Introdução: As escolhas relacionadas à fecundidade são complexas e envolvem idéias e valores das sociedades e de seus integrantes. Existem muitos estudos que procuram explicar a fecundidade a partir de variáveis socioeconômicas e culturais, mas não indagam os motivos que teriam levado as mulheres a proceder de uma forma ou de outra para a formação de suas famílias. A fecundidade abaixo do nível de reposição é observada nos grandes centros urbanos brasileiros há algumas décadas, mas permanecem diferenciais intra-urbanos que precisam ser identificados, assim como seus determinantes. Objetivo: Identificar os diferenciais de fecundidade no município de Curitiba e contribuir para o conhecimento e entendimento do comportamento reprodutivo, motivações e vivência das mulheres com alta fecundidade. Metodologia: Pesquisa quantitativa e qualitativa, de caráter descritivo e exploratório. Analisou-se inicialmente a tendência da fecundidade e os diferenciais por bairro. O estudo na etapa quantitativa incluiu 441 mulheres residentes em Curitiba que tiveram o quinto ou mais filhos nascidos vivos em 2005, identificadas pelo SINASC. Para coleta dos dados nesta etapa utilizou-se questionário semi-estruturado. Os dados foram organizados em banco de dados Access e analisados com o uso do programa computacional Statistica v.8.0. Os sujeitos da etapa qualitativa constituíram-se de nove mulheres entrevistadas em profundidade a partir de roteiro temático. Os dados qualitativos foram interpretados seguindo os ensinamentos da \"análise de conteúdo\". Resultados: A taxa de fecundidade em Curitiba chegou a 1,5 filhos por mulher em 2005, mas com diferenciais intra-urbanos. Nove dos 75 bairros de Curitiba concentravam 59,6% das mulheres com alta fecundidade. Cerca de 90% das entrevistadas tiveram mais filhos do que desejavam. O número ideal de filhos referidos variou entre 2,4 e 2,9. No momento da entrevista 85% das mulheres usavam algum método contraceptivo com prevalência da laqueadura e da pílula. A esterilização voluntária foi efetivada para apenas 36,4% das mulheres e 42% dos homens solicitantes. A auto-avaliação de saúde não boa foi referida por 40% das mulheres. As entrevistadas relataram dificuldade de acesso aos programas de proteção social e à casa própria. Contribuíram para o maior número de filhos, as falhas dos programas de planejamento familiar, a falta de informação e domínio da negociação no uso dos métodos contraceptivos, as desigualdades de gênero e a vulnerabilidade psico-afetiva das mulheres. As entrevistadas da etapa qualitativa vivenciaram trajetórias reprodutivas e produtivas conflituosas marcadas pelas desigualdades sociais e de gênero. A maioria das mulheres do estudo apresentava elevada vulnerabilidade social. Conclusões: Uma diversidade de fatores, além dos socioeconômicos, exerce influência na definição da maternidade e do número de filhos. Identificou-se que são necessárias medidas que implementem o acesso à contracepção, a inclusão dos homens neste processo, a capacitação de profissionais para a assistência sexual e reprodutiva. São indispensáveis a promoção de políticas compatíveis para realização da maternidade, que facilitem a participação das mulheres no mercado de trabalho e promovam a eqüidade entre os sexos tanto neste mercado quanto no âmbito doméstico e medidas efetivas de proteção social. A liberação da laqueadura no pós-parto normal imediato foi recomendada, com vistas a agilizar e facilitar o acesso das mulheres a este procedimento. / Introduction: The choices concerning about fertility are complex because they involve ideas and values of societies and their members. Many studies seek to explain the fertility socioeconomic and cultural changeable but don\'t consider the women reasons to select one way or another to form their families. The fertility rate below the replacement is observed in Brazilians urban centers a few decades ago, but is necessary to identify the intra-urban differentials remain and its determinants. Objective: To identify the fertility differentials in Curitiba and to contribute to the women with high fertility reproductive behavior knowledge and comprehension, their motivations and experiences. Methodology: quantitative and qualitative researches, descriptive and exploratory in nature. The trend in fertility and the differentials were examined by neighborhood initially. The study included 441 women living in Curitiba which had the fifth or more children born alive in 2005 and identified by SINASC. In this step the data collect used a semi-structured questionnaire. They were organized in Access database and analyzed using the Statistica computer program, v.8.0. Nine women were the qualitative phase subjects interviewed in depth from thematic roadmap. Qualitative data were interpreted by following the teachings of the \" contents analysis.