Simone Grilo Diniz

Violence against women in health-care institutions: an emerging problem

Maternal morbidity and mortality in childbirth is a matter of utmost importance in public health. In this article, we argue that part of the problem lies in violence committed by health workers in childbearing or abortion services, which affects health-service access, compliance, quality, and effectiveness. We analysed rigorous research from the past decade and discuss four forms of violent abuse by doctors and nurses: neglect and verbal, physical, and sexual abuse. These forms of violence recur, are often deliberate, are a serious violation of human rights, and are related to poor quality and effectiveness of health-care services. This abuse is a means of controlling patients that is learnt during training and reinforced in health facilities. Abuse occurs mainly in situations in which the legitimacy of health services is questionable or can be the result of prejudice against certain population groups. We discuss ways to prevent violent abuse.

Gender violence and reproductive health

The available literature reflects the growing interest in gender violence and reproductive health. Violence is generally studied by identifying pathologies, measuring their demands on services and evaluating their repercussions on fetal outcome. Institutional violence, however, has received little attention and is mainly concerned with the consequences of inappropriate use of technologies. Data from the Sexuality and Health Feminist Collective shows that among patients, 20.5% stated that they have never talked about their sexual life with their partners; 38.3% stated that they have had sexual intercourse against their will, including situations ranging from sexual harassment to rape which was referred by 12.3% of them. One of the most relevant issues arising from the anamnesis and interviews of these women was the violence to which they were submitted by health services. The high prevalence of violent situations indicates the urgency of incorporating an approach which deals with gender violence and promotes the empowerment of women into the routine of reproductive health services.

Factors associated with sexual initiation and condom use among adolescents on Santiago Island, Cape Verde, West Africa

The current study focuses on factors associated with sexual initiation and condom use among teenagers on Santiago Island, Cape Verde, according to gender. This was a representative, probabilistic sample of 13-to-17-year-olds (n = 768) attending public secondary schools on Santiago Island in 2007. Associations were tested by test of proportion, Pearsons chi-square, or Fishers exact test and logistic regression. Factors related to sexual initiation among boys were: age over 14 years, Catholic religion, and alcohol consumption. For girls, the factors included: > 9 years of schooling and involvement in an affective-sexual relationship. Unlike other Sub-Saharan countries, this study showed a high prevalence of condom use during initial sexual activity. Adolescents are able to safely begin sexually active life if they have access to information, sex education, and other STD prevention and contraceptive methods. This study provides insights on the development of policies to reduce the vulnerability of the young population to STD/AIDS and the limits and challenges related to the promotion of condom use and sex education, focusing on unequal gender relations.

The possible role of selenium status in adverse pregnancy outcomes.

The present study reviews the possible role of Se status during pregnancy regarding adverse pregnancy outcomes, with emphasis on those related to diminished antioxidant activity and increased oxidative stress. Studies have reported that Se could play an important role in adverse outcomes such as miscarriages, neural tube defects, diaphragmatic hernia, premature birth, low birth weight, pre-eclampsia, glucose intolerance and gestational diabetes. Also, low Se status has been associated with adverse outcomes among HIV-infected pregnant women and their offspring. Nevertheless, the function of Se in the aetiology of pregnancy complications is yet to be elucidated. Available evidence presents the following limitations: most study designs do not allow conclusions about causal relationships; study populations, selection of subjects, research setting, procedures for defining sample size and analytical methods are often poorly described; many studies fail to adjust for important confounding variables. In addition, population studies assessing the relationship between Se intake during pregnancy and health outcomes are scarce. Further research is still needed to clarify the role of Se status in adverse pregnancy outcomes, especially those related to augmented oxidative stress.

Sexual and reproductive health and rights in public health education.

Abstract This paper addresses the challenges faced in mainstreaming the teaching of sexual and reproductive health and rights into public health education. For this paper, we define sexual and reproductive health and rights education as including not only its biomedical aspects but also an understanding of its history, values and politics, grounded in gender politics and social justice, addressing sexuality, and placed within a broader context of health systems and global health. Using a case study approach with an opportunistically selected sample of schools of public health within our regional contexts, we examine the status of sexual and reproductive health and rights education and some of the drivers and obstacles to the development and delivery of sexual and reproductive health and rights curricula. Despite diverse national and institutional contexts, there are many commonalities. Teaching of sexual and reproductive health and rights is not fully integrated into core curricula. Existing initiatives rely on personal faculty interest or short-term courses, neither of which are truly sustainable or replicable. We call for a multidisciplinary and more comprehensive integration of sexual and reproductive health and rights in public health education. The education of tomorrows public health leaders is critical, and a strategy is needed to ensure that they understand and are prepared to engage with the range of sexual and reproductive health and rights issues within their historical and political contexts.

ABUSE AND DISRESPECT IN CHILDBIRTH CARE AS A PUBLIC HEALTH ISSUE IN BRAZIL: ORIGINS, DEFINITIONS, IMPACTS ON MATERNAL HEALTH, AND PROPOSALS FOR ITS PREVENTION

Changes in lifestyle have led to an increase of overweight in the juvenile population. However, there are limited studies about this topic in relation to an indigenous population. The aim of this study is to verify the overweight and height defi cit in children aged 8 and 9 years, of both sexes, from urban, rural and indigenous communities of the city of Nova Laranjeiras in the State of Paraná. The 277 (148 boys) students were divided into three groups: rural (n = 100), urban (n = 99) and Indian communities (n = 78). The measurements taken were body mass (kg), height (m) and body mass index. The statistics method was an analysis of covariance and chi-square test (P <.05). Among the 277 schoolchildren, the prevalence of overweight was 14.6% in the rural area, 27.1% in urban area and 30.3% in the indigenous area in boys, and 15.7% in rural areas, 17.6% in urban and 20% in Indian girls. There was no difference in the frequency of overweight among groups for both sexes. The prevalence of height defi cit was different between the groups; it was higher in indigenous children than urban and rural children. Among the Indians, 42.4% of boys and 51.1% girls had low stature. Only indigenous children were overweight and of low height, while being prevalent in 15.1% of boys and 11.1% girls. Low stature is frequent in indigenous populations, and it would be ideal to have more research to identify its causes and consequences. Children showed high rates of overweight in all regions, demonstrating that poor eating habits and a sedentary lifestyle are not only characteristics of urban centres.

