RESUMO
OBJECTIVE: Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS: We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS: In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS: In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.
Assuntos
Aborto Induzido , Aborto Legal , Gravidez , Feminino , Humanos , Argentina , Brasil , Idade GestacionalRESUMO
ABSTRACT OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.
RESUMEN OBJETIVO Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016-2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba chi-cuadrado. RESULTADOS En el 2016, 37 personas por cada 100,000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100,000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100,000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0.2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas.
Assuntos
Humanos , Feminino , Gravidez , Argentina , Aborto Induzido , Aborto Legal , Modelos de Assistência à SaúdeRESUMO
STUDY OBJECTIVE: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. RESULTS: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. CONCLUSION: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.
Assuntos
Gravidez na Adolescência/prevenção & controle , Adolescente , Feminino , Humanos , América Latina , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Youth violence in Latin America is an important public health problem. However, the evidence from preventive programs within the region to address this problem is limited. Identifying context-specific factors that facilitate or hinder the success of interventions is necessary to guarantee the successful implementation of new preventive strategies. We present a systematic review and synthesis of qualitative studies to identify factors affecting the implementation of programs to prevent youth violence in Latin America. We searched 10 electronic databases and websites of international institutions. The quality of the studies was assessed using the critical appraisal skills program checklist, while the certainty of the findings of the synthesis was assessed using the certainty of the qualitative evidence approach. We included eight papers describing five programs in Argentina, Venezuela, Peru, El Salvador, and Mexico. Most of the factors affecting the implementation of programs were aspects related to features of the programs and social/political constraints. The synthesis suggests that future programs can benefit from having a multidisciplinary and/or multisectoral approach involving different key players. At the same time, potential strategies for avoiding problems related to such active engagement should be planned via promoting effective channels for communication and supervision. The review also suggests the importance of increasing awareness and motivation toward the problem of youth violence among relevant agencies and stakeholders. While the limited volume and quality of the literature impact on the ability to draw conclusions, the results could be useful for new programs being designed and the ones seeking to be adapted from other contexts.
Assuntos
Desenvolvimento de Programas/métodos , Violência/prevenção & controle , Adolescente , Argentina , Bullying/prevenção & controle , Criança , El Salvador , Feminino , Humanos , América Latina , Masculino , México , Peru , Pesquisa Qualitativa , Venezuela , Adulto JovemRESUMO
Objetivos: Describir las prácticas médicas realizadas en la atención prenatal en mujeres en Perú e identificar silas prácticas de control prenatal (CPN) recibidas por mujeres adolescentes y adultas fueron distintas. Material ymétodos: Estudio descriptivo y comparativo. Se utilizaron datos recolectados por la Encuesta Demográfica y de Salud Familiar continua 2004-2008, con 994 adolescentes (15-19 años) y 12556 adultas (20-49 años). Se efectuaron comparaciones entre adolescentes y adultas en relación con las prácticas médicas efectuadas durante la atención prenatal. Resultados: El 50% de las adolescentes inició el CPN en el tercer mes de embarazo en comparacióncon la mitad de las adultas que lo inició en el segundo mes. La mitad de las adolescentes reportaron 7 visitasde CPN en total mientras que el 50% de adultas reportaron 8. Menor proporción de adolescentes reportó haberrecibido algunas de las acciones y prácticas médicas que se efectúan durante la atención prenatal...
Objective: To describe medical practices reported by women that received prenatal care (PNC) in Peru.Particularly, we aim to identify differences in the services provided to adolescents compared to adult women.Methods: Descriptive study. Data came from the Demographic Health Surveys 2004-2008 in Peru, which includedinformation of 994 adolescents (15-19 years old) and 12 556 adult women (20-49 years old). Comparisons weremade between adolescents and adult women regarding the practices received during prenatal care visits. Results:Among adolescents, 50% initiated PNC during the third month of pregnancy whereas half of the adult womenstarted on the second month. Adolescents received 7 prenatal visits comparing to 8 in adult women. Comparing to adult women, adolescents reported in lower proportions that they received some of the medical practices duringprenatal care...
Assuntos
Feminino , Humanos , Adolescente , Gravidez , Adulto Jovem , Serviços de Saúde , Gravidez na Adolescência , Cuidado Pré-Natal , Epidemiologia Descritiva , PeruRESUMO
OBJECTIVE: To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. MATERIALS AND METHODS: A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. RESULTS: A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). CONCLUSION: It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.
