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Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraption, safe abortion, and post-abortion care.

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Access to comprehensive contraceptive services for youth is essential to improving sexual and reproductive health. However, youth in many countries still face substantial obstacles to contraceptive access and use. The purpose of this study is to compare the contraceptive access experiences and perspectives of pregnant and parenting Mexican-origin youth in Guanajuato, Mexico, and Fresno County, California. Focus groups and in-depth interviews were conducted in Spanish and English among female youth in Mexico (n = 49) and California (n = 25). Participants also completed a brief sociodemographic survey. Using a modified grounded theory approach, qualitative data were coded and thematically analysed based on Penchansky and Thomas's Theory of Access, and results were compared by location. Although knowledge of a service provider was high among youth in both locations, access was affected by social, cultural, and institutional dynamics and contraceptive use was mixed. Across locations, participants described obstacles to accessing their preferred method. Participants worried about parental and peer opinions about their use of contraception (acceptability), and about perceived side effects including infertility and pain (adequacy). Contextual differences included lack of contraceptive choice in Guanajuato (availability) and incomplete knowledge about options in Fresno County (awareness). The power to request and receive their method of choice (agency) emerged as an important dimension that was not part of the original theory. Latina youth living in Mexico and the United States face multiple challenges accessing needed contraceptive options and services. Recognising and reducing these barriers can strengthen the contraceptive care landscape and promote the reproductive health and agency of young people. DOI: 10.1080/26410397.2023.2216527Plain language summary: Although sexually active youth need access to comprehensive sexual and reproductive health services, youth in many countries face substantial barriers to care. This study compares the experiences of pregnant and parenting youth in accessing contraceptive services in Mexico and the United States. We conducted interviews and focus groups with 74 Mexican-origin young women and found that contraceptive use and access was affected by their concerns about parental and peer opinions as well as by provider attitudes. In Mexico, several participants reported being denied their preferred method by their provider. Identifying and addressing barriers to services can improve the quality of care and the reproductive health of young people.

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Objectives: To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods: Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results: Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion: This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.

Objetivo: Apresentar e analisar a resposta do sistema de saúde peruano às necessidades de saúde sexual e reprodutiva de mulheres venezuelanas radicadas em Lima, Peru, e identificar algumas explicações para essa resposta. Métodos: Entrevistas telefônicas semiestruturadas detalhadas com 30 mulheres venezuelanas, 10 profissionais de saúde e 2 funcionários do Ministério da Saúde. Resultados: Com base nas experiências das mulheres venezuelanas que recorreram a esses serviços no período de 2019 a 2020 e nas perspectivas de profissionais e autoridades de saúde, apresentamos uma análise da capacidade e das limitações dos serviços de saúde pública para atender às necessidades de saúde sexual e reprodutiva dessa população. Os relatos das mulheres migrantes indicam uma experiência positiva com um sistema de saúde, que, apesar das deficiências, responde às necessidades mais comuns de saúde sexual e reprodutiva. Isso está em conformidade com os relatos dos profissionais de saúde e das autoridades, que enfatizam a existência de políticas prioritárias de atenção à saúde sexual e reprodutiva. Conclusão: Este estudo mostra de que maneira um âmbito de prioridade nacional (reduzir a mortalidade materna) e mecanismos operacionais de proteção social (como o Seguro Integral de Saúde) se convertem em instrumentos complementares, afetando positivamente e estendendo benefícios à população migrante, embora essa população não tenha sido levada em consideração quando da elaboração dessas políticas.

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Objective: Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods: Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results: A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions: Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

Objetivo: Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos: Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados: Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões: Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

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RESUMEN Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, residentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xenofobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condiciones de salud actual y el goce efectivo de los derechos en SSR.