\" Results: The rate of fertility in Curitiba reached 1.5 children per woman in 2005, but with intra-urban differentials. Nine of the 75 districts of Curitiba concentrated 59.6% of women with high fertility. About 90% of respondents had more children than desired. The ideal number of children referred ranged between 2.4 and 2.9. At the time of the interview 85% of women were using contraceptive methods, with prevalence of sterilization and the pill. The voluntary sterilization was carried out for only 36.4% of women and 42% of male applicants. The self-assessment of health \"not good\" was cited by 40% of women. Interviewees reported difficulty of access to programs of social protection and housing. Contributed to the largest number of children, the failures of programs for family planning, lack of information and area of negotiation in the use of contraceptive methods, inequalities of gender and psycho-emotional vulnerability of women. Subjects of qualitative stage experienced conflict trajectories reproductive and productive marked by social inequality and gender. Most women in the study had high social vulnerability. Conclusions: A variety of factors, in addition to the socioeconomic, exerts influence on the definition of motherhood and the number of children. It was identified that are necessary to implement the access to contraception, the inclusion of men in this process, the training of professionals for sexual and reproductive assistance. Its essential to promote politics for consistent implementation of motherhood, to facilitate the participation of women in the labor market and promote equity between the sexes in this market as both under domestic and effective measures of social protection. The release of sterilization in the immediate post-normal delivery was recommended, in order to expedite and facilitate women\'s access to this procedure.

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.

Die vorliegende Arbeit geht der Frage nach, inwiefern Einstellungen und Verhaltensweisen der Frauen zu Familienplanung und Geburtenregelung auch zwischen den Wohnbezirken einer Stadt unterschiedlich sind, welche Ursachen dafür vorliegen und ob infolgedessen eine regionale Differenzierung bei der medizinischen Betreuung und der sozialen Beratung und Unterstützung erforderlich ist. Mit 3000 zufällig ausgewählten Probandinnen wurden rund 1 % der Ostberliner Frauen im Alter von 15 bis unter 45 Jahren in die Untersuchung einbezogen. Bei der Prüfung der Abhängigkeit der Familienplanung und des Kinderwunsches von der vorliegenden sozioökonomischen Situation der Frauen beziehungsweise der Paare wurde eine jeweilige Regionalanalyse erstellt. Um die soziale Situation der Frau darzustellen, wurden Indikatoren wie Alter der Frau, Anzahl der geborenen Kinder, Familienstand, Bildungsgrad und Erwerbstätigkeit der Frau einbezogen. Entsprechend der regionalen Gliederung Ostberlins in 11 (Stadt-) Bezirke wurde untersucht, ob und in welcher Weise sich die Auffassungen, Meinungen und Verhaltensweisen der dort lebenden Frauen hinsichtlich der von ihnen gewünschten Kinderzahl, der Argumente für einen fehlenden (aktuellen) Kinderwunsch, der Kenntnis, Einstellung und praktizierten Kontrazeption, vorangegangener Schwangerschaftsabbrüche und der Meinung zum Abbruch sowie zum Beginn und der Häufigkeit sexueller Kontakte unterscheiden. Auffallend ist der hohe Anteil junger Frauen mit einer hohen Frequenz sexueller Kontakte, allerdings ohne eine Schwangerschaft anzustreben. Der größte Teil der Verhütung wird durch die Frauen abgedeckt. Dies gilt ebenfalls für den Umgang mit nicht gewollten Schwangerschaften bis hin zur Durchführung einer Abruptio. In der vorliegenden Studie gab knapp ein Drittel der Frauen bereits durchgeführte Schwangerschaftsabbrüche an. Dieses Abbruchverhalten korreliert mit einer oft sehr späten Information über kontrazeptive Möglichkeiten sowie deren Anwendung und muss Grund genug sein, das Wissen um eine gezielte Geburtenregulierung zu intensivieren und je nach regionalen Bedürfnissen umzusetzen. Bei fast allen diesen inhaltlichen Bereichen sind Unterschiede nach dem Wohnsitz der Frau zu erkennen, die mit einem Signifikanzniveau von 5 % Irrtumswahrscheinlichkeit statistisch gesichert werden konnten. Damit konnte die Grundhypothese, dass auch innerhalb einer großstädtischen Population regionale Unterschiede im generativen Verhalten bei Frauen und Paaren bestehen, bestätigt werden. Die regionalen Unterschiede im generativen Verhalten sind vorrangig auf die in den einzelnen Bezirken vorhandenen Sozialstrukturen der Frauen im gebährfähigen Alter zurück-zuführen. / The present paper describes the differences that exist in behaviours and attitudes towards