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The objective of this article was to characterize how urbanization and indigenous identity shape nutrition attitudes and practices in El Alto, a rapidly urbanizing and predominantly indigenous (Aymara) community on Bolivia's Andean plateau. We took a qualitative ethnographic approach, interviewing health care providers ( n = 11) and conducting focus groups with mothers of young children ( n = 4 focus groups with 25 mothers total [age = 18-43 years, 60% Aymara]). Participants generally described their urban environment as being problematic for nutrition, a place where unhealthy "junk foods" and "chemicals" have supplanted healthy, "natural," "indigenous" foods from the countryside. Placing nutrition in El Alto within a broader context of cultural identity and a struggle to harmonize different lifestyles and worldviews, we propose how an intercultural framework for nutrition can harmonize Western scientific perspectives with rural and indigenous food culture.

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La resiliencia puede describirse como la consecuciónde resultados positivos a pesar de las adversidadesasí como el proceso por medio del cual sealcanzan estos resultados. Cuando el desarrollo juvenilseda en contextos con numerosos factores deriesgo, las intervenciones basadas en la resilienciapueden mejorar los resultados de múltiples dimensionesde salud y bienestar. Sin embargo, los estudiossobre resiliencia en los países en vías de desarrolloy con población marginalizada todavía sonescasos. Para este estudio cualitativo sobre juventuden el Bañado Sur se llevaron a cabo entrevistasen profundidad con 20 adolescentes identificadoscomo particularmente resilientes. Los datos se analizaronde manera a comprender cómo estos desviadospositivos fueron capaces de manejarse ensus entornos adversos para identificar factores quepodrían promover la resiliencia en otros jóveneslocales. Los factores que influyeron en la resilienciade los adolescentes fueron de múltiples nivelesy los motivaron a perseverarmoldeando su toma dedecisiones y ayudándolos a buscar otros recursos.Varios factores se identificaron como vías que conectana los jóvenes con múltiples fortalezas y recursoscomo los deportes, la escuela, la religión ylos programas de Mil Solidarios.Si bien muchos delos hallazgos de este estudio son consistentes conla literatura general sobre resiliencia, algunos delos factores tienen mayor trascendencia para la juventuden el Bañado Sur, resaltando la importanciade la comprensión de la resiliencia en su contexto específico. En el Bañado Sur revistieron particularrelevancia la percepción de la educación como mediode movilidad social, la importancia de la luchacolectiva, los ejemplos de resiliencia y la habilidadpara distanciarse socialmente de ciertas situaciones...

Introduction: resilience describes the attainmentof positive outcomes despite adversity as well asthe process by which these outcomes are achieved. Where youth development occurs in contexts with accumulated risk factors, resilience-based interventions could improve outcomes across multiple dimensions of health and wellbeing. Yet resilience research in developing countries and with marginalized populations remains scarce. Methods: For this qualitative study of youth in the Bañado Sur, in-depth interviews were conducted with 20 adolescents identified as particularly resilient. Data were analyzed to understand how these positive deviants were able to navigate their adverse environments in order to identify factors that could promote resilience in other local youth. Factors at multiple levels influenced adolescents’ resilience by motivating them to persevere, shaping their decision making, and helping them navigate towards other resources. Results: Several factors were identified as pathways that connected youthto multiple assets and resources, including sports, school, religion, and Mil Solidarios programs. While many of the findings of this study are consistent with the broader resilience literature, some factors appear to have stronger implications for youth in the Bañado Sur, highlighting theimportance of understanding resilience in acontext-specific way. In the Bañado Sur, the perception of education as the means for socialmobility, the importance of collective struggle, resilient role models, and social distancing skills were particularly important...

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Introducción: muchas veces los hombres jóvenes se definen a sí mismos y a su identidad masculina a través de relaciones románticas y sexuales; sus decisiones sexuales pueden afectar su transición hacia la madurez, así como la adquisición de infecciones de transmisión sexual, VIH y tasas de embarazos. Objetivo: Este artículo analiza cómo influyen en el modo en que actúan en las relaciones sexuales y románticas y la formación de su identidad masculina, los grupos de amigos de hombres jóvenes paraguayos, sus familias. Metodología: En el 2010 llevamos a cabo cinco charlasen grupo en Asunción, Paraguay, en las que se examinaron las normas comunitarias con grupos de adolescentes entre 14 y 19 años de edad. Luego entrevistamos a la mitad de los miembros de cada grupo para examinar sus relaciones con amigos, la familia, mujeres jóvenes y sus creencias sobre las normas de género existentes. Resultados: Los jóvenes describieron dos tipos de normas masculinas (“pareja/proveedor” y “macho”) y dos tipos de relaciones románticas (“casual” y “formal”). Muchas veces se encontró una concordancia en el lenguaje utilizado para describir cada abanico de conductas, lo que pone de relieve la relación existente entre las normas masculinas y las relaciones románticas.

