Men are frequently left out of the picture in the study of family planning and sexual risk behavior. This approach means few programs and policies address men's family planning and sexual health issues. There is also a lack of understanding of the role fatherhood plays in men's development and in family planning and sexual health. For Mexican immigrant men, the picture is even worse given their disadvantaged position and the unique obstacles they face (e.g., language barriers, acculturation issues) that put them at risk for experiencing unintended pregnancies and contracting Sexually Transmitted Infections (STIs). Grounded in symbolic interactionism and life course theory, I explored how social roles (e.g., partner, father), individual factors (e.g., education, cultural values), and health systems influence the family planning and sexual risk-taking experiences of young Mexican immigrant men paying particular attention to differences and similarities between fathers and nonfathers. To answer the research questions, a qualitative study was conducted using secondary data from the Latino Health Project: Men Only. The sample was comprised of 21 fathers and 25 nonfathers ages 18 to 30 (N = 46), all of whom had lived in the United States for 10 years or fewer, thus being considered recent immigrants. Data for the project were collected using a semi-structured interview guide with open-ended questions followed by directive probes. The analysis process used grounded theory methodology techniques (LaRossa, 2005). Key findings suggest that both fatherhood status and partners play an important role in men's experience with sexual and reproductive health, with partners playing a more influential role. Fatherhood plays a more active role in men's ideas about family planning while partners seem to play an influential role in men's actual behaviors such as engaging in family planning services and using birth control other than condoms. The influence that fatherhood and partners have on men's experiences with family planning and sexual risk-taking was shaped by a unique combination of accurate information, different levels of knowledge, and misinformation. Access to services was shaped by health systems that prevented men from seeking services due to documentation issues and economic barriers. Cultural factors such as machismo, marianismo, and personalismo also influenced some attitudes and behaviors related to birth control use, vasectomies, risk-taking, and services utilization. Findings suggest these men are exposing themselves and their partners to unintended pregnancies and sexually transmitted infections. Beyond these being public health concerns, it is crucial that researchers, policy makers, and service providers remember that current sexual risk behaviors have a direct impact on the fertility and family formation patterns of the fastest growing population in the United States. / Graduation date: 2012 / Access restricted to the OSU Community at author's request from Jan. 9, 2012 - Jan. 9, 2013

Improving the implementation of family planning through integration with HIV services is vital to reduce maternal and child morbidity and mortality that has been a concern especially in developing countries like Ethiopia (UNFPA 2016). The aim of this study was to develop a strategic plan that could facilitate the implementation of an integrated family planning and HIV services at the public health centre level. The researcher utilized an explanatory sequential mixed method design with quantitative data collected in the first phase and qualitative data collected in the second phase. Data were collected from 403 clients in face-to-face structured interviews and from 305 service providers by means of a self-administered questionnaire. Descriptive analysis was applied to describe the findings of the study. Significance testing between variables was computed by odds ratio, p-value and 95% confidence interval. Bivariate and multi-variate logistic regressions were used for the analysis. In Phase 1, awareness of family planning methods, male involvement, marital status, client satisfaction, family income, waiting time, training, awareness of policies/guideline and transport availability were statistically significant challenges identified by clients and service providers. The client and service provider respondents identified previous use of family planning, men’s involvement, client satisfaction, availability of behavioural change communication materials, accessibility, budget, infrastructure and medical resources as opportunities. In phase 2, the researcher utilized the nominal group technique (NGT) to collect qualitative data from programme officers. Twenty-four programme officers from 10 sub city health offices, city and national level participated in two nominal groups, consisting of 12 participants each. Multiple group analysis was used to analyse the data from the nominal groups. The five strategies ranked as the most important were leadership and management; capacity building; implementation of policies and guidelines; advocacy/awareness, and infrastructure. The findings in phase 1 and phase 2 formed the basis for the development of a strategic plan using the process planning model. The strategic plan was developed and validated with the active participation and involvement of programme officers. The plan is intended to be implemented by service providers and programme officers to facilitate the implementation of integrated family planning and HIV services at the public health centre level. / Health Studies / D. Litt et. Phil. (Health Studies)