family planning and birth control of women from different districts of a big city, the causes of such differences and the resulting need for regional differentiation in health care and social services. The test persons were selected at random. They included 3000 women of age 15 to under 45, ie about 1 % of East Berlin s women of this age bracket. The investigation into the relationship between family planning and wish for children on the one hand and the socio-economic situation of the women (or couples) on the other included a regional analysis. The indicators to describe the social situation of a woman included such data as the age of the woman, the number of children born, her marital status and her gainful employment. An analysis was made on how the women s views, opinions and behaviours regarding desired number of children, the points for not wanting a child at the current time, their knowledge of, attitude toward and practice of contraceptive means, the incidence of previous interruptions of pregnancy and the opinions on abortion as well as on the beginning and frequency of sexual intercourse varied between the 11 municipal districts. The striking thing was that a great proportion of the young women had a high frequency of sexual contacts, but no desire to become pregnant. In most cases the contraceptive measures were covered by the women. This applied also to the handling of unwanted pregnancies, including abortions. Nearly one third of the test persons stated that they had had induced abortions. There was a correlation between abortion behaviour and the age at which information on contraceptive options and their application had been obtained. This should be a good point for intensifying the education on birth control, taking regional requirements and particularities into account. The results of nearly all subjects analysed varied from district to district. With an error probability of only 5 %, these differences can be considered as statistically significant. This confirms one basic hypothesis, namely that the population of a big city shows regional differences in the generative behaviour of women and couples. These regional differences are mainly due to the fact that the social structures that exist for the women capable of childbearing are different in the various districts of the city.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / RESUMO O surgimento do HIV/aids e o delineamento da epidemia demandaram mudanÃas para a saÃde sexual e reprodutiva de homens e mulheres que (con) vivem com o vÃrus. A sobrevida e a qualidade de vida melhoradas com o aparecimento da terapia antiretroviral combinada colocou em destaque o aspecto de cronicidade da infecÃÃo pelo HIV, delineando possibilidades de relaÃÃes afetivo-sexuais e reprodutivas, mediante esta nova realidade, num panorama complexo que envolve casais soroconcordantes e sorodiscordantes em contextos de vida similares aos nÃo-infectados, num processo de re-significaÃÃo do HIV/aids e de busca pelo controle dessa pandemia. Este estudo teve como objetivo compreender vivÃncias sexuais e reprodutivas de pessoas que (con) vivem com HIV. A Teoria HumanÃstica de Enfermagem de Paterson e Zderad foi utilizada como referencial teÃrico-metodolÃgico. Trata-se de uma pesquisa descritiva com delineamento qualitativo, realizada no ambulatÃrio de infectologia do Hospital-Escola Santo InÃcio, em Juazeiro do Norte-CE. Os sujeitos do estudo foram 16 pessoas que (con) vivem com HIV/aids, 7 homens e 9 mulheres. Os dados foram coletados nos meses de julho a novembro de 2007, por meio de observaÃÃo livre, consulta aos prontuÃrios e entrevista semi-estruturada. Para anÃlise dos depoimentos foi adotada a tÃcnica de anÃlise de conteÃdo, de onde emergiram trÃs temÃticas: 1. VivÃncia Sexual; 2. VivÃncia Reprodutiva; e 3. VivÃncia da Conjugalidade. Nestas temÃticas, foram identificadas onze sub-temÃticas: 1. O preservativo nas relaÃÃes sexuais; 2. AlteraÃÃes no desejo apÃs a descoberta da soropositividade ao HIV; 3. AlteraÃÃes na prÃtica sexual apÃs a descoberta da soropositividade ao HIV; 4. MÃtodos contraceptivos usados antes da vivÃncia e convivÃncia com o HIV/aids; 5. O preservativo como referÃncia contraceptiva e de proteÃÃo nas relaÃÃes sexuais; 6. Desconhecimento do uso de outros mÃtodos contraceptivos na infecÃÃo pelo HIV; 7. Desejo de ter filhos; 8. Medo da transmissÃo vertical do HIV; 9. (Des)conhecimento das medidas profilÃticas na reduÃÃo da transmissÃo vertical do HIV; 10. ModificaÃÃo na relaÃÃo conjugal frente ao cuidado consigo e com o outro; 11. A quebra da confianÃa depositada no outro frente ao HIV. Das pessoas que vivem e convivem com HIV/aids foram apreendidas diferentes experiÃncias e significados para as vivÃncias sexuais e reprodutivas, em cenÃrios de vida