Ana Márcia Spanó Nakano

Percepção de mulheres em situação de violência sobre o suporte e apoio recebido em seu contexto social

We seek to identify the perceptions of women in situations of violence concerning the support and assistance received in its social context, particularly, the institutionalized resources to combat violence against women. A descriptive exploratory qualitative approach was developed at the Institute of Forensic Medicine in Ribeirao Preto, Brazil. We interviewed 57 women victims of aggravated assault domestic violence and analyzed the results thematically. The search for help occurs in its own social environment, together with family and friends. The use of health services depends on the perception of the severity of the condition and does not always result in adequate responses to these womens demands. In justice, the reality of helplessness and disbelief points to dislocation and failure of available social support institutions for victims. For integral and humanized care, the actions should go beyond the protocols of action, thinking of prevention and reduced violence strategies.Buscamos identificar a percepcao das mulheres em situacao de violencia sobre o suporte e o apoio recebido em seu contexto social, particularmente, dos recursos institucionalizados de combate a violencia contra a mulher. Estudo descritivo e exploratorio de abordagem qualitativa desenvolvido no Instituto Medico Legal de Ribeirao Preto. Foram entrevistadas 57 mulheres, vitimas de violencia domestica do tipo lesao corporal dolosa, e os dados analisados pela modalidade tematica. A busca por ajuda ocorre no seu proprio meio social, junto a familia e amigos. A utilizacao dos servicos de saude depende da percepcao da gravidade do estado de saude e nem sempre resulta em resposta adequada as demandas das mulheres. Na justica, a realidade de desamparo e descrenca aponta para desarticulacao e inoperância das instituicoes sociais de suporte as vitimas. Para o atendimento integral e humanizado, as acoes devem ir alem de protocolos de acao, pensando em estrategias de prevencao e reducao de violencia.

Conhecimento e atitudes dos profissionais de saúde em relação à violência de gênero

OBJETIVOS: Varias sao as politicas publicas no Brasil para o enfrentamento da violencia contra a mulher. Registra-se na literatura que os profissionais de saude acham o tema de dificil abordagem. Para melhorar o atendimento no SUS em Ribeirao Preto, realizou-se um estudo para avaliar o conhecimento e a atitude dos profissionais de saude em relacao a violencia de genero. METODOS: Contataram-se 278 profissionais de saude, dos quais 221 foram entrevistados utilizando-se um questionario estruturado. RESULTADOS: 51 (23,0%) eram enfermeiras e 170 (77,0%) medicos; 119 (53,8%) homens e 102 (46,2%) mulheres, com idade media de 38,6 anos; 200 (90,5%) consideravam-se brancos ou asiaticos e 21 (9,5%) pretos e pardos. Tinham em media 12,5 anos de vida profissional e 158 (68,8%) eram oriundos de universidade publica. Apenas pouco mais da metade (58,7%) mostrou conhecimento geral adequado (bom e alto) sobre a violencia de genero, o que indica a necessidade de capacitar os profissionais para este atendimento. Em relacao as barreiras para averiguar a violencia, os profissionais citaram a falta de uma politica institucional e o silencio da mulher que nao revela a violencia. Os entrevistados, em particular as mulheres jovens, apresentaram atitudes mais favoraveis para o acolhimento da mulher em situacao de violencia. CONCLUSOES: A maioria dos entrevistados demonstrou atitudes positivas e podemos inferir que ha bom potencial para o manejo adequado dos casos, se receberem capacitacao.

Significados atribuídos por puérperas adolescentes à maternidade: autocuidado e cuidado com o bebê

The objectives of this study were to identify the meanings attributed by adolescent mothers towards care for their babies and self-care, and to identify what they recognize as difficulties during their postpartum period and concerning caring for their respective babies. This study used a qualitative approach that took place in a maternity hospital that attends women through the Brazilian National Health Care System (Sistema Unico de Saude) from January to March of 2005. The subjects were 22 adolescent first time pregnant women. The data was collected via semi-structured interviews, recorded, and submitted to posterior thematic content analysis. Maternity is understood as a psychological, social, and physical change with maternal care as a duty to be exercised, taking priority when compared with self-care. The lack of experience, information, and their financial situations were pointed out as the main difficulties to care, with family listed as support. Society underestimates the adolescents capacity to care for the child, needing to create strategies for developing the adolescents autonomy in order that she actively assume her maternal responsibilities. DESCRIPTORS: Womens health. Adolescent health. Postpartum period. Self care.

