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BACKGROUND: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access. METHODS: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state. RESULTS: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM. CONCLUSIONS: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.
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Resumen OBJETIVO: Determinar la frecuencia de aceptación y los factores asociados con la anticoncepción moderna posaborto en pacientes atendidas en un hospital público de Perú. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado en pacientes en el posaborto inmediato atendidas de junio a diciembre de 2022 en el servicio de Urgencias del Hospital San Juan de Lurigancho, Lima, Perú, seleccionadas por conveniencia. Se utilizó un cuestionario validado. Se aplicó la prueba χ2 de Pearson con un nivel de significación del 5%. RESULTADOS: Se estudiaron 166 pacientes en el posaborto inmediato de las que el 94% (n = 156) aceptó algún método anticonceptivo moderno; el más frecuente fue el inyectable mensual (44.0%) y el menos aceptado el dispositivo intrauterino (0.6%). Los factores personales asociados con la aceptación del método anticonceptivo moderno fueron: edad (p < 0.01), no tener pareja (p < 0.001) y ésta estuviera de acuerdo con el anticonceptivo elegido (p < 0.001). Los factores institucionales asociados fueron: tiempo de la consejería en planificación familiar (p = 0.047), privacidad-confidencialidad de la consejería (p < 0.001) y satisfacción con la atención ofrecida durante la orientación (p = 0.026). CONCLUSIONES: La edad, carecer de pareja y estar de acuerdo con ésta acerca de la elección del método anticonceptivo posaborto junto con los factores institucionales (tiempo de consejería en planificación familiar, importancia de la privacidad-confidencialidad y percepción de la atención en consejería en planificación familiar) se asociaron, significativamente, con la aceptación de algún método anticonceptivo moderno posaborto.
Abstract OBJECTIVE: To determine the frequency of acceptance and factors associated with modern postabortion contraception in patients attended at a public hospital in Peru. MATERIALS AND METHODS: Observational and cross-sectional study conducted in immediate postabortion patients attended from June to December 2022 at the Emergency Department of the Hospital San Juan de Lurigancho, Lima, Peru, selected by convenience. A validated questionnaire was used. Pearson's test c2 was used with a significance level of 5%. RESULTS: We studied 166 patients in the immediate postabortion period, of whom 94% (n = 156) accepted some modern contraceptive method; the most common was the monthly injectable (44.0%) and the least accepted was the intrauterine device (0.6%). Personal factors associated with modern contraceptive method acceptance were age (p < 0.01), no partner (p < 0.001), and partner's agreement with the chosen contraceptive method (p < 0.001). Associated institutional factors were agreeing with the time of family planning counseling (p = 0.047), considering the importance of privacy-confidentiality of counseling (p < 0.001), and agreeing with the care offered during counseling (p = 0.026). CONCLUSIONS: Age, lack of a partner, and agreeing with the partner about the choice of postabortion contraceptive method along with institutional factors (time of family planning counseling, importance of privacy-confidentiality, and perception of care in family planning counseling) were significantly associated with acceptance of some modern postabortion contraceptive method.
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INTRODUCTION: Scientific evidence suggests that mother-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowledge of CAM in women during the first postpartum semester. METHODS: An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention consisted of face-to-face counseling about MAC combined with informative brochures and WhatsAppâ messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months postpartum. The analysis was performed using R software version 4.0.3. RESULTS: Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC. DISCUSSION: Early postpartum intervention with various communication and information strategies can be useful to choose the MAC that is considered most appropriate for each woman and its correct use.
Introducción: La evidencia científica sugiere que estrategias de atención conjunta madre-hijo facilitarían el conocimiento de métodos anticonceptivos (MAC) y su acceso. El objetivo fue evaluar el efecto del Modelo de atención integrada de la madre y el niño sobre la adherencia y conocimientos de MAC en mujeres durante el primer semestre postparto. Métodos: Se realizó un estudio de intervención, se conformaron 2 grupos, GI: grupo de intervención (3 controles hasta los 6 meses postparto) y GC: grupo control (un control a los 6 meses postparto). La intervención consistió en asesoramiento presencial acerca de MAC combinada con folletería informativa y mensajes de WhatsAppâ. Se recabaron datos sociodemográficos, antecedentes gineco-obstétricos, uso y conocimientos de MAC. Se comparó la adherencia al uso y el conocimiento de MAC en ambos grupos a los 6 meses post parto. El análisis se realizó mediante el software R versión 4.0.3. Resultados: Se incorporaron 39 mujeres en cada grupo. Se halló una diferencia en el uso de MAC entre grupos a los 6 meses (92.3% vs. 64.1%), siendo más elevado su uso en el GI. Se hallaron diferencias significativas en el conocimiento de algunos MAC a los 6 meses. Un mayor porcentaje de mujeres del GI conocía las pastillas anticonceptivas (p = 0.009), ligadura de trompas (p = 0.04) y la vasectomía (p = 0.010), en comparación con el GC. Discusión: La intervención en el postparto temprano con diversas estrategias de comunicación e información pueden ser útiles para elegir el MAC que se considere más adecuado para cada mujer y su utilización correcta.
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Cuidado del Niño , Anticoncepción , Embarazo , Niño , Femenino , Humanos , Anticoncepción/métodos , Periodo Posparto , Relaciones Madre-HijoRESUMEN
ABSTRACT OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.