complexos, ainda permeados pelos estigmas decorrentes da aids. Os sujeitos deste estudo viviam em uniÃo conjugal variando de oito meses hà mais de quinze anos, dos quais onze viviam em relaÃÃo conjugal soroconcordante ao HIV e cinco em relaÃÃo sorodiscordante. NÃo percebemos divergÃncia de dados pela variÃvel tempo de uniÃo. Verificamos situaÃÃo sÃcio-econÃmica precÃria e presenÃa de filhos, dos quais cinco concebidos apÃs o conhecimento do status sorolÃgico, e mais duas mulheres no perÃodo gestacional. O tempo de convivÃncia com a infecÃÃo foi variÃvel, de menos de um ano a mais de onze anos. Em metade dos casos o contexto de descoberta da infecÃÃo pelo HIV envolveu o perÃodo gestacional, sendo os outros apÃs doenÃa oportunista ou por convocaÃÃo de parceiro, revelando-se como um momento difÃcil pela infidelidade conjugal comprovada. Os resultados indicaram que o preservativo nÃo fazia parte da rotina sexual atà o conhecimento do status sorolÃgico, sendo essa condiÃÃo determinante para a adesÃo ao preservativo masculino. A estabilidade da relaÃÃo conjugal atuava, na fase prÃ-infecÃÃo, como um dos fatores que contribuÃa para a determinaÃÃo do nÃo uso de preservativo, oferecendo contextos de maior vulnerabilidade, onde o gÃnero aparece como principal fator. O uso do preservativo masculino, apÃs a soroconversÃo, evidenciou as dificuldades nessa adesÃo, principalmente entre os que nunca haviam experienciado esse mÃtodo de proteÃÃo, revelando possÃvel consciÃncia para a necessidade de adaptaÃÃo ao dispositivo na relaÃÃo sexual, que se mostra re-significada para essas pessoas. Contudo, hà um enfrentamento maior para a manutenÃÃo da prÃtica de prevenÃÃo pelo uso do preservativo masculino em casais sorodiscordantes. A descoberta da soropositividade ao HIV demandou modificaÃÃes na rotina sexual, evidenciando a diminuiÃÃo do desejo sexual e alteraÃÃo nas prÃticas sexuais, com distintos aspectos entre homens e mulheres pesquisados. Foram expressas mudanÃas no uso rotineiro dos mÃtodos contraceptivos anterior à soroconversÃo, com a utilizaÃÃo de novos mÃtodos, notadamente o preservativo masculino, frente à presenÃa do HIV. Evidenciamos o desconhecimento de alternativas anticonceptivas diante da infecÃÃo pelo HIV e da aids. O desejo de ter filhos foi observado em homens e mulheres, onde o medo da transmissÃo vertical aparece como forte determinante em abolir essa escolha, com o desconhecimento de medidas profilÃticas na reduÃÃo da transmissÃo vertical. As dificuldades no enfrentamento do HIV/aids impÃem mudanÃas no cotidiano da conjugalidade, destacando um comportamento conjugal bilateral de cuidado com o outro em uma relaÃÃo ambÃgua frente à confianÃa quebrada exposta com o conhecimento do status sorolÃgico. Este estudo nos permitiu perceber que à preciso abrir canais de diÃlogo sobre experiÃncias sexuais e reprodutivas, salientando a importante dimensÃo que à conferida Ãs relaÃÃes entre profissionais e pacientes, como partÃcipes na busca da promoÃÃo da saÃde numa realidade em construÃÃo, de re-significaÃÃo de vida, relaÃÃes e saÃde. Evidencia-se o perÃodo gestacional como um importante momento para o diagnÃstico da infecÃÃo pelo HIV, para aconselhamento das recomendaÃÃes para reduÃÃo da transmissÃo vertical, com inicio precoce da profilaxia da transmissÃo vertical, num atendimento humanizado, livre de julgamentos e preconceitos. A assistÃncia em saÃde sexual e reprodutiva Ãs pessoas vivendo com HIV demanda inÃmeras questÃes e desafios, mas, sobretudo, aponta para a necessidade da assistÃncia integral, nÃo-dicotÃmica, onde prevenÃÃo e tratamento se conjugam, reconhecendo limites, possibilidades, finalidades e prioridades, na individualizaÃÃo do cuidado humano. / ABSTRACT The arise of HIV/AIDS and the design of the epidemy demanded changes in the sexual and reproductive health of men and women who live with the virus. The fact that survival and life quality improved with the advent of antiretroviral therapy highlighted the aspect of chronicity of HIV infection, outlining possibilities for affective-sexual and reproductive relationships in this new reality, in a complex scenery that involves concordant and discordant couples in contexts of life similar to non-infected people, in a process of re-signification of HIV/AIDS and of search for control of this pandemy. This study aimed to understand sexual and reproductive experience of people who live with HIV. The Humanistic Nursing Theory by Paterson and Zderad was used as a theoretical and methodological reference. This is a descriptive research with qualitative design, held at the infectology clinic of the School Hospital Santo InÃcio, in Juazeiro do Norte-CE. The subjects of the study were 16 people who live with HIV/AIDS, 7 men and 9 women. Data were collected from July