Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Reproductive health is the right of every person. The new Children’s Act (Act 38 of 2005) gives to children 12 years and older rights to reproductive health, which includes contraceptive access as well as information on sexuality and reproduction. They have the right to HIV/AIDS testing and treatment with only their own consent. The aim of the study was to investigate the personal and contextual factors which influence the accessibility and uptake of reproductive health education during early youth (13 to 18 years). The study also aimed to identify contextually appropriate recommendations toward improved reproductive health provision for these youths. A descriptive, non-experimental, research design was employed with a primarily quantitative approach. A sample of 270 participants, constituting 20% of the study population (N=1373) was randomly selected from Northlink FET Colleges, Cape Town. A self-completion structured questionnaire was used to collect the data. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences, Stellenbosch University. Permission to conduct the research was obtained from the management of Northlink FET College. A group of 30 participants, who met the inclusion criteria, constituting 11% of the sample, participated in a pilot study. Reliability and validity were assured by means of a pilot study and the use of experts in the field, nursing research and statistics. Data was collected personally by the Principal Investigator. The data analysis was primarily descriptive in nature and presented in frequency tables, proportions and measures of relationships, using where indicated Chi-square (x2) and Mann-Whitney U tests. A thematic approach was used to analyze the qualitative data yielded from the open-ended question. Subsequently, in order to strengthen the investigation, the qualitative data, within the identified themes, was quantified based on a validated analytical approach. The results show that 74.1% (n=195) of participants were sexually experienced by the time of the study. Of the participants who reported having already had sexual intercourse, 60.5% (n=115) indicated having made their sexual début by the age of 16. A third of participants (33.2%,n=77) received their first reproductive health education by age 13. Only half of the participants (50.4%,n=116) indicated that the reproductive health education they received always influenced them to make safer sex choices. Of the participants, 21.9% (n=59) stated that they felt that they were in some way hindered in accessing contraceptives during age 13 to 18 years. The vast majority of the participants (94.4%, n=255) indicated that they would prefer reproductive health education to be provided by a professional healthcare provider at a clinic (61.5%, n=166) or by a nurse at school (33%; n=89). Increased reproductive health education within the schooling systems was requested by 52 (19.3%) participants, with more than 30% (n=84) indicating their home as the preferred source of such education. Several recommendations, grounded in the study findings, were identified, including the provision of reproductive health care and accessibility to contraceptives for youths as young as 12 years within a school setting. This care should be provided by healthcare professionals, such as nurses, on a similar operating basis as that which is provided in primary health clinics. The findings reveal to the pressing need for the development, implementation and evaluation of an alternative model for reproductive health care provision in order to assure the complete deliverance of the rights and care to youths as stipulated in the new Child Act (Act 38 of 2005). / AFRIKAANSE OPSOMMING: Voortplantings gesondheid is die reg van elke persoon. Die nuwe Kinderwet (Wet 38 van 2005) gee aan elke kind 12 jaar en ouer die reg tot voortplantings gesondheid, wat insluit toegang tot swangerskap voorbehoeding en informasie aangaande seksualiteit en voortplanting. Die jeug het ook die reg tot HIV/AIDS toetsing en behandeling met net hulle eie toestemming. Die doelwitte daargestel is om te bepaal watter persoonlike en kontekstuele faktore die toegang en gebruik van voortplantings gesondheidsonderrig bevorder en/of benadeel by jonger tieners (13 tot 18 jaar). Die studie sou ook vasstel wat die voorwaardes is vir n toeganklike voortplantings gesondheidsorg diens vir hierdie tieners. !n Beskrywende, nie-eksperimentele navorsingsontwerp was gebruik met n primer kwantitatiewe benadering. !n Steekproef van 270 deelnemers, insluitende 20% van die studie populasie (N=1373) was vanuit die Northlink Verdere Onderrig en Opleidings Kolleges (Kaapstad) by die studie betrek. Die vraelys gebruik was gestruktueerd en is self deur deelnemers voltooi. Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die Bestuur van Northlink Kollege. ’n Loodstudie was gebruik, waarby 30 deelnemers wat inpas by die insluitings kriteria (11% van die studie populasie) betrek is. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Die finale data is persoonlik deur die navorser ingevorder. Data was geannaliseer met die bystand van ’n statistikus en is as frekwensie tabelle uitgebeeld met die gebruik van Chi-hoek (x2) en Mann-Whitney U toetse. ’n Tema benadering is geneem om die kwalitatiewe data te annaliseer. Gevolgens is die data van die kwalitatiewe studie gekwantifiseer. Die bevindings van die studie het getoon dat 74.1% (n=195) van deelnemers seksuele ondervinding voor die studie gehad het. Van die deelnemers het 60.5% (n=115) hulle eerste seksuele ondervinding gehad voor die ouderdom van 16 jaar. Van die deelnemers het 33.2% (n=77) hulle voortplantings onderrig teen 13 jarige ouderdom ontvang. Net 50.4% (n=116) van deelnemers het bekend gemaak dat die onderrig wat hulle ontvang het, hulle altyd gelei het tot veiliger seksuele keuses. Van die deelnemers het 21.9% (n=59) het gevoel dat hulle op een of ander manier verhoed was om voorbehoeding te bekom. Van die deelnemers, sou 94.4% (n=255) verkies het om alternatiewe voortplantings gesondheidsonderrig van ’n professionele gesondheidsorg voorsiener te ontvang, 61.5% (n=166) in klinieke en 33% (n=89) deur ’n verpleegster by ’n skool. ’n Toename in voortplantings onderrig binne die skoolsisteem is versoek deur 52 (19.3%) van die deelnemers, met 30% (n=84) van die deelnemers wat voortplantings onderrig van die huis af sou verkies het. Die hoop word dus uitgespreek dat die voorsiening van voortplantings gesondheidsorg aan kinders so jonk as 12 jaar binne die skool sisteem voorsien kan word, deur ’n professionele gesondheidsorg verpleegster op ’n soortgelyke basis as in publieke gesondheids klinieke. Die studie se bevindinge lei die navorser tot die voorstel om n alternatiewe model te ontwikkel en beplan. Hierdeur moet die voorsiening van voortplantings gesondheidsorg geskied wat sou verseker dat die volledige regte en sorgvoorwaardes aan die heug toegestaan deur die nuwe Kinder Wet (Wet 38 van 2005), aan voldoen word.

Les questions de genre, de santé et droits sexuels et reproductifs et de développement ont depuis plus de deux décennies pris une place grandissante à la fois chez les théoriciens et les praticiens du développement, chercheurs, institutions nationales et internationales, organisations non gouvernementales et experts des agences de développement. La Suède a joué un rôle déterminant dans l'évolution de cet agenda global. Parmi les plus grands contributeurs d'Aide Publique au Développement, la Suède est le pays qui a le plus intégré les perspectives de genre et de droits au coeur de son dispositif d'aide internationale. Le cycle des grandes conférences onusiennes des années 1990, qui font de l'égalité femmes- hommes à la fois une condition et un moyen pour atteindre un développement humain durable a été l'occasion pour la Suède de s'affirmer comme une puissance d'influence de premier ordre. L'examen des facteurs déterminants dans l'histoire suédoise (références culturelles, politiques, sociales) ainsi qu'une lecture critique des textes fondateurs depuis 1994 (déclarations politiques, lois, documents stratégiques et de communication, évaluations programmatiques) mettent en valeur l'apport original de l'aide publique suédoise qui, au-delà de la dimension massive de son volume, révèle le caractère fondamentalement anthropologique et politique du développement et rappelle que la mondialisation ne saurait ignorer le questionnement croissant autour des inégalités, en particulier genrées. / For the last twenty years, Gender, Sexual and Reproductive Health and Rights and Development issues have been at the heart of a growing trend of interest from both development thinkers and practitioners, researchers, international and national institutions, non governmental organisations, and experts from development agencies. Sweden has played a key role in the evolution of this global agenda. Among the major Overseas Development Assistance contributors, Sweden has proven to be one of the "like-minded" countries, which has integrated the gender perspective and the rights perspective at the very heart of its ODA mechanisms. The cycle of 1990's UN conferences, which has promoted gender equality as both a condition and a mean to achieve a sustainable human development was the occasion for Sweden to take a clear leadership as an influential "soft power". The analysis of decisive factors in the Swedish history (cultural, political and social references) as well as a critical reading of founding documents since 1994 (political statements, bills and laws, strategic/planning and communication papers, program evaluations) shows the original contribution of Swedish ODA, which beyond its remarkable amount, reveals the anthropological and political fundamentals of development and recalls that globalisation should not ignore the growing demands around inequalities, in particular gender inequalities.