Violência contra a mulher: a visibilidade do problema para um grupo de profissionais de saúde

A identificacao de mulheres em situacao de violencia e de extrema importância. Entretanto, o setor saude nem sempre vem oferecendo uma resposta satisfatoria para o problema. Buscamos identificar como os profissionais de saude de uma maternidade percebem e atuam frente situacao de violencia. Constitui-se uma pesquisa qualitativa, sendo os dados coletados atraves de entrevistas semi-estruturadas e analisados pela modalidade tematica. O grupo de estudo foi composto por 12 profissionais de saude de uma maternidade filantropica de Ribeirao Preto. Observou-se que os profissionais de saude caracterizaram a violencia contra a mulher como um problema serio e importante na sociedade, tendo como causa e consequencia a desigualdade de genero. No entanto, na pratica profissional ha uma abordagem reducionista e biologicista com fragmentacao da atencao a saude da mulher, justificado pela falta de formacao profissional, suporte institucional e de uma equipe multidisciplinar.It is extremely important to identify women living in a violent situation. However, the health sector has not always offered a satisfactory response for the issue. We sought to identify how the health professionals of a maternity perceive and act in view of a violent situation. This is a qualitative research, in which the data were collected through semistructured interviews and subject to thematic analysis. The study group consisted of 12 health professionals from a philanthropic maternity hospital located in Ribeirão Preto, Sao Paulo State, Brazil. It was observed that health professionals characterize violence against women as a severe and important problem in society, caused by and leading to gender inequality. However, professional practice tends towards a biologistic and reductionist approach, which fragments womens health care,justified bythe lack of professional training, institutional support and a multidisciplinary team.

O espaço social das mulheres e a referência para o cuidado na prática da amamentação

This study aimed to identify agents or institutions taken as reference by women when breastfeeding. A qualitative study was carried out on 20 primiparous who were assisted, for reasons not related to breastfeeding, in the five health services selected by this study. Data were collected by semi-structured interviews carried out in the participants’ households and were analyzed by content analysis in the thematic mode. We identified that health professionals play a standardize role of breastfeeding based on scientific knowledge. In the daily breastfeeding routine, the family is the first reference for women, transmitting beliefs, habits and behaviors. We believe in the valorization of the family context by the health professional, in which actions and interactions in the breastfeeding issue are developed in order to constitute the foundations for a new care model in breastfeeding. This model should, therefore, consider the practice diversity, adapting actions to the multiple roles of being mother/fortress/wife/worker in the social context.

Indicadores do aleitamento materno no município de Ribeirão Preto, São Paulo

O estudo objetiva identificar a situacao do Aleitamento Materno utilizando os indicadores propostos pela OMS (1991), em criancas menores de 1 ano que compareceram a segunda etapa da campanha nacional de vacinacao em 1999, no municipio de Ribeirao Preto, SP. Do total de 7.894 criancas menores de 1 ano que compareceram a campanha de vacinacao, fizeram parte da amostra estudada 1.715 criancas (21,7%). Destas, 951 (55,5%) receberam leite materno nas ultimas 24 horas. Para o grupo menores de 4 meses (554 criancas) obtivemos os indices de 104 (18,8%) em Aleitamento Materno Exclusivo; 223 (40,3%) em Aleitamento Materno Predominante; 327 (59%) em Aleitamento Materno Completo; e 471 (85%) em Aleitamento Materno. A utilizacao de outro leite associado ao leite materno foi verificada em 144 (26%) das criancas menores de 4 meses e em 268 (31,5%) das criancas menores de 6 meses. A duracao media do aleitamento materno para o municipio foi de 6 meses. A metodologia possibilitou comparacao dos dados com aqueles obtidos para o Estado de Sao Paulo e forneceu subsidios para redirecionar e planejar acoes em aleitamento materno.

Women's social space and the reference for breastfeeding practice

This study aimed to identify agents or institutions taken as reference by women when breastfeeding. A qualitative study was carried out on 20 primiparous who were assisted, for reasons not related to breastfeeding, in the five health services selected by this study. Data were collected by semi-structured interviews carried out in the participants’ households and were analyzed by content analysis in the thematic mode. We identified that health professionals play a standardize role of breastfeeding based on scientific knowledge. In the daily breastfeeding routine, the family is the first reference for women, transmitting beliefs, habits and behaviors. We believe in the valorization of the family context by the health professional, in which actions and interactions in the breastfeeding issue are developed in order to constitute the foundations for a new care model in breastfeeding. This model should, therefore, consider the practice diversity, adapting actions to the multiple roles of being mother/fortress/wife/worker in the social context.

La violencia intrafamiliar, el uso de drogas en la pareja, desde la perspectiva de la mujer maltratada

