outro quantitativo. Após a identificação dos sujeitos, eles foram contatados via telefone ou correio. Para a etapa qualitativa, se realizaram 10 entrevistas semi-estruturadas com homens selecionados de acordo com critérios propositais de escolaridade e número de filhos. Em seguida, foi aplicado um formulário estruturado a 202 homens, sorteados a partir da lista completa daqueles que haviam sido vasectomizados entre 1998 e 2004. As entrevistas semi-estruturadas foram transcritas e inseridas no programa The Ethnograph para desvelar as unidades de significado ou temas identificados. Os dados obtidos através dos formulários estruturados foram digitados através do módulo data entry do programa computacional SPSS. A análise dos dados quantitativos foi, inicialmente , descritiva, preparando-se tabelas com a distribuição de freqüências das principais variáveis estudas, de acordo com os objetivos definidos. Em seguida, foi avaliada a associação entre possíveis conseqüências da vasectomia e caracterísitcas dos homens e circunstâncias de vida em que a cirurgia foi realizada utilizando-se o teste qui-quadrado. Resultados: os resultados evidenciaram algumas mudanças no perfil dos homens que se submeteram à vasectomia com crescimento na porcentagem dos que tinham renda per capita até R$ 300,00: 47,6 por cento no período entre 1998-1999 e 61,3 por cento entre 2003 e 2004. Esse crescimento foi mais significativo entre os homens com menos de 35 anos de idade e que tinham dois ou mais filhos vivos na ocasião da cirurgia. A análise dos dados qualitativos revelou que os homens, em geral, consideravam que a decisão de submeter-se à vasectomia havia sido deles próprios e não admitiam influência de outras pessoas. Porém, ficou evidente que a decisão de operar-se só foi tomada diante do exemplo de pessoas significativas outros homens que testemunhavam da inocuidade do procedimento sobre a vida sexual. Essa decisão também, em geral, só foi tomada quando a esposa/companheira não podia mais usar outro método contraceptivo. Observou-se que 97 por cento estavam satisfeitos por terem feito a cirurgia e pouca referência a efeitos indesejados em distintas áreas de sua vida. Pouco mais da metade dos entrevistados atribuiu à vasectomia mudanças para melhor sobre sua saúde, corpo, relacionamento em geral com a família e situação econômica. Quase dois terços referiram-se a esse tipo de mudanças na vida sexual e no relacionamento em geral com a esposa. Prevaleceu a idéia de que a vasectomia só trouxera benefícios, principalmente maior tranqüilidade nas relações sexuais, sem medo de engravidar. Nas entrevistas semi-dirigidas a possibilidade de arrependimento foi mencionada como um potencial aspecto negativo da vasectomia, para a qual não havia solução na opinião dos entrevistados. Entre os poucos homens insatisfeitos com a vasectomia, apenas um havia feito a reversão da cirurgia porque vivia com uma nova companheira e queria ter filhos; entre os demais a insatisfação devia-se à dor provocada pelo procedimento cirúrgico. Conclusões: no contexto da regulamentação legal, o acesso à vasectomia parece facilitado aos homens com menor renda, mais jovens e com maior número de filhos, que optam pela cirurgia quando não vêem outra opção para regular a fecundidade do casal. Os homens tendem a intervir, na medida em que se percebem incapazes de cumprir seu papel de provedor da família. A possibilidade de fazer a vasectomia fica condicionada pelo acesso ao método e pelas informações sobre o mesmo, especialmente aquelas providas por pessoas significativas. O crescimento na busca pela vasectomia deve ser visto também de forma crítica: não apenas porque, necessariamente, não indica maior eqüidade nas relações de gênero, mas também porque segue testemunhando as deficiências de acesso ao planejamento familiar em nosso meio / Objective: to describe the characteristics of men who underwent vasectomy at the public service in Campinas, state of São Paulo and investigate their perception regarding the consequences of sterilization in some areas of their life, as well as the possible relationship between the circumstances of the surgery and these consequences. Methodology: A descriptive study including a qualitative and a quantitative component was carried out. Participants were contacted by telephone or by mail. For the qualitative phase semi-structured interviews were conducted with 10 men, selected according to purposeful sampling criteria