Graciana Alves Duarte

The opinion of Brazilian women regarding vaginal labor and cesarean section

Objectives: The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. Methods: Six hundred and fifty‐six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. Results: Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C‐section‐only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). Conclusions: Apparently, pain and womens perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.OBJECTIVES The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. METHODS Six hundred and fifty-six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. RESULTS Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C-section-only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). CONCLUSIONS Apparently, pain and womens perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.

The Closer You Are, the Better You Understand: The Reaction of Brazilian Obstetrician—Gynaecologists to Unwanted Pregnancy

Abstract In Brazil, abortion is legally restricted but highly prevalent. The objective of this study was to obtain data on the opinions of obstetrician—gynaecologists regarding abortion and to verify whether there is consistency between their personal opinion with respect to abortion and their private decision when confronted personally with an unwanted pregnancy or with a request for abortion from a patient or relative. A structured questionnaire was sent to obstetrician—gynaecologists, members of the Brazilian Federation of Gynaecological and Obstetrical Societies (FEBRASGO). A total of 4,261 physicians responded, a 30% response rate. Almost a quarter of female physicians and a third of male physicians had had an unwanted pregnancy, and 80% of these were aborted. Even among those for whom religion was very important, almost 70% chose abortion when personally faced with an unwanted pregnancy. Twice as many respondents accepted abortion as a solution for themselves or their partners as for their patients. The difference was much smaller only if the physician had personally experienced abortion. Thus, the closer physicians are to the problem of abortion, the greater their understanding that there are circumstances under which abortion is the best or only alternative. We expect the publication of these data to contribute towards liberalisation of the abortion law in Brazil. Résumé Au Brésil, l’avortement est limité par la loi, mais très fréquent. Cette étude souhaitait recueillir l’avis des gynécologues-obstétriciens sur l’avortement et déterminer si leurs opinions personnelles étaient cohérentes avec leurs décisions privées quand ils ont été confrontés personnellementàune grossesse non désirée ouàla demande d’avortement d’une patiente ou parente. Un questionnaire structuré a été adressé aux adhérents de la Fédération brésilienne des sociétés de gynécologie et d’obstétrique (FEBRASGO). Au total, 4261 médecins ont répondu, soit 30%. Près d’un quart des femmes médecins et un tiers des hommes médecins avaient été confrontésàdes grossesses non désirées, et 80% s’étaient terminées par un avortement. MÁme parmi ceux pour qui la religion était très importante, près de 70% avaient choisi l’avortement. Deux fois plus de répondants acceptaient l’avortement comme solution pour eux-mÁmes ou leurs partenaires que pour leurs patientes. La différence était beaucoup plus faible seulement si le médecin avait connu personnellement un avortement. Ainsi, plus les médecins étaient proches du problème de l’avortement, mieux ils comprenaient qu’il existe des circonstances dans lesquelles l’avortement est la meilleure ou la seule solution. Nous pensons que la publication de ces données contribueraàla libéralisation de la législation sur l’avortement au Brésil. Resumen En Brasil, el aborto es legalmente restringido pero muy frecuente. Este estudio procura obtener datos sobre las opiniones de los gineco-obstetras respecto al aborto y determinar si éstas son consecuentes con sus decisiones privadas cuando enfrentan personalmente un embarazo no deseado o una solicitud de aborto de una paciente o pariente. Se envió un cuestionario estructurado a los gineco-obstetras afiliados a la Federación Brasileña de Sociedades de Ginecologáa y Obstetricia (FEBRASGO). Un total de 4,261 médicos respondieron, con un ándice de respuesta del 30%. Casi una cuarta parte de las médicas y una tercera parte de los médicos habáan enfrentado un caso de embarazo no deseado, y el 80% de éstos fueron abortados. Aun entre aquéllas para quienes la religión es muy importante, casi el 70% optó por interrumpir un embarazo no deseado. El doble de los respondedores aceptó el aborto como una solución tanto para ellos mismos o sus parejas como para sus pacientes. La diferencia fue mucho menor sólo si el médico habáa experimentado un aborto personalmente. Por tanto, mientras más se acercaban los médicos al problema del aborto, mayor era su entendimiento de que existen circunstancias en las que el aborto es la mejor o única opción. Esperamos que la publicación de estos datos contribuya hacia la liberalización de la ley de aborto en Brasil.

