Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-11T18:40:53Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Angelita.pdf: 1916830 bytes, checksum: d67113ee81a6823bf500e2cd9baf84eb (MD5) / Made available in DSpace on 2016-07-11T18:40:53Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Angelita.pdf: 1916830 bytes, checksum: d67113ee81a6823bf500e2cd9baf84eb (MD5) Previous issue date: 2015-03-31 / FACEPE / Essa pesquisa é fruto do diálogo entre os campos de saberes da Sexualidade e da Saúde Mental. Nosso objetivo foi compreender a interface entre loucura e sexualidade nos discursos dos profissionais dos SRTs da cidade do Recife. A partir do referencial epistemológico do construcionismo social que nega as versões naturalizadas e universalizadas de realidade, compreendemos loucura e sexualidade como contructos sociais. Para analisar os dados coletados, utilizamos a Análise Crítica do Discurso, cujo foco de atenção recai sobre as dinâmicas das relações de poder que engendram os discursos. Como procedimentos de coleta, recorremos à entrevista semi-estruturada com 09 profissionais dos SRTs - analisamos apenas 06 -, ao diário de campo e à observação no SRT feminino no momento da coleta. Observamos avanços na política de desinstitucionalização no que se refere à implantação dos SRTs, uma vez que as casas localizadas na própria comunidade possibilitam a esses moradores, antes hospitalizados, um acesso a condições mínimas de dignidade. No eixo clínico, as ações de reabilitação psicossocial parecem focalizar os cuidados básicos com o corpo e com a casa, por meio de condutas pautadas pela palavra, pela escuta, pelo afeto e pelo acompanhamento direto a essas atividades da vida diária, promovendo uma mudança significativa na conformação desses corpos. No entanto, identificamos que o cuidado precisa ser ampliado na direção da acolhida da história desses corpos que trazem profundo sofrimento por terem suas sexualidades interrompidas e violentadas pela institucionalização psiquiátrica. Percebemos que os discursos sobre as expressões de sexualidade desses moradores e moradoras ora apresentam características da institucionalização, como infantilização, silenciamentos e condutas de tutela, assentados em padrões de gênero pautados na moral sexual cristã; ora, são discursos de reconhecimento dessa sexualidade como uma dimensão importante da vida desses sujeitos e que, portanto, precisa ser pensada pela equipe. Identificamos fragilidades no campo da conscientização dos direitos sexuais e dos direitos reprodutivos como elementos importantes no modelamento da atenção e dos modos de cuidar da equipe e, ainda, na compreensão da sexualidade desses moradores e dessas moradoras como um direito a ser garantido. Ainda nesse campo, encontram-se dificuldades de acesso à rede de serviços voltados para saúde do homem e da mulher. Diante disso, pensamos que a Reforma psiquiátrica precisa contemplar, em seu processo de inversão do modelo de atenção em saúde mental, uma pauta de ação que contemple o lugar de sentido da questão da sexualidade dos moradores e das moradoras dos SRTs, a fim de cuidar de uma dimensão de suas vidas há muito negligenciada pelas políticas públicas de saúde, promovendo, com isso, a autonomia e a cidadania. / This research emerges from the dialogue between Sexuality and Mental Health. We aimed at understanding the interface between madness and sexuality in the discourse of RTSs (Residential Therapeutic Servants) from Recife. Based on the epistemological grounds of social constructionism which denies naturalized and universal versions of reality, we understand madness and sexuality as social constructions. To analyze the collected data, Critical Discourse Analysis was used, focusing on the dynamics of power relations that articulate discourses. We discussed issues regarding the psychiatrization of madness, reviewing devices of body control and sexuality of mad individuals leading to the Psychiatric Reform in its Deinstitutionalization. Next, we explained some aspects of human sexuality from Foucault to Sexual and Reproductive Rights in its articulation to Mental Health. Research was conducted in the field of RTSs on qualitative approach. Data collection consisted of semi-structured interview with 09 RTS professionals – but only 06 were analyzed – field diary and observation of female RTS during data collection. We noticed advances in deinstitutionalization policies where the installation of RTSs is concerned, once the facilities located in the very community allow residents, previously committed, access to condition of minimal dignity. Clinically, actions of psychosocial rehabilitation seem to concentrate basic care on body and housing, by means of behavior modeled by speaking, listening, affection and direct support to daily activities, thus promoting significant change in the conformity of those bodies. However, we identified the necessity of extending such care towards embracing biographically the history of those bodies that carry deep suffering for having their sexualities interrupted and violated by psychiatric institutionalization. We noted that discourses on expression of sexuality from male and female residents either present characteristics of institutionalization, such as infantilization, silencing and guardianship, consolidated in patterns of gender shaped by Christian sexual moral; or are discourses of recognition of sexuality as an important dimension of these subjects’ lives and should, therefore, be taken into account by the staff. We identified fragilities in the field of awareness raising for sexual and reproductive rights as relevant elements in the modeling of attention and staff care’s attitude as well as in the comprehension of female and male residents’ sexuality as a right to be guaranteed. Also on this matter, difficulties were found in accessing healthcare service network for men and women. Bearing this in mind, Psychiatric Reform needs to embrace in the process of inverting the model of attention in mental health, a plan of action that includes the place of meaning of RTS male and female residents’ sexuality, in order to support a dimension of their lives long neglected by public health policies, therefore promoting autonomy and citizenship.