concerning schooling and number of children; after that a pre-tested structured form was completed by 202 men, randomly chosen by lot from the complete list of those who had been vasectomized between 1998 and 2004. The semi-structured interviews were verbatim transcribed and the The Ethnograph program was used in the thematic analysis of content, for the identification thematic units or themes in the discourse of the participants. The data obtained through the structured forms were typed using the data entry module of the SPSS computer program. For the descriptive analysis tables were prepared with the frequency of the variables studied. Subsequently, the association among possible consequences of vasectomy, participants characteristics and the life circumstances in which the surgery performed were evaluated through the Chi-square test. Results: Some changes in the characteristics of man who underwent vasectomy were observed: an increase in the percentage of men sterilized who had per capita up to R$ 300,00 (three hunfred reais): that is, 47.6 per cent in the period of 1998-1999 and 61.3 per cent between 2003 and 2004. This increase was significant among the men who were less than 35 years old and had two or more live children at the moment of surgery. Analysis of the interviews showed. that men considered that the decision to undergo vasectomy was their own and did not report a great influence of other people. However, it became evident that the decision to perform the surgery was only made in face of the example of significant people other men who witnessed that the procedure was innocuous and had no adverse effect on their sexual life. This decision was usually only made when the wife/partner could no longer use another contraceptive method. Satisfaction with surgery (97 per cent ) and only a few reports of unwanted effects in different areas of their lives were observed. A little more than half of the interviewed participants mentioned positive changes on their health, body, relationship with the family and economic situation. About two thirds reported that these changes in their sexual lives and in the relationship with the wives.. The prevalent idea was that vasectomy brought benefits, mainly more tranquility in their sexual relationship without fear of pregnancy. In the semistructured interview the possibility to regret was mentioned as a potencial negative aspect of the vasectomy. It was mentioned for the participants as a problem without a solution. Among this few men not satisfied with the vasectomy, only one had done the reversion of the surgery because he had a new partner and they wanted more children, among the other the pain caused by the surgery procedures made them feel dissatisfaction. Conclusion: Considering the legal regulation context, the access to vasectomy seems to be facilitated for the men with low income, young and high number of children, who choose the vasectomy when they did not have another option to regulate the couple fertility. The men will act when they realize if the fertility was not interrupted they will unable to keep their role of family provider. The possibility to do vasectomy is conditioned by the access to the method and by the information about it, especially those provided by significative people. The increase in the number of men who choose vasectomy should be viewed critically not only because it does not indicate balance in the gender relation but also because the access to family planning presents some deficiencies in our environment

Introdução - As mulheres são as principais agentes de cuidados em saúde das famílias e comunidades. Apesar disso, as consequências da globalização e da modernidade nas mulheres de baixa renda resultaram em uma necessidade de adesão às diversas formas de regulação da fecundidade. A Estratégia Saúde da Família traz como característica de trabalho para seus profissionais a observância dos direitos e a atenção à saúde reprodutiva e especificamente ao planejamento familiar. Objetivo - Analisar em que dimensão de significados sociopolíticos encontram-se as relações, ações e atividades de planejamento familiar no âmbito da Estratégia Saúde da Família do município de Sobral, no Estado do Ceará, Brasil. Metodologia - Pesquisa qualitativa, de caráter descritivo e explicativo, mediante entrevistas semi-estruturadas e não estruturadas, com questões em aberto, observação livre e análise documental, iniciada após prévia