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YENER A, GİRAY B. Tubal Reanastomoz Sonrası Gebelik Sonuçları: Yeni Bir Teknik. DICLE MEDICAL JOURNAL 2021. [DOI: 10.5798/dicletip.1037826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Profile of Female Sterilization in Brazil. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study analyzes the profile of female sterilization in Brazil by age, parity, type of delivery, place of delivery, color/race, region of residence, years of schooling, marital status, number of unions, and desired number of children reported by women; (2) Methods: The descriptive analysis is based on the most recent Brazilian database on reproductive health: the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). This dataset has information on the history of pregnancies with live births from January 2001 to July 2007; (3) Results: The study suggests that (a) women with high levels of sterilization, high percentages of more than one pregnancy in the period, and larger parity than the desired number of children tend to have high parity, be black, brown, or indigenous, reside in the North or Northeast, have low levels of education, and have two or more unions; and (b) women with high levels of sterilization, low percentages of more than one pregnancy in the period, and lower parity than the desired number of children tend to have cesarean sections, give birth utilizing private health care obtained through a private insurance plan or direct out-of-pocket payment at private hospitals, and be married. (4) Conclusions: The 1997 family planning law could be altered in order to allow female sterilization in conjunction with childbirth, as a way to attend the demand of Brazilian women in public hospitals. Policies are necessary not only to regulate the public sector, but also to aim better services at private institutions. Female sterilization should be discussed in the context of fertility below the replacement level, as one of its associated factors.
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Potter JE, Stevenson AJ, Coleman-Minahan K, Hopkins K, White K, Baum SE, Grossman D. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception 2019; 100:1-4. [PMID: 30851238 DOI: 10.1016/j.contraception.2019.02.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E Potter
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712.
| | - Amanda Jean Stevenson
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Sociology, University of Colorado Boulder, UCB 327 Ketchum 195, Boulder, CO, 80309
| | - Kate Coleman-Minahan
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; University of Colorado College of Nursing, 13120 East 19th Avenue, Aurora, CO, 80045
| | - Kristine Hopkins
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
| | - Kari White
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave South RPHB 320, Birmingham, AL, 35294
| | - Sarah E Baum
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Ibis Reproductive Health, 1330 Broadway Suite 1100, Oakland, CA, 94612
| | - Daniel Grossman
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612
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Borges ALV, Dos Santos OA, Fujimori E. Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy. Midwifery 2017; 56:94-101. [PMID: 29096285 DOI: 10.1016/j.midw.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women. DESIGN AND SETTING a prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014. PARTICIPANTS A total of 264 woman aged 15-44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum. MEASUREMENTS At baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status. FINDINGS Only 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97]. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Brazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect postpartum contraceptive use. Women with unintended pregnancies present an important opportunity to offer additional family planning counseling.
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Affiliation(s)
- Ana Luiza Vilela Borges
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
| | - Osmara Alves Dos Santos
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
| | - Elizabeth Fujimori
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
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Marteleto LJ, Weitzman A, Coutinho RZ, Alves SV. Women's Reproductive Intentions and Behaviors during the Zika Epidemic in Brazil. POPULATION AND DEVELOPMENT REVIEW 2017; 43:199-227. [PMID: 31359895 PMCID: PMC6663086 DOI: 10.1111/padr.12074] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Letícia J Marteleto
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX 78712-1699
| | - Abigail Weitzman
- University of Michigan, Population Studies Center, 426 Thompson Ave
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Quadros MTD, Santos GMNCD. Obstáculos na procura pela esterilização feminina entre mulheres do Bolsa Família. CAD SAUDE PUBLICA 2017; 33:e00152515. [DOI: 10.1590/0102-311x00152515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
As mulheres pobres do programa Bolsa Família são acusadas de ter mais filhos para ingressar ou permanecer no programa. Em pesquisa etnográfica (2012/2014), analisamos os relatos de cinco beneficiárias e observamos o contrário. Elas procuraram pela esterilização no serviço público de saúde de Recife, Pernambuco, Brasil, para não ter mais filhos e enfrentaram diversos obstáculos. Dentre os impeditivos, apontaram dificuldades na contracepção reversível, bem como restrição da oferta de esterilização no serviço público de saúde, o que aumenta a procura durante o parto cesariano. O argumento de ser beneficiária do Bolsa Família é utilizado para reforçar a condição de pobreza e aumentar as chances de conseguir a esterilização, nem sempre exitoso. Apenas duas mulheres conseguiram realizar a esterilização, atribuindo o êxito à “sorte” ou à “graça de Deus”, não ao acesso a um direito. Os resultados do presente estudo sugerem que o aumento da prole não é resultante do ingresso no programa, e sim à falta de acesso a direitos reprodutivos.