Introduction: Many times young men define themselves and their male identity through romantic and sexual relationships; their sexual decisions can affect their transition to adulthood as well as the acquisition of sexually transmitted infections, HIV and pregnancy rates. Objective:This article discusses how to influence the waythey act in sexual and romantic relationshipsand the formation of their male identity, groupsof young men Paraguay an friends, their families. Methodology: In 2010 we conducted five talks group in Asuncion, Paraguay, in which Community rules were examined with groups of teenagers between 14 and 19 years old. Then we interviewed half of the members of each group to examine their relationships with friends, family, young women and their beliefs about existing gender norms. Results: Young described two types of male norms(“partner / supplier” and “male”) and two types of romantic relationships (“casual” and “formal”).Many times a match was found in the languageused to describe each range of behaviors, which highlights the relationship between male normsand romantic relationships. The rules received bythe neighborhood as models that were more machobehavior by young people themselves informedcharacteristics. The rules can not be changed unlessyoung people talk about their behavior clearly notnormative. This demonstrates that further studieson the formation, meaning and transformation of male standards are needed.

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Introducción: Este estudio trata de desarrollar un perfil descriptivo de las obstetras en Paraguay. El estudio incluyó tres componentes: investigación de los antecedentes de los documentos oficiales y entrevistas a informantes claves para completar cuestionarios, entrevistas cualitativas con parteras y obstetras del Paraguay, y la observación de los participantes. Métodos: Los datos de los documentos oficiales y los cuestionarios fueron tabulados utilizando estadística descriptiva, entrevistas individuales y entrevistas de grupos pequeños de obstetras, estudiantes de obstetricia y médicos gineco-obstetras y se llevaron a cabo en cinco regiones de salud del Paraguay. Resultados: Participaron veintidós obstetras, nueve estudiantes de obstetricia, nueve gineco-obstetras y cinco dirigentes de las organizaciones profesionales de la salud. Tres temas destacados surgieron de las entrevistas. El primero fue la evolución del rol de la obstetra en el sistema de salud, sobre todo en la capital, Asunción. El segundo fue qué tanto las obstetras como los médicos gineco-obstetras informaron acerca de que las mujeres no tenían preparación suficiente para el parto y el periodo prenatal.

Introduction: This study sought to develop adescriptive profile of midwifery in Paraguay. Itinvolved three components: background research from official documents and key informant interviewsto complete questionnaires, qualitative interviews with Paraguayan midwives and obstetricians, and participant observation. Methods: Data from official documents and questionnaires weretabulated using descriptive statistics. Individual interviews and small-group interviews of midwives, student midwives, and obstetricians were conductedin five health departments of Paraguay. Results: Twenty-two midwives, nine student midwives, nine obstetricians, and five leaders of professional health organizations participated. Three salientthemes were identified from the interviews. Firstwas the changing role of the midwife in the health system, particularly in the capital city of Asunción.Second, midwives and obstetricians both reported that women were not sufficiently prepared for laborand birth during the antenatalperiod. Limited antenatal education and childbirth classes existed and midwives felt that this was amajor barrier to vaginal birth. Finally, access tomidwife-provided antenatal care is perceived to belimited. Obstetricians are now providing antenatal care more often than they used to, and in some public hospitals they also attend vaginal deliveries. Limiting the utilization of midwives may well be amajor contributor to the rising rates of caesarean sections. Midwives are not fulfilling their potentialto prepare women for labor and birth, despitetheir high-level professional training. They havethe potential to improve antenatal preparation forlow-intervention birth, and this would be a moreeffective use of human resources for both obstetricians and midwives.

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OBJECTIVE: The goal of this study was to provide a descriptive profile of midwifery in Paraguay. DESIGN: The study involved three components: background research from official documents and key informant interviews to complete questionnaires, qualitative interviews with Paraguayan midwives and obstetricians, and participant observation. Data from official documents and questionnaires were tabulated using descriptive statistics. Individual interviews and small-group interviews of midwives, student midwives, and obstetricians were conducted in five health departments of Paraguay. SETTING: The research took place in the capital of Paraguay, Asunción, and four additional health departments: Central, Cordillera, Guira, and Misiones. PARTICIPANTS: Twenty-two midwives, nine student midwives, nine obstetricians, and five leaders of professional health organisations in Paraguay participated in this study. FINDINGS: Three salient themes were identified throughout the interviews. First was the understanding of the changing role of the midwife in the health system, particularly in and around the capital city of Asunción. Second, midwives and obstetricians both reported that women were not sufficiently prepared for labour and birth during the antenatal period. Limited antenatal education and childbirth classes existed and midwives felt that this was a major barrier to vaginal birth. Finally, access to midwife-provided antenatal care is perceived to be limited. A major barrier to accessing midwifery care for women in the capital is related to the midwives' changing role in practice. Obstetricians are now providing antenatal care more often than they used to, and in some public hospitals they also attend vaginal deliveries. KEY CONCLUSIONS AND IMPLICATIONS: Limiting the utilisation of midwives may well be a major contributor to the rising rates of caesarean sections. Women are not prepared for labour and birth in the antenatal period, or are scheduled for elective caesarean sections antenatal ly. Midwives are not fulfilling their potential to prepare women for labour and birth, despite their high-level professional training. Midwives have the potential to improve antenatal preparation for low-intervention birth. This transition in care provision would be a more effective use of human resources for both obstetricians and midwives.