Legalization of Abortion in Argentina: A Path-Dependency Reading of the Influence of the Catholic Church and the Contrast with the Uruguayan Experience Alexa Elleny Quiles Hernández Abstract Argentina's abortion laws only allow women to access a lawful procedure in cases of rape and health or life threat, and this has been driving women who do not wish to continue a pregnancy into criminal considerations and, in many cases, dangerous and unhygienic environments. The aim of this work is to delineate part of the historical path that has forged the strong relations between the Argentinean State and the Catholic Church since the colonial period and the influence this has had on restrictive abortion rights for women today despite the growing number of demands to legalize voluntary termination. To highlight this influence, this study contrasts the Argentinean experience with that of neighboring Uruguay, a country that successfully legalized abortion in 2012 and which drew an effective division between the Church and the State at an early stage, furnishing a more autonomous environment for the government to respond to citizens' needs. For this, this work takes on Paul Pierson's approach to increasing returns and path- dependency theory and researches and analyzes events, dynamics and factors that have paved...

The high levels of early and unintended pregnancy among adolescents in African countries including Lesotho are attributed to various factors. These include inaccessibility, negative and unfavourable community attitude towards adolescent contraceptive uptake and use, poor knowledge of sexual and reproductive health issues including sexuality education, high levels of poverty and vulnerability, negative socio-cultural practices such as child marriage, and increasing sexual and gender-based violence. Adolescent pregnancy and parenting are usually associated with poor health, social exclusion, and stigma, leading to girls’ suspension and sometimes expulsion from school. Most African governments have adopted laws and developed policies protecting the rights of all children, including adolescents’ rights to enrol and be retained in school. These rights are to be always protected, including during pregnancy and motherhood. Aiming to explore the challenges in implementing policies and guidelines on school re-entry, this dissertation argues that despite the constitutional, legal and policy provisions to protect pregnant and parenting adolescent girls, punitive and discriminatory strategies against them undermine countries’ human rights commitments. Using the socio-legal approach, the study attributes the legal, policy and strategy implementation challenges, especially those on sexual and reproductive health and education to influences of family, societal, religious and cultural beliefs and practices. It proposes more comprehensive, innovative, gender transformative, targeted and rights-based interventions; and supportive policies and strategies to facilitate continuous awareness creation, social and attitudinal change, and social justice to address adolescents’ specific needs and justify the state’s obligations and legal duties to respect, protect and fulfil citizen’s rights in Lesotho. / Mini Dissertation (MPhil (Sexual and Reproductive Rights in Africa))--University of Pretoria, 2021. / Centre for Human Rights / MPhil (Sexual and Reproductive Rights in Africa) / Unrestricted