aprovação do Comitê de Ética em Pesquisa e consentimento esclarecido dos entrevistados. Os sujeitos são profissionais de saúde da Estratégia Saúde da Família. A interpretação dos dados seguiu os ensinamentos da análise de conteúdo. Resultados - Os entrevistados apontaram problemas no atendimento em planejamento familiar, embora percebam de maneira positiva suas relações com os outros profissionais de saúde e com os usuários. Conclusão - Os dados coletados e analisados nesta pesquisa permitem sustentar que existe um distanciamento entre as políticas que são propostas para as ações em planejamento familiar e as práticas dos profissionais de saúde que lidam diretamente com estas necessidades contraceptivas dentro da Estratégia Saúde da Família / Introduction - Women are the main agents of health care to families and communities. Despite that, the consequences of globalization and modernity over poor women lead to the necessity of adherence to the several modes of fecundity regulation. Brazilian Family Health Strategy has as its principal work process the observation of reproductive rights in women health care, specifically the family planning concerns. Objective - To analyze in what dimensions of sociopolitical meanings are the family planning relations, actions and activities in the context of Family Health Strategy in Sobral, Ceará, Brazil. Methodology - Descriptive and explanatory qualitative research, made by semi-structured and non-structured interviews, with open-ended questions; participant observation and documental analysis. The research protocol was approved by USP Ethical Board Review and the ethical Brazilian recommendations on human research were observed. The researchs participants were health professionals of Sobral Family Health Strategy. The data were submitted to the thematic content analysis. Results - The participants highlight problems in family planning provision, despite they perceive their relationship with the clients and into the health team in the positive manner. Conclusion - Measures for improvement of family planning are related to structure, equipments, professional training and empowerment of educational groups

Libya, one of less advanced countries, has experienced extensive demographic change in recent decades. Although, efforts have been made to collect descriptive statistics relating to population change (such as Censuses), there has been no serious explanations of demographic change by academics of the reasons behind population trends in Libya.This thesis sought to explore in a rigorous fashion the extent to which socio-economic circumstances, particularly increased levels of female education, has influenced female fertility behaviour. This hypothesis was examined for the population of El Gebel El Akhdar, Libya.The study was based on a sample of 600 married women categorised by location (urban and rural), age (below and above 45 years) education level and socio-economic status. Quantitative and qualitative techniques were used to understand fertility differentials for both the older and younger women included in the survey both in urban and rural areas. It was demonstrated that there were important changes in female fertility behaviour taking place both in relation to the intermediate variables (marriage, post-partum infecundability, contraception) as presented in Bongaarts? theory (1982, 1985) and in relation to socio-economic factors (education, occupation, income, age difference of partner, place of birth and residence). Female education was given special attention in the research following the general research framework of Jeffery and Basu theory (1996).Females with higher educational attainment, and thus higher employability, were characterised by relatively higher ages at first marriage, a smaller family size and a concurrently positive attitude towards approval and use of family planning and using contraceptive. They also engaged in a period of shorter breastfeeding. The inverse emerged as true for uneducated women.In addition to the effect of education on fertility, it emerged that change in female fertility behaviours and attitudes were also influenced by the interaction of many other socio-economic factors such as income, occupation, and partner age difference. On the contrary, the place of birth and place of residence did not help to explain fertility outcomes.

Philosophiae Doctor - PhD / The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.