The aim of the study was to develop strategies to reduce the unmet need for modern contraception among agro-pastoral women. The objectives of the study were to determine the prevalence of unmet need for modern contraception, determine the factors associated with unmet need for modern contraception, and explore the barriers that hindered agro-pastoral women from using modern contraception. A mixed-method research design was used to conduct the study. Data were collected from agro-pastoral women and family planning service providers. Questionnaire and individual in-depth interviews were used to collect the data. The validity and reliability of the quantitative data and trustworthiness of the qualitative data were ensured. Use of standard data collection tools, employing method and data triangulation, and documenting all the procedures of data collection and analysis were among the ways employed to do so The quantitative data were analysed using simple descriptive statistics and multivariate logistic regression. Thematic analysis was employed to analyse the qualitative data. Ethical principles of research such as beneficence, justice, informed consent, respect for persons, privacy and confidentiality and scientific integrity were considered to conduct the study. The study revealed an unmet need of 29.2% (n=112) for modern contraception among agro-pastoral women. The unmet need for birth spacing constituted 21.1% (n=81), whereas the unmet need for birth limiting was 8.1% (n=31). The age of the women, the number of living children, knowledge of modern contraceptive methods, and knowledge of FP service centres were found to be associated with women‘s unmet need for modern contraception. Lack of time and money, lack of knowledge about modern contraception, and fear of side effects were the major individual-level barriers. There were also culture-related factors such as the need for many children that hindered agro-pastoral women from using modern contraception. Moreover, the study disclosed that religious unacceptability and husband‘s and relatives‘ opposition were also among the mentioned barriers. The quality of FP service provision in terms of the competence and behaviour of health service providers, unavailability and inaccessibility of FP service, were also indicated as barriers. The findings informed the development of strategies to reduce agro-pastoral women‘s unmet needs for modern contraception in Eastern Ethiopia. The study further recommended that the health bureaus of the region, zone and district collaborate in ensuring that agro-pastoral women realise the significance of the provision of accessible, equitable, quality modern contraception. It is also essential to equip health facilities with qualified health service providers and necessary facilities. Religious leaders should be involved in disseminating vital, relevant and empowering FP information. / Health Studies / Ph. D. (Public Health)

The issue of women's reproductive rights has become an international concern in the recent decade. Ongoing debates on women's reproductive rights in world conferences and conventions have heightened the need for empirical research and theoretical explanations of women's reproductive rights Nevertheless, very few sociological studies have treated women's reproductive rights as a dependent variable. This study examines the effects of family planning programs and the processes of modernization on women's reproductive rights. Several facets of modernization; processes of socioeconomic development, secularization, women's education, and levels of gender equality are considered. The study involves 101 countries identified by the World Bank (1994) as developing countries. It is argued, on the one hand, that variations in women's reproductive rights in developing nations may be explained by the social changes brought about by modernization processes. On other hand, the universality of the anti-natalistic population policies in developing countries in the late 20th century provides a strong state control over fertility rate, which may contribute to the attainment of women's reproductive rights. Using linear structural equation analysis, the study finds that fertility decline due to family planning programs leads to the achievement of women's reproductive rights. The empirical findings support the hypothesis that socioeconomic development has a positive effect on women's education, and that there is no statistically significant relationship between modernization and gender equality. The results of the study, meanwhile, indicate that, in developing societies, women's education is negatively related to women's reproductive rights. The study suggests: first, family planning programs as a social policy in developing countries influence fertility decline, and enhance women's reproductive rights; second, gender equality in society is an important factor that increases the level of reproductive rights for women in developing countries; and finally, the finding that women's education reduces the attainment of reproductive rights may imply the need to develop valid scales for measuring reproductive rights. The findings of this study contribute toward the development of a structural model of reproductive rights.