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Unintended pregnancies resulted in $21 billion in avoidable health care costs in the United States as of the most recently available data in 2010 and are associated with myriad negative health effects for mothers and children. They disparately impact vulnerable groups of women, such as those 18-29 years old, Black women, low-income women, single women, and less educated women. A medication abortion is one method of terminating a pregnancy which is over 95% effective, safe (with major adverse events in less than 0.5% of cases), has minor side effects, and costs less than 20% of a live birth.However, states have different levels of medication abortion utilization: in 2020, percentages ranged from 13.7% in Missouri to 96.6% in Wyoming in 2020. The FDA’s abortifacient protocol is more restrictive than medically necessary to ensure women’s safety. For example, although the FDA expanded medication abortions for use up to ten weeks of gestation in 2016 from the previous seven-week limit, studies show safety and efficacy beyond ten weeks of gestation. Many states have laws which restrict access to medication abortions beyond their laws that restrict access to all abortions. Additionally, many states have laws that regulate access to medication abortions more strictly than the FDA. These laws can result in a delay in obtaining abortion care, possibly past the FDA’s ten-week limit for medication abortions, which could make the patient ineligible for a medication abortion in some states. A state’s percentage of medication abortion utilization may depend upon which law(s) that state has in place restricting access. This is the first study to examine that relationship. There is a gap in the literature as to why medication abortion is underutilized given that a majority of abortions occur within the FDA’s ten-week time limit and that the majority of women who received an abortion would have preferred to receive it earlier than they did. The goal of this dissertation is to examine the impact of certain laws restricting medication abortion access on medication abortion utilization in states with such laws in place as compared to states without such laws in place. The aims of the proposed dissertation were threefold. Study one examined medication abortion utilization among women who obtained abortions in states with laws that restrict public and/or private insurance coverage of abortion as compared to states with no insurance coverage restrictions from 2010 to 2019. It was expected that restricting public and/or private insurance coverage of abortion would be statistically significantly associated with lower state medication abortion utilization as compared to states without public and/or private insurance coverage restrictions. Study two examined medication abortion utilization among women who obtained abortions in states that required both in-person physician involvement prior to the abortion and that the first dose be administered in person in the presence of a physician and states with only one physician involvement requirement as compared to states with neither physician involvement requirement from 2010 to 2019. It was expected that state laws requiring either or both in-person physician involvement prior to the abortion and/or that the first dose be administered in the presence of a physician will be statistically significantly associated with lower medication abortion utilization as compared to states requiring no in-person physician involvement. Study three examined medication abortion utilization among women who obtained abortions in states that require both in-person physician involvement prior to the abortion and that the first dose be administered in person in the presence of a physician and states with only one physician involvement requirement as compared to states with neither physician involvement requirement, adjusting for the percentage of women aged 15-44 living in counties without an abortion provider in 2017. It was expected that state laws requiring either or both in-person physician involvement prior to the abortion and/or that the first dose be administered in the presence of a physician would be statistically significantly associated with lower medication abortion utilization as compared to states requiring no in-person physician involvement, adjusting for the percentage of women aged 15-44 living in counties without an abortion provider in 2017. We used multiple imputation of data in all three of our studies, linear mixed model analyses in the first two, and a regression analysis in the third. While our studies did not uncover any statistically significant associations between the laws examined alone and medication abortion utilization, there were some statistically significant secondary findings. All three of our studies found states with higher percentages of patients who were at least ten weeks pregnant at the time of their abortions to be associated with lower percentages of medication abortion utilization. Our first study found that having had no previous live births was associated with a higher percentage of medication abortion utilization in states with laws restricting Health Exchange insurance plans from covering abortions, regardless of whether there were other laws restricting insurance coverage of abortion in place. Both our first and second studies found that being over thirty years of age at the time of obtaining an abortion was associated with a higher percentage of medication abortion utilization in states with at least one form of abortion insurance coverage restriction law and regardless of how many in-person physician interactions were required, respectively. These findings should guide both future research aimed at taking further steps toward understanding states’ disparate levels of medication abortion utilization as well as policymakers’ efforts at improving access to medication abortion services. / Public Health