Introdução - As mulheres são as principais agentes de cuidados em saúde das famílias e comunidades. Apesar disso, as consequências da globalização e da modernidade nas mulheres de baixa renda resultaram em uma necessidade de adesão às diversas formas de regulação da fecundidade. A Estratégia Saúde da Família traz como característica de trabalho para seus profissionais a observância dos direitos e a atenção à saúde reprodutiva e especificamente ao planejamento familiar. Objetivo - Analisar em que dimensão de significados sociopolíticos encontram-se as relações, ações e atividades de planejamento familiar no âmbito da Estratégia Saúde da Família do município de Sobral, no Estado do Ceará, Brasil. Metodologia - Pesquisa qualitativa, de caráter descritivo e explicativo, mediante entrevistas semi-estruturadas e não estruturadas, com questões em aberto, observação livre e análise documental, iniciada após prévia aprovação do Comitê de Ética em Pesquisa e consentimento esclarecido dos entrevistados. Os sujeitos são profissionais de saúde da Estratégia Saúde da Família. A interpretação dos dados seguiu os ensinamentos da análise de conteúdo. Resultados - Os entrevistados apontaram problemas no atendimento em planejamento familiar, embora percebam de maneira positiva suas relações com os outros profissionais de saúde e com os usuários. Conclusão - Os dados coletados e analisados nesta pesquisa permitem sustentar que existe um distanciamento entre as políticas que são propostas para as ações em planejamento familiar e as práticas dos profissionais de saúde que lidam diretamente com estas necessidades contraceptivas dentro da Estratégia Saúde da Família / Introduction - Women are the main agents of health care to families and communities. Despite that, the consequences of globalization and modernity over poor women lead to the necessity of adherence to the several modes of fecundity regulation. Brazilian Family Health Strategy has as its principal work process the observation of reproductive rights in women health care, specifically the family planning concerns. Objective - To analyze in what dimensions of sociopolitical meanings are the family planning relations, actions and activities in the context of Family Health Strategy in Sobral, Ceará, Brazil. Methodology - Descriptive and explanatory qualitative research, made by semi-structured and non-structured interviews, with open-ended questions; participant observation and documental analysis. The research protocol was approved by USP Ethical Board Review and the ethical Brazilian recommendations on human research were observed. The researchs participants were health professionals of Sobral Family Health Strategy. The data were submitted to the thematic content analysis. Results - The participants highlight problems in family planning provision, despite they perceive their relationship with the clients and into the health team in the positive manner. Conclusion - Measures for improvement of family planning are related to structure, equipments, professional training and empowerment of educational groups

Background: Approximately 70% of US adults currently receiving opioid agonist treatment (OAT) for opioid use disorder are of reproductive age. Among women receiving OAT at risk of having an unintended pregnancy, typically less than half report any current contraceptive use compared to 90% in the general population. In addition, the rate of unintended pregnancy among women receiving OAT is disproportionately higher than the general population (~80% vs. 45%, respectively). Lack of knowledge about family planning may be contributing to decreased rates of contraceptive use and increased rates of unintended pregnancy among women receiving OAT. Method: Participants were a convenience sample of women and men receiving OAT or a comparison group receiving primary care (PC) services. Family planning knowledge was assessed with the recently validated Contraceptive Knowledge Assessment (CKA), a self-administered 25-question multiple-choice survey. A two-way ANOVA, with fixed factors (i.e. patient sample and sex), compared the total number of correct responses for all questions and five more specific content areas (p<.05). Results: Overall, 332 participants completed this survey. The mean percent of total correct responses was significantly lower in the OAT sample (n=167) compared to the PC sample (n=165), 47% vs. 53% correct, respectively (p<.001) or approximately 1.5 questions less. The mean percent of correct responses in four of the five content areas was also lower among the OAT sample compared to the PC sample (ps<.01). The mean percent of total correct responses was significantly higher among women (n=169) than men (n=163), 56% vs. 44% correct, respectively (p<.0001) or approximately 3 questions more. The percent of correct responses in four of the five content areas was also higher among women than men (ps<.01). Conclusion: Given the substantial discrepancy in rates of contraceptive use and unintended pregnancy between individuals receiving OAT and the general population, it is somewhat unexpected that individuals receiving OAT did not have lower levels of family planning knowledge, although patients in both samples only answered approximately 50% of the questions correctly. Results from the present study suggest deficits in family planning knowledge, while statistically significant, may be less clinically so. Overall, lack of family planning knowledge is likely only playing a small role in population differences in contraceptive use and unintended pregnancy and interventions aimed at decreasing these differences will need to address other barriers to accessing family planning services and utilizing contraception in this population.