Les objectifs de notre étude étaient d’identifier et décrire les obstacles à la planification familiale ; d’analyser et déterminer les facteurs associés aux non recours par les femmes; et d’analyser l’attitude des professionnels de santé en matière de planification familiale. Une recherche bibliographique sur le thème et une enquête par questionnaire administrée lors d’entretiens face-à-face auprès des femmes en âge de procréer et auprès des professionnels de santé ont été réalisées. Les analyses statistiques ont été réalisées à l’aide d’EPI INFO 6 et SAS version 9.4. Une régression logistique a permis de mesurer l’association entre l’utilisation et non de méthodes de planification familiale. Au total, 314 femmes et 17 professionnels de santé ont été interrogés. L’accès aux services, l’âge, et l’ethnie étaient significativement associés au non recours à la planification familiale. Les obstacles, dont l’opposition du conjoint, manque d’information, manque de personnel qualifié limitaient le recours à la planification famille. La mise en oeuvre des interventions ciblées devront permettre de surmonter les obstacles et seraient les principaux déterminants au recours des services de planification par les femmes. / The objectives of our study were identified and describe the barriers to family planning; analyze and identify factors associated with non-use by women; and to analyze the attitude of health professionals regarding family planning. A literature search on the topic and a questionnaire survey administered in face-to-face interviews with women of childbearing age and health professionals were conducted. Statistical analyzes were performed using EPI INFO 6 and SAS version 9.4. Logistic regression measured the association between the use and non-use of family planning methods. A total of 314 women and 17 health professionals were interviewed. Access to services, age, and ethnicity were significantly associated with non-use of family planning. Barriers, including spousal opposition, lack of information, lack of qualified staff, limited the use of family planning. The implementation of targeted interventions will need to overcome barriers and be key determinants of women's use of planning services.

Embora o dispositivo intrauterino (DIU) seja pouco usado no Brasil, ele é o método contraceptivo reversível mais usado no mundo. Trata-se de um método seguro, altamente eficaz e com resultados positivos na saúde das populações. Por meio da prevenção de gestações não planejadas, atua na redução da morbidade e mortalidade materna, mortalidade infantil e abortos inseguros. Pesquisas recentes, contudo, mostram que o acesso ao DIU nos serviços de Atenção Básica à Saúde nem sempre é facilitado, sendo permeado por barreiras organizacionais que contribuem para sua subutilização. Tais barreiras podem restringir o pleno exercício dos direitos sexuais e reprodutivos das mulheres brasileiras. Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde e elaborar, como produto desta dissertação, uma síntese destas barreiras, destinada aos gestores de saúde, com suas implicações e recomendações. Método: Estudo quantitativo, descritivo. A coleta de dados foi realizada por meio do preenchimento de um instrumento estruturado, online, pelos 79 profissionais responsáveis pela área técnica de Saúde da Mulher. O cenário do estudo foi a macrorregião Sul de Minas Gerais. A análise dos dados foi realizada por meio do software Stata, versão 14.0, e descrita por meio de número absoluto e proporções. Resultados: A maioria dos municípios possui protocolo de atenção à saúde da mulher (55,7%). Destes, 77,3% elaboraram seu próprio protocolo, mas 29,6% não treinaram a equipe de saúde para usá-lo. Dentre todos os municípios participantes, 15,2% não disponibilizam DIU, sendo que alguns também não referenciam a mulher para outros serviços (8,3%). Dentre aqueles que disponibilizam o DIU, a grande maioria não possui protocolo específico (68,7%); uma parcela não adota a gravidez como condição impossibilitante da inserção do DIU (10,5%) e, por outro lado, adotam condições menos relevantes como infecção vaginal (80,6%). Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos. Como exames necessários, foi citado o Papanicolaou (94,7%), teste de gravidez (63,2%) e exame de sangue (29,8%). Quanto ao local de disponibilização, 83,7% não o disponibilizam nas Unidades Básicas de Saúde. Como profissional que insere o DIU, 97,0% referiram médico e nenhum citou o enfermeiro. Quanto aos grupos de planejamento reprodutivo, 43,0% dos municípios não os realizam. Por fim, 86,1% dos trabalhadores reportaram não haver dificuldades para obtenção do DIU. Conclusão: Foram identificadas barreiras organizacionais que dizem respeito ao uso de protocolos, também barreiras relacionadas à disponibilização e inserção do DIU, e barreiras relativas aos grupos de planejamento reprodutivo. / Introduction: Although the intrauterine device (IUD) is little used in Brazil, it is the most used reversible contraceptive method in the world. It is about a safe method, highly effective and with positive results in the health of populations. By means of preventing unplanned pregnancies, it works to reduce maternal morbidity and mortality, infant mortality and unsafe abortions. Recent research, however, show that access to IUD in Primary Health