Adequação do conhecimento sobre métodos anticoncepcionais entre mulheres de Campinas, São Paulo

OBJETIVO: Realizou-se uma analise de dados secundarios para avaliar a adequacao do conhecimento sobre metodos anticoncepcionais e sua associacao com caracteristicas socioeconomicas e demograficas. METODO: Foi estudada uma amostra de 472 mulheres da Cidade de Campinas, Estado de Sao Paulo. Aplicou-se o teste qui-quadrado para avaliar diferencas entre as variaveis, e realizou-se analise multipla por regressao logistica para identificar as variaveis independentes associadas a adequacao do conhecimento (medida atraves de um escore). RESULTADOS: Pouco menos da metade das mulheres alcancou um escore de conhecimento dos metodos anticoncepcionais maior que seis, classificado como adequado. A maior escolaridade e a melhor classificacao de estrato socioeconomico associaram-se a um maior escore de conhecimento. CONCLUSAO: Os resultados apontam a necessidade de maiores investimentos na educacao das mulheres de modo geral e, especificamente, quanto a contracepcao. Ao mesmo tempo, e necessario que os profissionais que trabalham nos servicos publicos de saude estejam capacitados para proverem acesso aos metodos e a informacao adequada sobre eles.OBJECTIVE: An analysis of secondary data was carried out to evaluate the knowledge adequacy on contraceptives and its association with socioeconomic and demographic characteristics. METHODS: The sample consisted of 472 women from the city of Campinas, state of Sao Paulo, Brazil. Chi-square test was used to evaluate differences among variables and logistic regression was performed to identify independent variables associated with knowledge adequacy (evaluated through a score). RESULTS: Of the total, 47.6% women reached a score higher than six, which was classified as an adequate knowledge on contraceptives. Higher schooling and better socioeconomic status were associated to higher scores of knowledge. CONCLUSIONS: The results show that it is necessary to improve womens education in general, and on contraceptive methods specifically. In addition, professionals working in public health services should be capacitated to provide contraceptives as well as adequate information on contraceptive methods.

Exclusive breastfeeding among working women with free daycare available at workplace

OBJETIVO: Investigar os fatores relacionados a decisao das mulheres em amamentar e a duracao planejada e, de fato observada, do aleitamento exclusivo entre trabalhadoras que dispoem de creche na empresa. METODOS: Estudo qualitativo no qual se comparou um grupo de 15 trabalhadoras cujos bebes estavam sendo alimentados apenas com leite materno quando comecaram a frequentar a creche da empresa com outro similar que incluia mulheres cujos bebes que, ao ingressar, ja estavam recebendo, alem do leite materno, outros alimentos. Foram realizadas entrevistas semi-estruturadas e grupos focais. RESULTADOS: Evidenciaram-se como fatores relacionados a decisao de iniciar a amamentacao e mante-la ao retornar ao trabalho: o desejo de amamentar, embasado no valor que as mulheres dos dois grupos atribuiam ao aleitamento materno, bem como seus maridos e outras pessoas significativas (por exemplo: mae, irma, amigas). A duracao do aleitamento exclusivo relacionou-se principalmente a orientacao do pediatra que cuidava do bebe, que foi distinta em cada um dos grupos estudados. CONCLUSAO: A existencia da creche no local de trabalho aparece como elemento relevante para a manutencao do aleitamento apos a licenca de maternidade, especialmente o materno exclusivo. A decisao sobre quanto tempo amamentar de forma exclusiva esteve relacionada as informacoes recebidas acerca do assunto antes e durante a gestacao, e no pos-parto. A diferenca entre os dois grupos estudados foi que as mulheres que mantiveram o aleitamento exclusivo por quase seis meses acreditavam que quanto mais tempo dessem somente o leite materno, mais beneficios o bebe teria, enquanto as mulheres do outro grupo acreditavam que tres meses de aleitamento exclusivo eram suficientes.

Choice of contraceptive methods by women attending a public health clinic

This paper presents the perceptions of 250 women who requested contraceptive methods (CM) at a public health clinic in relation to their freedom of choice and the role of an educational activity and consultation in this degree of freedom. Satisfaction with the chosen method and continuation after 6 months were also studied. Nearly all the women (99.6%) had already chosen a CM when they came to the clinic, and 90.0% left the clinic with the method; 81.9% reported that they felt very free to choose the method, and 60.0% felt that the educational activity and consultation had improved their degree of freedom. Six months later, 87.3% were using the same CM they had chosen. The proportion of women who changed the method and the proportion of those who felt they had not received sufficient information about the CM when they initiated use were significantly higher among women who reported any dissatisfaction with that method. The educational activity and consultation legitimated the womens choices (which they had already made before attending the health clinic) on the basis of such supplementary sources of information. This fact appears to have contributed to the womens feeling that they had sufficient freedom of choice.

