In Russia today women use traditional forms of birth control at unusually high rates, whereas, conversely their use of modern contraceptives is unusually low. During the Soviet period, women's access to modern contraceptive methods may have been limited. However, one would postulate that after the collapse of the Soviet Union, the nature of the new reforms that developed would have lent itself to an increase in modern contraception usage on par with other countries. In Russia today there is not a lack of availability of modern contraceptives. Yet, women are still not using modern contraception at a rate that is congruent with an increase in availability. What then is influencing Russian women's decisions? The contraceptive acceptance of Russian women today is shaped by cultural legacies of the Soviet Union surrounding both contraceptives themselves and sex and sex education.

Objetivo: Medir a expressão da integrina av~3 no endométrio de mulheres usuárias do DIUT200. Desenho: Estudo observacional controlado. Local realizado: Centro de saúde secundário e laboratório universitário. Pacientes: Treze mulheres sadias e férteis (controles) e treze usuárias do DIUT200 (casos). lntervençao: Biópsia endometrial realizada entre o 6°-1 0° dia pós-ovulatório do ciclo menstrual. Principal Desfecho Avaliado: A expressão da integrina av~3 através do HSCORE em amostras endometriais criopreservadas. Resultados: O HSCORE das usuárias do DIUT200 foi 0,9 ± 0,7 (média± DP), enquanto que o dos controles foi 2,13 ± 0,7 (média ± DP) (p = 0.001 Teste-t de Student). Todos os controles foram positivos para a expressão da integrina av~3. mas as usuárias do DIUT200 não apresentou positivdade para a integrina av~3 em 38,5% dos casos (p = 0,03 Teste Exato de Fisher). Conclusao: Os resultados apoiam a teoria que o DIUT200 de cobre também tem um mecanismo de ação que interfere diretamente com a receptividade uterina e a implantação. / Objective: To measure the expression of avf33 integrin in the endometrium of IUDT200 users. Design: Observational controlled study Setting: Secondary health care center and University laboratory Patients: Thirteen healthy fertile women (contrais) and thirteen IUDT200 users (cases). lntervention: Endometrial biopsy on postovulatory day 6-1 O of the menstrual cycle. Main Outcome Measure: The expression of avJ33 by HSCORE on cryopreserved endometrial sections. Results: The HSCORE for IUD users was 0.9 ± 0.7 (mean ± SEM), while for contrais was 2.13 ± 0.7 (mean ±SEM) (p < 0.001 Teste-t de Student). Ali contrais were positiva for avJ33, but women with IUD did not express avl33 integrin in 38.5% of the cases (p < 0.03 Fisher's exact test). Conclusion: These results support the theory that copper IUD T200 also has a mechanism of action that is directed at interference with uterine receptivity and implantation.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Assisted reproduction (AR) became available in Mexico during the mid eighties. Since then, the AR industry has developed and flourished within a context of little regulation, considerable media coverage and an increasing number of consumers. As part of this process, terms such as 'assisted reproduction', 'infertility, ‘eligible AR users' and ‘qualified AR service provider' have required definitions. Through four years of multisited ethnographic work at clinics, conferences and online forums, and by analysing media coverage and legal debates around infertility I have charted the introduction and development of AR, and I have tried to understand the process of its assimilation and (re)construction within the Mexican setting. The organisation of this thesis reflects the dynamic complexity with which the different actors have constructed the Mexican AR arena. The thesis begins with a description of the theoretical framework and the methodological rationale, followed by a genealogical analysis of Mexican AR focusing on the elements that made its adoption possible, the transformation of gynaecologists into AR specialists, the establishment of AR clinics and services, and the emergence of two new types of AR specialist: the andrologist and the AR biologist. I then analyse the way AR is framed as a paranatural procedure that imitates nature while simultaneously going beyond it and examine the elements that make up what the community of AR specialists suggest are the major causes for infertility: ‘the age factor' and ‘the male factor'. Finally, I describe the pilgrimage AR users embark on in search of parenthood and their quest for information and support. Understanding the process by which AR has been assimilated and transformed in the Mexican context sheds light on the way techno-science is (re)constructed when it arrives in new settings. In addition, this knowledge has the potential to inform local medical and social practices, and regulatory frameworks in the field.