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Humanos , Femenino , Anticoncepción , Anticonceptivos , Servicios de Planificación Familiar , Necesidades y Demandas de Servicios de SaludRESUMEN
Abstract Introduction: Medical students play an important role in achieving sexual and reproductive health outcomes, including a greater participation of men in family planning. Objective: To describe the level of knowledge, perception, and acceptance of vasectomy in a sample of Latin American medical students (i.e., whether they would recommend this procedure to their patients, and in the case of male students, whether they would undergo it at some point in their lives) in a sample of Latin American medical students. Materials and methods: Multicenter, cross-sectional, analytical study conducted in November 2020 in 2 676 medical students (1st-7th year) from 8 Latin American countries. Data were collected using a questionnaire validated in each country and completed in Google Forms. The chi-square test of independence was used to determine differences in study variables (knowledge, perception, and acceptance) for each established subgroup, with a significance level of p<0.05. Results: The level of knowledge was high and medium in 55.38% and 36.32% of participants, respectively. The country with the highest ratio of students with a high level of knowledge was Mexico (77.31%) and the one with the lowest ratio was Brazil (3.33%). Regarding perception, 96.97% of the students considered that vasectomy does not affect masculinity and 98.99% that contraception is also the responsibility of men. With respect to acceptance, 94.02% would recommend the procedure, but only 69.82% of men (n=759) would undergo it. Conclusions: Most participants have a good level of knowledge, good perception, and a good level of acceptance of the procedure. However, it is necessary to implement more training strategies that allow them to promote the use of vasectomy as a family planning alternative in their professional life.
Resumen Introducción. Los estudiantes de medicina desempeñan un rol importante en el logro de resultados en salud sexual y reproductiva, incluyendo una mayor participación de los hombres en la planificación familiar. Objetivo. Describir el nivel de conocimientos, la percepción y el nivel de aceptación de la vasectomia (i.e. sí la recomendarían a sus pacientes y, en el caso de los hombres, sí se la realizarían en algún momento de su vida) en una muestra de estudiantes de medicina latinoamericanos. Materiales y métodos. Estudio multicéntrico, transversal analítico realizado en noviembre de 2020 en 2 676 estudiantes de medicina (1er-7mo año) de 8 países latinoamericanos. Los datos se recolectaron mediante un cuestionario validado en cada país y diligenciado mediante Google Forms. Se utilizó la prueba de chi-cuadrado de independencia para determinar las diferencias en las variables de estudio (nivel de conocimientos, percepción y nivel de aceptación) para cada subgrupo establecido, con un nivel de significancia de p<0.05. Resultados. El nivel de conocimientos fue alto y medio en 55.38% y 36.32% de los participantes, respectivamente. El país con mayor proporción de estudiantes con alto nivel de conocimientos fue México (77.31%) y el de menor proporción, Brasil (3.33%). Respecto a la percepción, 96.97% de los estudiantes consideró que la vasectomía no afecta la masculinidad y 98.99% que la anticoncepción también es responsabilidad del hombre. En cuanto a la aceptación, el 94.02% recomendaría el procedimiento, pero solo el 69.82% de los varones (n=759) se la realizaría. Conclusiones. La mayoría de los participantes tiene un buen nivel de conocimientos, buena percepción y un buen nivel de aceptación del procedimiento. No obstante, es necesario implementar más estrategias de capacitación que les permitan promover el uso de la vasectomía como alternativa de planificación familiar en su vida profesional.
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Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and Methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and STIs were excluded. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to post-procedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother's health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with complications within the first seven post-VIP days in the studied patients. Prospective studies to assess the safety and cost of the different VIP options are required.
Objetivos: caracterizar una cohorte de mujeres con interrupción voluntaria del embarazo (IVE) y describir las complicaciones intraoperatorias según la técnica aplicada. Materiales y métodos: estudio descriptivo, de cohorte histórica en mujeres intervenidas a IVE en dos Instituciones Prestadoras de Salud-IPS en Medellín, Colombia, en el 2019. Se excluyeron aquellas mujeres con infección pélvica, e ITS. Se realizó un muestreo consecutivo, se evaluaron variables sociodemográficas, de salud sexual y reproductiva, características clínicas del embarazo, causa legal de la IVE, características de la atención y las complicaciones hasta los 7 días posteriores al procedimiento de las técnicas de IVE. Finalmente, se hace análisis descriptivo. Resultados: durante el periodo de estudio hubo 1.520 mujeres elegibles de las cuales 46 fueron intervenidas en otras instituciones por lo que quedaron 1.474 candidatas a ingresar al estudio, de estas se excluyeron 30 por presentar infecciones pélvicas o de transmisión sexual, por lo que, finalmente, se analizaron 1.444 mujeres gestantes. Los riesgos para la salud de la mujer fueron la causa legal más frecuente con un 94,3%. El 99% de las mujeres tenían asesoría previa, y el 78,4% aceptó algún método anticonceptivo post-IVE. El 95,6% de las mujeres fueron intervenidas por la técnica de aspiración manual endouterina (AMEU) y al 4,4% se la practicó la técnica de dilatación y curetaje (D&C). En un 17,56% de las pacientes intervenidas con D&C se presentaron complicaciones hasta el séptimo día posoperatorio, no hubo complicaciones en el grupo sometido a AMEU, el 80% de las mujeres asistieron a control el séptimo día post-IVE. Conclusiones: la AMEU es un procedimiento seguro que no generó complicaciones intraoperatorias en el procedimiento hasta los primeros siete días después de la IVE, en las pacientes estudiadas. Se requieren estudios prospectivos que evalúen la seguridad y costos de las diferentes alternativas de IVE.