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Barbosa RM, Cabral CDS, do Lago TDG, Pinho ADA. Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study, Brazil. PLoS One 2016; 11:e0164887. [PMID: 27812146 PMCID: PMC5094764 DOI: 10.1371/journal.pone.0164887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV). OBJECTIVE This study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis. METHODS A cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women's reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1-2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored. FINDINGS No statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54-1.43) and 0.94 (0.69-1.29), respectively, among women with 1-2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV. CONCLUSION The results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV's eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV.
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Affiliation(s)
- Regina Maria Barbosa
- Núcleo de Estudos da População Elza Berquó –Universidade Estadual de Campinas–Campinas, Brazil
- Centro de Referêcia e Treinamento em DST/AIDS–Secretaria de Estado da Saúde de São Paulo–São Paulo, Brazil
| | - Cristiane da Silva Cabral
- Departamento de Saúde Materno-Infantil–Faculdade de Saúde Pública–Universidade de São Paulo–São Paulo, Brazil
| | | | - Adriana de Araujo Pinho
- Laboratório de Educação em Ambiente e Saúde–Instituto Oswaldo Cruz–Fiocruz–Rio de Janeiro, Brazil
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Cleland J, Shah IH, Daniele M. Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities. Stud Fam Plann 2015; 46:423-41. [DOI: 10.1111/j.1728-4465.2015.00041.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- John Cleland
- Emeritus Professor of Medical Demography, Department of Population Health; London School of Hygiene & Tropical Medicine; Keppel Street London WC1E 7HT United Kingdom
| | - Iqbal H. Shah
- Doctoral student, Faculty of Epidemiology and Population Health, Department of Population Health; London School of Hygiene & Tropical Medicine; Keppel Street London WC1E 7HT United Kingdom
| | - Marina Daniele
- Principal Research Scientist, Department of Global Health and Population; Harvard T.H. Chan School of Public Health; Boston Massachusetts
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Aiken AR. Happiness about unintended pregnancy and its relationship to contraceptive desires among a predominantly Latina cohort. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:99-106. [PMID: 26095732 PMCID: PMC4487420 DOI: 10.1363/47e2215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire. METHODS Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings. RESULTS The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness. CONCLUSIONS Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods.
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Hopkins K, de Lima Amaral EF, Mourão ANM. The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008. Birth 2014; 41:169-77. [PMID: 24684250 PMCID: PMC4426198 DOI: 10.1111/birt.12106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. METHODS We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. RESULTS Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source-hospital type variable for all women and even more so among first births. CONCLUSIONS Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates.