A research report submitted to the School of Social Science, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies for the year 2015 / Introduction: Early sexual debut remains a public health concern, and it continues to gather interest among researchers. In part interest is driven by the unchanging age at sexual debut and even though the age of sexual debut remains unchanged, the rate of early sexual debut keeps rising in many developing countries (Pettifor et al, 2009). Approximately 60% of young people in South Africa report to have had sexual intercourse by the time they are 16 years old (Peltzer, 2006). Furthermore early sexual debut has been identified as an indicator of risky sexual behaviour; as it exacerbates the individuals exposure to sexually transmitted diseases especially HIV, which is most prevalent among the youth in the ages 15-24 years old (Mchunu, 2012). Similarly, violence also remains a public health concern as it endangers the development of young people. Approximately 3.5 million people report injuries caused by violence every year, and violence accounts for 30% of mortality (Norman et al, 2010). A prevalent feature of violence is the dual role of young men as victims and as perpetrators of violence (Seedat et al, 2009). In some areas of South Africa homicide deaths of males outnumber those of females at a rate of 7 males to 1 female death (Seedat et al, 2009). Furthermore other reported consequences of violence among the youth are mental health problems, injuries and a negative education outcome among young people in South Africa. Young people are future leaders and parents of South Africa and it is therefore important to have a study that will examine the association between two factors that have been deemed as risk factors for the development of young people. The general objective of this study is to examine the association between violence and early sexual debut among youth in South Africa. The first specific objective of the study is to identify the level of early sexual debut among youth in South Africa, while the second specific objective of the study is to examine the association between violence and early sexual debut controlling for socio-economic and demographic variables. Methodology: Data was obtained from the National HIV communication survey with a sample of 1 873,956 females and 932,397 males. who are in their youth (15-24 years old). Data was managed using the STATA 12 and was analysed in a way that answers the objectives of the study. For descriptive analysis, frequency tables and graphs were used. A chi-square test was conducted, to test for an association between violence and early sexual debut and for multivariate analysis the study employed a multinomial logistic model / GR2017

Sverige har under en längre period utgjort de OECD-land med ett av de högsta antal förlossningsskador. Historiskt har förlossningsvården varit en sfär för kvinnor. Medicinvetenskapen intog emellertid en allt mer betydande roll under 1800-talet och läkarkåren utgjordes av män. Den gravida kvinnan blev en patologisk kropp. Följden har lett till att kvinnor föder i gynställning och bristningar är standard. Syftet med studien har utgjorts av att, genom Foucaults teori om biomakt undersöka hur en svensk, samhällelig och medicinsk normalisering av förlossningsskador kan förstås som en följd av medikalisering av kvinnlig sexualitet och reproduktion. Med ett konstruktivistiskt angreppssätt baserat på upplevelser och definitionsprocesser har kvinnors subjektiva erfarenheter av sina skador studerats genom strukturerade intervjuer. Resultatet skildrar en statlig inverkan i reproduktionsfrågor och dess disciplinerande kontrollorgan, inte minst inom mödra- och barnahälsovården. Känslor av skam, skuld, litenhet och förminskande är upplevelser bemötandet i vården orsakat. Samhället är aktiva i att upprätthålla realiteten för kvinnorna och förmedlas diskursivt, då kvinnan som gör anspråk på den egna kroppen kategoriseras som avvikande. Det saknas ett psykosocialt inriktat stöd i vårdkedjan. / For a long period of time Sweden has been an OECD-country with one of the highest quantity of obstetric injuries. Childbirth has mainly been a sphere for women historically. Medical science however took an increasingly significant role during the 19th century and the profession mainly contained men. The pregnant woman became a pathological body. The consequence has led to women giving birth in lithotomy position and obstetric trauma is standard. The aim of this study has been, through Foucaults theory of bio power, analyse how a Swedish, social and medical normalization of obstetric injuries can be understood as a result of medicalization of the female sexuality and reproductivity. With a constructivist approach, the subjective experiences of their obstetric injuries has been analysed via structured interviews with women. The result shows a public impact in questions regarding female reproductivity and sexuality from the institute administrators. Emotional states of shame, guilt, pity and diminishing occur by the encounter with the institutes. Societies maintain the reality for women and mediate it discursively, since women who claim their bodies as their own are abnormal. Psychosocial support lacks in the care chain.