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A tese versa sobre as grandes questões relativas à contracepção no Brasil. Integra um esforço por analisar condutas referentes à contracepção, segundo lógicas que priorizam a situacionalidade e a relacionalidade de tais fenômenos. As estratégias para gerir a fecundidade são constitutivas da sexualidade heterossexual. Mulheres e homens podem usar ou não contracepção; as razões dessa conduta extrapolam aspectos concernentes a informação e acesso. Busca-se compreender as práticas contraceptivas a partir do processo do aprendizado das lógicas relacionais e de gênero, em diferentes momentos dos percursos biográficos: o início da trajetória afetivo-sexual, os contextos de irrupção de uma gravidez e o encerramento da potencialidade reprodutiva, por meio da esterilização contraceptiva. Este compósito demandou a utilização de materiais empíricos distintos para a construção e análise das etapas eleitas dos percursos biográficos. Enfoca-se, primeiramente, o momento de passagem à sexualidade com parceiro. Problematiza-se a ideia de relaxamento das práticas contraceptivas, a partir da iniciação sexual, concepção corrente na literatura nacional em função do decréscimo de uso de preservativo em relações sexuais posteriores. Aborda-se, em seguida, as atitudes e as questões presentes no processo de construção da prática contraceptiva, no momento em que a vida sexual se torna regular. A proposição da perspectiva da gestão contraceptiva sublinha as posições dos protagonistas, marcadas pelo gênero. Por último, analisa-se as circunstâncias biográficas e os cenários relacionais da esterilização contraceptiva, a qual emerge como uma estratégia de estabilização ou de consolidação de um percurso contraceptivo/reprodutivo. O debate em torno da contracepção no Brasil apresenta a tendência a enfatizar a determinação social para explicar as gestações imprevistas. Contudo, salienta-se, com base em uma literatura crítica, as dimensões de agência individual, ainda que circunscritas por um campo delimitado de possibilidades. / The thesis deals with the major issues relating to contraception in Brazil. Integrates an effort to analyze behaviors related to contraception, according to logics that prioritize the situatedness and relationality of such phenomena. Strategies to manage fertility are constitutive of heterosexual sexuality. Women and men can use contraception or not; the reasons for that conduct extrapolate aspects concerning information and access. We seek to understand contraceptive practices from the process of learning of relational logic and gender, at different times of biographies: the beginning of the affective-sexual trajectory, the contexts of eruption of pregnancy and termination of reproductive potential by means contraceptive sterilization. This composite require use of different empirical materials for the construction and analysis of the stages of elected biographies. It focuses, first, the passing moment sexuality with a partner. Problematizes the idea of relaxation of contraceptive practices, from the sexual initiation, current design in the national literature due to the decrease in condom use in sex later. We discuss then the attitudes and issues present in the construction process of contraceptive practice, at the time the sexual life becomes regular. The proposition from the perspective of contraceptive management emphasizes the positions of the protagonists, marked by gender. Finally, we analyze the biographical circumstances and relational scenarios of contraceptive sterilization, which emerges as a strategy of stabilization or consolidation of a contraceptive / reproductive route. The debate around the contraception in Brazil has a tendency to emphasize the social determining to explain unexpected pregnancies. However, it is noted based on a critical literature, the dimensions of individual agency, although circumscribed by a delimited range of possibilities.