O rastreamento para o cÃncer do colo uterino e o planejamento familiar sÃo prÃticas preventivas de relevÃncia em saÃde da mulher em idade fÃrtil. A atenÃÃo bÃsica ainda privilegia o ciclo gravÃdico-puerperal e a prevenÃÃo da neoplasia maligna do colo, ficando o planejamento familiar em segundo plano. Contudo, a despeito da melhor cobertura na realizaÃÃo da citologia cervicovaginal, as taxas de mortalidade pela neoplasia persistem elevadas. Persistem, tambÃm, taxas altas de gestaÃÃo na adolescÃncia, de abortamentos e iniquidades em saÃde. O objetivo do projeto foi caracterizar a situaÃÃo de saÃde reprodutiva de mulheres em idade fÃrtil de uma comunidade urbana de baixa renda em Fortaleza, priorizando a realizaÃÃo da citologia e o uso de mÃtodos contraceptivos. Tratou-se de estudo transversal por entrevistas domiciliares com 244 mulheres de 13 a 52 anos. A anÃlise exploratÃria inicial permitiu estabelecer correlaÃÃes atravÃs do teste do qui-quadrado de Pearson para as variÃveis nominais e ANOVA para mÃdias e desvios padrÃes. Para expressar a magnitude das associaÃÃes foram calculadas razÃes de chance (odds ratio) como expressÃes das razÃes de prevalÃncia utilizando regressÃo logÃstica simples e mÃltipla. Dentre as entrevistadas com atividade sexual e 25 anos ou mais, 90,3% realizaram citologia no mÃximo a cada trÃs anos, 59,3% anualmente. Correlacionaram-se positivamente à periodicidade anual o trabalho remunerado (OR=2,63; IC95%: 1,49-4,64) e a condiÃÃo de ter tido no mÃximo uma gestaÃÃo (OR=2,60; IC95%: 1,11-6,08). Quanto ao planejamento familiar, pouco mais da metade das mulheres (51,9%) usava algum mÃtodo e 39,5% delas nÃo foram orientadas por mÃdico ou enfermeiro. Predominou utilizaÃÃo de anticoncepcionais orais (40,4%) e condom (28,7%). A renda familiar de R$ 800,00 ou superior associou-se à maior chance de contracepÃÃo orientada por profissional adequado (OR=3,3, IC95%: 1,28-8,54), contrariamente à histÃria de abortamento (OR=0,32, IC95%: 0,13-0,82). Observou-se alta frequÃncia de realizaÃÃo da citologia cervicovaginal, inclusive anualmente e fora da faixa etÃria recomendada pelo MinistÃrio da SaÃde. Houve baixa prevalÃncia de anticoncepÃÃo, oferta insuficiente quanto à variedade e elevada proporÃÃo de mulheres que nÃo recebeu orientaÃÃo adequada para o uso de mÃtodos contraceptivos. Renda familiar e abortamento prÃvio foram fatores associados ao planejamento familiar orientado por profissional adequado, enquanto o trabalho remunerado e o fato de ter tido no mÃximo uma gestaÃÃo foram associados à coleta anual de citologia para prevenÃÃo do cÃncer do colo uterino. / Cervical cancer screening and family planning are relevant preventive health practices for women of childbearing age. Primary care still privileges gestational period and cervical neoplasia prevention over family planning. Nevertheless, despite improvements on the coverage for cervicovaginal cytology, cervical neoplasia mortality rates show only slight decrease. High rates of teenage pregnancy, abortions and health iniquities persist. The project aimed to portrait the reproductive health situation of childbearing aged women from a low income urban community in Fortaleza, prioritizing cytology procedures and the use of contraceptive methods. This was a cross-sectional study carried out through home interviews with 244 women from the age of 13 to 52 years old. The initial exploratory analysis allowed establishing correlations through the chi-square test for nominal variables and ANOVA for means and standard deviations. Odds ratios as expressions of prevalence ratios were obtained to express the magnitude of the associations using simple and multiple logistic regression. Amongst sexually active women and aged 25 years or more, 90.3% underwent cytology at least every 3 years, and 59.3% did it annually. Cytology annual frequency positively correlated to remunerated employment (OR=2.63; IC95%: 1.49-4.64) and to the condition of having had the maximum of one pregnancy (OR=2.60; IC95%: 1.11-6.08). Regarding family planning, just over half of women (51.9%) used any contraception and 39.5% of them were not guided by doctors or nurses. Oral contraceptives (40.4%) and condom (28.7%) predominated as current contraceptive methods. Family income of R$ 800.00 or above positively correlated with contraception guided by an appropriate professional (OR=3.3, IC95%: 1.28-8.54) and negatively correlated to a history of previous abortion (OR=0.32, IC95%: 0.13-0.82). High rates of cervicovaginal cytology were observed, even annually and out of the age group suggested by the Health Ministry. There was a low rate of contraception, insufficient offer as to methods variety and a high proportion of women who did not received adequate guidance on the use of contraceptive methods. Family income and previous abortion were associated to family planning guided by a qualified professional, whilst remunerated employment and having had the maximum of one pregnancy were associated to annual cytology screening to prevent cervix neoplasia.

