Ludmila Fontenele Cavalcanti

Representações sociais de profissionais de saúde sobre violência sexual contra a mulher: estudo em três maternidades públicas municipais do Rio de Janeiro, Brasil

The purpose of this study was to analyze social representations of sexual violence against women, as constructed and reproduced in prenatal care settings in three municipal maternity hospitals in Rio de Janeiro, Brazil. This qualitative research explored two themes: ideas about and explanations of sexual violence committed against woman. The forty-five interviews conducted with health professionals were examined using thematic content analysis. The results show that social representations of sexual violence against women were associated with ideas of suffering, behavioral disturbances, and forced sexual intercourse. The explanations offered for why this type of violence occurs included gender relations, urban violence, and ascription of blame to the victim. It can be concluded that hegemonic patterns of asymmetrical relations persist, even in the discourse of maternity health professionals, who are the point of reference for attending to victims of sexual violence. Incorporating the analytical category of gender into healthcare professional training could make prenatal care an important gateway for the recognition and management of sexual violence against women.The purpose of this study was to analyze social representations of sexual violence against women, as constructed and reproduced in prenatal care settings in three municipal maternity hospitals in Rio de Janeiro, Brazil. This qualitative research explored two themes: ideas about and explanations of sexual violence committed against woman. The forty-five interviews conducted with health professionals were examined using thematic content analysis. The results show that social representations of sexual violence against women were associated with ideas of suffering, behavioral disturbances, and forced sexual intercourse. The explanations offered for why this type of violence occurs included gender relations, urban violence, and ascription of blame to the victim. It can be concluded that hegemonic patterns of asymmetrical relations persist, even in the discourse of maternity health professionals, who are the point of reference for attending to victims of sexual violence. Incorporating the analytical category of gender into healthcare professional training could make prenatal care an important gateway for the recognition and management of sexual violence against women.

Os sentidos do risco na gravidez segundo a obstetrícia: um estudo bibliográfico

This study analyzes the meaning of high-risk pregnancy in articles published by a representative Brazilian journal in the field of Obstetrics in the 1990s. The methodological approach includes the quantitative and qualitative analysis of 40 articles, which reveals a diversity of meanings attributed to high-risk pregnancy and a reduced discussion on the theme. The conclusion shows the need to include an interdisciplinary approach to the theme by taking into account the complexity of the aspects involving womens participation in pregnancy care.This study analyzes the meaning of high-risk pregnancy in articles published by a representative Brazilian journal in the field of Obstetrics in the 1990s. The methodological approach includes the quantitative and qualitative analysis of 40 articles, which reveals a diversity of meanings attributed to high-risk pregnancy and a reduced discussion on the theme. The conclusion shows the need to include an interdisciplinary approach to the theme by taking into account the complexity of the aspects involving womens participation in pregnancy care.

Atuação diante das situações de aborto legal na perspectiva dos profissionais de saúde do Hospital Municipal Fernando Magalhães

The scope of this study was to analyze perceptions of health professionals at Fernando Magalhães Public Hospital regarding situations involving the practice of legal abortion. With this in mind, we sought to characterize the professionals interviewed, understand the qualifying process for assistance of women requiring abortion and identify the perceptions of the professionals regarding the practice of legal abortion. The quantitative and qualitative approach in terms of methodology was adopted. The instruments used were analysis of institutional documentation and semi-structured interviews based on a script with informed consent. The results of this research revealed: the inappropriate use of the right to conscientious objection by health professionals; the existence of difficulties faced by professionals in construction of a posture that ensures access to legally sanctioned abortion; and the interference of ethical and religious values as an important element in professional attitudes that discourage the practice of legal abortion. Measures for the ongoing education of professionals and the monitoring of actions applied to technical norms are recommended.