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Wang LG, Qiu Y, Fan YJ, Li XY, Han XJ. Reversible contraceptive effect of the oviduct plug with nickel–titanium shape memory alloy and silicone rubber in rabbits. Contraception 2011; 83:373-7. [DOI: 10.1016/j.contraception.2010.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 08/05/2010] [Accepted: 08/06/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Lei-Guang Wang
- Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Family Planning Institute of Science and Technology, Shandong 250002, China
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Pádua KSD, Osis MJD, Faúndes A, Barbosa AH, Moraes Filho OB. Factors associated with cesarean sections in Brazilian hospitals. Rev Saude Publica 2010; 44:70-9. [PMID: 20140331 DOI: 10.1590/s0034-89102010000100008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/31/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the prevalence of cesarean sections in Brazilian hospitals. METHODS A cross-sectional study was carried out with data from the World Health Organization's Global Data System for Maternal and Perinatal Health, for the Brazilian states of São Paulo, Pernambuco and the Federal District. Data relating to 15,354 women who gave birth between September/2004 and March/2005 were analyzed, according to sociodemographic, reproductive, and hospital-related characteristics. Bivariate analyses - with calculations of the prevalence ratios and respective confidence intervals - and multivariate Poisson regression analyses were performed. RESULTS The prevalence ratio of cesarean sections was significantly higher among older women, who were married/living with a partner and with higher body mass index. The following conditions during pregnancy or birth were associated with higher cesarean section prevalence ratio: parturient being diagnosed as HIV-positive, heavier weight and greater head circumference of the newborn, and more prenatal consultations. In regression analysis, the following variables showed direct association with the outcome: parturient being older and with higher schooling level, presence of hypertension/eclampsia, chronic condition or some other medical condition, newborn's greater head circumference, being primiparous, having had a cesarean in the last pregnancy and having received an epidural block or rachidian analgesic during labor. Although the proportion of cesareans was higher in hospitals with a high complexity index, the difference was not statistically significant, as well as for other characteristics of hospitals. CONCLUSIONS The conditions of the pregnancy, newborn and the sociodemographic and reproductive characteristics of the parturient were independently associated with cesarean delivery. The hospital complexity index was not associated with cesarean delivery, probably due to the homogeneity of the hospital sample.
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Affiliation(s)
- Karla Simônia de Pádua
- Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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Ludermir AB, Machado KMDM, Costa AMD, Alves SV, Araújo TVBD. Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil. CAD SAUDE PUBLICA 2010; 25:1361-8. [PMID: 19503966 DOI: 10.1590/s0102-311x2009000600018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 08/29/2008] [Indexed: 11/22/2022] Open
Abstract
A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.
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Affiliation(s)
- Ana Bernarda Ludermir
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife, Brasil.
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Potter JE, Schmertmann CP, Assunção RM, Cavenaghi SM. Mapping the Timing, Pace, and Scale of the Fertility Transition in Brazil. POPULATION AND DEVELOPMENT REVIEW 2010; 36:283-307. [PMID: 20734553 PMCID: PMC3562356 DOI: 10.1111/j.1728-4457.2010.00330.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Between 1960 and 2000, fertility fell sharply in Brazil, but this transition was unevenly distributed in space and time. Using Bayesian spatial statistical methods and microdata from five censuses, we develop and apply a procedure for fitting logistic curves to the fertility transitions in more than 500 small regions of Brazil over this 40-year period. Doing so enables us to map the main features of the Brazilian fertility transition in considerable detail. We detect early declines in some regions of the country and document large differences between early and late transitions in regard to both the initial level of fertility and the speed of the transition. We also use our results to test hypotheses regarding changes in the level of development at the onset of the fertility transition and identify a temporary stall in the Brazilian transition that occurred in the late 1990s. A web site with project details is at http://schmert.net/BayesLogistic.
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Osis MJD, Carvalho LECD, Cecatti JG, Bento SF, Pádua KSD. Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde. CAD SAUDE PUBLICA 2009; 25:625-34. [DOI: 10.1590/s0102-311x2009000300017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 09/03/2008] [Indexed: 11/22/2022] Open
Abstract
A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.
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Affiliation(s)
| | | | - José Guilherme Cecatti
- Centro de Pesquisas em Saúde Reprodutiva de Campinas, Brasil; Universidade Estadual de Campinas, Brasil
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O'Dougherty M. Lia Won't: Agency in the Retrospective Pregnancy Narratives of Low-Income Brazilian Women. JOURNAL OF LATIN AMERICAN AND CARIBBEAN ANTHROPOLOGY 2008. [DOI: 10.1111/j.1935-4940.2008.00044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oliveira F, Kerr L, Frota A, Nóbrega A, Bruno Z, Leitão T, Kendall C, Galvão M. HIV-positive women in northeast Brazil: tubal sterilization, medical recommendation and reproductive rights. AIDS Care 2008; 19:1258-65. [PMID: 18071969 DOI: 10.1080/09540120701405411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tubal sterilization is the most common contraceptive method used by Brazilian HIV-positive women. This cross sectional study describes the main reasons why HIV-positive women decide to be sterilized and identifies factors associated with choosing sterilization in HIV-positive women in Ceará, northeast Brazil. Data from 229 non-sterilized women, 80 women sterilized before HIV diagnosis and 48 women sterilized after diagnosis were analysed. Of the women sterilized after HIV diagnosis, 96% had the procedure done in the postpartum, during a caesarean section. No desire for more children was the most common appointed reason to be sterilized (39.6%), followed by medical recommendation because of HIV (31.3%). Seventy-nine women (28.5%) had a child after HIV diagnosis. Of those, 46 (58.2%) were sterilized in the postpartum. Factors associated with sterilization for HIV-positive women were: having a child after diagnosis (AOR: 120.9; 95%CI: 27.8-525.4) and having at least three children (AOR: 2.8; 95%CI: 1.1-7.1). It is recommended that non-coercive counselling should be provided so that HIV-positive women can make informed decisions on their reproductive options.