The purpose of the study was to examine reproductive life planning practices among Title X family planning health care providers and clinical staff. Reproductive life planning is a program priority for Title X clinics, those that receive federal money for providing family planning services to low-income women and men. The goal of reproductive life planning is to decrease unwanted and unintended pregnancies and improve preconception health care however; this practice has not been described. First, a conceptual analysis was conducted to create a definition of reproductive life planning that was consistent with the literature. Reproductive life planning is a process that is centered on reproductive and other life goals and is personalized, collaborative, fluid, and focused on health-promotion. Second, a mixed methods design was used to examine reproductive life planning practices and qualitative interviews were conducted to explore barriers and facilitators to implementing reproductive life planning practices. Data were obtained from health care providers and clinical staff employed at Title X clinics in Illinois, Iowa, Minnesota, Missouri, Nebraska, and North Dakota. A total of 148 clinicians completed a web-based survey which was analyzed to describe which types of patients, the topics covered, and the frequency with which reproductive life planning was discussed during an office visit. Surveys were then examined to identify 20 providers to conduct qualitative interviews with to further explore reproductive life planning practices. The qualitative interviews were also performed to explore the barriers and facilitators clinicians face to practicing reproductive life planning. The results of the web-based questionnaire were examined mainly with medians and frequencies to examine reproductive life planning practices. Qualitative interviews were coded using a content analysis approach to two aims; one to examine how reproductive life planning was using during clinic visits and two, to identify the barriers and facilitators clinicians face when discussing reproductive life planning with patients. Findings from the survey and the interviews suggest that most clinicians are discussing pregnancy intentions with their patients. However, from the interviews, three types of scope of reproductive life planning emerged; those clinicians who screened their patients’ pregnancy intentions, those who planted the seed in the patient’s mind, and those who explored the context of a patient’s life and their goals to contextualize how pregnancy and childbearing would fit into their lives in order to clarify pregnancy intention and move toward the corresponding health behaviors. It is argued that the third group of providers is using reproductive life planning as intended by experts. Finally, barriers to RLP discussions were examined as well as approached providers used to overcome the barriers. In conclusion, many clinicians are practicing reproductive life planning as intended, however many are not. Improved training and protocols are needed to ensure clinicians are providing their patients with the best reproductive life planning discussions. Additionally, systemic structures, like access to quality family planning services, need to be improved to aid clinicians in helping their patient plan their families.

In China, April 13, 1989 was marked as the "1.1 Billion Population Day." Though it has become the first "demographic billionaire" in the world, China has obtained remarkable results in population control. According to the statement issued by China's National Bureau of Statistics in 1987, the natural population growth rate dropped from 25.83 per thousand in 1970 to 11.28 per thousand in 1985. This has been viewed as an achievement not previously seen in any other population. In the past four decades, the Chinese government has adopted a population policy to organize the fertility transition in a planned way through education, motivation and persuasion. Five communication campaigns have been instituted to implement the policy. The successive family planning campaigns have played a vital role in educating and persuading individuals to accept the new fertility norms advocated by the government. In the communication processes of these campaigns, the strategies used have changed from the media-oriented strategy of the first campaign, to the introduction of an interpersonal approach in the second followed by an integration of media, interpersonal and organisational communication in the three latest campaigns. The integration of the media and interpersonal communication approaches was achieved through group discussion sessions and home visits, in which media messages were mediated and interpreted as a reinforcement to media impact. The group dynamics in the interpersonal communication has played an important role in changing individuals' attitudes towards and behaviour of family planning. As a campaign is an organized activity which requires organizational channels to ensure the conduct of the activity and the flow of information, a well-established organization hierarchy for family planning work has facilitated the management of family planning campaigns and also been regarded as a fundemental element to the success of the later campaigns.

<p>The subject of sexuality has been one of the most heated issues of the Popes throughout the history of the Catholic Church. The topics discussed by the various popes over the years, regarding sexuality, are limited to marriage, the conjugal act, the decline in morals, natural and artificial birth control, abortion, as well as more recently, modern methods of assisted reproduction. </p><p>Moral changes and trends in modern society have had an impact on Catholic Religion. Modern society faces a culture that influences norms and expectations and seems to accept free sexuality. The popes respond slowly or not at all to these cultural trends.</p>