Elaine Reis Brandão

Aproximacoes socioantropologicas sobre a gravidez na adolescencia

This paper aims to discuss the construction of teenage pregnancy as a social problem. It also seeks to present and analyze the data of the qualitative phase of the research study Teenage Pregnancy: A Multicentric Study of Young People, Sexuality and Reproduction in Brazil (GRAVAD study) undertaken in four Brazilian capitals: Porto Alegre, Rio de Janeiro and Salvador. The data indicate the indissoluble character of the articulation between social class and gender in the understanding of the phenomenon of teenage pregnancy. Among girls from the middle class we observe alterations in their management of their school projects and course, which, until that point, were processed in a linear manner. The same does not occur among girls from lower income groups whose irregularity in school life is independent of motherhood. Among the young men there are no significant changes, since middle class boys not interrupt their school projects or courses, and boys from lower income groups enter the work force precociously, and this is not a direct consequence of teenage fatherhood.

Sexualidade e gravidez na adolescência entre jovens de camadas médias do Rio de Janeiro, Brasil

The subject of this paper is teenage pregnancy among middle-class youth, a topic not sufficiently studied in Brazil. The paper is based on a qualitative, socio-anthropological study of 14 middle-class families in Rio de Janeiro, Brazil, whose children have remained single, living with their parents after the childs birth. A total of 25 in-depth interviews were conducted with 6 young men and 7 young women, ages 18 to 24, and their parents (11 mothers, one father), to examine the event in retrospect and its impact on these young people and their families. Three aspects are analyzed: difficulties young people face in internalizing contraception as a norm; late discovery of pregnancy; and how the decision to either have an abortion or give birth is made by young people and their parents. This research allows seeing teenage pregnancy as an event that hinges on the process of constructing a young persons autonomy, in which sexuality plays a prominent role. Concluding, the phenomenon should be analyzed in a specific historical and cultural context, with changes over the decades in the rules underlying the process of individualization among young people.

Vulnerabilidades no uso de métodos contraceptivos entre adolescentes e jovens: interseções entre políticas públicas e atenção à saúde

This article discusses the moments of vulnerability in the utilization of contraceptive methods in the affective-sexual relations in adolescence and youth. The analyzed material consists of 17 semi-structured interviews with young people between 18 and 24 years (9 females and 8 males) of the middle-class of the city of Rio de Janeiro that had passed though at least one episode of pregnancy during adolescence. We also discuss the recent implementation of public policies focused on the sexuality and reproductive health of adolescents and the position of health professionals with respect to this subject within the scope of the Program of Integrated Healthcare for Women, Children and Adolescents (PAISMCA/SES-RJ). The results of the study show discontinuities in the use of contraceptive methods due to the strong gender hierarchy in the relationships between adolescents and the absence of appropriate sexual education in the family and school environments. There is little space for dealing with the sexual questions of the young in health services and schools. There are also cultural barriers that make it difficult for the society to approach the subject in a less prejudicial way, thus turning sexual initiation into a process full of silence and moral disapproval.

Desafios da contracepção juvenil: interseções entre gênero, sexualidade e saúde

This paper shows, from a social anthropological perspective, the challenges faced by young people in managing their sexual and affective lives, when it comes to preventing unexpected pregnancy. It aims to discuss some of the difficulties young people have when dealing with contraception along their sexual and affective lives and also to identify circumstances in which they tend not to use contraceptive methods. A qualitative research is presented, in which empirical data consists of 73 in-depth interviews with young people of both sex, with age ranging from 18 to 24, living in three state capitals in Brazil (Salvador, Rio de Janeiro, Porto Alegre), and inserted in two social segments (popular and intermediate), who went through at least one experience of teenage pregnancy. A thematic analysis of data was adopted in order to assemble similar and repeated elements in the testimonies of the young people interviewed as well as to assemble the contrasts of gender and social segments. Results that reveal the difficulties of young people in adopting a continued use of contraceptive methods were listed according to the following themes: relationship context; relationship with the family regarding sexuality; side effects of hormonal anticonceptive methods; negligence with contraception; problems with health services; failure of contraceptive methods; a strong sense of fatherhood found in the popular segments; use of condoms with unknown female partners; withdrawal with no knowledge of the partner menstrual cycle.