Empowering women in Brazil

Brazil is a middle-income country with a fertility rate of 2.1 children per woman and a health-care system that guarantees universal free access-the Sistema Unico de Saude (SUS). It has vibrant social organisations in which activists from the feminist movement have influenced the development and implementation of progressive national womens health policies. Hospital births account for 96% of all births (and more than 99% in urban areas). Despite increases in investment in health-care provision maternal mortality rates have remained high for more than a decade although capture of accurate mortality data remains a problem. According to the Brazilian Ministry of Health the maternal mortality ratio in 2002 was 75.3 per 100 000 livebirths which is considered by WHO to be in the high mortality band. The World Health statistics (2000) estimated a much higher ratio: 260 maternal deaths per 100 000 livebirths although this figure is contested in Brazil. Three-quarters of all deaths happened in thepostpartum period. If we consider ethnic differences data from 2002 showed that whereas the average maternal mortality ratio in Brazil was 49.3 per 100 000 for white women it was 240.4 for black women. The risk of dying from hypertensive disease in pregnancy was 8.2 times higher for black than for white women. Because the data did not include late maternal deaths (between 43 days and 1 year after childbirth) maternal mortality is likely to be greater. (excerpt)

Inequality, Zika epidemics, and the lack of reproductive rights in Latin America.

Abstract It is well-documented that structural economic inequalities in Latin America are expressed through and reinforce existing gender gaps. This article aims to look at the relationship between structural inequalities and reproductive health in the case of the Zika epidemic. The consequences of the epidemic will continue to affect the same women whose access to comprehensive reproductive health services, including safe abortion, is restricted at best. Résumé Il est bien établi que les inégalités économiques structurelles en Amérique latine sont exprimées par les écarts entre hommes et femmes et qu’elles les accentuent. Cet article souhaite examiner les relations entre les inégalités structurelles et la santé génésique dans le cas de l’épidémie de maladie à virus Zika. Les conséquences de l’épidémie continueront de toucher les femmes dont l’accès à des services complets de santé génésique, y compris d’avortement médicalisé, est au mieux restreint. Resumen Está bien documentado que las desigualdades económicas estructurales en Latinoamérica se expresan por medio de las brechas de género existentes y las refuerzan. Este artículo busca examinar la relación entre las desigualdades estructurales y la salud reproductiva en el caso de la epidemia de Zika. Las consecuencias de la epidemia continuarán afectando a las mismas mujeres cuyo acceso a los servicios integrales de salud reproductiva, que incluyen aborto seguro, está restringido en el mejor de los casos.

Unlocking the potential of effective care for life-long maternal and infant health: the need to adress the 'invisible' service after birth

1 Professor of Evidence Based Midwifery Practice, Florence Nightingale School of Nursing and Midwifery, Waterloo Bridge Wing, King’s College London. debra.bick@tvu.ac.uk 2 MD, MSc, Research Obstetrician, Division of Health and Social Care Research, King’s College, London. maria.bastos@kcl.ac.uk 3 Assistante Professor, Maternal and Child Health Department, School of Public Health, University of São Paulo, SP, Brazil. sidiniz@usp.br There is increasing recognition among women, academics, policy makers, service providers and clinicians of the need to increase the normal birth rate. The reasons include enhanced maternal and neonatal health outcomes and more cost effective use of finite health care resources. The drive to increase normal birth is to be applauded, although ironically, in many countries, including the UK and Latin America, the normal birth rate continues to decline. Clearly, there is a long way to go before normal birth (defined in the UK as birth with no intervention at all becomes a reality for many women. However the focus on normal birth may inadvertently detract key maternity service stakeholders from promoting what should be an effective continuum of care through pregnancy, birth and the postnatal period, with each phase of a womans pregnancy and birth journey not managed or resourced as a separate entity, and no phase of the journey taking precedence over another.

O impacto do tipo de hospital e tipo de parto sobre a idade gestacional ao nascer no Município de São Paulo, 2013-2014

Introduction: There was a left-shift on the distribution curve of gestational age (GA) and a reduction of the proportion of live births of 40 weeks, when compared to the expected standard in many countries. Objective: To study the distribution of gestational age births in São Paulo city (SP) and its relationship with the type of hospital and delivery. Methods: Data were extracted from Live Birth Information System (SINASC) linked to the National Database of Health Establishments (CNES) in 2013 and 2014. Data are presented according to birth in public (SUS) and private (non SUS) hospitals, type of delivery and gestational age, standardized according to the mothers age. Results: There was a left-shift in GA curve for total births which was more pronounced among cesarean births and private hospitals. The median GA of public hospitals was 39 weeks, while in the private hospitals, 38 weeks. The proportion of preterm births (9,5%) was similar in public and private hospitals, but among public hospital there was a higher proportion of very preterm births (<32 weeks), while (34-36) in private hospitals late preterm and early term were more frequent. Conclusions: The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.