Attention services is not always facilitated, being permeated by organizational barriers that contribute to their underutilization. Such barriers may restrict the full exercise of sexual and reproductive rights of Brazilian women. Objective: To identify organizational barriers for providing IUD in the Primary Health Attention services and elaborate, as a product of this dissertation, a summary of these barriers, which is intended for health managers, with their implications and recommendations. Method: Qualitative, descriptive study. Data collection was performed by completing, online, a structured instrument, by 79 professionals responsible for the technical field of Womens Health. The study setting was the macro-region in the southern of Minas Gerais. Data analysis was performed using Stata software, version 14.0, and described by absolute number and proportions. Results: Most municipalities have attention protocol to womens health (55.7%). Of these, 77.3% developed its own protocol, but 29.6% did not train health staff to use it. Among all participating municipalities, 15.2% do not offer IUD, and some did not refer women to other services (8.3%). Among those, which provide the IUD, the vast majority do not have specific protocol (68.7%); a portion does not adopt pregnancy as an impeditive condition of insertion of the IUD (10.5%) and, on the other hand, adopt less relevant conditions such as vaginal infection (80.6%). As a criterion for accessing the IUD, 86.5% reported prescription, 71.6% exams, 44.6% aged over 18 years old and 24.4% participation in groups. As required exams, it was quoted the Pap smear (94.7%), pregnancy test (63,2%) and blood tests (29,8%). As a place of availability, 83.7% do not provide in the Basic Health Units. As a professional to insert the IUD, 97.0% reported the doctor and none cited the nurse. Municipalities do not realize reproductive planning group at 43.0%. Finally, 86.1% of workers reported not having difficulties in obtaining the IUD. Conclusion: Organizational barriers were identified concerning the use of protocols, also barriers related to the availability and IUD insertion, and barriers related to the reproductive planning groups.

Introdução: O uso de métodos anticonceptivos modernos pela maior parte das mulheres brasileiras não diminuiu, conforme esperado, assim como a ocorrência de gestações não desejadas, abortamentos e, consequentemente, mortes maternas, o que revela uso com perfil irregular e descontínuo. No Brasil, há pouca informação sobre os padrões e os determinantes da ocorrência dessas descontinuidades contraceptivas. Devido às inconsistências no uso de métodos serem relativamente comuns, é necessário mensurar o quanto as mulheres interrompem seu uso a despeito de não desejarem engravidar e/ou os alternam inúmeras vezes, nem sempre com opção por um método mais eficaz. Objetivo: Analisar os padrões e os determinantes das descontinuidades contraceptivas no uso da pílula oral, do hormonal injetável e do preservativo masculino. Método: Estudo longitudinal retrospectivo, conduzido com amostra probabilística de 1.551 mulheres de 18 a 49 anos de idade, usuárias de 57 Unidades Básicas de Saúde da cidade de São Paulo/SP (2015) e Aracaju/SE (2016). Os dados foram coletados por entrevista face a face usando o calendário contraceptivo. No Stata 14.2, as análises das taxas de descontinuidade contraceptiva no período de doze meses foram realizadas pelo método de Kaplan-Meier e dos fatores associados por meio dos Modelos de Riscos Proporcionais de Cox, ambos para descontinuidade total, abandono, troca para método menos eficaz e troca para método mais eficaz. Resultados: A taxa de descontinuidade total no uso de métodos foi 41,9% aos doze meses, sendo maior entre usuárias do preservativo masculino (48,1%), seguida de hormonal injetável (39,0%) e pílula oral (38,6%). Entre as usuárias de pílula oral, a taxa de abandono foi a maior; entre as usuárias do hormonal injetável, foi a troca para um método menos eficaz; e, entre as usuárias do preservativo masculino, foi a troca para um método mais eficaz. Os aspectos associados às descontinuidades variam segundo o tipo de método. A descontinuidade no uso da pílula oral foi associada à idade (18-24 anos), vivência de abortamento, incerteza quanto à intenção reprodutiva e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do hormonal injetável foi associada ao maior número de parceiros sexuais, à vivência de abortamento e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do preservativo masculino foi associada à idade (25-34 e 35-49 anos), à união conjugal, ao menor poder aquisitivo (classe econômica D/E) e ao maior número de filhos vivos. Conclusões: Foram observadas altas taxas de descontinuidades no uso de métodos contraceptivos, que variaram conforme o tipo de método. Chama a atenção o papel dos efeitos colaterais na determinação da ocorrência de descontinuidade no uso dos métodos hormonais. Por sua vez, a troca por método mais eficaz foi pouco frequente, com exceção das usuárias de preservativo masculino. Sugere-se ampliar o acesso aos métodos contraceptivos mais eficazes e de longa duração e melhorar a assistência em contracepção nos serviços do Sistema Único de Saúde, de forma a contemplar as necessidades de saúde das mulheres e seus direitos sexuais e reprodutivos. / Introduction: Use of modern contraceptive methods by the majority of Brazilian women did not reduce the occurrence of unintended pregnancies, abortions or maternal deaths as expected, which means that it might be an irregular and discontinuous use. In Brazil, there is a little information on the patterns and determinants of the occurrence of these contraceptive discontinuations. Because inconsistencies in the use of methods are relatively common, it is necessary to measure how much women discontinue their use despite they are willing to get pregnant and/or switching them countless times, not always with the option of a more efficient method. Objective: Our purpose is to investigate patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injection and condom. Method: We conducted a retrospective longitudinal study with probabilistic sample of 1,551 women among 18-49 year old who are primary users of 57 health care facilities, both in Sao Paulo (2015) city and Aracaju city (2016). Data were collected by face-to-face interview in line with contraceptive calendar. In Stata 14.2 analyzes of 12-month contraceptive discontinuation rates were performed using the Kaplan-Meier Survival Estimates method and associated factors using the Cox Proportional Hazards Models, both for total discontinuation, abandonment, and switching to a less efficient method and switching to more efficient method. Results: The discontinuation rate in the use of methods was 41.9% at 12 months, being higher among male condom users (48.1%), followed by hormonal injection (39.0%) and oral pill (38.6%). Among oral pill users, the abandon rate was the highest; among users of hormonal injections, was the switching to a less efficient method; and among male condom users, it was the switching to a more efficient method. The aspects associated to the discontinuations varied according to the type of method. Discontinuation of oral pill users was associated with age (18-24 years old), experience of abortion, uncertainty about reproductive intention and side effects/health concern. Discontinuation in the use of hormonal injections was associated with a greater number of sexual partners, the experience of abortion, and the side effects/health concern. Discontinuation of condom users was associated with age (25-34 and 35-49 years old), marital union, lower income and the highest number of live children. Conclusion: High discontinuation rates were observed in the use of contraceptive methods, which varied according to the type of method. The role of side effects/health concern in determining the occurrence of discontinuation in the use of hormonal methods is noteworthy. On the other hand, switching to more efficient method was infrequent, except for the male condoms users. It is suggested to amplify access to the more effective methods as well as long active also improving care in contraception in the all health care facilities services, in order to take into account both women health needs and their sexual and reproductive rights.

Made available in DSpace on 2016-04-29T14:16:00Z (GMT). No. of bitstreams: 1 Ademar Sales Macaubas.pdf: 2396066 bytes, checksum: f561c58bea5a00cd82f68b9eb454a146 (MD5) Previous issue date: 2011-06-10 / Fundação Ford / The objective of this work is to identify and analyze the repercussions and meanings of the female sterilization in the life trajectory of the women and their husbands/partners attended by the Family Planning Service-SPF of the Policlínica Dr. Henrique de Aquino CPA I, in Cuiabá (MT). The main strategy of the investigation was the analysis centered in the decision process for the surgery of tubal ligature, among the set of contraceptives currently made available for men and women. With the execution of a exploratory examination, of quali-quantitative nature, on the social conditions and the motivation for seeking the SPF, of a group of 130 women, between the years 2006 and 2008, we started from the basic point that it is the woman who takes the initiative of seeking the intervention and, for the most part, assumes the burden of the decision, besides the risk of the surgical process in her own body. The listening to these women was privileged among the set of procedures of data collecting, through the use of qualitative techniques, specially the oral history resources. Focusing the interview on the moment of decision, significant and correlated situations were approached: infancy, teenage; work and income; maternity; sexuality and conjugality; knowledge, attributed meanings and use of contraceptives methods; main changes perceived after the surgical procedure; besides, specially, of the description and meaning attributed to what determined it, impacts and consequences of the sterilization. Men were also heard, as co actors in the reproductive process, standing out the importance of their comprehension of the option for the vasectomy as a method. As for the results, are outstanding: the diversified consequences on the sexual activity and self image of their performance, from living with more liberty and better enjoyment of the pleasure to the decrease and disappearance of the sexual desire; clear misinformation about the STDs/Aids and the need and possibility of safe sex; the strong desire to be a mother, of personal and cultural basis, also among the efficient factors