Protocolos na atenção à saúde de mulheres em situação de violência sexual sob a ótica de profissionais de saúde

The use of protocols in health care for women suffering from sexual violence was analyzed from the standpoint of health professionals. It involved a qualitative study conducted in 18 institutions with 140 professionals interviewed in Fortaleza and Rio de Janeiro. After organization of the data, the clusters of meaning pointed to the potential benefits of the use of protocols; limits to be faced in the adoption of protocols; and the need for protocol development and professional training. The results revealed points of convergence and divergence between the two municipalities regarding the use of protocols in health care for women suffering from sexual violence. In Rio de Janeiro, the adoption of protocols in the services by the majority of interviewees and the existence of an established reporting system are acknowledged and involve the work of professionals from different areas. In Fortaleza, the participants of only one institution mentioned the use of protocols and an internal reporting system. In both capitals, professional qualifications to work with women suffering from sexual violence is inadequate due to the limited coverage of the issue during the undergraduate years of the healthcare professions and the lack of training in the health services.

Cuidado de la salud para niños y adolescentes víctimas de violencia sexual en cuatro capitales brasileñas

O artigo analisa a atencao a saude de criancas e adolescentes em situacao de violencia sexual (VS) na rede publica municipal de saude de quatro capitais brasileiras – Porto Alegre (RS), Belem (PA), Fortaleza (CE) e Campo Grande (MS) –, enfocando a disponibilidade de servicos e a oferta de atendimentos, tais como a anticoncepcao de emergencia hormonal (AEH), profilaxias para doencas sexualmente transmissiveis (DSTs) e interrupcao legal da gravidez (ILG). O metodo de estudo de casos foi conduzido por entrevistas semiestruturadas, com vinte gestores e tecnicos do nivel central, representantes das secretarias municipais de saude, e de analise documental. A atencao e desigual entre as capitais. Considerando-se a alta demanda, ha baixa oferta de servicos em tres delas. Os atendimentos especializados, como AEH e ILG, encontram resistencias dos profissionais e setores religiosos. Destacam-se inovacoes de dois Centros Integrados de Atencao e de um Centro de Atencao Psicossocial Pos-Trauma.

Atendimento à saúde de crianças e adolescentes em situação de violência sexual, em quatro capitais brasileiras

O artigo analisa a atencao a saude de criancas e adolescentes em situacao de violencia sexual (VS) na rede publica municipal de saude de quatro capitais brasileiras – Porto Alegre (RS), Belem (PA), Fortaleza (CE) e Campo Grande (MS) –, enfocando a disponibilidade de servicos e a oferta de atendimentos, tais como a anticoncepcao de emergencia hormonal (AEH), profilaxias para doencas sexualmente transmissiveis (DSTs) e interrupcao legal da gravidez (ILG). O metodo de estudo de casos foi conduzido por entrevistas semiestruturadas, com vinte gestores e tecnicos do nivel central, representantes das secretarias municipais de saude, e de analise documental. A atencao e desigual entre as capitais. Considerando-se a alta demanda, ha baixa oferta de servicos em tres delas. Os atendimentos especializados, como AEH e ILG, encontram resistencias dos profissionais e setores religiosos. Destacam-se inovacoes de dois Centros Integrados de Atencao e de um Centro de Atencao Psicossocial Pos-Trauma.

Implementação da atenção em saúde às violências sexuais contra as mulheres em duas capitais brasileiras

Este artigo analisa a implementacao da atencao em saude as mulheres em situacao de violencia sexual em duas capitais brasileiras (Rio de Janeiro/Fortaleza). O estudo qualitativo analisou documentos sobre o tema e entrevistas semiestruturadas com 37 gestores dos sistemas de saude municipais. A questao vem sendo abordada de forma diferenciada pelos municipios, o que decorre das distintas trajetorias de consolidacao dos servicos, das aproximacoes com o movimento feminista e dos contextos culturais especificos. Notou-se que a implementacao das acoes nesse âmbito ainda apresenta fragilidades, exigindo esforcos de articulacao politica e tecnica para a estruturacao e a manutencao dos servicos.