ABSTRACT Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

RESUMO Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

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RESUMEN Objetivo. Presentar y analizar la respuesta que el sistema de salud peruano viene dando a las necesidades en salud sexual y reproductiva de las mujeres venezolanas que radican en la ciudad de Lima, Perú e identificar algunas de las razones que nos permite entender esta respuesta. Métodos. La información se recogió mediante entrevistas a profundidad semiestructuradas por vía telefónica a 30 mujeres venezolanas, 10 trabajadores de salud y 2 funcionarios del Ministerio de Salud. Resultados. A partir de las experiencias de mujeres venezolanas que acudieron a estos servicios durante el 2019-2020 y de las perspectivas del personal y autoridades de salud presentamos un análisis de la capacidad y limitaciones que los servicios de salud públicos tienen para atender las necesidades de salud sexual y reproductiva de esta población. Los testimonios de las mujeres migrantes reportan una experiencia positiva con un sistema de salud que, a pesar de las deficiencias, responde a las necesidades de salud sexual y reproductiva más comunes. Estas coinciden con los testimonios del personal de salud y con las de las autoridades quienes enfatizan la existencia de políticas prioritarias para la atención de la Salud Sexual y Reproductiva. Conclusión. Este estudio muestra cómo un marco de prioridad nacional (disminuir la mortalidad materna), acompañado de mecanismos operativos de protección social (como el Seguro Integral de Salud), se convierten en instrumentos complementarios, que repercute de manera positiva y extiende beneficios para las y los migrantes, a pesar de no haber considerado a esta población durante el diseño de estas políticas.

ABSTRACT Objectives. To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods. Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results. Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion. This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.

RESUMO Objetivo. Apresentar e analisar a resposta do sistema de saúde peruano às necessidades de saúde sexual e reprodutiva de mulheres venezuelanas radicadas em Lima, Peru, e identificar algumas explicações para essa resposta. Métodos. Entrevistas telefônicas semiestruturadas detalhadas com 30 mulheres venezuelanas, 10 profissionais de saúde e 2 funcionários do Ministério da Saúde. Resultados. Com base nas experiências das mulheres venezuelanas que recorreram a esses serviços no período de 2019 a 2020 e nas perspectivas de profissionais e autoridades de saúde, apresentamos uma análise da capacidade e das limitações dos serviços de saúde pública para atender às necessidades de saúde sexual e reprodutiva dessa população. Os relatos das mulheres migrantes indicam uma experiência positiva com um sistema de saúde, que, apesar das deficiências, responde às necessidades mais comuns de saúde sexual e reprodutiva. Isso está em conformidade com os relatos dos profissionais de saúde e das autoridades, que enfatizam a existência de políticas prioritárias de atenção à saúde sexual e reprodutiva. Conclusão. Este estudo mostra de que maneira um âmbito de prioridade nacional (reduzir a mortalidade materna) e mecanismos operacionais de proteção social (como o Seguro Integral de Saúde) se convertem em instrumentos complementares, afetando positivamente e estendendo benefícios à população migrante, embora essa população não tenha sido levada em consideração quando da elaboração dessas políticas.

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Abstract Objectives: to analyze abortions provided by law (APL) carried out in Brazil between 2010 and 2019 regarding the need for travel of users, as well as the expenditure of time and money on these trips. Methods: descriptive study of records of outpatient care and hospitalizations for APL between 2010 and 2019. The municipal provision and the inter-municipal flows for the realization of the APL, the availability of public transportation for this travel, as well as its cost and time, were identified. Results: 2.6% of Brazilian municipalities had a sustained provision of APL between 2010 and 2019. Of the 15,889 APL performed, 14.8% occurred in municipalities other than those where the user lived. The smaller the population size of the municipality of residence, the higher the percentage of the need for travel. Of these inter-municipal trips, 16.0% had regular round-trip links by public transport. The total travel time ranged from 26 minutes to 4 and a half days, and the cost from R$2.70 to R$1,218.06; the highest medians were among residents of the Midwest region. Conclusions: the concentration of services, the deficiency of inter-municipal public transport, and the expenditure on travel to access the APL are barriers to users that need the health service, demanding public policies to overcome them.

Resumo Objetivos: analisar as restrições aos abortos previstos em lei (APL) realizados no Brasil entre 2010 e 2019 quanto à necessidade de deslocamento das usuárias, bem como quanto ao dispêndio de tempo e dinheiro nessas viagens. Métodos: estudo descritivo dos registros de atendimentos ambulatoriais e internações para APL entre 2010 e 2019. Foram identificados a oferta municipal e os fluxos intermunicipais para realização dos APL, a disponibilidade de transporte coletivo para esse deslocamento, bem como seu custo e tempo. Resultados: 2,6% dos municípios brasileiros tiveram oferta sustentada de APL entre 2010 e 2019. Dos 15.889 APL realizados, 14,8% se deram em municípios diferentes daqueles de residência da usuária. Quanto menor o porte populacional do município de residência, maior o percentual com necessidade de viajar. Desses deslocamentos intermunicipais, 16,0% tinham ligações regulares de ida e retorno em transporte público. O tempo de viagem total variou de 26 minutos a quatro dias e meio, e o custo de R$ 2,70 a R$ 1.218,06; as maiores medianas estiveram entre as residentes da região Centro-Oeste. Conclusões: a concentração de serviços, a deficiência de transporte público intermunicipal, bem como o dispêndio com a viagem para acesso ao APL são barreiras às usuárias que precisam do serviço de saúde, demandando políticas públicas para sua superação.