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RESUMEN Objetivos: caracterizar una cohorte de mujeres con interrupción voluntaria del embarazo (IVE) y describir las complicaciones intraoperatorias según la técnica aplicada. Materiales y métodos: estudio descriptivo, de cohorte histórica en mujeres intervenidas a IVE en dos Instituciones Prestadoras de Salud-IPS en Medellín, Colombia, en el 2019. Se excluyeron aquellas mujeres con infección pélvica, e infecciones de transmisión sexual (ITS). Se realizó un muestreo consecutivo, se evaluaron variables sociodemográficas, de salud sexual y reproductiva, características clínicas del embarazo, causa legal de la IVE, características de la atención y las complicaciones hasta los 7 días posteriores al procedimiento de las técnicas de IVE. Finalmente, se hace análisis descriptivo. Resultados: durante el periodo de estudio hubo 1.520 mujeres elegibles de las cuales 46 fueron intervenidas en otras instituciones por lo que quedaron 1.474 candidatas a ingresar al estudio, de estas se excluyeron 30 por presentar infecciones pélvicas o de transmisión sexual, por lo que, finalmente, se analizaron 1.444 mujeres gestantes. Los riesgos para la salud de la mujer fueron la causa legal más frecuente con un 94,3%. El 99% de las mujeres tenían asesoría previa, y el 78,4% aceptó algún método anticonceptivo post-IVE. El 95,6% de las mujeres fueron intervenidas por la técnica de aspiración manual endouterina (AMEU) y al 4,4% se la practicó la técnica de dilatación y curetaje (D&C). En un 17,56% de las pacientes intervenidas con D&C se presentaron complicaciones hasta el séptimo día posoperatorio, no hubo complicaciones en el grupo sometido a AMEU, el 80% de las mujeres asistieron a control el séptimo día post-IVE. Conclusiones: la AMEU es un procedimiento seguro que no generó complicaciones intraoperatorias en el procedimiento, mientras la D&C se acompañó de complicaciones en una de cada seis pacientes. Se requieren estudios prospectivos que evalúen la seguridad y costos de las diferentes alternativas de IVE.
ABSTRACT Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and Sexually Transmitted Infections (STIs) were included. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to postprocedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother's health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with intraperatory comoplications. D&C was associated to complications in one of each six patients. Prospective studies to assess the safety and cost of the different VIP options are required.
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Humanos , Femenino , Embarazo , Aborto , Aborto Terapéutico , Servicios de Planificación FamiliarRESUMEN
Objective: To determine the incidence of low libido in women using the levonorgestrel (LNG) subdermal implant for contraception after 12 months and to identify other adverse effects. Materials and methods: Cohort study that included women over the age of 18, with no children or prior gestations and in a stable relationship, with an LNG implant inserted at least three months before in a private teaching hospital in Armenia (Quindío), Colombia, between 2014 and 2019. Women with a history of sexual dysfunction, sexually transmitted infections in the past six months, weighing more than 89 kg and difficult to follow were excluded. Consecutive sampling was used. The characteristics of the study population were described, the cumulative incidence of low libido and the adverse effects related to the LNG subdermal implant after 12 months of follow-up were estimated. The tool used was the Female Sexual Dysfunction Index (FSFI). Descriptive statistics were applied. Results: The participants were 238 women with a mean age of 24.69 (SD ± 5.82) years. An 18.82% incidence of low libido was found. In 60.25% of the women were diagnosed with low libido in the first 6 months of follow-up. Adverse effects manifested as early as 3 months after the insertion of the implant, the most frequent being irregular bleeding (62.34%), followed by amenorrhea (38.91%) and weight gain (33.89%). Conclusions: It is important for practitioners and users to become aware of the presence of low libido disorder and the adverse events that may occur with the use of the levonorgestrel subdermal implant. Future research is required to confirm these findings and the underlying physiological cause.
Objetivo: definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG a 12 meses de seguimiento. Se aplicó como instrumento el Índice de Función Sexual Femenino. Se utilizó estadística descriptiva. Resultados: participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.
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Anticonceptivos Femeninos , Levonorgestrel , Adulto , Armenia , Estudios de Cohortes , Colombia , Anticoncepción , Anticonceptivos Femeninos/efectos adversos , Implantes de Medicamentos , Femenino , Humanos , Incidencia , Levonorgestrel/efectos adversos , Libido , Persona de Mediana Edad , Adulto JovenRESUMEN
RESUMEN Objetivo: definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG Resultados: participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.
ABSTRACT Objective: To determine the incidence of low libido in women using the levonorgestrel (LNG) sub-dermal implant for contraception after 12 months and to identify other adverse effects. Materials and methods: Cohort study that included women over the age of 18, with no children or prior gestations and in a stable relationship, with an LNG implant inserted at least three months before in a private teaching hospital in Armenia (Quindío), Colombia, between 2014 and 2019. Women with a history of sexual dysfunction, sexually transmitted infections in the past six months, weighing more than 89 kg and difficult to follow were excluded. Consecutive sampling was used. The characteristics of the study population were described, the cumulative incidence of low libido and the adverse effects related to the LNG sub-dermal implant after 12 months of follow-up were estimated. The tool used was the Female Sexual Dysfunction Index (FSFI). Descriptive statistics were applied. Results: The participants were 238 women with a mean age of 24.69 (SD ± 5.82) years. An 18.82% incidence of low libido was found. In 60.25% of the women were diagnosed with low libido in the first 6 months of follow-up. Adverse effects manifested as early as 3 months after the insertion of the implant, the most frequent being irregular bleeding (62.34%), followed by amenorrhea (38.91%) and weight gain (33.89%). Conclusions: It is important for practitioners and users to become aware of the presence of low libido disorder and the adverse events that may occur with the use of the levonorgestrel subdermal implant. Future research is required to confirm these findings and the underlying physiological cause.