through November, 2007, through free observation, analysis of medical records and semi-structured interview. For the testimoniesâ analysis the technique of content analysis was adopted, from which emerged three themes: 1. Sexual experience; 2. Reproductive experience, and 3. Marriage Experience. In these themes one identified eleven sub-themes: 1. The condom in sexual intercourses; 2. Changes in desire after the discovery of HIV seropositivity, 3. Changes in sexual practice after the discovery of HIV seropositivity, 4. Contraceptive methods used before the experience and living with HIV/AIDS; 5. The condom as a contraceptive reference and protection in sexual intercourses; 6. Ignorance about the use of other contraceptive methods in HIV infection; 7. Desire to have children; 8. Fear of vertical transmission of HIV; 9. (Lack of) knowledge about prophylactic measures to reduce the vertical transmission of HIV; 10. Modification in marital relationship due to self-care and care with the other; 11. The distrust in the partner because of HIV. Out of the people who experience and live with HIV/AIDS one got different experiences and meanings for sexual and reproductive experiences in complex life sceneries, still permeated by the stigma resulting from AIDS. The subjects of this study lived in marital union ranging from eight months through over fifteen years, eleven of whom lived in conjugal concordant relationship to HIV and five in discordant relationship. We did not notice divergence of data by the variable time of union. We noticed difficult socioeconomic situation and presence of children, including five conceived after the knowledge of HIV, and two women during pregnancy. The time spent living with the infection varied from less than a year to more than eleven years. In half the cases the context of discovery of HIV infection involved the gestational period, the others after opportunistic disease or by convincing of the partner, being a difficult moment due to proved marital infidelity. The results indicated that the condom was not part of their sexual routine until the knowledge of HIV, being the virus a determinant condition for joining the condom. The stability of the conjugal relationship served in the pre-infection phase as one of the factors that contributed to the non-use of condoms, causing larger contexts of vulnerability, where the genre appears as the main factor. The use of male condoms, after seroconversion, highlighted the difficulties in adhesion, especially among those who had never experienced this method of protection, revealing possible awareness of the need to adapt to the device in sexual intercourse, which is re-signified for these people. However, there is a bigger confrontation for the maintenance of the prevention practice by the use of condoms in discordant couples. The discovery of HIV seropositivity demanded changes in sexual routine, showing a decrease in sexual desire and change in sexual practices, with different aspects for men and women surveyed. There were changes in routine of contraceptive methods used before the seroconversion, using new methods, especially the male condom, in the presence of HIV. We highlighted the lack of knowledge of alternatives contraceptive methods face to HIV infection and AIDS. The desire to have children was observed in men and women, and the fear of vertical transmission appears as a strong determinant to deny that choice, with the lack of prophylactic measures to reduce vertical transmission. The difficulties in fighting against HIV/AIDS require changes in the daily life of the couple, highlighting a bilateral marital behavior of care for the other in an ambiguous relationship because of distrust with the knowledge of HIV infection. This study allowed us to realize that we must open channels of dialogue about sexual and reproductive experiences, stressing the important dimension that is given to the relationships between professionals and patients, as participants in the search of health promotion in a reality still in construction, of re-signification of life, of relationships and health. The gestational period is highlighted as an important moment for the diagnosis of HIV infection, to advise the recommendations and to reduce vertical transmission, beginning with early prevention of vertical transmission, through humanized care, free of judgments and prejudice. The assistance in sexual and reproductive health for people living with HIV demands several questions and challenges, but it points mainly to the need of integral and non-dichotomous assistance, where prevention and treatment work together, recognizing limits, possibilities, aims and priorities, in the individualization of human care.

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.