INTRODUÇÂO: pesquisas direcionadas para atender às necessidades das comunidades locais, especificamente no caso de comunidades vulneráveis, além de produzirem resultados mais efetivos, devido à possibilidade de identificação e atuação na realidade observada, são também uma forma de qualificar e fortalecer a atenção primária em saúde. Este artigo é uma proposta de atuação embasada em referencial teórico. OBJETIVOS: conhecer as expectativas dos profissionais, bem como seus conhecimentos e disponibilidade para prestarem informações sobre planejamento familiar; conhecer as expectativas e necessidades das usuárias; e desenvolver estratégias para capacitação de profissionais de saúde que atuam em planejamento familiar. MÉTODOS: propõe-se uma pesquisa de avaliação com abordagem qualitativa e utilização da técnica de grupo focal. Sugere-se proceder à análise dos dados através da técnica de análise de conteúdo cujo processo deverá contemplar dois momentos: análise específica de cada grupo e análise cumulativa e comparativa do conjunto dos grupos pesquisados. CONCLUSÃO: através do trabalho em equipe multiprofissional é possível identificar e superar obstáculos que possam dificultar o processo de trabalho, com vistas a se obterem melhorias na qualidade do atendimento, com foco no planejamento familiar, respeitando-se as expectativas e necessidades das usuárias dos serviços de saúde. / INTRODUCTION: researches aimed at meeting the needs of local communities, specifically in the case of vulnerable communities, produce highly effective results due to the possibility of identifying and acting on the observed reality; being also a way to qualify and strengthen primary healthcare. This article is an action proposal based on theoretical framework. PURPOSES: to understand the healthcare worker´s expectations, knowledge and readiness to provide information on family planning; to meet the expectations and needs of the users; and to develop strategies for training health professionals working in family planning. METHODS: it is proposed an evaluation research with qualitative approach and the use of the focus group technique. It is suggested to analyze the data using the technique of content analysis including in this process two stages: specific analysis of each group and cumulative and comparative analysis of all the groups surveyed. CONCLUSION: by working with multidisciplinary team, it is possible to identify and overcome obstacles that may hinder the care process that aims at achieving improvements in the quality of healthcare, with a focus on family planning, respecting the expectations and needs of the health services users.