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Humanos , Femenino , Adulto , Disfunciones Sexuales Fisiológicas , Levonorgestrel , Disfunciones Sexuales Psicológicas , Factores de Riesgo , Estudios de Cohortes , Anticoncepción , Servicios de Planificación FamiliarRESUMEN
INTRODUCTION: We examined parity and age among women seeking an abortion in Mexico City's public first-trimester abortion programme, Interrupcion Legal de Embarazo (ILE). We hypothesised that younger women, especially students, used abortion to prevent first births while older women used abortion to limit births. METHODS: We used clinical data from a sample of 47 462 women who had an abortion between 2007 and 2016 and classified them as nulliparous or parous according to previous births prior to the abortion. We used logistic regression to identify sociodemographic and clinical factors associated with using abortion to prevent a first birth (nulliparous) versus limiting births (parous) and calculated absolute multivariable predicted probabilities. RESULTS: Overall, 41% of abortions were in nulliparous women seeking to prevent a first birth, and 59% were in women who already had one or more children. The adjusted probability of using abortion to prevent a first birth was 80.4% (95% CI 78.3 to 82.4) for women aged 12-17 years and 54.3% (95% CI 51.6 to 57.0) for women aged 18-24 years. Adolescents (aged 12-17 years) who were employed or students had nearly 90% adjusted probability of using abortion to prevent a first birth (employed 87.8%, 95% CI 82.9 to 92.8; students 88.5%, 95% CI 82.9 to 94.1). At all ages, employed women and students had higher probabilities of using abortion to prevent a first birth compared with unemployed women and women who work in the home. CONCLUSION: Legal first-trimester abortion services in Mexico can help prevent first births in adolescents, especially students.
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Aborto Inducido , Aborto Espontáneo , Adolescente , Anciano , Orden de Nacimiento , Niño , Femenino , Humanos , México/epidemiología , Paridad , EmbarazoRESUMEN
OBJECTIVE: This study aimed to assess the factors associated with highly effective contraceptive (HEC) use among reproductive-age women in Peru, using evidence from a nationwide survey. STUDY DESIGN: We analyzed the data corresponding to a national representative sample of 30,169 Peruvian women aged 15-49 years, surveyed during the Demographic and Family Health Survey, 2017. Usage of HEC methods included pills, IUD, injections, sterilization and implant. We assessed the factors associated with its use using Poisson regression models, reporting the crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95 % confidence intervals (95 % CI). RESULTS: The prevalence of HEC use was 29.9 %. Factors related to a more likely use of HEC methods were having one (aPR: 4.03; 95 % CI: 3.19-5.09) or more children (aPR: 5.60; 95 % CI: 4.42-7.09), and having a health insurance children (aPR: 1.14; 95 % CI: 1.05-1.24). Women from the highlands (aPR: 0.74; 95 % CI: 0.67-0.81), aged ≥35 years (aPR: 0.78; 95 % CI: 0.67-0.90), not currently married or cohabiting (aPR: 0.52; 95 % CI: 0.47-0.58), and who considered it really hard to have to take transportation when they need medical help or advice (aPR: 0.92; 95 % CI: 0.86-0.99) were less likely to use highly effective contraception. CONCLUSION: Quality and access to reproductive health is still a challenge in Peru. Family planning programs should be better disseminated and integrated. Similarly, promotion of educational campaigns and easy access to HEC methods are needed.
Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Demografía , Servicios de Planificación Familiar , Femenino , Humanos , Persona de Mediana Edad , Perú , Distribución de Poisson , Embarazo , Análisis de Regresión , Adulto JovenRESUMEN
Resumen OBJETIVO: Estimar la prevalencia de abandono, cambio o falla de los anticonceptivos hormonales que derivan en embarazos no deseados en mujeres universitarias entre 17 y 30 años. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado entre el 1 de agosto y el 30 de noviembre de 2018 en estudiantes de la Facultad de Ciencias de la Salud de la Universidad de Boyacá, usuarias actuales o pasadas de métodos de anticoncepción hormonal. Variables de estudio: datos sociodemográficos, causas de abandono del tratamiento, cambio de método de planificación y falla del anticonceptivo. RESULTADOS: Se recolectaron 615 encuestas, se eliminaron 4 por datos incompletos. El promedio de edad de las estudiantes fue de 20.5 años (DE ± 3.6). El 26.15% recibió asesoría por distintos sujetos y medios diferentes al personal de salud. De las sustancias con interacción con los anticonceptivos hormonales, 25% consumía alcohol. Las principales reacciones adversas fueron: cefalea, aumento de peso y sangrado uterino anormal. Principales motivos de abandono: efectos adversos. El 10.3% de las encuestadas experimentó falla del anticonceptivo. CONCLUSIONES: Si bien el estudio evidencia que la primera causa de abandono fue el cese de la actividad sexual, un alto porcentaje de usuarias tuvo reacciones adversas leves y, de acuerdo con la persona que les suministró la información, se advirtieron dificultades para el apego a los anticonceptivos hormonales.