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The sexual and reproductive health of young migrants has not been sufficiently addressed in mobility studies. In this article, we dwell on some aspects of this issue in the migration process of Latin American youth. We conducted a qualitative study in the region of Tarapacá, Chile, carrying out in-depth interviews with key informants, health staff and young migrants between 18 and 25 years old. The results show some motivations to migrate related to sexual and reproductive health: young pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.

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Resumo A oferta do aborto em gestações decorrentes de estupro é limitada no Brasil, restrita a poucos estabelecimentos e concentrada em grandes centros urbanos. Objetivou-se estimar o potencial de expansão da oferta do serviço considerando a capacidade instalada nos municípios país. A partir dos dados de junho de 2021 no Cadastro Nacional de Estabelecimentos de Saúde foram elaborados três diferentes cenários de oferta de aborto previsto em lei em gestações decorrentes de estupro, e calculado o percentual da população do sexo feminino em idade fértil residente nos municípios de cada cenário por região. No primeiro cenário foram incluídos os municípios com oferta instalada, no segundo aqueles com potencial de oferta considerando as normativas vigentes, e no terceiro aqueles com potencial de oferta considerando apenas as recomendações da Organização Mundial de Saúde e o Código Penal brasileiro. Os cenários foram compostos, respectivamente, por 55, 662 e 3.741 municípios, sendo residência de 26,7%, 62,1% e 94,3% das pessoas do sexo feminino entre 10 e 49 anos do país. Em todas as regiões havia capacidade instalada para ampliação da oferta tanto à luz das normativas vigentes quanto das recomendações internacionais.

Abstract The provision of abortion in pregnancies resulting from rape in Brazil is limited, restricted to a few facilities and concentrated in large urban centers. We aimed to estimate the potential for expansion of this service considering the installed capacity in the country's municipalities. From the data of June 2021 in the Cadastro Nacional de Estabelecimentos de Saúde (Brazilian National Registry of Health Facilities, CNES), three different scenarios of abortion provision provided by law in pregnancies resulting from rape were elaborated, and the percentage of female population of childbearing age living in the municipalities of each scenario was calculated by region. The first scenario included the municipalities with installed provision; the second, those with potential for provision considering the current regulations; and the third, those with potential for provision considering only the recommendations of the World Health Organization and the Penal Code of Brazil. The scenarios were composed of 55, 662 and 3,741 municipalities, respectively, and were home to 26.7%, 62.1%, and 94.3% of the country's females between the ages of 10 and 49. In all regions, there was installed capacity to expand provision, both in light of current regulations and international recommendations.

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Introducción: La COVID-19 por su dimensión mundial y las fuertes modificaciones que ha generado en las dinámicas de vida se ha convertido en un fenómeno con repercusión en todos los contextos sociales y en la psicología individual o colectiva, a lo cual no escapa la salud sexual y reproductiva. Objetivo: Visibilizar los problemas reales o potenciales que la actual pandemia presupone en el área de la salud sexual y reproductiva, desde un enfoque psicosocial. Métodos: Se realizó una revisión bibliográfica a partir de las bases de datos electrónicas, Google Scholar, PubMed central, LILACS, BIREME, SciELO Regional, empleando como palabras claves SARS-CoV-2 or COVID-19 and reproductive sexual health or gender violence. La información recopilada se sintetizó en tres temas fundamentales: relaciones de pareja, inequidades de género y reacomodo de los servicios. Conclusiones: La crisis sanitaria actual y el distanciamiento social que impone pudieran tener un impacto negativo en las relaciones de pareja o las estructuras de dominación de género, donde las mujeres, las niñas y otros grupos vulnerables pudieran verse desfavorecidos. En este tema, como en muchos otros relacionados con la COVID-19, aunque se requieren más investigaciones, existen muchas cuestiones a las que se les debe prestar atención, desde una perspectiva sistémica y con un enfoque de prevención y contención oportuna. Se precisa del esfuerzo colectivo y desprejuiciado para el apoyo social, judicial, policial y de salud, que permita superar las secuelas actuales y futuras de esta pandemia en la atención a los problemas de la salud sexual y reproductiva(AU)