Assuntos
Escolaridade , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Criança , Comportamento Contraceptivo , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Civil , México/epidemiologia , Modelos Teóricos , Gravidez , Gravidez na Adolescência/prevenção & controle , Fatores Socioeconômicos , Evasão Escolar/estatística & dados numéricos , Adulto JovemRESUMO
Objetivo. Caracterizar a las adolescentes que han tenido algún embarazo y analizar la asociación de éste con el rezago educativo, a partir de una encuesta representativa en México. Material y métodos. Estudio transversal con información de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012, con datos sociodemográficos y reproductivos de 1 790 mujeres de 12 a 19 años de edad con inicio de vida sexual y antecedente de embarazo. Se ajustaron tres modelos estadísticos para observar la asociación entre variables. Resultados. El rezago educativo está presente en 74.9% de las adolescentes con antecedente de embarazo. Tener embarazo previo está asociado con cohabitar con la pareja (RM=8.4), rezago educativo (RM=2.4), nivel socioeconómico bajo (RM=2.0) y asistencia a la escuela (RM=0.5). El rezago educativo muestra una asociación con el antecedente de embarazo alguna vez en la vida (RM=2.4), no así con el primer embarazo al momento de la encuesta. Conclusión. Se requieren políticas y estrategias operativas eficientes para favorecer la permanencia escolar y reducir el rezago educativo en adolescentes con y sin hijos.
Objective. To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. Materials and methods. A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. Results. A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). Conclusion. It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Adulto Jovem , Gravidez na Adolescência/estatística & dados numéricos , Escolaridade , Gravidez na Adolescência/prevenção & controle , Fatores Socioeconômicos , Evasão Escolar/estatística & dados numéricos , Estudos Transversais , Inquéritos Epidemiológicos , Comportamento do Adolescente , Estado Civil , Comportamento Contraceptivo , México/epidemiologia , Modelos TeóricosRESUMO
BACKGROUND: Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents' or children's reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication. OBJECTIVE: The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics. SUBJECTS: A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study. METHODS: The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents. RESULTS: Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p<0.05 for father-adolescent dyads and p<0.001 for mother-adolescent dyads). CONCLUSION: Our findings suggest a low congruence between parents' and adolescents' reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.
Assuntos
Relações Pai-Filho , Relações Mãe-Filho , Pais/psicologia , Saúde Reprodutiva , Educação Sexual/métodos , Educação Sexual/estatística & dados numéricos , Adolescente , Adulto , Preservativos , Estudos Transversais , Países em Desenvolvimento , Feminino , Comunicação em Saúde , Humanos , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Relações Mãe-Filho/psicologia , Saúde Reprodutiva/educação , Instituições Acadêmicas , Comportamento Sexual , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aims to explore adolescents' intentions related to the early formation of a family. MATERIALS AND METHODS: We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974). RESULTS: Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (ß=0.13). CONCLUSIONS: In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.
Assuntos
Objetivos , Gravidez na Adolescência/prevenção & controle , Psicologia do Adolescente , Adolescente , Estudos Transversais , Educação , Feminino , Humanos , México , Gravidez , Inquéritos e QuestionáriosRESUMO
Objetivo. Analizar la percepción de mujeres y proveedores de salud sobre cuándo y cómo realizar acciones para la detección temprana del cáncer de mama y cervicouterino en localidades de Morelos con presencia de población indígena. Material y métodos. Se entrevistó a 10 proveedores de salud y 58 usuarias en unidades médicas del primer nivel de atención de cinco localidades; luego se analizó la información con base en el paradigma de la teoría fundamentada. Resultados. El personal de salud está deficientemente familiarizado con los lineamientos oficiales para la detección de cáncer cervicouterino y de mama. Pocos practican sus labores bajo una perspectiva de sensibilización intercultural. Las usuarias tienen nociones imprecisas o equivocadas de las acciones de detección. Conclusiones. La necesidad de capacitación con apego a las normas es evidente. Urge asumir un abordaje con pertinencia cultural que permita la comunicación eficiente y alfabetización en salud para la detección oportuna de estos dos cánceres.
Objective. To analyze the perception in relation to when and how to perform actions for the early detection of breast and cervical cancer among women and health care providers in communities with a high percentage of indigenous population in Morelos, Mexico. Materials and methods. Ten health providers and 58 women users of health services were interviewed which have a first level of attention in five communities. The analysis was developed under the approach of the Grounded Theory. Results. Providers are poorly informed about current regulations and specific clinical indications for the detection of cervical and breast cancer. Few propitiate health literacy under intercultural sensitization. The users have imprecise or wrong notions of the early detection. Conclusions. The need for training in adherence to norms is evident. It is urgent to assume a culturally relevant approach to enable efficient communication and promote health literacy for early detection of these two cancers.