Abstract OBJECTIVE: The objective of the study was the prevalence of abandonment, change and therapeutic failure, which could trigger unwanted pregnancies in university women between 17 and 30 years of age, who have used hormonal contraceptives as a method of family planning. MATERIALS AND METHODS: An observational, cross-sectional study was carried out during the period between August 1 and November 30, 2018, where students from the faculty of health sciences of the University of Boyacá. The variables studied corresponded to sociodemographic data, causes of treatment abandonment, change of planning method and therapeutic failure. RESULTS: The average age of the population was 20.5 years, evidence of the use of oral contraceptives and 26.15% were advised by personnel other than health. Alcohol was the main substance of consumption that interacts with hormonal contraceptives. The main adverse reactions were headache, weight gain and abnormal uterine bleeding. The main reasons for abandonment are related to the presence of adverse effects. The therapeutic failure was presented in 10.3% of the respondents. CONCLUSIONS: Although the evidence of the first cause of abandonment was the life of sexual life, there is a high percentage of users with adverse reactions and, according to the person who likes the information, it can be noticed that there is difficulty in the attachment to the use of this type of medication.
RESUMEN
RESUMEN Objetivo Analizar la percepción del embarazo adolescente en el Departamento Norte de Santander. Método Se realizó una investigación descriptiva de corte transversal con 406 madres adolescentes entre 10 y 19 años pertenecientes a las 6 subregiones del departamento. Se aplicó una encuesta estructurada y se tabularon los datos en el Paquete Estadístico para las Ciencias Sociales (SPSS [Statical Package for Social Sciencies]; versión No.23) Resultados El 69 % de las adolescentes considera que la falta de educación sexual está asociada al embarazo no planificado. El 66 % reconoce que los embarazos no planificados se pueden prevenir con el uso de métodos anticonceptivos, pues los embarazos indeseados son la principal causa de deserción escolar para un 62 % de las adolescentes. Discusión La garantía de un mayor acceso a la educación sexual integral junto con el acceso libre y fácil a los métodos anticonceptivos puede reducir la problemática del embarazo adolescente.(AU)
ABSTRACT Objetive Analyze the perception of adolescent pregnancy in the Department of North Santander. Method A descriptive cross-sectional study was conducted with 406 adolescent mothers between 10 and 19 years old in 6 sub-regions of the department. We used a structured survey and the Statistical Package for the Social Sciences (SPSS; Version No. 23) was employed for the data tabulation. Results 69 % of adolescents believe that unplanned pregnancy is associated with the lack of sexual education. 66 % say that it is preventable with the use of contraceptive methods. It is known that unwanted pregnancies are the main cause of school dropouts for 62 % of adolescents. Discussion: Ensuring greater access to sex education and facilitating the free and easy access to contraception can reduce the problem of teen pregnancy.(AU)
Asunto(s)
Humanos , Niño , Adolescente , Embarazo en Adolescencia/prevención & control , Conducta del Adolescente , Embarazo no Planeado , Planificación Familiar , Epidemiología Descriptiva , Estudios Transversales , ColombiaRESUMEN
CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity. .
CONTEXTO E OBJETIVO: A ligadura tubária é um dos métodos contraceptivos mais utilizados em todo o mundo. Como a controvérsia sobre seus possíveis efeitos ainda continua, o objetivo deste estudo foi avaliar as repercussões clínicas e psíquicas da laqueadura videolaparoscópica. TIPO DE ESTUDO E LOCAL: Estudo observacional de coorte único, retrospectivo, conduzido em hospital público terciário. MÉTODOS: Foi aplicado um questionário a 130 mulheres, entre 21-46 anos, submetidas à ligadura tubária videolaparoscópica, pelas técnicas de eletrocoagulação bipolar/secção ou inserção do anel tubário, entre janeiro de 1999 e dezembro de 2007. Nesse questionário avaliou-se: intervalo do ciclo menstrual, intensidade e duração do sangramento, sintomas pré-menstruais, dismenorreia, dispareunia, dor pélvica não cíclica e grau de satisfação sexual. Cada mulher serviu como seu próprio controle, foi realizada análise comparativa entre os períodos pré- e pós-cirúrgico e entre as duas técnicas utilizadas. RESULTADOS: As repercussões clínicas e psicológicas mostraram-se significativas, com aumento de sangramento (P = 0,001), de sintomas pré-menstruais (P < 0,001), dismenorreia (P = 0,019), dor pélvica não cíclica (P = 0,001), e redução no número de relações sexuais por semana (P = 0,001) e na libido (P = 0,001). Mulheres com idade ≤ 35 anos, no momento da laqueadura, mostraram-se mais propensas a desenvolverem alterações menstruais. A técnica de eletrocoagulação bipolar mostrou maiores repercussões clínicas e psíquicas. CONCLUSÃO: A ligadura tubária videolaparoscópica, independentemente da técnica, repercutiu com ...