O presente estudo teve por objetivo investigar as práticas e as representações ligadas à vida reprodutiva entre jovens universitários da Universidade de São Paulo (USP), especialmente aquelas dirigidas à contracepção e à prevenção de doenças sexualmente transmissíveis, no âmbito das relações heterossexuais.A pesquisa foi dividida em duas fases. Na primeira, foi elaborada uma amostra representativa dos estudantes matriculados em cursos de graduação da USP, na Cidade de São Paulo, no ano de 2000, e foram entrevistados 952 alunos e alunas com idade entre 17 e 24 anos. Na segunda, foram gravadas entrevistas em profundidade com 33 estudantes que se ofereceram voluntariamente para continuar participando da pesquisa. O uso do condom é freqüente entre os estudantes universitários, principalmente na primeira relação sexual. No entanto, o uso desse método apresenta descontinuidades. Além da primeira relação sexual, o condom é usado especialmente nas relações casuais e no início dos relacionamentos sexuais com um parceiro ou uma parceira novos. Os jovens negligenciam o condom no contexto do namoro, tendendo a substituí-lo pela pílula. A contracepção é cercada por descuidos, erros e esquecimentos e os estudantes mencionam que utilizam métodos de baixa eficácia, como o coito interrompido e a abstinência periódica para regular a fecundidade. Os estudantes manifestam um forte desejo de adiar a fecundidade, mas o uso inadequado de métodos contraceptivos e o recurso aos métodos de baixa eficácia podem levar a uma gestação não planejada. 77% do total de entrevistados afirmou que gostaria de ter até dois filhos e a idade ideal para ter o primeiro filho seria próxima aos 30 anos. Somente 4% dos entrevistados e entrevistadas referiram ter passado por uma gestação. Apesar do pequeno número de gestações referidas, o aborto provocado foi a forma de finalização de uma alta proporção dessas gestações. Os resultados da pesquisa indicam que uma complexa rede de representações simbólicas subsidia as condutas diante da contracepção e da saúde reprodutiva. Essas representações constróem o sentido da sexualidade, classificando-a, definindo regras e obrigações segundo cada situação e orientando práticas. Questões de gênero pontuam os discursos sobre os temas tratados. As diferentes concepções sobre o "ficar" e o namorar, a opção pelo método contraceptivo, as representações sobre as responsabilidades do homem e da mulher frente à contracepção e, especialmente, os discursos sobre o aborto revelam a importância que os diferenciais de gênero assumem perante a construção do sentido da sexualidade e da vida reprodutiva. Questões de gênero também marcam a busca de orientação médica, no âmbito da saúde reprodutiva. A consulta médica é restrita ao grupo das mulheres e o método mais indicado é a pílula, embora trate-se de jovens mulheres solteiras que estão iniciando a sua vida sexual. Observa-se, por sua vez, que os homens jovens estão totalmente alijados do sistema de saúde, ainda que se trate de um grupo com alta escolaridade que recorre à medicina privada. O estudo indica que os diferenciais de gênero estão presentes desde o processo de rotulações e significações que dão sentido a vivência da sexualidade e da regulação da fecundidade até o âmbito das políticas públicas voltadas para a saúde reprodutiva dos jovens, revelando uma importante lacuna nos serviços de saúde que necessita ser contemplada por políticas públicas capazes de promover a eqüidade de gênero na atenção à saúde reprodutiva e de incluir os jovens do sexo masculino nos serviços de saúde. / The present study aimed at investigating the practices and representations linked to the reproductive life of university youths from the Universidade São Paulo (USP) especially those geared at contraception and prevention of STD’s in the scope of heterosexual relations. The project was divided into two phases. In the first a representative sample of 952 male and female students between 17 and 24 years old enrolled in under-graduate courses at USP in the city of São Paulo in 2000 was elaborated. In the second phase in-depth-interviews with 33 students that volunteered to continue take part of the research were recorded. The use of condom is frequent among university students mainly at the first sexual intercourse. However, this method presents discontinuity. Beyond the first sexual intercourse it is used especially in the casual relationships and in the beginning of new sexual relationships with a new partner. Youth neglect the condom in the dating context tending to replace it for the pill. Contraception is surrounded by carelessness, mistakes and neglect and the students mention the use of low efficacy methods such as interrupted copulation and periodic abstinence for fertility control. The students revealed strong will to delay fertility but the inadequate use of contraceptive methods and use of low efficacy methods may lead to an unplanned pregnancy. 