of taming of the bodies, delaying sterilization, even in limit situations of risks; the recognized importance of the SPF, with a negative evaluation of the attendance, in terms of confidence and tranquility in the processing of the demands and the carrying out of the surgical intervention; difficulties pointed out between the comprehension of the legislation and the singular demands. Thus, the conclusions are towards that, even if the knowledge, by the studied population, can be characterized as of low control and mistakes of interpretation, the decision to make the ligature is, for the most part, connected to a conscious and coherent life project with the exit from the minimum level of survival and of the accomplishing of impossible aspirations, at least in the short term horizon of work pay and of the structures of social protection. Therefore, the objective is to significantly change the trajectories of the women, children and husbands/partners lives, with the overcoming of many obstacles / O trabalho tem como objetivo identificar e analisar as repercussões e significados da esterilização feminina na trajetória de vida das mulheres e de seus maridos/companheiros atendidos pelo Serviço de Planejamento Familiar-SPF da Policlínica Dr. Henrique de Aquino CPA I, em Cuiabá (MT). A principal estratégia de investigação foi a análise centralizada no processo de decisão pela cirurgia de laqueadura tubária, dentre o conjunto de recursos contraceptivos atualmente disponibilizados para homens e mulheres. Com a realização de um estudo exploratório, de natureza quali-quantitativa, sobre as condições sociais e a motivação para a procura do SPF, de um grupo de 130 mulheres, entre os anos de 2006 a 2008, partiu-se do dado básico de que é a mulher que toma a iniciativa da busca da intervenção e, em grande parte, assume o ônus da decisão, além do risco do processo cirúrgico em seu próprio corpo. A escuta dessas mulheres foi privilegiada no conjunto dos procedimentos de coleta de informações, mediante a utilização de técnicas qualitativas, especialmente dos recursos da história oral. Focalizando a entrevista no momento da decisão, foram abordadas situações a ele correlatas e significativas: infância e adolescência; trabalho e renda; maternidade; sexualidade e conjugalidade; conhecimento, significados atribuídos e uso dos métodos contraceptivos; principais mudanças percebidas depois do procedimento cirúrgico; além, especialmente, da descrição e da significação atribuídas aos determinantes, impactos e consequências da esterilização. Os homens foram também assim ouvidos, como coadjuvantes do processo reprodutivo, destacando-se a importância de sua compreensão sobre a opção da vasectomia como método. Quanto aos resultados, destacamse: as consequências diversificadas sobre a atividade sexual e a autoimagem em seu desempenho, desde a vivência com maior liberdade e melhor usufruto do prazer até a diminuição e desaparecimento do desejo sexual; nítida desinformação a respeito das DSTs/Aids e da necessidade e possibilidade de sexo seguro; o forte desejo de ser mãe, de bases pessoais e culturais, também entre os fatores eficientes de docilização dos corpos, retardando a esterilização, mesmo em situações-limite de riscos; a reconhecida importância do SPF, acompanhada de uma avaliação negativa quanto ao atendimento, em termos de confiança e tranquilidade no processamento das demandas e realização da intervenção cirúrgica; dificuldades apontadas entre a compreensão da legislação vigente e as demandas singulares. Enfim, as conclusões vão no sentido de que, mesmo que o conhecimento, pela população estudada, dos contraceptivos se caracterize por baixo domínio e equívocos de interpretação, a decisão de fazer a laqueadura está, em grande parte, articulada a um projeto de vida consciente e coerente com a saída do nível mínimo de sobrevivência e da realização de aspirações impossíveis, ao menos no horizonte da remuneração do trabalho e das estruturas de proteção social de curto prazo. O objetivo, portanto, está em mudar significativamente as trajetórias de vida das mulheres, filhos e maridos/companheiros, a partir da superação de muitos obstáculos

O planejamento familiar é uma ação de saúde que permite a regulação da fecundidade, faz parte da Atenção Básica, atualmente vem sendo oferecido através do Programas de Saúde da Família é um direito reprodutivo. A qualidade da assistência em planejamento familiar é imprescindível para os índices de saúde reprodutiva e sexual, sendo a oferta, a livre escolha por métodos contraceptivos e a informação dada aos clientes são elementos fundamentais para garantir a qualidade dessa assistência. Este estudo teve como objetivo descrever a assistência prestada em planejamento familiar segundo as mulheres em idade fértil e os profissionais de saúde do Núcleo de Saúde de Família I no município de Ribeirão Preto, São Paulo. Trata-se de um estudo descritivo, com abordagem quantitativa. A amostra foi composta por 242 mulheres em idade fértil cadastradas no Núcleo de Saúde da Família I e por 11 profissionais de saúde que atuavam neste serviço. Os dados foram coletados através de entrevistas estruturadas em domicilio e no serviço de saúde. A estatística descritiva e os testes quiquadrado de Pearson ou Exato de Fisher foram utilizados para a análise dos dados. Os