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A LactaÃÃo Exclusiva com AmenorrÃia (LAM) constitui MÃtodo Anticoncepcional (MAC) natural, com eficÃcia de 98% atà o sexto mÃs de vida da crianÃa. Atualmente, a promoÃÃo dos MAC disponÃveis no paÃs à realizada pelas equipes do Programa SaÃde da FamÃlia (PSF) e, particularmente, pelo enfermeiro, que deve fazÃ-la com neutralidade, respeitando a livre escolha dos usuÃrios. O objetivo geral deste estudo foi analisar conhecimento e desempenho de enfermeiros do PSF sobre a LAM. Os objetivos especÃficos foram: Identificar experiÃncias pessoais de enfermeiros (pais ou mÃes) relacionadas com aleitamento e a LAM; Verificar conhecimento e confianÃa de enfermeiros relacionados a LAM; Identificar promoÃÃo da LAM por parte dos enfermeiros e percepÃÃo destes quanto a aceitaÃÃo da LAM pela clientela; Conhecer estratÃgias e oportunidades utilizadas por enfermeiros para promoÃÃo da LAM; Apresentar resultados da prÃtica de enfermeiros com relaÃÃo ao acompanhamento de usuÃrias de LAM. Tratou-se de estudo de campo, transversal, realizado de fevereiro a julho de 2008, nas Secretarias Executivas Regionais (SER) I, III, IV e V de Fortaleza-CE, com 137 enfermeiros. A coleta de dados ocorreu nas Unidades BÃsicas de SaÃde das referidas SER utilizando a entrevista. Houve predomÃnio de enfermeiras, correspondendo a 121 (88,3%) dos participantes, que apresentaram idade mÃdia de 35,1 anos. Pouco mais da metade, 70 (51,1%), referiram ter filhos, e desses, 61(92,4%) informaram ter vivenciado o aleitamento materno exclusivo, o que gerou uma mÃdia de 4,38 meses. No entanto, apenas 12 (19,6%) enfermeiros afirmaram ter adotado a LAM, mesmo considerando sua praticidade e seus benefÃcios. Apenas 2 (1,5%) enfermeiros desconheciam a LAM como opÃÃo contraceptiva. Quanto a auto-avaliaÃÃo dos conhecimentos sobre o assunto, 34 (24,8%) enfermeiros classificaram seus conhecimentos como excelente e Ãtimo, 80 (58,4%) bom, 20 (14,6%) como regular e 3 (2,2%) insuficiente. A maioria, 88 (64,2%), desconhecia a eficÃcia da LAM e somente 5 (3,7%) informaram a eficÃcia correta. Mesmo com 65 (47,4%) dos enfermeiros desacreditando na eficÃcia da LAM e apenas 19 (13,9%) sendo conhecedores dos trÃs requisitos para o funcionamento Ãtimo do mÃtodo, 112 (81,8%) afirmaram orientar Ãs mulheres sobre a utilizaÃÃo do mesmo. A aceitaÃÃo das mulheres ocorre de forma parcial, na medida em que solicitam mÃtodo complementar para continuar em uso da LAM. A orientaÃÃo à fornecida pelos enfermeiros em diferentes momentos, relacionados ao perÃodo gravÃdico-puerperal (prÃnatal, puerpÃrio e puericultura) e fora deste, nas consultas de planejamento familiar, sendo, na maioria das vezes, adotada a orientaÃÃo individual. No momento da pesquisa, 59 (52,7%) enfermeiros acompanhavam usuÃrias de LAM. O tempo mÃdio de uso pelas clientes à de 3 a 4 meses, sendo a volta ao trabalho e a introduÃÃo de outros alimentos à dieta infantil os principais motivos de interrupÃÃo da LAM. O anticoncepcional oral combinado foi o MAC de sucessÃo da LAM. Infere-se, pois, que à necessÃrio melhorar o conhecimento dos enfermeiros do PSF sobre essa Ãrea do cuidado, uma vez que nessas circunstÃncias a promoÃÃo da LAM fica comprometida, afetando a adesÃo das mulheres ao mÃtodo, bem como a eficÃcia do mesmo. / Exclusive to The Lactation Amenorrhea (LAM) is a contraceptive method (MAC) natural, with efficiency of 98% by the sixth month of life. Currently, promotion of MAC is available in the country carried out by teams of the Family Health Program (FHP), particularly by nurses, who must do it in neutral, respecting the free choice of users. The aim of this study was to analyze knowledge and performance of nurses of the PSF on the LAM. The specific objectives were: To identify personal experiences of nurses (parents or mothers) in relation to breastfeeding and LAM; To assess knowledge and confidence of nurses related to LAM; To identify promotion of LAM by the perception of nurses and how the acceptance of LAM by the customer; To know opportunities and strategies used by nurses to