77% of the interviewees state that they would like to have up to two children and that the ideal age for the first child would around 30. Only 4% of the interviewees referred having had a gestation. Despite the small number of pregnancies referred the provoked abortion represented a high proportion of pregnancy termination. The results of the survey indicate that a complex network of symbolic representations accounts for the conducts in terms of contraception and reproductive health. These representations construct the sense of sexuality, classifying it, defining rules and obligations according to each situation and guiding practices. Gender issues mark the discourses on the themes discussed. The different conceptions about noncommitted dating and dating proper, the option for the contraceptive method, representations on the male and female responsibilities with reference to contraception and especially the discourses on abortion reveal the importance the gender differentials possess in face of the construction of meaning of sexuality and reproductive life. Gender issues influence the search for medical guidance in the context of reproductive health. Medical consultation is restricted to the female group and the most prescribed contraceptive method is the pill in spite of the fact that they are young single women in the beginning of their sexual life. On the other hand it was observed that young men are totally cast out of the health system notwithstanding the fact that this is a group with high level education with access to private medicine. The study indicates that the gender differentials are present from the process of labeling and signification that attribute meaning to the experiencing of sexuality and the regulation of fertility to the scope of public policies capable of promoting gender equity in the attention to reproductive health of youth. That reveals an important gap in the health services that must be addressed by gender equity promoting public policies that also inscribe male youth in the health services.

Inserindo-se no campo de discussão da saúde dos homens, esta dissertação apresenta a trajetória da noção de gênero e do conceito de saúde reprodutiva e sexual voltada aos homens na perspectiva teórico-política da saúde coletiva. Teve como objetivo analisar como se configurava, em 2004, a atenção à saúde reprodutiva e sexual masculina no município de Francisco Morato a partir do discurso de profissionais, gerentes e gestores de saúde. Os sujeitos da pesquisa foram oito profissionais, cinco gerentes e três gestores de saúde, tendo-se utilizado a entrevista como método de coleta de dados e a análise temática para o tratamento dos mesmos. Nossa análise constatou que a percepção das diferenças de gênero influencia a construção de discursos nos quais convivem elementos novos e antigos sobre a participação dos homens nos serviços de saúde. Mostramos que as ações gerais, como o planejamento familiar e os atendimentos de rotina, são calcadas em uma visão biomédica. Por outro lado, há ações isoladas que consideram as peculiaridades da vida dos homens para além do seu corpo biológico, como as atividades preventivas em espaços de sociabilidade masculina e a orientação sobre sexualidade em residências. O lugar-comum entre os entrevistados é o discurso de que os homens usam os serviços de saúde de forma seletiva, menos freqüente que as mulheres, sobretudo na atenção básica. Em consonância com diversos autores, este estudo revelou que os homens procuram os serviços quando ocorre a intensificação de algum problema de saúde e como participantes de alguns programas e serviços disponibilizados para si próprios e para a família. Ficou evidente o vínculo entre o aumento na participação e o incentivo à presença dos homens proporcionado pelo programa de saúde da família (PSF). Esse aumento deflagrou alguns esforços de entrevistados para atraí-los aos espaços de cuidado à saúde, revelando que os sujeitos de pesquisa percebem certas características do masculino em sua realidade particular, bem como a existência de poucos espaços coletivos organizados para discutir o cuidado à saúde. A dissertação se encerra afirmando a necessidade de uma maior formulação e implementação de propostas que levem em conta os diversos perfis de morbimortalidade do município / Within the discussion field of masculinities, this dissertation introduces the path of gender notion and the concept of reproductive and sexual health concerning men, under the political theoretical perspective of collective health. It aimed to analyze the conditions of male reproductive and sexual health care in the municipality of Francisco Morato in 2004, based on the discourse of eight health care practitioners, five managers and three public health administrators. The participants, whose discourses were submitted to thematic analysis, were interviewed for data collection. The way through which the perception of gender differences builds the discourses which congregate new and old elements on mens participation in healthcare services was analyzed. It was shown that general actions, such as family planning and routine assistance, are based on a biomedical viewpoint. On the other hand, there are isolated actions which consider the peculiarities of mens life beyond their biological body, such as preventive actions in male sociability spaces and home guidance on sexuality. It was common-place among the interviewees the discourse that men use health services selectively, less frequently than women, especially regarding primary health care. In consonance with several authors, this study revealed that men look for health services when they are afflicted by more serious health problems and /or as participants in some specific health programs which became available to them or to their families. The link between the increase in mens participation and the incentive to their presence promoted by Family Health Program (FHP) was unequivocal. This increase generated some efforts from the part of the interviewees to attract male users to health care centers showing that the subjects of this research realize that they have certain of these male characteristics in their private reality and also the existence of very few organized collective spaces where health care could be discussed. In conclusion, this dissertation emphasizes the need for further formulation and implementation of proposals which take into consideration the different morbidity and mortality profiles in the municipality