Asunto(s)
Adulto , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Laparoscopía , Trastornos de la Menstruación/etiología , Esterilización Tubaria/efectos adversos , Esterilización Tubaria/psicología , Coito/psicología , Servicios de Planificación Familiar/métodos , Libido , Ciclo Menstrual/fisiología , Productos para la Higiene Menstrual , Satisfacción del Paciente , Encuestas y Cuestionarios , Estudios Retrospectivos , Esterilización Tubaria/métodos , Centros de Atención TerciariaRESUMEN
Objetivo: Analizar la aplicación de métodos anticonceptivos a las mujeres costarricenses entre los años 1930 y 1945. Desarrollo: En Costa Rica a mediados del siglo XX, se dieron transformaciones sociales y económicas importantes, cambios que propiciaron el deseo de tener pocos hijos y además se redujeron los “costos del control”, considerando entre estos los obstáculos de tipo cultural, religioso y familiar, que tuvieron que resolver las mujeres para modificar sus prácticas reproductivas. Conclusión: La disponibilidad de los métodos anticonceptivos para las mujeres costarricenses influyó en el descenso de la natalidad, además de la aplicación del Programa Nacional de Planificación Familiar y Educación Sexual.
Objective: This paper intends to analyze the application of contraceptives to women in Costa Rica between 1930 and 1945. Main thesis: In Costa Rica, during the mid-twentieth century, there were important social and economic changes that led to the desire to have fewer children, and also “control costs” were reduced, considering among these, the barriers of cultural, religious and family type that women had to resolve to modify their reproductive practices. Conclusion: The availability of contraception for Costa Rican women influenced the declining birth rate, as well as the implementation of the National Family Planning and Sexual Education Program.
Asunto(s)
Humanos , Educación Sexual , Anticonceptivos , Ensayo , Costa Rica , Planificación Familiar , Servicios de Planificación FamiliarRESUMEN
Research conducted to define general knowledge of university students' attitudes and behaviors about family planning. The sample consisted of 755 Sakarya University students. Data were collected from an open-ended questionnaire form and face-to-face interviews. The data analysis process was conducted using specific software. Most participants (59.7%) were over 22 years old and female, and 1.2 % of the females were married. Women in the study had a positive outlook regarding the positive effects of family planning on sexual health and stated that family planning is important to both society and our economy. The awareness and knowledge regarding family planning was found to be strongest among older participants. The family planning concept was understood correctly by about half of the students. Finally, young people did not have sufficient knowledge about family planning, its methods or where to obtain information on the topic.
Pesquisa foi realizada para definir o conhecimento das atitudes e comportamento dos estudantes universitários sobre planejamento familiar. Estudo envolveu 755 alunos da Universidade Sakarya. Os dados foram coletados de um questionário aberto e técnica face a face. A análise de dados foi feita com um software específico. A maioria dos participantes (59,7 %) com mais de 22 anos foi feminina e 1,2% casadas. As mulheres no estudo têm uma visão positiva dos efeitos do planejamento familiar na saúde sexual e declararam sua importância para a sociedade e economia. A conscientização e conhecimento sobre planejamento familiar foram considerados positivos entre os participantes mais velhos. O conceito de planejamento foi entendido corretamente por cerca de metade dos alunos. Finalmente, os jovens não tinham conhecimento suficiente sobre planejamento familiar, seus métodos ou onde buscar informações sobre o assunto.
Investigación que objetivó definir conocimientos generales de estudiantes universitarios y su actitud y comportamiento acerca de planificación familiar. Muestra constituida por 755 estudiantes de la Universidad de Sakarya. Datos obtenidos mediante preguntas abiertas efectuadas presencialmente. Se analizaron los resultados utilizando software específico. La mayoría de los participantes (59,7%) tenía más de 22 años, pertenecía al sexo femenino, 1,2% de ellos estaba casado. Las mujeres participantes poseían una visión positiva del efecto benéfico de la planificación familiar en la salud sexual, y establecieron que la planificación familiar es importante a nivel social y económico. La percepción y conocimientos acerca de planificación familiar resultó ser más positiva entre las participantes de mayor edad. El concepto de planificación familiar era entendido correctamente por aproximadamente la mitad de los estudiantes. Se concluye en que la juventud no poseía conocimientos suficientes sobre planificación familiar, sus métodos o de cómo obtener información respecto del tema.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Conocimiento , Servicios de Planificación Familiar/estadística & datos numéricosRESUMEN
OBJECTIVE: To assess private-sector stakeholders' and donors' perceptions of a total market approach (TMA) to family planning in Nicaragua in the context of decreased funding; to build evidence for potential strategies and mechanisms for TMA implementation (including public-private partnerships (PPPs)); and to identify information gaps and future priorities for related research and advocacy. METHODS: A descriptive exploratory study was conducted in various locations in Nicaragua from March to April 2010. A total of 24 key private-sector stakeholders and donors were interviewed and their responses analyzed using two questionnaires and a stakeholder analysis tool (PolicyMakerTM software). RESULTS: All survey participants supported a TMA, and public-private collaboration, in family planning in Nicaragua. Based on the survey responses, opportunities for further developing PPPs for family planning include building on and expanding existing governmental frameworks, such as Nicaragua's current coordination mechanism for contraceptive security. Obstacles include the lack of ongoing government engagement with the commercial (for-profit) sector and confusion about regulations for its involvement in family planning. Strategies for strengthening existing PPPs include establishing a coordination mechanism specifically for the commercial sector and collecting and disseminating evidence supporting public-private collaboration in family planning. CONCLUSIONS: There was no formal or absolute opposition to a TMA or PPPs in family planning in Nicaragua among a group of diverse nongovernmental stakeholders and donors. This type of study can help identify strategies to mobilize existing and potential advocates in achieving articulated policy goals, including diversification of funding sources for family planning to achieve contraceptive security.