Introduction: COVID-19 due to its global dimension and the strong changes it has generated in the dynamics of life has become a phenomenon with repercussions in all social contexts and in individual or collective psychology, to which sexual and reproductive health does not escape. Objective: Make visible the real or potential problems that the current pandemic presupposes in the area of sexual and reproductive health, from a psychosocial approach. Methods: A literature review was carried out from the electronic databases like Google Scholar, central PubMed, LILACS, BIREME, Regional SciELO, using as keywords SARS-CoV-2 or COVID-19 and reproductive sexual health or gender violence. The information collected was synthesized in three fundamental themes: relationships, gender inequities and re-arrangement of services. Conclusions: The current health crisis and the social distancing it imposes could have a negative impact on relationships or structures of gender domination, where women, girls and other vulnerable groups could be disadvantaged. On this topic, as in many others related to COVID-19, although more research is required, there are many issues that need to be addressed from a systemic perspective and with a timely prevention and containment approach. A collective and unprejudiced effort is needed for social, judicial, police and health support, which allows overcoming the current and future consequences of this pandemic in the attention to the problems of sexual and reproductive health(AU)

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OBJECTIVES: This study aimed to evaluate the cost-effectiveness of 2 contraceptive counseling strategies in Colombia for women living with human immunodeficiency virus (HIV). The first integrates (1) reproductive health and HIV services (integrated model [IM]), and the second (2) offers these services separately (non-IM). METHODS: Cost-effectiveness analysis from the third-party payer perspective (Colombian healthcare system). A decision analysis tree was used over a 24-month time horizon at a 3% discount rate, considering only direct costs. The outcome was the number of averted HIV perinatal transmission infections. We performed a discrete sensibility analysis and a probabilistic second-order sensitivity analysis with 10 000 iterations (Monte Carlo simulation). RESULTS: Compared with the non-IM, the IM prevented 3% additional HIV perinatal transmission infections, with an incremental cost-effectiveness of US dollar 525 and the highest net monetary benefit at the proposed willingness to pay. In the probabilistic sensitivity analysis, we found a substantial amount of parameter uncertainty that challenges the evidence in favor of the cost-effectiveness of the IM strategy. CONCLUSIONS: This study opens the possibility of integrating reproductive health and HIV services for women living with HIV in Colombia. In addition, it raises the necessity to produce additional good quality local empirical evidence to inform better and support the estimation of the economic efficiency of such a model in the country.

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RESUMEN Fundamento: un adecuado control y manejo del riesgo preconcepcional permite determinar el estado de salud de cada mujer, lo que hace posible asumir un embarazo con mejores resultados para el binomio mediante el control de los factores de riesgo. Objetivo: caracterizar el comportamiento del riesgo reproductivo preconcepcional. Métodos: se realizó un estudio observacional, descriptivo y transversal en los consultorios del médico y la enfermera de la familia del Policlínico Pedro Borrás Astorga del municipio Pinar del Río, durante el año 2019. El universo fue de 4 772 mujeres en edad fértil. Se utilizó la estadística descriptiva y los resultados se reflejaron en tablas. Resultados: se identificaron 848 mujeres con riesgo reproductivo preconcepcional, un gran número de mujeres presentan enfermedades crónicas no transmisibles y algunas tienen más de una enfermedad. Predominó la malnutrición por defecto y por exceso, la hipertensión arterial y el asma bronquial y como antecedentes obstétricos, los abortos provocados, el período intergenésico corto y la hipertensión inducida por el embarazo, las anemias y los hijos pretérminos anteriores o bajo peso al nacer. Un alto porciento se encuentra controlado con algunas dificultades con las adolescentes. Conclusiones: el riesgo reproductivo preconcepcional es una problemática aún sin resolver ya que hubo un número de las mujeres que no estaban controladas. El seguimiento adecuado de las parejas con riesgo preconcepcional y su responsabilidad en la planificación de un embarazo contribuye al mejoramiento de la calidad de vida de madres e hijos.