resultados revelam que a maioria das mulheres (69,8%) utiliza o Núcleo de Saúde da Família I para segmento de saúde, possuem em média 32,6 anos, são casadas (43%), possuem vida sexual ativa (65,7%), já engravidaram sem planejar utilizando métodos contraceptivos (46,2%), utilizam métodos contraceptivos para o controle da fecundidade (66,5%), sendo a pílula e o preservativo masculino os mais conhecidos e utilizados, já suspenderam o uso de métodos contraceptivos sem orientação médica (57,8%). O Núcleo de Saúde da Família I não se constituiu em local de orientação para 51,2% das mulheres sobre planejamento familiar, bem como para homens e adolescentes. As mulheres recebem orientações sobre planejamento familiar de forma individual (90,1%), há pouca utilização de material ilustrativo durante as orientações (38,7%), A mulheres utilizam os métodos contraceptivos mais orientados e oferecidos pelos profissionais de saúde, recebem acompanhamento clínico (75,6%). O conhecimento das mulheres, sobre as principais características dos métodos contraceptivos, está associado ao método em uso. Há orientação para o uso de preservativo masculino visando prevenir DST/HIV, porém este método é pouco utilizado. Os profissionais de saúde estão formados, em média, há 13 anos, atuam, em média, há quatro anos e nove meses no Núcleo de Saúde da Família I e atuam, em média, há sete anos em planejamento familiar e a maioria não recebeu capacitação em planejamento familiar. Atividades de orientação em grupo são desenvolvidas esporadicamente. Os métodos contraceptivos mais eficazes são os mais orientados e oferecidos para as mulheres pelos profissionais de saúde. Concluímos que a informação sobre os diversos métodos contraceptivos e a escolha livre não é realidade das mulheres do Núcleo de Saúde da Família I, já que utilizam os métodos contraceptivos mais orientados e oferecidos pelos profissionais de saúde. A falta de capacitação profissional, assim como as ações educativas descontinuas e pouco concretizadas, colocam em risco a saúde reprodutiva e sexual das mulheres. A assistência em planejamento familiar apresenta-se deficitária, necessitando de adequação com vistas a uma assistência de qualidade na perspectiva dos direitos reprodutivos e sexuais. / Family planning is a health action that permits regulating fecundity and is part of Basic Health Care services. The quality of family planning care is essential for reproductive and sexual health ratios, in which the offering and free choice of contraceptive methods and the information given to clients are fundamental elements to guarantee care quality. This study aimed to describe family planning care delivery according to women of fertile age and health professionals at Family Health Center I in Ribeirão Preto, São Paulo. This is a descriptive study with a quantitative approach. The sample was composed of 242 women of fertile age registered at Family Health Center I and 11 health professionals working at this service. Data were collected through structured interviews held at home and at the health service. Descriptive statistics and Pearsons Chi-Square or Fishers Exact test were used for data analysis. The results reveal that most women (69.8%) use Family Health Center I for the health segment. Their average age is 32.6 years; they are married (43%); have an active sexual life (65.7%); have already been pregnant without planning to use contraceptive methods (46.2%); use contraceptive methods for fecundity control (66,5%), with the pill and the male condom as the most known and used methods; have already suspended the use of contraceptive methods without medical advice (57.8%). The Health Service under analysis did not represent a place of family planning advice for 51.2% of the women, nor for men and adolescents. The women receive individual advice about family planning (90.1%) and little illustration material is used during the advice sessions (38.7%). They use the contraceptive methods that are most indicated and offered by health professionals, and receive clinical follow-up (75.6%). The womens knowledge about the main characteristics of the contrace3ptive methods is associated with the method they are using. Advice is given about the use of the male condom with a view to preventing STD/HIV, although this method is little used. Average time since graduation for the health professionals is 13 years; they have been working at Family Health Centre I for four years and nine months on the average, have been active in family planning for seven years on the average and most of them did not receive any training on family planning. Group orientation activities occur sporadically. The most effective contraception methods are also those the health professionals indicate and offer most frequently. We conclude that information about the different contraceptive methods and free choice are not a reality for the women in this study, as they use the contraceptive methods that are most indicated and offered by the health professionals. The lack of professional training, as well as discontinued and not very concrete education actions put the reproductive and sexual health of these women at risk. Deficits in family planning care are found, demanding adaptation with a view to offering high-quality care from the perspective of reproductive and sexual rights.