Conscientious objection or fear of social stigma and unawareness of ethical obligations.

Conscientious objection is a legitimate right of physicians to reject the practice of actions that violate their ethical or moral principles. The application of that principle is being used in many countries as a justification to deny safe abortion care to women who have the legal right to have access to safe termination of pregnancy. The problem is that, often, this concept is abused by physicians who camouflage under the guise of conscientious objection their fear of experiencing discrimination and social stigma if they perform legal abortions. These colleagues seem to ignore the ethical principle that the primary conscientious duty of OB/GYNs is—at all times—to treat, or provide benefit and prevent harm to, the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty. One of the jobs of the FIGO Working Group for the Prevention of Unsafe Abortion is to change this paradigm and make our colleagues proud of providing legal abortion services that protect womens life and health, and concerned about disrespecting the human rights of women and professional ethical principles.

Participação masculina no uso de métodos contraceptivos

This study aimed to evaluate male participation in the use of contraceptive methods and to identify relevant variables. A secondary data analysis was conducted, and the sample size was estimated at 175 men using contraceptives methods that require male participation. The study used the qui-square test to evaluate differences between groups, as well as multiple logistic regression analysis. Some 38% of interviewees used some birth control method that required male participation. Higher level of schooling was associated with the use of some form of contraception requiring male participation, i.e., condom use or vasectomy. Considering the samples characteristics, the study concluded that it is possible for important changes to take place in Brazilian society with regard to the male perspective on contraception. For these changes to be possible it is necessary to invest in education for both men and women, shown to be an important factor for a balance in gender relations.O objetivo deste trabalho foi avaliar o uso de metodos contraceptivos com participacao masculina numa amostra de homens unidos e identificar variaveis que pudessem estar associadas a esta conduta. Trata-se de uma analise de dados secundarios cujo tamanho amostral foi calculado em 174 homens que usavam metodos de participacao masculina. Utilizou-se o teste qui-quadrado, para avaliar as associacoes das variaveis dependentes com as independentes, e a analise multipla por regressao logistica. Cerca de 38% dos entrevistados usavam algum contraceptivo de participacao masculina. O maior grau de escolaridade relacionou-se ao uso de algum metodo de participacao masculina, de preservativo (condom)e vasectomia. Levando-se em conta as caracteristicas da amostra, considerou-se a possibilidade de concretizarem-se, na sociedade brasileira, mudancas importantes na perspectiva masculina quanto a contracepcao. Para viabilizar tais mudancas, evidenciou-se a necessidade de investir na educacao de homens e mulheres, uma vez que esta se apresentou como um divisor de aguas no equilibrio das relacoes de genero.

Comparison of women having clandestine and hospital abortions: Maputo, Mozambique

Abstract In Mozambique a Ministry of Health decree since 1981 allows public hospitals to carry out abortions if pregnancy results from contraceptive failure or places a womans health or life at risk. As a result the number of hospital abortions has increased and the number of women attending hospital for complications of clandestine abortion has decreased. Nevertheless, clandestine abortions continue to cause maternal deaths and morbidity. This study compared women attending the main hospital in Maputo for complications of clandestine abortion and those having an induced abortion in the hospital. Most of those in the first group were young and primigravida, had experienced fewer abortions and lived in poorer socio-economic conditions. Fewer had a steady partner, were more frequently recent migrants to Maputo, and had lower knowledge and use of contraceptives. To reduce the number of illegal abortions and their consequences, governmental programmes should aim to make contraceptive and abortion services more available and accessible, particularly to young, unmarried women of low socio-economic status.