ABSTRACT Background: an appropriate control and handling of the pre-conception risk allows determining the state of each woman's health, making possible to assume a pregnancy with better results for the binomial by means of the control of the risk factors. Objective: to characterize the behavior of the reproductive pre-conception risk. Methods: an observational, descriptive and traverse study was the carried out in the family doctor's and nurse offices of the Pedro Borrás Astorga Policlinic in Pinar del Río in 2019. The universe was constituted by 4772 women in fertile age. The descriptive statistic was used and the results were reflected in charts. Results: 848 women were identified with reproductive pre-conception risk, a great number of women present non-transmissible chronic illnesses and some have more than one illness. The malnutrition prevailed as much for defect as for excess, the arterial hypertension and the bronchial asthma and as obstetric antecedents, the induced miscarriages, the short birth intervals and the hypertension induced by the pregnancy, the anemia's and the previous preterm children and/or low-birth-weight babies. A high percent is controlled with some difficulties with the adolescents. Conclusions: the reproductive pre-conception risk is still a problem without solving since there was a number of the woman that they were not controlled. The appropriate control of the couples with pre-conception risk and its responsibility in the planning of a pregnancy contributes the improvement of the quality of mothers' and children's life.

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Abstract This opinion article brings considerations about advantages and challenges with the use of telehealth in sexual and reproductive health services aiming family planning in the face of COVID-19 pandemic new scenario.

Resumo Este artigo de opinião traz algumas considerações sobre vantagens e desafios do uso da telessaúde em serviços de saúde sexual e reprodutiva focado no planejamento familiar diante do novo cenário da pandemia da COVID-19.

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BACKGROUND: Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994-2012), at a national and subnational level. METHODS: The series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes. RESULTS: From 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage. CONCLUSIONS: The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.

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Resumo: Nos casos previstos em lei, o aborto é ofertado pelo Sistema Único de Saúde (SUS). O presente estudo busca mapear e caracterizar a oferta e realização do procedimento no Brasil em 2019. Foram incluídos os Serviços de Referência para Interrupção de Gravidez em Casos Previstos em Lei (SRIGCPL) registrados no Sistema do Cadastro Nacional de Estabelecimentos de Saúde (SCNES) e os estabelecimentos com registros de aborto por razões médicas e legais no Sistema de Informações Ambulatoriais ou no Sistema de Informações Hospitalares. Os estabelecimentos foram caracterizados em tipo e subtipo, natureza jurídica e convênios, e georreferenciados a partir dos dados do SCNES. Em seguida, os municípios foram divididos entre os com e os sem oferta em 2019 e então apresentados por categorias de Índice de Desenvolvimento Humano Municipal (IDH-M) e porte populacional. Logo foi calculada a taxa de realização de aborto previsto em lei dos dois grupos de municípios. Ao todo, 290 estabelecimentos ofertavam o serviço, sendo 101 SRIGCPL e 251 estabelecimentos com registro de procedimento. Os estabelecimentos estavam em 3,6% (200) dos municípios brasileiros. A oferta se deu majoritariamente em hospitais (98,6%), pela administração pública (62,1%), conveniada ao SUS (99,7%), em municípios da Região Sudeste (40,5%), com mais de 100 mil habitantes (59,5%) e de IDH-M alto ou muito alto (77,5%). A taxa de realização de aborto previsto em lei entre as residentes em idade fértil dos municípios sem oferta do serviço foi de 4,8 vezes menor que nos municípios com o serviço. A oferta do aborto previsto em lei no Brasil se dá de forma desigual no território, com possível implicação no acesso ao serviço.