OBJETIVO: Evaluar las percepciones de los grupos interesados y de los donantes del sector privado sobre la aplicación de un enfoque de mercado total a la planificación familiar en Nicaragua en el contexto de una reducción del financiamiento; establecer datos científicos que avalen posibles estrategias y mecanismos para ejecutar este tipo de enfoque (lo que incluye alianzas entre los sectores público y privado); y determinar las brechas de información y las prioridades futuras en la investigación y la promoción de este enfoque. MÉTODOS: Entre marzo y abril del 2010 se llevó a cabo un estudio exploratorio descriptivo en varios lugares de Nicaragua. Se entrevistaron 24 personas de varios grupos interesados y de donantes clave del sector privado y se analizaron sus respuestas mediante dos cuestionarios y una herramienta de análisis específica (programa informático PolicyMakerTM). RESULTADOS: Todos los encuestados respaldaron la aplicación de un enfoque de mercado total y la colaboración entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Según las respuestas obtenidas en la encuesta, las oportunidades para desarrollar alianzas adicionales entre los dos sectores respecto de la planificación familiar incluyen mejorar y ampliar los marcos gubernamentales existentes, como el actual mecanismo de coordinación de Nicaragua para la seguridad anticonceptiva. Los obstáculos son la falta de colaboración actual del gobierno con el sector comercial (con fines de lucro) y la confusión acerca de la reglamentación para participar en la planificación familiar. Las estrategias para fortalecer las alianzas existentes entre los sectores público y privado comprenden el establecimiento de un mecanismo de coordinación específico para el sector comercial, y la recolección y difusión de datos que avalen la colaboración entre los dos sectores respecto de la planificación familiar. CONCLUSIONES: En la evaluación de varios grupos interesados y de donantes del sector no gubernamental no se encontró ninguna oposición formal o absoluta a un enfoque de mercado total o a la conformación de alianzas entre los sectores público y privado respecto de la planificación familiar en Nicaragua. Este tipo de estudio puede ayudar a identificar estrategias que motiven a los promotores de la causa actuales y potenciales a alcanzar las metas políticas enunciadas, lo que incluye la diversificación de las fuentes de financiamiento para la planificación familiar a fin de alcanzar la seguridad anticonceptiva.
Asunto(s)
Humanos , Actitud , Servicios de Planificación Familiar/organización & administración , Mercadotecnía , Sector Privado , NicaraguaRESUMEN
OBJECTIVE: Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services. METHODS: In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section. RESULTS: Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31 percent received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant. CONCLUSIONS: The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of highquality family-planning and contraceptive services in Guatemala's public health system.
OBJETIVO: La baja frecuencia del uso de métodos anticonceptivos eficaces sigue siendo un arduo problema. En este artículo se analiza la frecuencia con que se adopta un método de anticoncepción eficaz durante el puerperio y los diferentes métodos anticonceptivos empleados antes del egreso de los hospitales públicos de Guatemala. También se analiza la necesidad de mejorar las prácticas de los servicios de planificación familiar y anticoncepción. MÉTODOS: En marzo del 2006, se implantó un sistema de vigilancia para recopilar datos sobre el inicio de métodos anticonceptivos eficaces. Se hizo un seguimiento de mujeres durante el puerperio en 34 hospitales públicos. Se llevaron a cabo análisis de una sola variable y de dos variables, y se utilizó la prueba de la chi al cuadrado de las tendencias lineales con objeto de comparar las tasas de esterilización quirúrgica femenina después del parto vaginal y la cesárea. RESULTADOS: Entre el 1 de marzo del 2006 y el 31 de diciembre del 2008, de las 218 656 mujeres a las que se les hizo un seguimiento durante el puerperio, en 31 por ciento se inició un método anticonceptivo eficaz antes del alta hospitalaria. La frecuencia de inicio de un método anticonceptivo eficaz en el puerperio varió entre los diferentes hospitales. Los resultados hospitalarios concordaron con los datos nacionales sobre las mujeres en edad fecunda. En las mujeres que se sometieron a esterilización quirúrgica, las diferencias entre las que habían dado a luz por vía vaginal y las sometidas a una cesárea fueron estadísticamente significativas. CONCLUSIONES: En general, existe una baja frecuencia de inicio de un método anticonceptivo eficaz durante el puerperio en los hospitales públicos de Guatemala. Sin embargo, es mayor en los hospitales de inferior nivel de atención de salud cuyos vínculos con la comunidad son intensos. La recopilación sistemática de datos reveló que determinadas áreas debían ser objeto de mejora, en particular era necesario mejorar el conocimiento de los proveedores de servicios de salud en materia de criterios médicos sobre la indicación del uso de un método anticonceptivo eficaz durante el puerperio. La promoción de la provisión de servicios de planificación familiar y anticoncepción de alta calidad en el sistema de salud pública de Guatemala constituye una prioridad.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Anticoncepción , Servicios de Planificación Familiar/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Periodo Posparto , Cesárea , Condones , Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción , Anticonceptivos Femeninos , Anticonceptivos Orales Combinados , Parto Obstétrico , Países en Desarrollo , Servicios de Planificación Familiar/organización & administración , Guatemala , Accesibilidad a los Servicios de Salud , Hospitales Públicos/organización & administración , Dispositivos Intrauterinos , Acetato de Medroxiprogesterona , Esterilización ReproductivaRESUMEN
The aim of this study was to identify the care provided by health professionals who work in family planning, in a Family Health Unit in the municipality of Ribeirao Preto, São Paulo. This was a descriptive, cross-sectional and quali-quantitative study. Data were collected through interviews with 11 health professionals. The results revealed that most professionals had not received training in family planning, and that information about contraceptive methods is transmitted in an individual way, having women as the target-public. The contraceptive methods which the professionals suggest and offer more are those considered most effective. These findings indicate that family planning care at the Family Health Unit needs to be adjusted not only to ensure quality of service, but also to ensure sexual and reproductive rights.