Introdução: No Brasil, o uso de métodos contraceptivos está centrado na pílula anticoncepcional oral, na laqueadura e na camisinha masculina. Métodos contraceptivos reversíveis de longa duração, como o dispositivo intrauterino, são pouco usados, ao contrário do que ocorre no contexto internacional. A literatura mostra que há várias razões para essa subutilização, dentre as quais destaca-se o escasso conhecimento das mulheres sobre o mesmo que, por sua vez, promove atitudes negativas e concepções equivocadas em relação ao método e dificulta que as mulheres optem por ele. Objetivo: Analisar o conhecimento, as atitudes e as práticas de mulheres usuárias de Unidades Básicas de Saúde sobre o dispositivo intrauterino. Método: Estudo quantitativo transversal, em que amostra probabilística de 1.026 mulheres, de 18 a 49 anos de idade, usuárias de 38 Unidades Básicas de Saúde da cidade de São Paulo, foi entrevistada por meio de um instrumento estruturado. O nível de conhecimento sobre o método foi analisado por meio de uma escala composta por sete itens, preparada por meio Teoria de Resposta ao Item e análise fatorial. As atitudes foram analisadas em função das razões relatadas pelas mulheres para usar/não usar o DIU. As práticas foram analisadas considerando o uso anterior e o uso atual. Modelos de regressão logística múltipla foram conduzidos para identificar as características sociodemográficas e da história reprodutiva associadas ao conhecimento, uso e desejo de usar o dispositivo intrauterino. Resultados: Apenas 4,5% das mulheres alcançaram o escore máximo da escala do nível de conhecimento, ao passo que 13,1% obtiveram escore zero. As mulheres mais escolarizadas, de grupo socioeconômico mais elevado, que possuíam mais de um filho e que usavam ou já haviam usado o dispositivo intrauterino mostraram maior nível de conhecimento. A maioria das entrevistadas referiu não ter o desejo de usar o dispositivo intrauterino no futuro, principalmente porque estavam satisfeitas com o método em uso e por conta dos efeitos colaterais, tal e qual mulheres que nunca usaram o método. Aquelas que usavam, que já haviam usado e que gostariam de usar o dispositivo intrauterino apresentaram maior nível de conhecimento sobre o mesmo. Conclusão: O nível de conhecimento sobre o dispositivo intrauterino é baixo e influencia as atitudes e as práticas das mulheres. Aparentemente, conhecimento, atitudes e práticas sobre o dispositivo uterino são interconectados. / Introduction: In Brazil, the use of contraceptive methods is focused on the oral pill, tubal ligation and male condom. Different from the international context, long-term reversible contraceptive methods, such as the intrauterine device, are rarely used. According to the literature, there are several reasons for this underutilization, among them, stands out the lack of women´s knowledge, which in turn promotes negative attitudes and misconceptions about the method and, consequently, makes the choose to use it more difficult. Objective: To analyze the knowledge, attitudes and practices of women users of primary health care facilities about the intrauterine device. Method: A cross-sectional quantitative study was conducted among a probability sample of 1,026 women aged 1849, who were users of 38 primary health care facilities of Sao Paulo City. All participants were interviewed through a structured instrument. The level of knowledge about the method was analyzed through a seven-item scale, developed through Item Response Theory and factorial analysis. The attitudes were analyzed according to the reasons reported by the women to use/not to use the intrauterine device. The practices were analyzed considering the previous use and the current use. Multiple logistic regression models were conducted to identify sociodemographic and reproductive history characteristics associated with the knowledge, use, and desire to use the intrauterine device. Results: Only 4,5% of the women achieved the maximum score on the knowledge level scale, while 13,1% scored zero. Women with more educational level, belonging to higher socioeconomic group, who had more than one child, and who used or had already used the intrauterine device showed a higher level of knowledge. Most of the interviewees reported not having the desire to use the IUD in the future, mainly because they were satisfied with the contraceptive method in use and because of the side effects; similar to women who never used the method. Those who used, who had already used and would like to use the intrauterine device had a higher level of knowledge about it. Conclusion: The level of knowledge about the intrauterine device is low and influences women\'s attitudes and practices. Apparently, knowledge, attitudes and practices about the uterine device are interconnected.