Introdução: As escolhas relacionadas à fecundidade são complexas e envolvem idéias e valores das sociedades e de seus integrantes. Existem muitos estudos que procuram explicar a fecundidade a partir de variáveis socioeconômicas e culturais, mas não indagam os motivos que teriam levado as mulheres a proceder de uma forma ou de outra para a formação de suas famílias. A fecundidade abaixo do nível de reposição é observada nos grandes centros urbanos brasileiros há algumas décadas, mas permanecem diferenciais intra-urbanos que precisam ser identificados, assim como seus determinantes. Objetivo: Identificar os diferenciais de fecundidade no município de Curitiba e contribuir para o conhecimento e entendimento do comportamento reprodutivo, motivações e vivência das mulheres com alta fecundidade. Metodologia: Pesquisa quantitativa e qualitativa, de caráter descritivo e exploratório. Analisou-se inicialmente a tendência da fecundidade e os diferenciais por bairro. O estudo na etapa quantitativa incluiu 441 mulheres residentes em Curitiba que tiveram o quinto ou mais filhos nascidos vivos em 2005, identificadas pelo SINASC. Para coleta dos dados nesta etapa utilizou-se questionário semi-estruturado. Os dados foram organizados em banco de dados Access e analisados com o uso do programa computacional Statistica v.8.0. Os sujeitos da etapa qualitativa constituíram-se de nove mulheres entrevistadas em profundidade a partir de roteiro temático. Os dados qualitativos foram interpretados seguindo os ensinamentos da \"análise de conteúdo\". Resultados: A taxa de fecundidade em Curitiba chegou a 1,5 filhos por mulher em 2005, mas com diferenciais intra-urbanos. Nove dos 75 bairros de Curitiba concentravam 59,6% das mulheres com alta fecundidade. Cerca de 90% das entrevistadas tiveram mais filhos do que desejavam. O número ideal de filhos referidos variou entre 2,4 e 2,9. No momento da entrevista 85% das mulheres usavam algum método contraceptivo com prevalência da laqueadura e da pílula. A esterilização voluntária foi efetivada para apenas 36,4% das mulheres e 42% dos homens solicitantes. A auto-avaliação de saúde não boa foi referida por 40% das mulheres. As entrevistadas relataram dificuldade de acesso aos programas de proteção social e à casa própria. Contribuíram para o maior número de filhos, as falhas dos programas de planejamento familiar, a falta de informação e domínio da negociação no uso dos métodos contraceptivos, as desigualdades de gênero e a vulnerabilidade psico-afetiva das mulheres. As entrevistadas da etapa qualitativa vivenciaram trajetórias reprodutivas e produtivas conflituosas marcadas pelas desigualdades sociais e de gênero. A maioria das mulheres do estudo apresentava elevada vulnerabilidade social. Conclusões: Uma diversidade de fatores, além dos socioeconômicos, exerce influência na definição da maternidade e do número de filhos. Identificou-se que são necessárias medidas que implementem o acesso à contracepção, a inclusão dos homens neste processo, a capacitação de profissionais para a assistência sexual e reprodutiva. São indispensáveis a promoção de políticas compatíveis para realização da maternidade, que facilitem a participação das mulheres no mercado de trabalho e promovam a eqüidade entre os sexos tanto neste mercado quanto no âmbito doméstico e medidas efetivas de proteção social. A liberação da laqueadura no pós-parto normal imediato foi recomendada, com vistas a agilizar e facilitar o acesso das mulheres a este procedimento. / Introduction: The choices concerning about fertility are complex because they involve ideas and values of societies and their members. Many studies seek to explain the fertility socioeconomic and cultural changeable but don\'t consider the women reasons to select one way or another to form their families. The fertility rate below the replacement is observed in Brazilians urban centers a few decades ago, but is necessary to identify the intra-urban differentials remain and its determinants. Objective: To identify the fertility differentials in Curitiba and to contribute to the women with high fertility reproductive behavior knowledge and comprehension, their motivations and experiences. Methodology: quantitative and qualitative researches, descriptive and exploratory in nature. The trend in fertility and the differentials were examined by neighborhood initially. The study included 441 women living in Curitiba which had the fifth or more children born alive in 2005 and identified by SINASC. In this step the data collect used a semi-structured questionnaire. They were organized in Access database and analyzed using the Statistica computer program, v.8.0. Nine women were the qualitative phase subjects interviewed in depth from thematic roadmap. Qualitative data were interpreted by following the teachings of the \" contents analysis.\" Results: The rate of fertility in Curitiba reached 1.5 children per woman in 2005, but with intra-urban differentials. Nine of the 75 districts of Curitiba concentrated 59.6% of women with high fertility. About 90% of respondents had more children than desired. The ideal number of children referred ranged between 2.4 and 2.9. At the time of the interview 85% of women were using contraceptive methods, with prevalence of sterilization and the pill. The voluntary sterilization was carried out for only 36.4% of women and 42% of male applicants. The self-assessment of health \"not good\" was cited by 40% of women. Interviewees reported difficulty of access to programs of social protection and housing. Contributed to the largest number of children, the failures of programs for family planning, lack of information and area of negotiation in the use of contraceptive methods, inequalities of gender and psycho-emotional vulnerability of women. Subjects of qualitative stage experienced conflict trajectories reproductive and productive marked by social inequality and gender. Most women in the study had high social vulnerability. Conclusions: A variety of factors, in addition to the socioeconomic, exerts influence on the definition of motherhood and the number of children. It was identified that are necessary to implement the access to contraception, the inclusion of men in this process, the training of professionals for sexual and reproductive assistance. Its essential to promote politics for consistent implementation of motherhood, to facilitate the participation of women in the labor market and promote equity between the sexes in this market as both under domestic and effective measures of social protection. The release of sterilization in the immediate post-normal delivery was recommended, in order to expedite and facilitate women\'s access to this procedure.

