Perfil da distribuição da contracepção de emergência para adolescentes em municípios do Estado de São Paulo

Abstract

The position adopted by São Paulo's counties, which received amounts of emergency contraception from the Federal Health Department in 2005 and 2006, is described in relation to the distribution of these to adolescents. Using quantitative surveys carried out with semi-structured questionnaires sent by e-mail to the Municipal Health Offices: influxes, services and health care professionals and the criteria of dispensation were examined. Of the total, 91.0% answered to the research, demonstrating that 85.4% began to offer the method to adolescents less than 18 years old, especially at emergency rooms (69.1%). At public health care clinics traditional and public family health care clinics there was less integration, 65.3% and 37.6%, and in services specialized in adolescent care only 31.9% of the counties offer them (percentages not excludent). Usually, the distribution is carried out by doctors and/or nurses, but 30% of clinics sub-utilize the nursing potential. Cases of sexual violence are fundamentally attended to, but excluding these cases, there is a drop of 10 to 30 percentage points in the distribution of emergency contraceptive to adolescents in cases of the failure or non-use of the regular contraceptive. The conclusion is that there exists selectivity in the method's dispensation, very scarcely offered in Basic Adolescent Health Care Services, which makes it difficult for adolescents to have access to emergency birth control in situations where pregnancy is a risk. This selective behavior among health care professionals has become common practice and goes against the initial objectives of the Federal Health Department. This position is due in part to health care professionals not being up to date on the laws and federal norms concerning Sexual and Reproductive Health, and also to the lack of knowledge of the method's mechanism action (sometimes identified as dangerous or abortive), as well as the prejudice towards adolescent sexual practicesleading to the purchasing of emergency contraceptive in drugstores and its incorrect use.

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

“…A elaboração de fluxos operacionais torna-se relevante para qualificar o processo de trabalho de profissionais que se articulam em rede e contribuir para responder às exigências legais, além de reorientar práticas 30 . As dificuldades encontradas nessa pesquisa, em relação à AEH, também são mencionadas na literatura 31,32 . Nota-se a ausência de capilaridade da oferta nas unidades básicas de saúde, centralizada nas unidades de referência.…”

Vulnerability in adolescence: a case report of attempted abortion and sexual violence

“…Veiled sexual violence 11,20 in childhood and adolescence is related to unsafe abortion 7,17 . In Brazil, there is a report of sexual violence against female children and adolescents 12,16,17 with consequent unplanned pregnancies 20 followed by violence. The abortion 7,15 remains a clandestine practice, especially in the context of Latin America 21,22 .…”

“…A Brazilian study in public health showed that 15% of women induced abortion throughout the reproductive life, being the adolescence life span the most frequent 15,16,18 . Adolescents have priority in public health policies in Brazil 12,17 and are considered vulnerable by the age group (under 14 years) and also by social and emotional dependence 2,19,20 and it is the joint responsibility of health managers 2,7 to facilitate access to safe abortion services in cases of pregnancy resulting from rape, when there is no other way to save the mother's life 18 , as well as increase social awareness 4,16 .…”

“…Adolescents have priority in public health policies in Brazil 12,17 and are considered vulnerable by the age group (under 14 years) and also by social and emotional dependence 2,19,20 and it is the joint responsibility of health managers 2,7 to facilitate access to safe abortion services in cases of pregnancy resulting from rape, when there is no other way to save the mother's life 18 , as well as increase social awareness 4,16 . Veiled sexual violence 11,20 in childhood and adolescence is related to unsafe abortion 7,17 .…”

“…About half of women who had abortions received care in the health system and were hospitalized for complications 16,17 . Considered a persistent and preventable pandemic world wide 6,15,16 , unsafe abortion 17 places women at risk in developing countries where abortion is highly restricted by law or, although legally permitted as in Brazil in cases of pregnancy resulting from rape, when there is no other means of saving the life of the mother 18 , safe abortion is not easily accessible 6 . In such settings, faced with an unwanted pregnancy, women often induce abortion or obtain clandestine abortions from doctors, paramedics, or traditional healers 1 .…”