Ações para o enfrentamento da violência contra a mulher em duas unidades de atenção primária à saúde no município do Rio de Janeiro

Propos-se conhecer e discutir acoes voltadas para o enfrentamento da violencia domestica no âmbito do Programa de Assistencia Integral a Saude da Mulher. Para tanto, buscou-se levantar e comparar as praticas profissionais em duas unidades de saude do municipio do Rio de Janeiro, sendo uma delas referencia para o atendimento as vitimas de violencia. Foram realizadas oito entrevistas em profundidade, semiestruturadas, com profissionais das equipes do Programa de Saude da Mulher. Embora ambas as unidades identifiquem frequentemente usuarias vitimas de violencia domestica, na unidade de referencia os profissionais se mostraram mais preparados para identificar o problema quando este nao se apresenta de forma explicita e para desenvolver acoes de acolhimento dentro da propria unidade de saude. O que diferencia as duas unidades e o encaminhamento dado ao problema, relacionado com a forma como cada servico entende a violencia como demanda inerente tambem a esfera da saude.

Teenage pregnancy and moral panic in Brazil

This paper examines teenage pregnancy as a social‐historical construction of increasing concern in Brazil. It presents findings from over five years of empirical research alongside an analysis of a sample of newspaper articles representative of the dominant positions in the Brazilian press concerning teenage pregnancy. In contrast to mainstream arguments and to broader moral panic surrounding teenage pregnancy, we argue that contemporary patterns of sexual behaviour among young people in Brazil do not signal growing permissiveness and are not straightforwardly related to poverty, family dysfunction or lack of life projects on the part of young people themselves. On the contrary, early pregnancy and parenthood retain strong continuities with core Brazilian values and norms of sexual culture.

Contraception and family planning services as viewed by users of three clinics in the Unified National Health System, Rio de Janeiro State, Brazil

This article presents partial data from a larger qualitative, socio-anthropological survey in five States of Brazil, aimed at grasping the perspectives of users in urban and rural areas on their contraceptive and reproductive experiences, and their perceptions concerning contraceptive and family planning care in the Unified National Health System. The article focuses on findings in the State of Rio de Janeiro from 60 individual semi-structured interviews with users 18 to 49 years of age in two primary care clinics in the State capital and one rural clinic under the Family Health Program (FHP). There was a greater diversity in the use of methods in the capital as compared to the interior, where tubal ligation was the only alternative to the pill. Group education work in the capital expands the possibilities for choice of methods and collective learning, although access to the IUD and tubal ligation is still considered problematic, due to difficulties in providing such care. The health services prioritize care for women that have already begun childbearing, and more care is needed for non-pregnant adult women and adolescents, in addition to strengthening the educational work in the FHP.

Marcos normativos da anticoncepção de emergência e as dificuldades de sua institucionalização nos serviços públicos de saúde

Este artigo discute as dificuldades de implementacao da Anticoncepcao de Emergencia (AE) nas praticas do Sistema Unico de Saude, no periodo de 2000 a 2008, mediante revisao critica da literatura sobre o tema e analise de documentos oficiais. Aponta avancos no âmbito da legislacao em saude para a utilizacao da AE, os quais permitem oficialmente reconhece-la no pais como alternativa contraceptiva em situacoes emergenciais, para alem dos casos de violencia sexual. O levantamento da literatura nacional e internacional, centrada na America Latina e em alguns estudos da Europa, dos EUA e do Canada, suscita questoes referentes a nao-incorporacao dessas normas nas praticas cotidianas dos servicos de saude, revelando representacoes sociais dificeis de serem revertidas em pouco tempo. Documentos oficiais do MS e do CFM foram analisados para construcao do marco legal e politico-institucional que pauta a discussao. Os resultados mostram paradoxos entre as normas asseguradas e as praticas existentes nos servicos de saude: dificuldade no acesso e utilizacao da AE via servicos publicos de saude; a pilula do dia seguinte (PDS) e comumente considerada abortiva por profissionais de saude, usuarias e seus parceiros; embora pesquisas apontem aumento significativo do uso desse metodo, ha resistencia dos servicos a disponibiliza-lo; persiste a ideia recorrente no senso comum de que a AE levaria os usuarios, principalmente adolescentes, a abandonar outros metodos contraceptivos de uso regular, inclusive preservativo, fato nao confirmado pelos estudos realizados, pois eles indicam que os adolescentes que recorrem a AE sao os que usam tal metodo.