promote LAM; To show results of the practice of nurses with respect to the monitoring of users of LAM. It was a field study, cross, held from February to July 2008, the Regional Executive Secretariats (SER) I, III, IV and V of Fortaleza-CE, with 137 nurses. Data collection occurred in the Basic Health Units using the interview. There were the nurses, accounting for 121 (88.3%) participants, who had a mean age of 35.1 years. Slightly more than half, 70 (51.1%) reported having children, and of those, 61 (92.4%) reported having experienced exclusive breastfeeding, which had an average of 4.38 months. However, only 12 (19.6%) nurses said they had adopted the LAM, even considering its practicality and its benefits. Only 2 (1.5%) nurses know how to LAM contraceptive option. As the self-assessment of knowledge on the subject, 34 (24.8%) nurses rated their knowledge as excellent or good, 80 (58.4%) good, 20 (14.6%) as regular and 3 (2, 2%) inadequate. Most, 88 (64.2%), know the effectiveness of LAM and only 5 (3.7%) reported the efficacy correct. Even with 65 (47.4%) of nurses discrediting the effectiveness of LAM and only 19 (13.9%) being knowledgeable of the three requirements for optimal operation of the method, 112 (81.8%) said guide for women on the use of it. The acceptance of women occurs in part, to the extent that seeking complementary method to continue use of LAM. The guidance is provided by nurses at different times, related to the pregnancy-puerperal period (prenatal, postpartum and child care) and outside, in the consultations for family planning and, in most cases, adopted the individual approach. The students, 59 (52.7%) nurses accompanied users of LAM. The average time of use by customers is 3 to 4 months, and the return to work and the introduction of other foods to the infant diet the main reasons for discontinuation of LAM. The oral combination was the MAC of succession of LAM. It is therefore the need to improve knowledge of nurses of the PSF over the area of care, since in such circumstances the promotion of LAM is compromised, affecting the adherence of women to the method and the effectiveness of it.

Objetivos: Objetivos: Avaliar o crescimento de crianças amamentadas cujas mães haviam inserido um implante de liberação de etonogestrel no pós-parto imediato. Métodos: Ensaio clínico aberto, randomizado, controlado e paralelo de mulheres pós-parto que foram randomizadas em blocos para inserção precoce (até 48 horas pós-parto antes da alta) ou convencional (6 semanas após o parto) de um implante etonogestrel. O desfecho primário foi o peso médio do bebê aos 12 meses (360 dias), e uma diferença de >=10% entre os grupos foi considerada clinicamente significativa. Os desfechos secundários foram a comprimento da criança, o perímetro cefálico e a circunferência braquial. Estas variáveis foram medidas no início e aos 14 e 40, 90, 180, 270 e 360 dias pós-parto. O modelo de regressão linear de efeitos mistos foi utilizado para avaliar os desfechos, com um poder de 80%, e um nível de significância de 1% para o desfecho primário e 0,3% para os desfechos secundários, devido à correção para múltiplas hipóteses. Resultados: De junho a agosto de 2015, um total de 100 mulheres foram randomizadas para inserção precoce ou convencional do implante de etonogestrel no pós-parto. As características sociodemográficas foram semelhantes entre os grupos, exceto no nível de escolaridade, que foi maior no grupo de inserção convencional (88% vs. 70% no grupo de inserção precoce, p = 0,02). Não houve diferença no peso do bebê em 360 dias entre os grupos [precoce: (média ± desvio padrão) 10060,3 ± 1156,0 g vs convencional: 9812,1 ± 1270,3g, estimativa da diferença de média 321,6g, intervalo de confiança 95% (IC): -183,5 A 495,7]. As curvas de crescimento do comprimento e as curvas dos perímetros cefálico e braquial também não diferiram entre os grupos. Conclusões: Não há diferença no crescimento das crianças amamentadas, em 12 meses, cujas mães receberam a inserção do implante liberador de etnogestrel precocemente comparado com a inserção pós-parto convencional. / Objective: To evaluate the growth of breastfed children whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. Methods: An open, randomized, controlled, and parallel trial of postpartum women who were block randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of a etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days), and a difference of >=10% between groups was considered clinically significant. The secondary outcomes were infant\'s lenght, head and arm circumferences. These variables were measured at baseline and at 14 and 40, 90, 180, 270, and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes, with a power of 80%, and a significance level of 1% for primary outcome and 0.3% for secondary outcomes, due to correction for multiple hypothesis testing. Results: From June to August of 2015, a total of 100 women were randomized to either early or conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups, except for educational attainment, which was higher in the conventional insertion group (88% vs. 70% in the early insertion group, p=.02). There was no difference in infant weight at 360 days between the groups [early: (mean ± standard deviation) 10060.3 ±1156.0 g vs conventional: 9812.1 ± 1270.3g, mean difference estimate 321.6g, 95% confidence interval (CI): - 183.5 to 495.7]. The growth curves of the lenght and the curves of the head and arm circumferences did not differ between the groups. Conclusion: There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant.

An extensive body of research suggests that increasing access to contraception can improve the health of women and children and increase their socioeconomic mobility through increased wages and labor force participation. In the United States, however, contraception and childbearing has historically been used as a form of racist and eugenic population control. This thesis outlines the history of contraception in an intersectional context, inspired largely by the work of Martha Bailey and Dorothy Roberts, from forced childbearing during chattel slavery, to the forced and or coercive sterilization of large populations of Black and Brown women in the modern era. Given the historical racism of contraception, combined with the possibilities for increased socioeconomic mobility and self-determination that accompany increased access to contraception, leads this thesis to ask: who lacks access to contraception in the U.S. today? An original analysis of data from the Guttmacher Center determines that Hispanic women are the most likely to lack access to birth control, followed by younger women and impoverished women. These findings, in conversation with the current implications of the racist past of contraception, imply the need for anti-racist contraception programs that prioritize informed consent and patient autonomy. Such programs could improve women’s and child health, decrease government spending, and contribute to increasing economic and racial equality.

Despite the availability of contraception in Canada, almost half of pregnancies are unintended and account for approximately 95% of elective, induced abortions. Nearly one-third of Canadian women will access an elective abortion in their lifetime and 30-40% of these women will access at least one further termination. Although contraceptive counselling is generally provided as part of abortion care, there is a paucity of research about the effectiveness of peri-abortive counselling methods or women’s experiences with this care. This research was designed to better understand peri-abortive contraceptive decision-making through the lens of the Ottawa Decision Support Framework and addressed gaps in previous research. The thesis was completed in two parts, a literature review and the first Canadian qualitative study on this topic. Unlike most of the available research that focused on typical outcomes such as contraceptive uptake or continuation, the data from the interpretive descriptive study described women’s informational needs, desired supports, and preferences for peri-abortive contraceptive care. The literature review described the current research and the findings from the qualitative study demonstrated that Canadian women’s experiences with peri-abortive contraceptive care are similar to those in studies published in other countries. This thesis contributes to the limited body of knowledge in understanding what women need and want when receiving contraceptive care as part of abortion services.

No description available.