O objetivo deste estudo foi identificar a assistência oferecida pelos profissionais de saúde que atuam em planejamento familiar, em uma Unidade de Saúde da Família, no município de Ribeirão Preto, São Paulo. Trata-se de estudo descritivo, com corte transversal e abordagem quali-quantitativa. Os dados foram coletados por meio de entrevista com 11 profissionais da saúde. Os resultados revelaram que a maioria dos profissionais não recebeu capacitação em planejamento familiar, sendo que a informação sobre os métodos anticoncepcionais é transmitida de forma individual, tendo como público-alvo as mulheres. Os métodos anticoncepcionais, considerados mais eficazes, são aqueles sobre os quais os profissionais mais orientam e oferecem. Os achados apontam que a assistência em planejamento familiar na Unidade de Saúde da Família necessita de adequações, não só para assegurar a qualidade do serviço prestado como também para assegurar direitos sexuais e reprodutivos.
El objetivo de este estudio fue identificar la asistencia ofrecida por los profesionales de la salud que actúan en la planificación familiar, en una Unidad de Salud de la Familia, en el municipio de Ribeirao Preto, Sao Paulo. Se trata de un estudio descriptivo con corte transversal y abordaje cuali-cuantitativo. Los datos fueron recolectados por medio de entrevista con 11 profesionales de la salud. Los resultados revelaron que la mayoría de los profesionales no recibió capacitación en planificación familiar, siendo que la información sobre los métodos anti-conceptivos es trasmitida de forma individual, teniendo como público objetivo a las mujeres. Los métodos anticonceptivos considerados más eficaces son aquellos sobre los cuales los profesionales más orientan y ofrecen. Los hallazgos apuntan que la asistencia en planificación familiar en la Unidad de Salud de la Familia necesita de adecuaciones, no sólo para asegurar la calidad del servicio prestado, como también para asegurar los derechos sexuales y reproductivos.
Asunto(s)
Femenino , Humanos , Salud de la Familia , Servicios de Planificación Familiar , Estudios Transversales , Enfermería de la Familia , Servicios de Planificación Familiar/normas , Servicios de Planificación Familiar/estadística & datos numéricosRESUMEN
O artigo enfoca o risco e a ocorrência de gravidez não planejada, abortos, conhecimento, acesso e uso da contracepção de emergência entre mulheres com HIV/aids. Utilizou-se abordagem quantitativa observacional realizada através de inquérito domiciliar em Santo André (SP), na qual se constatou que, após a informação sobre a infecção, 62,8 por cento aderiram ao uso do preservativo masculino, 77,2 por cento utilizando-o exclusivamente, 13 por cento associando-o à pílula ou injeções hormonais e 9,8 por cento alternado seu uso com coito interrompido, tabelinha ou duchas vaginais. Falhas mecânicas no uso do preservativo ocorreram com 38 por cento e, somadas às falhas ligadas à alternância com métodos comportamentais, foram responsáveis por 40 por cento dos casos de gravidez não planejada, ocorridas com 24 por cento das entrevistadas, 22 por cento resultando em abortos provocados. A contracepção de emergência era conhecida por 51,4 por cento e apenas 2,7 por cento a utilizaram. Conclui-se que falhas mecânicas ou comportamentais associadas ao uso de preservativo por mulheres com HIV/aids aumentam sua exposição a gestações não planejadas e abortos. É necessário ampliar as opções e fornecimento de métodos anticoncepcionais, incluindo a contracepção de emergência, bem como reorientar constantemente o uso de preservativos entre este público.
This paper focuses both the risk and the occurrence of non-planned pregnancy, abortions, as well as the awareness about and the use of emergency contraception among HIV/aids-infected women. A quantitative observational approach was used after a domiciliary survey in Santo Andre, São Paulo State, Brazil, where it was found that, after receiving the information about the infection, 62.8 percent adopted the use of male condom, 77.2 percent using it exclusively, 13 percent associated with hormone injections, and 9.8 percent alternated with either interrupted intercourse, fertility schedule or vaginal shower. Mechanical flaws by the use of the preservative occurred to 38 percent. Added to flaws associated to the alternation with behavioral methods, they caused together 40 percent of non-planned pregnancy, which occurred to 24 percent of the interviewed women, 22 percent resulting in self-provoked abortions. Emergency contraception was known by 51.4 percent, although only 2.7 percent had used it. The conclusion is that mechanical or behavioral flaws related to the use of preservative by HIV/aids-infected women increased their exposure to non-planned gestations and abortions. It is needed to amplify both the options and the supply of contraceptive methods, including emergency contraception, with constant re-orientation on the use of preservative among this public.