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2006. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-11-09T18:18:17Z No. of bitstreams: 1 eloisarodrigues.pdf: 710176 bytes, checksum: 1466ea61dd93985d8e87c178fbc94438 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-11-13T19:09:29Z (GMT) No. of bitstreams: 1 eloisarodrigues.pdf: 710176 bytes, checksum: 1466ea61dd93985d8e87c178fbc94438 (MD5) / Made available in DSpace on 2012-11-13T19:09:29Z (GMT). No. of bitstreams: 1 eloisarodrigues.pdf: 710176 bytes, checksum: 1466ea61dd93985d8e87c178fbc94438 (MD5) Previous issue date: 2006 / O presente estudo transversal de base populacional teve como objetivo identificar o perfil da saúde reprodutiva e a prevalência de alta paridade entre mulheres do município do Rio Grande/RS. Defini-se alta paridade a ocorrência de quatro ou mais gestações que geraram filhos vivos com peso igual ou superior a 500 gramas e idade gestacional acima de 20 semanas. Partiu-se da hipótese que além do risco da própria multiparidade as mulheres com alta paridade estão mais expostas a outros fatores de risco como os de ordem social e econômico, dificuldade de acesso aos serviços de saúde e utilização inadequada de métodos anticoncepcionais. Além disso, acredita-se que estas mulheres geram prole com condições de nascimento mais desfavoráveis. O processo de amostragem foi aleatório sistemático por conglomerados onde foram sorteados 20 setores censitários da zona urbana da cidade e, em cada setor visitados 32 domicílios. Participaram da pesquisa 594 mulheres com idade entre 15 e 49 anos. A coleta de dados foi realizada entre setembro de 2005 e março de 2006. O instrumento utilizado para a coleta dos dados baseou-se em um questionário contendo perguntas fechadas estruturadas e semi estruturadas aplicado às mulheres sujeitos da pesquisa. O modelo teórico para determinação dos fatores de risco para a alta paridade foi construído por blocos de variáveis das características socioeconômicas e demográficas, história reprodutiva, anticoncepção, planejamento familiar, história conjugal, acesso aos serviços de saúde, condições de saúde e hábitos pessoais . A análise dos resultados foi obtida através de regressão logística não condicional. A prevalência de alta paridade no presente estudo foi de 15,8%. A análise bruta mostrou que a alta paridade esteve associada positivamente com a idade (p<0.001), cor da pele não branca (p=0.005), presença do companheiro (p<0.001), paridade dos pais maternos (p<0.001), história de filhos com baixo peso ao nascer (p=0.005) abortos (p<0.001), hábito de fumar (p=0.002) e participação do companheiro na escolha do método anticoncepcional (p=0.01)e negativamente com a renda per capita (p<0.001), escolaridade (p<0.001), trabalho fora de casa (p=0.03), idade da primeira gestação(p<0.001) e forma de acesso não gratuito ao método anticoncepcional (p<0.001). Após o ajuste conforme o modelo hierárquico de análise permaneceram significativamente associados ao desfecho estudado presença do companheiro (p=0.02), abortos (p=0.01), participação do companheiro na escolha do método anticoncepcional (p=0.01), renda per capita (p=0.001), escolaridade (p<0.001) e idade da primeira gestação (p<0.001). Esses resultados confirmam um quadro de desigualdades nos quais estão inseridas este grupo de mulheres com alta paridade no município do Rio Grande. Acredita-se que este estudo poderá contribuir para a construção de práticas e modelos de assistência à saúde que reduzam as desigualdades existentes em nossa sociedade, onde as práticas sejam desenvolvidas com equidade e coerência com as necessidades de saúde das mulheres e que repercuta em uma melhor qualidade de vida e saúde no campo da reprodução e sexualidade. / The present population-based transversal study had as objective to identify the reproductive health profile and the predominance of high parity amongst women from the municipal district of Rio Grande/RS. High parity being defined as the occurrence of four or more gestations that generated living children with weight same as or above 500 grams and gestational age above 20 weeks. Beginning from the hypothesis that, beyond the risk of multiple parity itself, the women with high parity are more exposed to other risk factors such as from social and economical order, difficult access to health services and inadequate use of contraceptive measures. Besides that, it is believed that these women give their progeny birth in further unfavorable conditions. The sampling process was systematic random along conglomerates where 20 censual sectors from the urban zone were picked by lot and in each sector 32 dwellings were visited. 