This dissertation examines the effectiveness of interventions related to family planning and the uptake of HIV-related preventive services among women in low-income settings. Women in low-income settings and living with HIV face many barriers to care, including limited access to services for family planning and HIV-related preventive care. At the same time, national, regional, and global efforts are looking for interventions to help control rapid population growth, create an HIV-free generation, and provide adequate preventive care for those living with HIV. This dissertation cuts across these issues and can help to inform debate and policies to address these issues. This dissertation comprises three discrete papers. Paper 1 (chapter 1) examines the effectiveness of a national scale-up of community-based distribution of family planning services on contraceptive use in Malawi’s rural areas during the period 2005-2016. The national-scale up of the intervention followed the success of a pilot of a similar intervention implemented in the period 1999-2004. As in the pilot, the scaled-up program distributed condoms and oral contraceptives and provided family planning education. Further, because education and income are important determinants of individual contraceptive use, the paper also examines whether the effectiveness of the national scale CBDs varies over these dimensions. The paper uses the Malawi Demographic and Health Surveys. The study finds that the intervention increased contraceptive use by 6.8 percentage points and the effects were greater among uneducated and low-income women. Paper 2 (chapter 2) conducts a cost-effectiveness analysis of a trial of cash incentives aimed at increasing the uptake of services for the prevention of mother-to-child transmission (PMTCT) of HIV. The trial was conducted in the Democratic of the Congo (DRC) as part of an effort to find ways of increasing uptake of PMTCT services in sub-Saharan Africa where uptake of these services remains low. The study is conducted from the societal perspective, relies on multiple sources within and outside of the DRC for cost data, and reports economic costs in 2016 International Dollars (I$). At a threshold of 3*GDP per capita for the DRC (I$2409), the study finds that the intervention is cost-effective. Paper 3 (chapter 3) examines the guideline concordance of the time to follow-up anal cancer screening in women living with HIV at high risk for anal cancer. In the US, the incidence of anal cancer in women living with HIV has increased significantly in the past 2-3 decades. However, early detection of anal cancer, through regular screening, can lead to effective secondary prevention of the disease. While guidelines for anal cancer screening exist, very little is known about the guideline concordance of the time to follow-up anal cancer screening in women at high risk of acquiring anal cancer. Hence this study. The study uses Medicaid Analytic eXtract files which compile claims of individuals enrolled in Medicaid—a public health insurance program largely for eligible low-income adults and the largest single payer for HIV/AIDS in the US. The study finds that time to follow-up screening is not guideline-concordant for most women living with HIV, particularly those with one of the two risk factors for anal cancer: a history of abnormal cervical test results or a history of genital warts.