A Amazônia peruana ocupa 62% do território do país. Ali existem 42 grupos etnolinguísticos, que apresentam características culturais, econômicas e políticas diferentes de outras populações do território nacional. Existe uma grande dívida histórica de reivindicação dos direitos destas populações, o que pressupõe elaborar formas de entender a dinâmica entre culturas diferentes, e projetando novas formas de relação que propiciem o encontro intercultural. Isso é importante para que a atenção à concepção, gravidez, parto e pós-parto se torne mais satisfatória e efetiva, e também para que sejam implementados serviços de saúde culturalmente adequados, com mais respeito aos direitos sexuais e reprodutivos no período gestacional. Objetivo: Conhecer as concepções sobre as necessidades específicas de saúde sexual e reprodutiva, com foco na saúde materna, no grupo étnico kukama kukamiria da comunidade de San Regis. Metodologia: Trata-se de um estudo qualitativo de base etnográfico, utilizando os instrumentos de entrevista aberta, observação participante e diário de campo. No total, foram realizadas 25 entrevistas individuais, com mulheres grávidas e puérperas, parteiras, médicos herbalistas, parceiros e servidores de saúde. A identidade dos participantes foi protegida com a utilização de nomes fictícios. Resultados: As mulheres grávidas costumam preferir os serviços das parteiras/ parteiros da comunidade de San Regis pelo vínculo emocional e afetivo entre as duas partes, que resulta numa atenção mais calorosa. As plantas e ervas medicinais são muito utilizadas para curar moléstias ou favorecer um melhor estado de saúde na gravidez, durante e depois do parto, além de serem usadas no cuidado do recém-nascido. Os serviços de saúde são menos procurados, por freqüentemente desrespeitos as tradições deste grupo kukama kukamiria e pelas técnicas inapropriadas que utilizam. Conclusão: As parteiras/parteiros são procuradas pela sua proximidade cultural e afetiva; nos serviços de saúde, freqüentemente a população se sente ameaçada pelo contato rude e procedimentos invasivos. / The Peruvian Amazon occupies 62% of the territory of the country. In such area there are 42 ethnolinguistic groups each presenting its own cultural, economic and political features, different from other groups within the national territory. A great historical debt exists in terms of the claims of these people, what calls for the construction of ways to understand the dynamics relations among the different cultures and for the proposal of new forms of relations allowing intercultural encounter. This is important so that the assistance given during conception, pregnancy, labor and the post-partum period may be more satisfactory and effective, and also for the implementation of culturally adequate health services which pay due respect to sexual and reproductive rights during the pregnant period. Objective: To know the representations of the specific sexual and reproductive health needs with a focus on maternal health, in the ethnic group Kukama Kukamiria, in the community called San Regis. Methodology: This is a qualitative ethnographic study, using the instruments of open interview, participating observation and field diaries. Altogether 25 individual interviews were made, with pregnant women and women in labor, birth attendants, herbal doctors, partners and health personnel. The identity of the participants has been protected by the use of fictitious names. Results: The pregnant women customarily prefer the services of male or female birth attendants of the San Regis community because of the emotional and affective links between the two sides which results in more humanized assistance. Medicinal plants and herbs are very used to cure ailments or produce a better state of health during pregnancy and during and after labor as well being used in the care of the new-born. The health services are less preterably sought after because of their frequent disrespect to the traditions of th-is kukama kukamiria group and because of the inappropriate techniques used. Conclusion: The male or female birth attendants are sought after due to their cultural and affective proximity; conversely, in the health services, people frequently feel threatened by the rude approach and invasive procedures.