594 women with age between 15 and 49 years participated in the research. The data gathering occurred between September 2005 and March 2006. The implement used for the data gathering was based in a questionary containing closed structured and semi-structured questions applied on the women subject of the research. The theoretical model for the determination of risk factors for high parity was build by blocks of variables of socioeconomic and demographic characteristics, reproductive history, contraception, family planning, conjugal history, access to health services, health conditions and personal habits. Analyses of the results were obtained through non-conditional logistic regression. The predominance of high parity in the present study were of 15.8%. In the bivaried analyses also it is high parity happened positive association with the age (p<0.001), non whit skin color (p=0.005), living with partner (p<0.001), parity of parents motherly (p,0.001), low birth weight of newborns (p=0.005),abortion (p=0.001), habit of smokes (p=0.002), participation of the partner in the choice of the measure (p=0.01) and negatively with per capita income ( p<0.001), schooling (p<0.001), work out house (p=0.03), age of the first gestation (p<0.001), non free access to contraceptive measures (p<0.001). Behind analyses multivaried remained of the high parity significant association living with partner (p=0.02), abortion (p=0.01), participation of the partner in the choice of the measure (p=0.01), income per capita (p=0.001), schooling(p<0.001), and age of the first gestation (p<0.001).That results confirm one panorama of the inequality on the whom to be insert high parity amongst women from the municipal district of Rio Grande/RS. It is believed that this study will be able to contribute to the making of practices and models for health assistance that can reduce the inequalities existing in our society, in which the developed practices are coherent with the needs of the health of women and that it may outcome for a better quality of life and health in the sexuality and reproduction field. / El presente estudio transversal de base populacional tuvo como objetivo identificar el perfil de la salud reproductiva y la prevalencia de alta paridad entre mujeres del municipio de Rio Grande/RS. Se define alta paridad a ocurrencia de cuatro o más gestaciones que generan hijos vivos con peso igual o superior a 500 gramos y edad gestacional arriba de 20 semanas. Se partió de la hipótesis que aparte del riesgo de la multiparidad en si, las mujeres con alta paridad están más expuestas a otros factores de riesgo tales como los de orden social y económico, dificultad de acceso a los servicios de salud y utilización inadequada de métodos anticoncepcionales. A parte de esto, se cree que estas mujeres generan prole con condiciones de nacimiento más desfavorables. El proceso de la muestra fue aleatorio sistemático por conglomerados donde fueron sorteados 20 sectores censados de la zona urbana de la ciudad y en cada sector visitados 32 domicilios. Participaron de la pesquisa 594 mujeres con edad entre 15 a 49 años. La colecta de datos fue realizada entre setiembre del 2005 y marzo del 2006. El instrumento utilizado para la colecta de los datos se basó en un cuestionario conteniendo preguntas cerradas estructuradas y semi-estructuradas aplicado a las mujeres sujetos de la pesquisa. El modelo teórico para determinación de los factores de riesgo para a alta paridad fue construido por blocos de variables de las características socioeconómicas y demográficas, historia reproductiva, anticoncepción, planeamiento familiar, historia conyugal, aceso a los servicios de salud, condiciones de salud y hábitos personales. El análisis de los resultados fue obtenido por medio de regresión logística no condicional. La prevalencia de alta paridad en el presente estudio fue de 18,8%. El análisis bruto mostró que la alta paridad estuvo asociada positivamente con la edad (p<0.001), color de piel no blanca (p=0.005), presencia de compañero (p<0.001), paridad de padres maternos (p<0.001), historia de hijos con bajo peso al nacer (p+0.005), abortos (p<0.001), hábito de fumar (p=0.002), y participación del compañero en la elección del método anticoncepcional (p=0.001), y negativamente con la renta “por capita” (p=0.001), escolaridad (p=0.001) y edad de la primera gestación (p<0.001). Estos resultados confirman un cuadro de desigualdades en los cuales están inseridas este grupo de mujeres con alta paridad en el municipio de Río Grande. Se cree que este estudio podrá contribuir para la construcción de prácticas y modelos de asistencia a la salud que reduzcan las desigualdades existentes en nuestra sociedad, donde las prácticas sean desenvueltas con igualdad y coherencia con las necesidades de salud en el campo de la reproducción y sexualidad.