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Affiliation(s)
- F Oliveira
- Department of Community Health, Federal University of Ceará School of Medicine, Fortaleza, Brazil.
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Osis MJD, Faúndes A, Makuch MY, Mello MDB, de Sousa MH, Araújo MJDO. Atenção ao planejamento familiar no Brasil hoje: reflexões sobre os resultados de uma pesquisa. CAD SAUDE PUBLICA 2006; 22:2481-90. [PMID: 17091186 DOI: 10.1590/s0102-311x2006001100023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 07/27/2006] [Indexed: 11/22/2022] Open
Abstract
Realizou-se estudo com uma primeira etapa descritiva, de corte transversal, e segunda etapa qualitativa, de estudo de casos. Avaliou-se a disponibilidade de métodos anticoncepcionais nas Unidades Básicas de saúde de municípios brasileiros, e características da atenção ao planejamento familiar e a articulação com a estratégia de saúde da família. Inicialmente, foram aplicados, por telefone, questionários sobre o recebimento recente de métodos anticoncepcionais, em municípios selecionados a partir de um plano complexo de amostragem. Na etapa qualitativa foram selecionados propositalmente e visitados quatro municípios, onde se realizaram observação e entrevistas semi-estruturadas com gestores e profissionais de saúde. Procedeu-se a análise estatística descritiva e regressão logística múltipla dos dados quantitativos. Para os qualitativos adotou-se a técnica de análise temática do conteúdo. Verificou-se que as ações de planejamento familiar, com freqüência, são executadas de forma isolada e que os profissionais das equipes de saúde da família não entendiam o planejamento familiar como parte da atenção básica e não se consideravam capacitados para prestar assistência nessa área. A atenção ao planejamento familiar continua a ser marcada pela indisponibilidade de métodos anticoncepcionais nos serviços públicos de saúde.
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de Bessa GH. Medicalization, reproductive agency, and the desire for surgical sterilization among low-income women in urban Brazil. Med Anthropol 2006; 25:221-63. [PMID: 16895828 DOI: 10.1080/01459740600840263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article draws on data from ethnographic fieldwork in an urban housing project to examine the social context and meanings of surgical sterilization for low-income women in Brazil. Low-income women resort to sterilization because they distrust or are unsatisfied with alternative methods and because it helps them to fulfill the requirements of modern, responsible motherhood. Although sterilization is an option among few alternatives, and one that has subjected women to greater medical management and intervention, I argue that sterilization also represents poor women's active struggle to improve their lives and to resist the burdens placed on them by unequal gender relations. This article contributes to a growing anthropological literature that demonstrates how reproduction has become a central site where social values are constituted and contested, and it details women's diverse responses to the process of medicalization.
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Affiliation(s)
- Gina Hunter de Bessa
- Department of Sociology and Anthropology, Campus Box 4660, Illinois State University, Normal, IL 61790-4660, USA.