Orientador: Íris Fenner Bertani / Banca: Regina Maura Rezende / Banca: Adriana Giaqueto / Resumo: Este trabalho tem como objetivo fazer uma aproximação da realidade vivenciada pelas mulheres que fazem uso do Ambulatório de Planejamento Familiar, equipamento de saúde pertencente à Secretaria Municipal de Saúde no município de Franca /SP. Trabalhamos como assistente social neste ambulatório desde a sua implantação em maio de 2000, o que nos possibilitou uma maior compreensão dos aspectos relativos à vida sexual e reprodutiva das usuárias, despertando nosso interesse em estudar e pesquisar assuntos pertinentes as suas vidas na tarefa de ser mulher, trabalhadora e mãe. Pesquisamos qual conhecimento estas mulheres têm sobre o planejamento familiar, considerando serem elas as maiores usuárias dos serviços de saúde e, em geral, quem decide qual método contraceptivo será usado pelo casal, mesmo quando quem vai se submeter à cirurgia de esterilização seja o seu companheiro. Justifica-se nosso interesse no descortinamento dessa realidade, pois munidas dessas reflexões elas poderão ter maiores condições de decidirem sobre suas vidas, mesmo dentro do contexto e influência da sociedade a qual pertencem e do meio em que vivem. Utilizamo-nos da pesquisa quantitativa e qualitativa. Para a abordagem quantitativa aplicamos questionário a sessenta mulheres usuárias do Ambulatório de Planejamento Familiar. Realizamos a pesquisa qualitativa entrevistando seis mulheres selecionadas aleatoriamente deste universo. A análise favoreceu a elaboração de um perfil das usuárias do ambulatório, bem como identificação das crenças e valores por elas relatados. O estudo favoreceu uma compreensão da vida dessas mulheres que ressaltam a maternidade como umas das vantagens em ser mulher, mas num paradoxo a colocam como um peso, um fardo, e expressam suas insatisfações em se aterem à vida privada, deixando explícito o desejo de se interarem do mundo público. / Abstract: This research has as objective to do an approach of the reality lived by the women that make use of the Clinic of Family Planning, equipment of health belonging to the Municipal Secretariat of Health in the municipal district of Franca / SP. We worked as social worker in this clinic from the implantation in May of 2000, what made possible us a larger understanding of the relative aspects to the users' sexual and reproductive life, rousing our interest in to study and to research pertinent subjects their lives in the task of being woman, worker and mother. We researched which knowledge these women have about the family planning, considering be them the largest users of the services of health and, in general, who decides which contraceptive method will be used by the couple, same when who will submit to the sterilization surgery is his companion. It is justified our interest in the discovery of that reality, because starting from those reflections they can have larger conditions of they decide about their lives, same inside of the context and influence of the society which they belong and of the middle in that they live. We used ourselves of the quantitative and qualitative research. For the quantitative approach we applied questionnaire to sixty women users of the Clinic of Family Planning. We realized the qualitative research interviewing six women of this universe randomly selected. The analysis favored the elaboration of a profile of the users of the clinic, as well as identification of the beliefs and values for them told. The study favored an understanding of those women's life that they emphasize the maternity as some of the advantages in being woman, but in a paradox they put it about a weight, a burden, and they express their dissatisfactions in detain to the private life, leaving explicit the desire of will acquaint of the public world. / Mestre