Conhecimento e atitude de usuários do SUS sobre o HPV e as vacinas disponíveis no Brasil

OBJECTIVE : To investigate knowledge of HPV and HPV vaccines in men and women, users of the Brazilian Unified Health System, and the intention to get themselves and their teenage children vaccinated. METHODS : A descriptive, cross-sectional study with 286 women (18-49 years old) and 252 men (18-60 years old), users of five primary health units and two polyclinics in Campinas, SP, Southeastern Brazil, was carried out. Participants were interviewed in 2011 using a structured questionnaire. Bivariate and Poisson regression analysis were performed to identify variables associated with knowledge of HPV and HPV vaccines, and participants vaccination intentions. RESULTS : Almost 40.0% of the participants reported having heard of HPV and 28.9% mentioned adequate information. The main information source was the media (41.7%). Only 8.6% of the participants had heard of the HPV vaccines. Once the participants were informed of the existence of HPV vaccines about 94% of them said they would get vaccinated and/or vaccinate their teenage children, if the vaccines were available in the public health system. Schooling of over 8 years and being female were the variables independently associated with having heard of HPV, the vaccines and having adequate knowledge of the virus. Advanced age was associated with having heard of HPV vaccines. There were no variables associated with the vaccination intentions. CONCLUSIONS : These results reinforce the need for educational activities that provide the population with adequate information on HPV and preventive measures.OBJECTIVE To investigate knowledge of HPV and HPV vaccines in men and women, users of the Brazilian Unified Health System, and the intention to get themselves and their teenage children vaccinated. METHODS A descriptive, cross-sectional study with 286 women (18-49 years old) and 252 men (18-60 years old), users of five primary health units and two polyclinics in Campinas, SP, Southeastern Brazil, was carried out. Participants were interviewed in 2011 using a structured questionnaire. Bivariate and Poisson regression analysis were performed to identify variables associated with knowledge of HPV and HPV vaccines, and participants vaccination intentions. RESULTS Almost 40.0% of the participants reported having heard of HPV and 28.9% mentioned adequate information. The main information source was the media (41.7%). Only 8.6% of the participants had heard of the HPV vaccines. Once the participants were informed of the existence of HPV vaccines about 94% of them said they would get vaccinated and/or vaccinate their teenage children, if the vaccines were available in the public health system. Schooling of over 8 years and being female were the variables independently associated with having heard of HPV, the vaccines and having adequate knowledge of the virus. Advanced age was associated with having heard of HPV vaccines. There were no variables associated with the vaccination intentions. CONCLUSIONS These results reinforce the need for educational activities that provide the population with adequate information on HPV and preventive measures.

Aborto e legislação: opinião de magistrados e promotores de justiça brasileiros

OBJECTIVE To analyze the opinion of judges and prosecutors concerning Brazilian abortion law and situations in which the abortion should be allowed. METHODS A cross-sectional study was performed with 1,493 judges and 2,614 prosecutors in Brazil between 2005 and 2006. Participants completed a structured questionnaire approaching sociodemographic characteristics, opinions about abortion law, and circumstances in which abortion is considered lawful. Bivariate and multivariate analyses of data were carried out through Poisson regression. RESULTS The majority of participants (78%) found that the circumstances in which abortion is considered lawful should be broadened, or even that abortion should not be criminalized. The highest rates of pro-abortion opinions resulted from: risk to the life of the mother (84%), anencephaly (83%), severe congenital malformation of fetus (82%), and pregnancy resulting from rape (82%). Variables related to religion were strongly associated to the opinion of participants. CONCLUSIONS There is a trend in considering the need of changing the current abortion law, in the sense of widening the circumstances in which abortion is considered lawful, or even toward decriminalizing abortion, regardless of the circumstances in which it takes place.OBJETIVO: Analisar opinioes de juizes e promotores de justica sobre a legislacao brasileira e as circunstâncias em que o aborto induzido deveria ser permitido. METODOS: Estudo transversal realizado com 1.493 juizes e 2.614 promotores no Brasil entre 2005 e 2006. Os participantes preencheram um questionario estruturado sobre caracteristicas sociodemograficas, opinioes acerca da legislacao que trata do aborto e circunstâncias para permiti-lo. Realizaram-se analises bivariada e multivariada por regressao de Poisson. RESULTADOS: A maioria (78%) dos participantes opinou que as circunstâncias nas quais nao se pune o aborto deveriam ser ampliadas, ou mesmo que o aborto nao deveria ser considerado crime. As maiores proporcoes de opinioes favoraveis a que o aborto seja permitido referiram-se a risco para a vida da gestante (84%), anencefalia (83%), malformacao congenita grave (82%) e gravidez resultante de estupro (82%). As variaveis relativas a religiao foram as mais frequentemente associadas a essas opinioes. CONCLUSOES: Observou-se uma tendencia a considerar a necessidade de mudancas na atual legislacao brasileira no sentido de ampliar as circunstâncias nas quais nao se pune o aborto e ate deixar de considera-lo como um crime, independentemente da circunstância em que e praticado.