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Zite N, Wuellner S, Gilliam M. Barriers to obtaining a desired postpartum tubal sterilization. Contraception 2006; 73:404-7. [PMID: 16531176 DOI: 10.1016/j.contraception.2005.10.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 10/17/2005] [Accepted: 10/21/2005] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine why women do not undergo postpartum sterilization despite expressing desire during antepartum care. METHODS In a retrospective chart review, we identified all women between March 2002 and November 2003 who requested postpartum sterilization during antepartum care but did not undergo the procedure. We report the reasons why sterilizations were not performed. RESULTS We reviewed 6,589 prenatal care and delivery records identifying 324 women meeting inclusion criteria. One hundred and four women changed their mind. Of women still desiring sterilization at discharge, the most common reasons for not undergoing the procedure were lack of valid Medicaid sterilization consent forms [n=121; 37.3%, 95% confidence interval (CI) 32.0-42.6%]; a medical condition precluding the procedure (n=47; 14.5%, 95% CI 10.7-18.3%); lack of availability of an operating room (n=2; 6.5%, 95% CI 3.8-9.2%). CONCLUSION We found that the Medicaid consent process, medical conditions and insufficient operating room space prevented women from having the desired surgery.
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Affiliation(s)
- Nikki Zite
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, 60612, USA
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Machado KMDM, Ludermir AB, da Costa AM. Changes in family structure and regret following tubal sterilization. CAD SAUDE PUBLICA 2005; 21:1768-77. [PMID: 16410861 DOI: 10.1590/s0102-311x2005000600024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Tubal sterilization is one of the contraceptive methods whose use has increased the most in Brazil, but a growing number of women have expressed regret after the procedure. A case-control study was conducted at the Centro Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Pernambuco, Brazil, in 1997 to investigate the association between changes in family structure and request for or submittal to surgical reversal of tubal sterilization, comparing 304 sterilized women who had requested or submitted to reversal of tubal sterilization and 304 women who were also sterilized but had not requested, had not submitted to, and who did not wish to submit to reversal. The simple and adjusted odds ratios were estimated using logistic regression. The results of the current study showed that death of children, partners without children prior to the current union, and partner change after tubal sterilization were associated with the request for or submittal to reversal of tubal sterilization. More strict criteria are suggested in the indication of tubal sterilization, including an in-depth profile of the woman requesting tubal sterilization and identification of risk factors for future regret.
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Abstract
OBJECTIVE The aim of this study was to assess the rate of and risk factors for not obtaining postpartum sterilization among women who expressed a desire for sterilization during antepartum care. METHODS In this retrospective study, we identified a cohort of women who expressed desire for postpartum sterilization at our center between March 2002 and November 2003. We compared women who did and those who did not undergo the procedure, based on demographic, antenatal, and intrapartum factors. RESULTS Of the 712 women who expressed desire for postpartum sterilization during antepartum care, 327 (46%) did not undergo the procedure. In multivariable analysis, women who were between the ages of 21 and 25 years (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.89), were African American (OR 0.68, 95% CI 0.47-1.00), requested sterilization in the second trimester (OR 0.50, 95% CI 0.29-0.86)), and had a vaginal delivery (OR 0.21, 95% CI 0.14-0.32) rather than cesarean delivery were least likely to undergo postpartum sterilization. CONCLUSION Despite their initial request, only 54% of women in our sample underwent sterilization. Young age, African-American race, request in the second trimester, and vaginal delivery were significantly associated with not undergoing sterilization. Our data suggest that providers should counsel all women who desire postpartum sterilization about the wide array of contraceptive methods available, with the understanding that approximately half of all women may not undergo the sterilization procedure. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Nikki Zite
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, 60612, USA
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Hopkins K, Maria Barbosa R, Riva Knauth D, Potter JE. The impact of health care providers on female sterilization among HIV-positive women in Brazil. Soc Sci Med 2005; 61:541-54. [PMID: 15899314 DOI: 10.1016/j.socscimed.2004.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 12/14/2004] [Indexed: 10/25/2022]
Abstract
This paper explores the reproductive preferences and outcomes of HIV-positive women in two cities in Brazil. We used three types of data, all drawn from women who delivered in public sector hospitals: (1) clinical records of 427 HIV-positive women; (2) pre- and postpartum in-depth interviews with 60 HIV-positive women; and (3) a prospective survey carried out among 363 women drawn from the general population. The HIV-positive samples were collected on women who had prenatal care between July 1999 and June 2000, and the general population survey was conducted with women who started prenatal care between April 1998 and June 1999. Among the women in the clinic sample, we found dramatic differences in the proportion sterilized postpartum: 51% in Sao Paulo vs. 4% in Porto Alegre, compared to 3.4% and 1.1%, respectively, of women in the general population. Our qualitative data suggest that HIV-positive women in this study had strong preferences to have no more future children and that female sterilization was the preferred way to achieve this end. Therefore, we conclude that the large difference in rates is mainly due to HIV-positive women's differential access to sterilization in the two settings. In-depth interviews revealed that women in Sao Paulo were often encouraged by clinic staff to be sterilized postpartum. In contrast, HIV-positive women in Porto Alegre clinics were not offered sterilization as an option and those who requested it were repeatedly put off. The striking difference found in the frequency with which doctors provide postpartum sterilization to seropositive women in our study sites deserves attention and discussion in the respective medical communities. At the higher level of national policy on reproductive rights, there may be grounds for reopening discussion about the norms regarding postpartum procedures, and for devoting far more resources to expanding contraceptive options.
