Karen Mary Giffin

Violência de gênero, sexualidade e saúde

Este artigo apresenta alguns resultados de um levantamento recente de estudos e dados internacionais sobre a violencia contra a mulher, bem como sobre as consequencias para a saude destas formas de violencia, onde o agressor e, mais frequentemente, um conhecido intimo. Na segunda parte desenvolvem-se alguns argumentos sobre as raizes desta violencia, abordando questoes acerca da construcao social da identidade de genero, das relacoes de genero e da sexualidade na tradicao dualista, que separa mente e corpo, enfatiza os elementos biologicos na sexualidade, e define homens e mulheres como seres radicalmente diferentes. Conclui-se que as criticas a visao dualista constroem, atualmente, uma visao mais integral da sexualidade e dos seres humanos.

Qualidade da atenção ao parto em maternidades do Rio de Janeiro

OBJETIVO: Avaliar a qualidade da atencao durante o processo de trabalho de parto de acordo com normas da Organizacao Mundial de Saude. METODOS: Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: publica e conveniada com o Sistema Unico de Saude, no Municipio do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade publica (230 partos vaginais e 231 cesareas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesareas). De outubro de 1998 a marco de 1999, foram realizadas entrevistas com puerperas e revisao de prontuarios. Foi construido escore sumarizador da qualidade do atendimento. RESULTADOS: Observou-se baixa frequencia de algumas praticas que devem ser encorajadas, como presenca de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulacao durante o trabalho de parto (9,6% das cesareas na maternidade publica e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesareas na maternidade publica e 8,0% das cesareas na conveniada). Praticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratacao venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restricao ao leito durante o trabalho de parto (90,1%) e posicao de litotomia (98,7%) para parto vaginal apresentaram alta frequencia. Os melhores resultados do escore sumarizador foram obtidos na maternidade publica. CONCLUSOES: As duas maternidades apresentam frequencia elevada de intervencoes durante a assistencia ao parto. A maternidade publica, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos a luz de evidencias de seus beneficios.

Pobreza, desigualdade e eqüidade em saúde: considerações a partir de uma perspectiva de gênero transversal

This article discusses the modernization of gender inequalities which has occurred in Brazil in the last 20 years under the hegemony of neo-liberal macro-economic policies. A concept of gender as transversal is applied to questions of reproductive health (contraception and abortion, prenatal care and birthing, adolescent pregnancy, maternal and reproductive mortality, STIs/AIDS, and violence, among others), permitting analysis by both gender and social class. The history of the PAISM (Program for Integral Health Care for Women), on the other hand, reveals the complex articulation of this national public health program which, although strongly influenced by the Brazilian womens movement, has been infiltrated by heterogeneous interests in the international context. PAISM serves as an example of the appropriation of proposals and principles that were generated by this social movement, but re-articulated to gloss over the process of deepening gender and class inequality.

Beyond empowerment: Heterosexualities and the prevention of AIDS

AIDS-related research on sexuality has demonstrated both the importance of investigation of the meanings of sexual categories, practices, and relationships, and the fact that such meanings may vary--among cultures, historical periods, and even among individuals within the same social setting. This paper considers AIDS-related research on sexuality as itself an important instance of the social construction of meaning. It is argued that the concept of empowerment, when understood as the power to use condoms, can in fact contribute to the reproduction of both gender hierarchies and dominant conceptions of sexuality in consumer society.

A inserção dos homens nos estudos de gênero: contribuições de um sujeito histórico

Este artigo resgata conceitos e discussoes sobre as questoes de genero que foram apresentados por homens que presenciaram o (res) surgimento do movimento feminista nos paises centrais nos anos 60, e participaram de grupos de homens nos anos 70. Situados como sujeitos do conhecimento/de genero no contexto dos debates criticos sobre a sociedade contemporânea, que foram amplamente disseminados naquela epoca, adotaram uma visao dialetica e historica da realidade social, trazendo contribuicoes que ajudaram a desconstruir a otica binaria antes prevalecente.

Differential trends in mortality from AIDS in men and women in Brazil (1984-1995).