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Young men often define themselves and their masculine identity through romantic and sexual relationships, and their resulting sexual decisions can affect their successful transition into adulthood, as well as STI, HIV and pregnancy rates. This paper looks at how young Paraguayan men's peer groups, family and masculine identity formation influence their behaviours in sexual and romantic relationships. In Asunción, Paraguay, we conducted five focus-group discussions (FGDs) examining neighbourhood norms in 2010, with male peer groups ranging in age from 14 to 19 years. We then interviewed half the members from each peer group to examine their relationships with friends, family and young women and their beliefs about existing gender norms. Young men described two types of masculine norms, 'partner/provider' and macho, and two types of romantic relationships, 'casual' and 'formal'. The language used to describe each spectrum of behaviours was often concordant and highlights the connection between masculine norms and romantic relationships. The perceived norms for the neighbourhood were more macho than the young men's reported behaviours. Norms cannot change unless young men speak out about their non-normative behaviours. This provides evidence for more research on the formation, meaning and transformation of male gender norms.

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Communication technology is a central feature of young people's lives, but its role in romantic and sexual relationships has not been thoroughly examined. This article describes how young adults use communication technology for partnering across relationship stages (formation, maintenance, and dissolution) and types (serious/casual), and proposes implications of usage in relationships. This study analyzed qualitative data from a five-week, prospective, coital diary method with related debriefing interviews (N = 70) of African American and Puerto Rican men and women aged 18 to 25 years in Hartford and Philadelphia. Cell phones, including calls, text messaging, and mobile Internet, were the most common forms of communication technology used for partnering goals. Participants reported using cell phones to pursue partnering goals across all relationship stages, including formation (meeting, screening, and getting to know new partners), maintaining existing relationships, and breaking up. Cell phone uses depended on the type of relationship (serious/casual) and the participants' intentions and desires. Results indicated that cell phones are an important element of communication among young adults in romantic and sexual relationships. Specific features of cell phone communication shape the process and context of partnering. Future research should explore emerging communication technologies and implications for psychosocial development, dating violence, and sexual behavior.

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OBJECTIVE: To assess the knowledge of, attitudes toward, and practices regarding postpartum contraception among healthcare providers and postpartum women in northern Haiti. METHODS: Six focus groups were conducted with postpartum patients and 3 were conducted with maternity service providers; a structured questionnaire was then administered to postpartum patients. RESULTS: In total, 282 postpartum women were included in the present study: 249 in the survey and 33 in focus groups. Although 97.9% of women expressed a desire for family-planning counseling before discharge from the postpartum ward, only 6.0% of women received such counseling. Most women wanted to space or limit their pregnancies; 79.8% of women, including those with only 1 child, wanted to choose a contraceptive method before discharge. Providers expressed concern for the volume of induced abortions and maternal deaths within the hospital, which many felt could be averted by improving postpartum family planning. However, there was no postpartum contraceptive counseling or method provision in the present setting, and no providers had experience in initiating methods immediately postpartum. CONCLUSION: Efforts to integrate family planning into postpartum care services could help to reduce the unmet need for family planning, and help patients and providers reach their goals.

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CONTEXT: Heterosexual anal sex is not uncommon in the United States, and it poses risk for STDs. However, who engages in it and why are not well understood, particularly among young adults. METHODS: In 2006-2008, data on sexual health-related topics were collected in surveys (483 respondents) and qualitative interviews (70 participants) with black and Puerto Rican 18-25-year-olds in Hartford and Philadelphia. Bivariate and multivariate analyses of survey data assessed predictors of anal sex with the most recent serious heterosexual partner. Interview transcripts were analyzed for anal sex experiences and reasons for and against engaging in this behavior. RESULTS: Some 34% of survey respondents had had anal sex; this behavior was more common with serious partners than with casual partners (22% vs. 8%). Black respondents were less likely than Puerto Ricans to report anal sex (odds ratio, 0.3); women were more likely to do so than were men (2.9). In the qualitative cohort, perceptions of anal sex as painful and unappealing were the predominant reasons for not having anal sex, whereas sexual pleasure and, in serious relationships, intimacy were the main reasons for engaging in it. Condom use during anal sex was rare and was motivated by STD or hygiene concerns. CONCLUSIONS: Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk. Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience.

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El propósito primordial de la evaluación de necesidades fue enriquecer la habilidad del CEPEP para incrementar la salud sexual y reproductiva adolescente en Asunción al construir un entendimiento de la comunidad circundante y población adolescente a fin de desarrolloar y lograr las actividades planeadas.

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