Abstract: Abortion is supplied by the Brazilian Unified National Health System (SUS) in cases allowed under the prevailing legislation. The current study seeks to map and characterize the supply and performance of this procedure in Brazil in 2019. Data included the Referral Services for Termination of Pregnancy Authorized by Law (SRIGCPL) recorded in the National Registry of Healthcare Establishments (SCNES) and the establishments with records of abortion for medical and legal reasons in the Outpatient Information System and Hospital Information System. Establishments were characterized by type and subtype, legal status, and contractual agreements, and georeferenced according to data from the SCNES. Next, municipalities were classified as those with and without supply of the procedure in 2019 and were presented by categories of Municipal Human Development Index (HDI-M) and population size. The data were used to calculate the rates of legally authorized abortions performed in the two groups of municipalities. In all, 290 establishments supplied the service, of which 101 SRIGCPL and 251 establishments with records of the procedure. The establishments were situated in 3.6% (200) of Brazil's municipalities. The supply was mostly in hospitals (98.6%), under the public administration (62.1%), in contractual agreements with the SUS (99.7%), in municipalities in the Southeast of Brazil (40.5%), with more than 100,000 inhabitants (59.5%), and with high or very high HDI-M (77.5%). The rate of legally authorized abortions in childbearing-age residents of municipalities without supply of the service was 4.8 times lower than in municipalities with the service. The supply of legally authorized abortions in Brazil is distributed unequally across the territory, with possible negative implications for access to the service.

Resumen: En los casos previstos por la ley, el aborto es ofrecido por el Sistema Único de Salud brasileño (SUS). El presente estudio busca mapear y caracterizar la oferta y realización del procedimiento en Brasil en 2019. Se incluyeron los Servicios de Referencia para la Interrupción del Embarazo en los Casos Previstos por Ley (SRIGCPL), registrados en el Sistema del Registro Nacional de Establecimientos de Salud (SCNES), así como los establecimientos con registros de aborto por razones médicas y legales en el Sistema de Información Ambulatoria o en el Sistema de Información Hospitalaria. Los establecimientos se caracterizaron por tipo y subtipo, naturaleza jurídica y convenios, y fueron georreferenciados a partir de los datos del SCNES. En seguida, los municipios se dividieron entre los que contaban con oferta y los que carecían de ella en 2019, entonces se presentaron por categorías de Índice de Desarrollo Humano Municipal (IDH-M) y tamaño poblacional. Luego se calculó la tasa de abortos previstos por ley de los dos grupos de municipios. En total, 290 establecimientos ofertaban el servicio, donde 101 eran SRIGCPL y 251 establecimientos con registro de procedimiento. Los establecimientos eran un 3,6% (200) de los municipios brasileños. La oferta se produjo mayoritariamente en hospitales (98,6%), de administración pública (62,1%), con convenio del SUS (99,7%), en municipios de la región Sudeste (40,5%), con más de 100 mil habitantes (59,5%) y de IDH-M alto o muy alto (77,5%). La tasa de abortos previstos por ley entre las residentes en edad fértil de los municipios sin oferta del servicio fue de 4,8 veces menor que en los municipios con este servicio. La oferta del aborto previsto por ley en Brasil se produce de forma desigual en el territorio, con una posible implicación en el acceso al servicio.

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ABSTRACT OBJECTIVES To describe the evolution of care during pregnancy and childbirth among postpartum women living in the municipality of Rio Grande, Southern Brazil, using data from surveys carried out every three years between 2007 and 2019. METHODS Within 48 hours after delivery, a single, standardized questionnaire was applied to all mothers who had children in local hospitals and met the inclusion criteria. Demographic and reproductive characteristics, lifestyle habits, socioeconomic level of the family, and care received during pregnancy and childbirth were investigated. In the analysis, the chi-square test for linear trend was used to assess the distribution of indicators per survey. RESULTS A total of 12,645 parturients were interviewed (98% of the women eligible to participate in the surveys). In the period evaluated, the proportion of births fell 35% among adolescents and increased 25% among women aged 35 years and over. Mothers gained, on average, two years of schooling, and their families experienced an important economic improvement, followed by loss of income in the last survey. Maternal smoking, before and during pregnancy, fell by half. The rate of mothers who started prenatal care in the first trimester and the number of consultations and laboratory tests increased. Almost 60% of prenatal consultations and 80% of births took place in the Brazilian Unified Health System. In 2019, vaginal delivery was once again the most common. The rates of low birth weight (9%) and prematurity (17%) virtually remained unchanged. CONCLUSIONS We found an important change in the reproductive profile and increased coverage of various prenatal care and delivery services. Children continue to be born well, but low birth weight and prematurity remain endemic.