Contracepção de emergência no contexto das farmácias: revisão crítica de literatura

RESUMO A revisao de literatura busca discutir as politicas de provisao da contracepcao de emergencia (CE), notadamente por meio das farmacias, na literatura internacional e nacional. Metodologia: pesquisa nas bases de dados Medline/Pubmed, Sociological Abstracts e Scielo Brasil, considerando-se o periodo de janeiro/2005 a dezembro/2009. Os descritores utilizados foram: emergency contraception e pharmacy; incluindo-se tambem anticoncepcao de emergencia para o contexto brasileiro. Para analise, foram selecionados 36 artigos, 29 internacionais e 7 nacionais. A discussao dos resultados contemplou duas perspectivas analiticas: disponibilidade e barreiras a CE nas farmacias, verificando a posicao dos farmaceuticos sobre o metodo; e a posicao das usuarias/consumidoras da CE a respeito do contraceptivo e seus locais de provisao, no contexto nacional e internacional. Tais estudos evidenciam que a adocao de politicas publicas favoraveis a distribuicao/venda da CE pelas farmacias confere, de modo geral, avaliacao positiva de farmaceuticos e usuarios, principalmente devido a possibilidade de dispensar o contraceptivo de forma mais agil. Os paises que adotaram tal politica discutem a necessidade de aconselhamento em saude sexual e reprodutiva para os consumidores no âmbito da propria farmacia. Entretanto, no Brasil, o medicamento quase sempre e vendido sem receita medica e orientacao do farmaceutico, pois nao ha politica publica que inclua a provisao pelas farmacias. ABSTRACT The literature review aims to discuss policies for provision of emergency contraception (EC), especially through pharmacies, in the international and national literature. Methodology: research in Medline/Pubmed, Sociological Abstracts and Scielo Brazil, considering the period of the January/2005-December/2009. The terms used were: emergency contraception and pharmacy, also including emergency contraception for the Brazilian context. For analysis, we selected 36 articles, 29 international and 7 national. The discussion of the results included two analytical perspectives: availability and barriers to EC in pharmacies, focusing on the position of pharmacists on the method, and the position of users of emergency contraception and the supplies sites, in the national and international context. Studies show that the adoption of policies favorable to the distribution of emergency contraception in pharmacies with a prescription for pharmacists, provides, generally positive assessment of pharmacists and users, mainly by dispensing more agile method. The adoption of this policy has generated the need for counseling on sexual and reproductive health consumers in the pharmacy. However, this strategy has not been suggested in Brazil, where the drug is often sold without a prescription and guidance of the pharmacist as there is no specific policy in this regard.

O aconselhamento e a testagem anti-HIV como estratégia preventiva: uma revisão da literatura internacional, 1999-2011

Com base em revisao bibliografica discute-se a literatura produzida nos anos de 1999 a 2011, no campo da saude coletiva, sobre uma importante estrategia de prevencao da transmissao do HIV: o aconselhamento e testagem anti-HIV. O artigo realiza um balanco da literatura internacional, analisando criticamente os aspectos mais assinalados pela comunidade cientifica, apontando divergencias e convergencias entre os estudos e identificando lacunas que possam estimular o desenvolvimento de novas pesquisas neste campo tematico. Como resultado, evidenciou-se que os processos de decisao de realizar um teste e a experiencia da testagem sao discutidos na literatura com abordagens fragmentadas, sejam de ordem individual ou institucional. Para compreender diversas dimensoes implicadas na adocao de uma pratica preventiva como o teste HIV, e preciso contemplar indicadores sociais tais como genero, religiao, identidade sexual, raca/cor, e relaciona-los as politicas publicas e a operacionalizacao dos servicos de saude. O uso expressivo do conceito de risco (aliado as categorias de grupo, comportamento, percepcao) e de escalas quantitativas para aferir a percepcao individual do risco como uma barreira para a realizacao do teste ilustra o foco excessivo sobre uma dimensao individual e parcial do problema.