Orientador: Maria Amália de Figueiredo Pereira Alvarenga / Resumo: O tema central do presente trabalho tem como escopo abordar as especificidades do Planejamento das Famílias Brasileiras na realidade ora vigente, a partir dos novos conceitos e concepções gerados através da evolução no campo do Direito das Famílias, marcada positivamente pela constitucionalização desta disciplina, que trouxe a superação da hipocrisia, do preconceito e da ideia do homem como centro norteador das famílias. Na área específica do planejamento familiar, o arcabouço legislativo está contido no art. 226, §7° da Carta Magna, que preconiza que o planejamento familiar é livre, baseado nos princípios da dignidade da pessoa humana, reafirmando o art. 1°, III, da Constituição Federal de 1988, e deve ser direcionado pelo princípio da paternidade responsável, bem como pela lei n. 9.263/96, que, em suma, dispõe sobre ações e procedimentos a serem realizados pelo sistema público de saúde, distribuição de métodos contraceptivos, realização de cirurgias de esterilização, e instituindo programas amplos da saúde sexual da população. Esta lei, no entanto, pouco dispôs sobre garantias à população atinentes à concretização de políticas públicas estatais no sentido de trazer informação direcionada ao planejamento familiar. Dessa maneira, a insuficiência de informação direcionada à assistência e educação na seara do planejamento familiar vem acarretando problemas relacionados ao crescimento demográfico e à má-formação psíquica das crianças advindas de uma estrutura familiar por vezes ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The central theme of this present work aims to point out the specificities of the brazilian family planning in the reality currently in force, from the new concepts and conceptions generated through evolution in the field of Family Law posively marked by the constitucionalisation of this subject, which has bring the overcoming of hyprocrisy, preconception and the idea of the men as the middle guiding of the families. In the specific area of family planning, backed by the protective housing of brazilian constitucion law, inserted on the art. 226, §7º of the Brazilian Constitution/1988 and should be directed by the responsible paternity principle, such as the law n. 9.263/96, that, briethly says about actions and procedures that has to be taken by the public system of health, distribution of contraceptives methods, performing sterilization surgeries and istituting wide programs of population´s sexual health. This law, althogh, has little arranged about guarantees to the population about concretization of public politics in the sense to bring information to people directed to family planning. The insufficient information directed to assistance and education in the area of family planning has been carrying problems related to demographic growth and to the bad psiquic formation of child coming from a fragile and lacking of information familiar structure. As a solution presented, it is necessary that the State provides public politics and structure of its organs to propitiate the p... (Complete abstract click electronic access below) / Mestre

<p>This study deals with the intergenerational coresidence during the nineteenth century. The main focus is placed on the possible differences in the coresidences among parents and children and whether demographic transition and industrialization changed this relation. Were parents and children living in the same household? It was also important to study the children network; if the children did not live with their parents, where did they live? In the neighbourhoods, in the parish or in another area? Two perspectives were mainly considered, industrialization and demographic transition. On one hand industrialization gave children the opportunity to work outside the parental household and consequently the relationship between parents and children probably became weaker. On the other hand the fall of infant mortality would have facilitated the creation of a new complex household. Did industrialization with a new labour market change in decline the coresidence among parents and children? Or did the fall of mortality increase the number of coresidences? Two more factors influenced the coresidences, social status of the first generation and number of children born. The area of study is the region of Sundsvall, situated in middle Sweden. During the nineteenth century this region experienced a fall of infant mortality and in the middle of the century the introduction of steam-sawmills started and it arrived to be one of the largest sawmill districts at the world in the end of the century. The cohort chosen regarded people born between 1770 and 1820 and they lived their old age in the Sundsvall district. The first methodological approach is cross-sectional and analyses the entire cohort. The second method is a longitudinal analysis of a micro study of 135 people. The results show the decrease of the coresidences between the two generations when parents were 80 years old. In the previous years no difference has been found between the preindustrial and industrial period, thus the decline of mortality did not help the increase of coresidences. Social status was the most determinant factor for the creation of coresidence. People employed in agriculture, peasants and crofters were more likely to coreside with married children compared to the workers’ groups. Social difference increases with the industrialization, workers experienced the decline of coresidence in a stronger way compared to the others groups. The number of children born from the first generation helps in a marginal way the creation of coresidences. The main difference was between one or more children born, but no differences were found among those people who had two children or more. The micro study put in evidence the life cycle of the family. Peasants and crofters were the most likely to experience the cycle of the stem family. However the coresidence could be interrupted by the death or the migration of the family members. Other alternatives as the presences of children in the neighbourhoods or the coresidence with unmarried children were noticed. Finally, the study showed that sons were more likely to live with their parents compared to daughters but in one third of the cases the first generation constituted the stem family with a daughter.</p>

This dissertation examines women's lives in a rapidly urbanizing rural community in Southern Pakistan to understand their responses to modernity in developing societies. Applying a mixed-methods approach, socio-demographic data is collected and contrasted with oral history and personal narratives to analyze social change through women's access to education and reproductive health care in the village. The results are framed within a post-modern and post-colonial feminist anthropological discourse to reveal that Sheherpind represents a model of 'multiple modernities' where women's agency and progress could only be contextualized in non-western, local cultural perspectives. Emerging trends in the village are evaluated for their 'Applied' significance to underscore areas of local, national and transnational policy significance. / Graduation date: 2013