Training for the challenges of sexual violence against children and adolescents in four Brazilian capitals

This article analyzes the training offered to municipal public employees to confront sexual violence against children and adolescents in four Brazilian capitals. Based on a multiple case study, it focuses on the training programs offered in the 2010-2011 biennium by the municipal government for professionals and managers in the public health network. We analyzed 66 semi-structured interviews and written documents pertaining to the training actions. We observed an unequal investment among the capitals and a lack of specificity in the treatment of the themes. There is a considerable lack of institutional memory which complicates the analysis of professional training strategies. Healthcare was the field which trained their professionals the most, including the subject of notification in training content. We noted little investment in training oriented toward the prevention of violence and the promotion of protective relationships and links. We emphasized the inductive role of federal and state programs in the areas of Tourism and Education. Few initiatives included the participation of more than one public sector. We suggest the creation of a training plan about violence and the sexual rights of children and adolescents, and in particular about sexual violence.

Capacitação profissional para o enfrentamento às violências sexuais contra crianças e adolescentes em Fortaleza, Ceará, Brasil

This study aimed to identify initiatives for training staff in the municipal healthcare system in Fortaleza, Ceará State, Brazil, to deal with cases of sexual abuse of children and adolescents. The reference for this exploratory study was the training program provided by the municipal government in 2010-2012 for administrators and health professionals in the public healthcare system in Fortaleza. At the time, the issue of sexual abuse was low in the systems training programs, despite recognition of its importance. Federal and State programs have provided input for such training programs in the various municipal health departments. The main strategy was to invest in training for health workers in primary care. Social workers were found to have insufficient training, aggravated by temporary work contracts and high staff turnover. The study suggests the need for training to deal with violence, particularly sexual abuse.Pretendeu-se identificar as iniciativas de capacitacao aos profissionais da rede publica municipal de Fortaleza, Ceara, Brasil, para o enfrentamento de violencias sexuais contra criancas e adolescentes. Esse estudo exploratorio tomou como referencia as capacitacoes ofertadas no bienio 2010-2012 pelo governo municipal para os gestores e profissionais que atuam na rede publica de Fortaleza. Constatou-se a baixa insercao da tematica das violencias sexuais nas capacitacoes ofertadas apesar do reconhecimento quanto a sua importância. Os programas federais e estaduais foram indutores das capacitacoes nas diferentes secretarias municipais. Considerouse estrategico o investimento do setor saude na capacitacao de profissionais da atencao basica. Em relacao aos profissionais da assistencia social, a insuficiencia de capacitacao e agravada pelas contratacoes temporarias e pela alta rotatividade. Sugere-se a construcao de um plano de capacitacao sobre violencias e, em especial, sobre violencia sexual.

Health care of children and adolescents in situation of sexual violence, in four Brazilian capitals

O artigo analisa a atencao a saude de criancas e adolescentes em situacao de violencia sexual (VS) na rede publica municipal de saude de quatro capitais brasileiras – Porto Alegre (RS), Belem (PA), Fortaleza (CE) e Campo Grande (MS) –, enfocando a disponibilidade de servicos e a oferta de atendimentos, tais como a anticoncepcao de emergencia hormonal (AEH), profilaxias para doencas sexualmente transmissiveis (DSTs) e interrupcao legal da gravidez (ILG). O metodo de estudo de casos foi conduzido por entrevistas semiestruturadas, com vinte gestores e tecnicos do nivel central, representantes das secretarias municipais de saude, e de analise documental. A atencao e desigual entre as capitais. Considerando-se a alta demanda, ha baixa oferta de servicos em tres delas. Os atendimentos especializados, como AEH e ILG, encontram resistencias dos profissionais e setores religiosos. Destacam-se inovacoes de dois Centros Integrados de Atencao e de um Centro de Atencao Psicossocial Pos-Trauma.