El presente estudio tiene la finalidad de visibilizar la violencia que afecta a las mujeres, teniendo como principales elementos precipitantes de la actitud violenta del agresor la ingesta de alcohol y/o drogas. Los objetivos del presente estudio son: conocer los significados que la mujer le atribuye a la violencia; reconocer los diferentes factores relacionados a la ocurrencia de la violencia intrafamiliar e identificar como se procesa el consumo de drogas en la pareja. El tipo de estudio es exploratorio y descriptivo, se utilizo la metodologia cualitativa, el recorte empirico lo constituyeron seis mujeres, quienes acudieron a realizar su denuncia a la Comisaria de Mujeres de Lima. Los hallazgos muestran que el tiempo de union oscilo entre dos meses y dieciocho anos, ocurriendo el maltrato en casi todo el tiempo de union. Con respecto al tipo de violencia sufrida la de mayor magnitud fue la fisica; de forma mas sutil la psicologica, la violencia sexual no fue referida, el dinero y celos fueron referidos como focos desencadenantes de las discusiones, las que estan asociados al uso de alcohol y droga en el agresor. Las categorias establecidas fueron: el tipo de violencia sufrida por las mujeres, el contexto de la violencia, la repercusion de la violencia sufrida por la mujer en su salud y la reaccion de violencia sufrida por medio de la denuncia. Como principales conclusiones tenemos que la violencia contra las mujeres se revela como tema social y sanitario, con repercusiones en la morbi-mortalitad y en terminos de calidad de vida de las mujeres., en el campo de la salud, es necesario reconocer a las mujeres en situacion de violencia, considerar como factores de riesgo para la pareja el uso de alcohol y drogas, las mujeres ocultan por verguenza la problematica que viven, el personal de salud debe ser capaz de diagnosticar la violencia en sus diferentes formas, expresadas por quejas o dolores cronicos sin causas aparentes.The present study has the visibilizar purpose the violence that affects the women, having as main elements precipitants of the aggressors violent attitude the ingest of alcohol and/or it drugs. The objectives of the present study are: to know the meanings that the woman attributes to the violence; to recognize the different factors related to the occurrence of the family violence and to identify like the consumption of drugs is processed in the couple. The study type is exploratory and descriptive, the qualitative methodology, the empiric cutting was used six women they constituted it who went to carry out its accusation to the Police station of Women from Lima. The discoveries show that the time of union oscillated between two months and eighteen years, happening the abuse in case the whole time of union. With regard to the type of suffering violence that of more magnitude was the physics; in a subtler way the psychological one, the sexual violence was not referred, the money and jealousies were referred as focuses desencadenantes of the discussions, those that are associated to the use of alcohol and it drugs in the aggressor. The established categories were: the type of violence undergone by the women, the context of the violence, the repercussion of the violence undergone by the women in its health and the reaction of violence undergone by means of the denunciation. As main conclusions we have that the violence against the women is revealed like social and sanitary topic, with repercussions in the morbi-mortality and in terms of warm of the womens life, in the field of the health, it is necessary to recognize the women in situations of violence, to consider as factors of risk for the couple the use of the alcohol and drugs, the women hide for shame the problem that you/they live, the personnel of health it should be able to diagnose the violence in their different forms, expressed by complaints or chronic pains without apparent causes.

A prática do aleitamento materno em um grupo de mulheres brasileiras: movimento de acomodaçäo e resistência

Actions to stimulate breastfeeding are directed to assist childrens needs and do not contemplate woman in her specificities The present study aimed at understanding the meanings women give to their experiences and demands in the practice of breastfeeding. 20 women that were experiencing breastfeeding for the first time were interviewed. Data analysis were based on the feminist theory. Authors found breast feeding as a feminine process socially determined. Women showed accomodation as they felt the act of breast feeding as donation, a sacrifice and dedication as well as resistance when they justified weaninng affirming the lack of physiological capacity for breastfeeding.Actions to stimulate breastfeeding are directed to assist childrens needs and do not contemplate woman in her specificities. The present study aimed at understanding the meanings women give to their experiences and demands in the practice of breastfeeding. 20 women that were experiencing breastfeeding for the first time were interviewed. Data analysis were based on the feminist theory. Authors found breast feeding as a feminine process socially determined. Women showed accommodation as they felt the act of breast feeding as donation, a sacrifice and dedication as well as resistance when they justified weaning affirming the lack of physiological capacity for breastfeeding.

Adolescent pregnancy: a comparative study between mothers who use public and private health systems

This is a comparative and descriptive study of adolescent mothers who were attended in three maternities of the public health system and three private maternities in a city in Sao Paulo, Brazil, between 2000 and 2002. This study aimed to compare the profile of mothers attended in both systems. The database of Ribeirao Preto was used and 5,286 adolescent mothers between 10 and 19 years old were selected according to type of delivery, level of instruction, number of prenatal consultations and parity. We found that the users of the public health system had less prenatal consultations, lower level of education, higher parity and the vaginal delivery was most frequent. The users of the private health system, on the contrary, had more prenatal consultations, higher level of instruction, and primiparity and cesarean sections were more frequent.This is a comparative and descriptive study of adolescent mothers who were attended in three maternities of the public health system and three private maternities in a city in São Paulo, Brazil, between 2000 and 2002. This study aimed to compare the profile of mothers attended in both systems. The database of Ribeirão Preto was used and 5,286 adolescent mothers between 10 and 19 years old were selected according to type of delivery, level of instruction, number of prenatal consultations and parity. We found that the users of the public health system had less prenatal consultations, lower level of education, higher parity and the vaginal delivery was most frequent. The users of the private health system, on the contrary, had more prenatal consultations, higher level of instruction, and primiparity and cesarean sections were more frequent.