Estimates suggest that about eight million American teens and young adults experience clinical symptoms of mental illness. For many, these mental health challenges will develop into a diagnosable and potentially life-long psychiatric disorder. Together they form a large population of adults who enter their prime reproductive age as psychiatric patients. Though individuals with mental illness enjoy the same reproductive rights as those without psychiatric conditions, social and medical discourses often portray their parenthood as risky and undesirable. Women with mental illness are in a particularly difficult position. As women, they are subjected to the gendered expectation that they become mothers. Yet at the same time, their mental illness results in their motherhood being frowned upon. Carrying these contradicting values, this study asks how women with psychiatric disorders make reproductive decisions. Do these women think of their reproductive capacity through the psychiatric framing of risk, or through gendered narratives of desired motherhood? Using open ended interviews with women with a psychiatric diagnosis, this study shows that women with mental illness approach their reproductive decision-making by utilizing narratives of both normal reproduction and disability. Some women portray their mental illness as an obstacle to motherhood while others create a separation between their mental and reproductive health. Still others defy the distinction between psychiatry and normalcy and describe their reproduction as a way to bring the two together. Despite the difference in framing, all the women in this study engage with the discourse of risk(s) that is brought on by their mental illness. To weigh risk and act upon it, they visit their and their peer’s biographical stories of illness, assess their fitness into normative ideas of good motherhood, and evaluate the worth of medical and scientific information. They question the way medical information is created, distributed, and made applicable to the idiosyncrasy of their reproductive life. In doing so, these women draw boundaries around trust as well as redefine medical neutrality. Finally, we show that women with mental illness and their health providers rely on a vaguely defined stepwise plan to approach reproduction. This plan brings normativity – and desirability - to their reproduction at the same time that it threatens to exclude them from motherhood. By bringing these arguments together we arrive at the overall conclusion that women with mental illness do not approach their reproduction as a monolithic group. Nor do they organize along diagnosis lines. This study shows that women across psychiatric diagnoses share similar reproductive desires, some hoping to have children and others wishing to avoid motherhood altogether. The popular idea that certain psychiatric diagnoses render women unsuitable for motherhood is not echoed by the women in this study. Instead, their embodied experience of mental illness allows them to embrace the newfound reproductive choice of psychiatric patients and highlights the stigma that perpetuates fears of motherhood with mental illness.

This thesis examines the abortion debate in Brazil within the context of Catholic and Evangelical belief systems. Using a systematic literature review and thematic content analysis, the primary objective is to illuminate the intersection of religion and the often taboo topic of abortion. Given the widespread poverty in Brazil, abortion becomes a profoundly critical issue that directly impacts the health and safety of women as it affects their ability to access medical care in safe and regulated settings, thereby reducing the risks associated with dangerous and illegal procedures. The findings underscore the substantial role played by Catholic and Evangelical belief systems in opposing the legalization of abortion, driven by their deeply held values. This influence is deeply rooted in historical opportunities seized during Brazil's democratization process. Moreover, Catholic, and Evangelical movements have demonstrated remarkable mobilization efforts, engaging in grassroots activities, and fostering mobilization within private spheres. The polarization of the abortion debate has intensified the visibility of these religious groups and mobilized their supporters in various ways. In conclusion, this study reveals that Catholic and Evangelical belief systems have emerged as influential political actors, significantly shaping public opinion and resistance to abortion legalization, even in cases where it is legally sanctioned. Given that religion's influence shows no signs of diminishing but rather continues to grow, further research in this context is crucial to understanding its profound impact on society.

Health disparities are differences in disease prevalence, mortality rates, and adverse health outcomes across social demographics. The prevalence of health disparities stems from sociopolitical inequities that contribute to the ongoing marginalization of different communities, the majority of which occur along racial and ethnic lines in the United States. As moral wrongs in need of moral repair, health disparities can be addressed in one of six ways, articulated in the scholarship of Margaret Urban Walker: (1) holding wrongdoers responsible; (2) addressing the harms imposed on victims; (3) instating moral terms and standards into harmed communities to regain their trust in social mechanisms meant to protect them; (4) recreating trust among harmed communities rooted in new norms; (5) nourishing hope; and (6) bringing together victims and wrongdoers. This dissertation engages the aforementioned morally reparative steps to redress the moral wrong of health disparities in the United States through proposed policy, educational, and clinical interventions. This dissertation examines health disparities from four perspectives. First, it employs a sociohistorical lens to chart the history of health disparities in the United States and the complex social factors contributing to their prevalence. Second, it uses international rights rhetoric of the United Nations and its supporting committees to examine methods of accountability from the United States aimed at reducing disparities and inequities. Third, the dissertation applies the lens of Jacques Maritain’s ontologically informed personalism to reclaim personhood as a viable concept that attends to the sacrality of humanity and our status as social and political beings. Fourth, the dissertation applies the historical, rights, and personalist perspectives in a case study centering black birthing people as an exemplary demographic plagued by racially impacted health disparities and in need of moral repair. This dissertation uses the four-perspective approach to conclude with a morally reparative framework aimed at eliminating health disparities through constructive healthcare policy, practice, and educational measures affirming personhood, human dignity, universal human rights, and health for all people.

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