No Brasil, a saúde, como direito do cidadão e dever do Estado, é garantida pela constituição de 1998. Em 1983 foi criado o PAISM, propondo a perspectiva de atendimento integral à saúde da mulher, com o objetivo de considerar, no âmbito da saúde, também o entorno social, emo cional e psicológico da mulher, bem co mo as questões relacionadas à contra cepção. No entanto, sua implantação ainda não se realizou efetivamente até o momento atual, o que pode ser observa do pela alta prevalência de gestações indesejadas, dificuldade de acesso a informações sobre planejamento familiar, predomínio da esterilização cirúrgica feminina como método contraceptivo e da cesárea como via de parto, aspectos que ferem os direitos sexuais e reprodu tivos das mulheres. Um novo contexto tem se desenhado a partir da implanta ção da Lei 9 263, que regulamenta o planejamento familiar, e pela qual a este rilização cirúrgica é aprovada e passa a ser ofertada pelo sistema público de saúde, o que,por sua vez, permite a desvinculação da esterilização com o parto. O presente estudo tem por objeti vo conhecer as características das mu lheres que se esterilizaram pelo SUS, em Ribeirão Preto, entre 2000 e 2004, segun do o tipo de parto, cesárea e parto vagi nal. A amostra foi composta por 235 mulheres esterilizadas nos primeiros cinco anos de oferta da esterilização cirúrgica (2000-2004). Os dados foram coletados através de entrevistas domici liares, utilizando-se questionário estrutu rado. Os resultados demonstraram que a maioria das mulheres esterilizadas era branca, casada, com escolaridade até o ensino fundamental e pertencia à catego ria socioeconômica C e D. A maioria foi esterilizada entre 30 e 39 anos de ida de, com média de 33,3 e mediana de 33 anos, 52,3% faziam uso da pílula como método contraceptivo antes da esteriliza ção. Elas têm, em média, 3,2 filhos e 51,7% teve o primeiro filho entre 13 e 19 anos de idade. Este estudo indicou que as mulheres esterilizadas, em sua maioria, têm mais filhos, começaram a ter filhos mais cedo, usaram mais contra ceptivos enquanto esperavam pela cirurgia e se esterilizaram mais tarde quando comparadas aos resultados de outros estudos. Em relação ao tipo de parto, 71,2% dos partos ao longo da trajetória reprodutiva dessas mulheres foram vaginais, enquanto 28,8% cesáre as, o que aponta para o importante aspecto da desvinculação da esteriliza ção com a cesárea, como objetiva a Lei, e que essas mulheres que tiveram, em sua maioria, partos vaginais, estão tendo melhor acesso à esterilização. / The Brazilian Constitution of 1998 guarantees that health is a citizen right and a duty of the State. The PAISM (Women Health Comprehensive Program) was created emphasizing a comprehensive approach aiming to consi der the social, emotional and psychologi cal issues as part of health condition as well as contraception. However its imple mentation has not been completed up to now. This can be observed by the high prevalence of unwanted pregnancies, difficult access to family planning information, predominance of female surgical sterilization as a contraceptive method and the cesarean section. All these aspects are obstacles to sexual and reproductive rights. Since the implementation of the Federal Legal Act 9263 which regulates Family Planning Provision and approves surgical steriliza tion offering it in the public health system it is possible a disconnection between birth delivery and the surgical procedu re of sterilization. The objective of this study is to know the characteristics of women sterilized by SUS (Unified Health System) in Ribeirão Preto, betwen 2000 and 2004, according to the type of delive ry, cesarean or vaginal. The sample in cludes 235 sterilized women during the first five years of the surgical sterilizati on provision (2000-2004) Data was col lected through household interviews using a structured questionnaire. The results showed that the most sterilized women were white, married, with 8 years of schooling or less and belonged to socioeconomic category C or D. They were sterilized between 30 and 39 years old, with the average of 33.3 years old and median age of 33, 52.3% were using oral contraceptives before sterilization. They were found to have an average of 3,2 children and 51.7% had the first child between 13 and 19 years old. This study indicated that steri lized women had more children, started giving birth earlier and used contracepti ves while they waited for the surgery, and were sterilized later when compa red to the results of other studies. As to delivery types, 71,2% of deliveries along the reproductive history of these women were vaginal while 28% were cesarean what points out the important aspect of the disconnection between sterilization and the cesarean, as deter mined by law, and that these women who had mostly vaginal deliveries are having a better access to sterilization.

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.

Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Vera_Maria_Vieira_dissertacao.pdf: 2732109 bytes, checksum: 095626f88ea8cc348003ef3d0e1e9735 (MD5) Previous issue date: 2004-11-16 / In Brazil, the prevalence contraceptive use is high, however the incorrect and inappropriate use is frequent, suggesting little knowledge about the methods. Thus, it was evaluated the knowledge about the most used contraceptive methods, measured through a score (0-10) and factors related to this knowledge. It was performed a population-based cross-sectional study, with 3,542 subjects, aged 15 or over, residents of the urban zone of Pelotas, RS. The average score of knowledge was of 4,65 (sd=2,07) being 5,02 (sd=2,10) for women and 4,18 (sd=1,92) for men. The lower age, higher schooling, report of unwanted pregnancy, and lifetime use of contraceptive methods exclusive or combined, were associated with higher knowledge score among men, while for women, the determinants of higher knowledge was higher age, live with partner, higher schooling, better socioeconomic level, not having religion and lifetime use of contraceptive methods exclusive or combined. Although the high prevalence of contraceptive use during the lifetime (75,3%), it is still limited the knowledge about the most used methods, as well as about the menstrual cycle and the fertile period. / A prevalência de uso de anticoncepcional no Brasil é alta, porém é freqüente seu uso incorreto e inadequado, sugerindo escasso conhecimento sobre os métodos. Assim, avaliou-se o conhecimento sobre métodos anticoncepcionais mais utilizados através de um escore (0-10) e fatores associados à este conhecimento. Foi realizado um estudo transversal de base populacional, com 3.542 indivíduos de quinze anos ou mais, residentes na zona urbana de Pelotas, RS. A média de escore de conhecimento foi de 4,65 (dp=2,07), sendo 5,02 (dp=2,10) para as mulheres e 4,18 (dp=1,92) para os homens. Menor idade, maior escolaridade, relato de gravidez indesejada e uso de método anticoncepcional exclusivo ou combinado ao longo da vida, mostraram-se associados a um maior escore de conhecimento entre os homens, enquanto para as mulheres, os determinantes de maior conhecimento foram maior idade, viver com companheiro, maior escolaridade, melhor nível econômico, não ter religião e uso de método anticoncepcional exclusivo ou combinado ao longo da vida. Apesar da alta prevalência de uso de anticoncepcional (75,3%), é limitado o conhecimento sobre os métodos mais utilizados, ciclo menstrual e período fértil.

The focus of the study was to evaluate the attitudes of midwives towards the implementation of the Choice on Termination of Pregnancy Act in the O.R. Tambo District hospitals in the Eastern Cape. There was no provision for termination of pregnancy (TOP) for unplanned pregnancy until 1994 when the Choice on Termination of Pregnancy (CTOP) Act was introduced. This act allowed any pregnant woman to request TOP when she wished for TOP. The midwives could voluntarily undergo training in TOP services and the designated institutions started offering TOP services, but stopped at a later stage. This resulted in overcrowding in health institutions which continued rendering TOP services. The researcher posed one question to be answered as: What are the attitudes of the midwives who are employed by health institutions in the O.R. Tambo District in the Eastern Cape Province towards the implementation of the Choice on Termination of Pregnancy Act? The aim of the study was to evaluate the attitude of midwives towards the implementation of the CTOP Act in the O.R. Tambo District hospitals. The objective of this study was to determine the attitudes of these midwives towards the implementation of these services in the O.R. Tambo District in the Eastern Cape Province. A quantitative descriptive design was used in this study. The population consisted of 150 midwives from two hospitals in the O.R. Tambo District. The sample consisted of 75 midwives; 30 midwives from Hospital 1 and 45 midwives from Hospital 2. Random systemic sampling was used in selecting the participants. Data were collected using a questionnaire developed by the researcher and approved by the supervisor and the University of Fort Hare Ethics Committee. In the study, using a sample of (n = 75), the attitude on the implementation of CTOP scale had high reliability of 0.81. Data were analysed with the help of a statistician using Statistix 8.1 software for Windows. Approval to conduct the study was obtained from the University of Fort Hare Ethics Committee, Eastern Cape Department of Health and Hospital 1 and Hospital 2 before the study was conducted. The dignity of the participants was maintained by explaining v the topic of the research study, the aim and objectives of the study, the method to be used for data collection and the significance of the study. The participants were allowed to ask questions and the name and telephone of the supervisor were provided in case they needed some clarity. Voluntary, written informed consent was obtained before the interviews were conducted. Privacy, anonymity and confidentiality were ensured and maintained through all the stages of the research process. The finding of this study was that the midwives employed by the health institutions in O. R. Tambo District Municipality displayed positive responses in the majority (n=11/61.1%) of 18 items in the questionnaire. Since the midwives in this study demonstrated a positive attitude towards TOP, it was recommended that the reason for stopping the TOP services in the concerned institutions should be investigated. The following are also recommended: Compulsory training of midwives should include aspects of reproductive epidemiology, in particular, the epidemiology of unsafe abortions. Training in TOP services should continue, so that there will be adequate number of midwives to provide the TOP services, and consideration of special remuneration for TOP providers. Employment of managers trained in TOP and voluntary training of managers working in TOP sections should be considered so that they may provide effective support to TOP providers. Formation of support centres for TOP providers at Provincial and National levels. Education of the community in prevention of unwanted pregnancies by means of contraceptives and indications for a need to provide TOP services, to prevent victimisation of the TOP providers. Availability of a toll free number for reporting victimisation of the TOP providers.