Abstract The purpose of this qualitative research has been to reflect on the public policies of reproductive health carried out in Peru during the government of Alejandro Toledo. The issue has also been analyzed from the feminist jurisprudence perspective in the context of how these political actions have fostered discrimination against women, especially adolescent girls. This study argues that of the Reproductive policies in Peru have lacked solidity and have been exposed to constant changes in orientation, whether influenced by the pressure of actors such as the Catholic Church, civilian organizations or through international treaties.   Keywords Reproductive health rights, Peruvian adolescents, public policies, family planning.

Estudos sobre a relação masculinidades-saúde tem apontando para a permanência de visões essencialistas sobre o sexo e desafios no que diz respeito aos direitos sexuais e reprodutivos, assim como para a dificuldade de se incluir homens nas práticas de cuidado em saúde devido às representações sociais do masculino e ao direcionamento dos serviços para mulheres e crianças. A implantação e implementação da \"Política Nacional de Atenção Integral à Saúde do Homem\" (PNAISH) no Brasil trouxe como desafio o reconhecimento das desigualdades de gênero vivenciadas pelos homens e de suas necessidades de saúde. Nesse sentido, compõe-se como justificativa para este trabalho a necessidade de se investigar como o homem tem sido contemplado institucionalmente em relação à sexualidade e reprodução. Assim, constitui-se como corpus da pesquisa o documento-base da política, documentos vinculados à construção da PNAISH e materiais desenvolvidos a partir desta, bem como publicações relacionadas à sexualidade e reprodução de homens nas páginas \"Saúde do Homem - Ministério da Saúde\" e \"Secretaria Municipal da Saúde de São Paulo\" em rede social. Por meio da análise de conteúdo, a discussão esteve amparada pelos pressupostos dos Estudos de Gênero e pelo pensamento foucaultiano. Buscou-se a compreensão de discursos que orientam a PNAISH: à que homens esta se dirige e como a política busca direcionar ações em saúde ao tratar da sexualidade e reprodução. Observou-se que a política reflete representações sociais, apresentando muitas das diferenças e desigualdades de gênero existentes. A sexualidade em seu sentido mais amplo é pouco abordada, observando-se ênfase dada à prática e potência sexual. Ainda, apesar de esforços, não houve plena incorporação de discursos de responsabilização igualitária nas questões reprodutivas e de parentalidade, estando ainda presentes visões sobre os homens como figuras de apoio. São necessárias ações que trabalhem as resistências a maiores liberdades e igualdades sexuais e reprodutivas? A PNAISH ainda precisa de maior aproximação das necessidades, diversidade de relações e desigualdades existentes / Studies about the masculinity-health relationship have pointed to the persistence of essentialist visions about sex and challenges regarding sexual and reproductive rights, as well as the difficulty of including men in health care practices due to the social representations of the masculinity and the direction of the services for women and children. The implantation and implementation of the \"Brazilian Comprehensive Healthcare Policy for Men\" (PNAISH) in Brazil has brought as a challenge the recognition of the gender inequalities experienced by men and their health needs. In this sense, the justification for this study is the need to investigate how man has been contemplated in sexuality and reproduction institutionally. Thus, is constituted as corpus of the research, the official text of the policy, documents related to the construction of the PNAISH and materials developed from it, as well as publications related to sexuality and reproduction of men in the Facebook pages \"Health of Man - Ministry of Health\" and \"Municipal Health Department of São Paulo \". Through content analysis, the discussion was supported by the theories of Gender Studies and Foucaultian thinking. We sought the understanding of discourses that guide the PNAISH: to which men this is directed and how politics seeks to direct actions in health when dealing with sexuality and reproduction. It was observed that the policy reflects social representations, presenting many of the existing gender differences and inequalities. Sexuality in its broadest sense is not too much discussed in the documents, with an emphasis on sexual act and potency. Yet, despite efforts, there was no full incorporation of egalitarian accountability discourses on reproductive and parenting issues, and visions about men as support figures are still present. Still are needed actions that work the resistance for greater sexual and reproductive freedoms and for equality. The PNAISH still needs to approximate more to the needs, to the diversity of existing relationships and to the inequalities