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Affiliation(s)
- Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, USA
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Knauth DR, Barbosa RM, Hopkins K. Between personal wishes and medical "prescription": mode of delivery and post-partum sterilisation among women with HIV in Brazil. REPRODUCTIVE HEALTH MATTERS 2004; 11:113-21. [PMID: 14708402 DOI: 10.1016/s0968-8080(03)22100-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
HIV-positive women are confronted during pregnancy with a range of medical information and prescriptions that substantially affect the experience of pregnancy and birth. Based on antenatal and post-partum interviews with 60 HIV-positive pregnant women from São Paulo and Porto Alegre, Brazil, this article presents evidence of some of the factors that affect mode of delivery and access to post-partum sterilisation, and the implications of these. Whether women gave birth vaginally or by caesarean section was medically prescribed, with women's own preferences taking second place. Some were advised that caesarean section was the only option with HIV in pregnancy; others were told it should be used only for medical indications, even if the woman wanted to be sterilised at the same time. The women in Porto Alegre were less likely to get a sterilisation than those in São Paulo, even with caesarean section, as sterilisation was not encouraged locally. Many of the women who accepted a caesarean had been convinced before they gave birth that it was the best choice for them, either because it reduced the risk of perinatal HIV transmission or because it facilitated tubal ligation, or both. However, after they gave birth, the women judged their experience of delivery and the post-partum period mainly in comparison to previous deliveries, and many of them viewed the birth experience with HIV as more difficult than previous deliveries and worse than they had expected.
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Barbosa RM, Knauth DR. Esterilização feminina, AIDS e cultura médica: os casos de São Paulo e Porto Alegre, Brasil. CAD SAUDE PUBLICA 2003; 19 Suppl 2:S365-76. [PMID: 15029356 DOI: 10.1590/s0102-311x2003000800018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este artigo busca identificar os fatores que interferem nas escolhas reprodutivas de gestantes HIV positivo focalizando, em particular, o papel desempenhado pelos serviços de saúde e pela cultura médica nessas escolhas. O desejo e a realização de laqueadura tubária pós-parto constituem os eventos reprodutivos tomados como questões de análise. Os dados apresentados resultam de uma pesquisa desenvolvida em serviços de pré-natal nas cidades de São Paulo e Porto Alegre, que utilizou um desenho que combinou duas estratégias metodológicas: quantitativa, a partir de dados coletados em 427 prontuários clínicos, e qualitativa, por meio da observação etnográfica e realização de sessenta entrevistas em profundidade. A grande maioria de mulheres nas duas cidades manifestou o desejo de realizar a esterilização depois do parto. Entretanto, uma proporção muito maior de mulheres em São Paulo atingiu sua meta comparada a uma pequena proporção em Porto Alegre. A cultura médica local com relação à laqueadura, aliada à organização da prática de assistência ao pré-natal e parto, mostrou-se fator fundamental para compreender as diferenças encontrada nas duas cidades.
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Affiliation(s)
- Regina Maria Barbosa
- Núcleo de Estudos Populacionais, Universidade Estadual de Campinas, Campinas, SP, 13081-970, Brasil.
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