Philosophiae Doctor - PhD / The first objective of this study is to show if diffusion of contraception in areas of traditional high fertility has gone through profound changes. Indeed, we would like to know if contraceptive behaviours have evolved because of new fertility perceptions and also because partners now have greater freedom to make choices in a relationship. The second objective of this study is not only to highlight the levels and trends of contraception and the factors influencing their use (government policies, role of family planning, etc.) in developing countries, but also to consider the population of unmet-needs of contraception. Indeed, the level of contraceptive use depends obviously on users, but also on non-users with no needs and non-users with unsatisfied needs. The understanding of this last category of females is essential to a more accurate estimation of contraception levels, and, therefore for the estimation of fertility levels. This study analyses the contraceptive use in several developing countries in Africa and highlights the unsatisfied needs of contraception, to understand why such needs exist. To do so, we shall analyse available demographic data for thirty-five African countries by using the available Demographic and Health Surveys (DHS), from the 1980's to 2000's considering the DHS I, DHS II, DHS III and DHS IV. This great variety of surveys, seventy-nine in total, permits one to compare levels of contraception and 'unmet-needs' from country to country. The surveys also, make it possible to compare the evolution over time of specific countries or specific regions, and to subsequently comprehend the determining factors of contraceptive use or non-use. / South Africa

Contraceptive usage for spacing of childbirth is an important indicator for understanding family planning practices as well as fertility transitions. Fertility transition are especially important in sub-Saharan Africa where fertility remains high in many countries. However, estimates and short-term projections are generally not available for countries in this region. We developed a Bayesian hierarchical time series model to estimate and project usage of contraceptives for spacing by 5-year age groups for all countries in sub-Saharan Africa for the years 1985-2030. Estimating country-age-year specific usage is challenging due to limited data availability. We use Bayesian hierarchical models to share information across countries and spline regression to share information across age groups. Temporal changes are captured with logistic growth curves and autocorrelated distortion terms. Models are validated with out of sample exercises which test the model's ability to project into the future as well as the models ability to estimate historical trends. Validation results show the model is well calibrated. Estimates reveal noteworthy variability across countries and across age groups.

This research explored the reproductive needs of people of low socio-economic standing living with HIV/AIDS (PLWHA) and attending public health facilities in South Africa. A qualitative research design based on the theoretical framework of critical realism using grounded theory was employed in revealing the dominant unobserved underlying mechanisms, powers and structures that influence their reproductive decision-making. HIV-positive men, HIV positive pregnant women and HIV positive non-pregnant women were recruited by HIV counsellors from the Ante-Natal Clinic and the Voluntary Counselling and Testing Clinic at the Kalafong Hospital. Individual interviews were used to explore participants’ reproductive needs. Focus group discussions were employed to holistically explore the HIV counsellors’ attitudes and perceptions regarding their clients’ reproductive needs and future family planning. Parenthood was an important factor to all participants in establishing their gender identities. Different cultural norms existed for men and women realising their reproductive needs. Society expects of women to be mothers, yet at the same time negatively judges HIV-positive women who choose to become pregnant or refuse to abort an existing pregnancy. Consequently, most women choose not to disclose their status and continue to live as if they are not HIV-positive. Having children is so important to these reproductive-aged PLWHA that they will risk their own health, the health of their partners and their babies. Emancipatory transformation of current HIV counselling services is needed and can be established by improving counsellor knowledge through training as well as giving PLWHA access to accredited HIV risk reducing services. / Thesis (PhD)--University of Pretoria, 2013. / lk2014 / Psychology / PhD / unrestricted