ObjectiveTo analyse trends in AIDS mortality in men and women in Brazil, for the period 1984–1995. Design and methodsNational statistics on yearly numbers of reported deaths by cause, in conjunction with census population counts and inter-censory estimates, were used to calculate age- and sex-specific AIDS mortality rates for Brazil as a whole and for São Paulo and Rio de Janeiro, the two largest cities in Brazil, and those most affected by the AIDS epidemic to date. ResultsNumbers of reported deaths from AIDS have increased yearly in Brazil since 1984, to approximately 15 000 in 1995. The data suggest that after a very dramatic rise in mortality rates, the epidemic may have started to slow even before the introduction of freely available highly-active anti-retroviral therapy, although unequally in terms of both geographical and sex distributions. Women also tended to die at relatively younger ages than men in all areas studied, and by 1995 the impact of AIDS on overall mortality was practically the same for men and women aged 25–34 years (21% in São Paulo). ConclusionsTrends in mortality from AIDS in Brazil reflect both the geographical expansion of the epidemic outwards from its original epicentres, and the fact that women are becoming increasingly affected by the AIDS epidemic.

Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and womens submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of womens empowerment during childbirth.This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and womens submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of womens empowerment during childbirth.

Women's health and the privatization of fertility control in Brazil

In Brazil, privatization of the public sphere and neglect of public health is part of a conservative modernization strategy that is dominated by elite groups. The politics of human reproduction, consistent with this pattern, have left women dependent on the private sector for access to the means of fertility control, in spite of the existence of a conceptually-advanced public programme for comprehensive health care for women--a programme which expressed the demands of, and is widely supported by, the womens movement. While both the rate of contraceptive use and the types of methods used (oral contraceptives and surgical sterilization) are modern, the privatization of fertility control has resulted in a complete separation between fertility control and health care for poor women, who are the vast majority. Evidence indicates that many, perhaps most, women accumulate the health effects of totally uncontrolled and incorrect use of oral contraceptives, including unwanted pregnancies and illegal abortions, in the end resorting to clandestine surgical sterilization, which is usually performed through unnecessary caesarean section. Data on reproductive morbidity and mortality, however, are virtually non-existent. International womens reproductive rights networks and alternative services for women have advocated greater empowerment for women, in terms of improved standards of self-care and increased power in the use of health services. As a result, a gender approach to reproductive health care is now being proposed for government programmes. The Brazilian case services as an example of the limits faced by such programmes when adopted in a wider context of unfavorable political conditions.

O agente comunitário de saúde pública: a proposta de Manguinhos

O artigo descreve a implantacao de um trabalho de atencao primaria a saude em favelas do Rio de Janeiro Agentes de saude das comunidades atendidas, cada uma responsavel por uma populacao de aproximadamente 2000 pessoas, trabalham dentro de um modelo operacional que inclui visitas domiciliares continuas as familias e trabalho em grupos de mulheres e de gestantes. As acoes basicas desenvolvidas neste periodo inicial representam uma extensao de cobertura do Programa de Assistencia Integral a Saude da Mulher e da Crianca. A segunda parte do artigo discute alguns pontos polemicos relacionados com a conceituacao deste modelo de atuacao, que promove tanto uma melhoria no estado de saude como o desenvolvimento social.

Gênero, saúde reprodutiva e vida cotidiana em uma experiência de pesquisa-ação com jovens da Maré, Rio de Janeiro

O artigo apresenta uma conceituacao da pesquisa-acao que articula a pedagogia de Paulo Freire e a proposta reflexiva e pratica do movimento de mulheres. Pretende contribuir para ampliar a compreensao dos problemas que afetam a juventude brasileira com base nas questoes de vida e saude vivenciadas por jovens rapazes e mocas moradores de uma area favelada da cidade do Rio de Janeiro. Estas questoes foram captadas por meio de um projeto de pesquisa-acao que aglutinou jovens em grupos de reflexao-acao que adotavam, como temas geradores, a identidade de genero, a sexualidade e a saude reprodutiva. Esses temas iam gradativamente se conectando a outras questoes significativas que emergiram das dimensoes socioculturais e politicas mais amplas que afetam a vida dos jovens, particularmente daqueles que vivem em contextos de pobreza, violencia e exclusao de direitos. Buscou-se consolidar, conceitual e empiricamente, o enfoque que transversaliza genero na classe social e o paradigma de conhecimento que legitima um novo sujeito de conhecimento engajado na acao transformadora.