RESUMO OBJETIVO Descrever a evolução da assistência à gestação e ao parto entre puérperas residentes no município de Rio Grande (RS) utilizando dados de inquéritos realizados a cada três anos, entre 2007 e 2019. MÉTODOS Em até 48 horas após o parto foi aplicado questionário único, padronizado, a todas as mães que tiveram filhos nos hospitais locais e cumpriram os critérios de inclusão. Foram investigadas características demográficas e reprodutivas, hábitos de vida, nível socioeconômico da família e cuidados recebidos durante a gestação e o parto. Na análise, utilizou-se o teste qui-quadrado de tendência linear para avaliar a distribuição dos indicadores por inquérito. RESULTADOS Ao todo, 12.645 parturientes foram entrevistadas (98% do total de mulheres aptas a participar da pesquisa). No período avaliado, a proporção de partos caiu 35% entre adolescentes e aumentou 25% entre mulheres com 35 anos ou mais. As mães ganharam, em média, dois anos de escolaridade, e suas famílias tiveram importante melhora econômica, seguida, porém, de perda de renda no último inquérito. O tabagismo materno, antes e durante a gravidez, caiu à metade. Houve aumento na taxa de mães que iniciaram o pré-natal no primeiro trimestre, e aumentou também o número de consultas e de testes laboratoriais. Quase 60% das consultas de pré-natal e 80% dos partos ocorreram no Sistema Único de Saúde. Em 2019, o parto vaginal voltou a ser o mais comum. As taxas de baixo peso ao nascer (9%) e prematuridade (17%) praticamente não se modificaram. CONCLUSÕES Houve mudança importante no perfil reprodutivo e aumento da cobertura de diversos serviços de assistência pré-natal e parto. As crianças seguem nascendo bem, mas o baixo peso ao nascer e a prematuridade continuam endêmicos.

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BACKGROUND: People living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people's needs, identities and circumstances. METHODS: This is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people's needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo. RESULTS: Once access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries. CONCLUSIONS: The evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people's needs, identities, and circumstances.

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RESUMEN INTRODUCCIÓN En Argentina se encuentra en discusión el ordenamiento legal del personal de partería. La legislación vigente en la provincia de Buenos Aires (PBA) incluye incumbencias para la atención integral de los procesos de salud sexual y reproductiva (SSyR). Se parte del supuesto de que esto mejora la calidad en los servicios de salud, incidiendo de manera positiva en los procesos y resultados de la atención. El objetivo del estudio fue describir el trabajo de las obstétricas en la Región Sanitaria XI (RSXI) de la PBA y analizar el modo en que contribuye a la calidad de la atención de las mujeres y sus familias en los servicios de SSyR. MÉTODOS Se realizó una investigación etnográfica en el subsector público de la RSXI de la PBA. Incluyó determinación de muestra con fines no probabilísticos mediante bola de nieve y relevamiento de datos a partir de técnicas de observación participante y entrevista en profundidad. RESULTADOS El personal de partería lleva adelante un modelo de atención que prioriza el abordaje integral de los procesos de SSyR, lo cual incluye aspectos preventivos y curativos que dan respuesta a dimensiones clínicas y también socioculturales. DISCUSIÓN El rol de esta profesión se encuentra atravesado por habilidades clínicas y por aptitudes para atender de manera integral las demandas. La conjunción de ambas -expresadas en iniciativas y acciones- mejora la calidad de las respuestas sanitarias.

ABSTRACT INTRODUCTION In Argentina, the legal framework of professional midwifery is under discussion. The current legislation in Buenos Aires (BA) province includes competences for the comprehensive care of sexual and reproductive health (SRH) processes. The starting assumption is that this improves health service quality and has a positive impact on health care processes and results. The objective of the study was to describe professional midwives' work in the XI Health Region of BA province and to analyze their contribution to the quality of care for women and their families in SRH services. METHODS An ethnographic research was performed in the public subsector of the BA XI Health Region with non-probability snowball sampling and data collected through participatory observation and in-depth interviews. RESULTS Midwives accomplish a model of care that prioritizes a comprehensive approach to SRH processes. This model includes preventive and curative aspects to respond to clinical and sociocultural factors as well. DISCUSSION The role of midwives is in-between clinical skills and comprehensive care competences. Both of them together, expressed in initiatives and actions, improve health care quality.

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INTRODUCTION: Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC. METHODS: Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta-analysis was not considered appropriate given the level of heterogeneity of the studies. RESULTS: A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non-permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV. CONCLUSIONS: This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.

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