Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil.

Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications

Atenas Program : Pioneer Brazilian service of outpatient care by telemedicine for women with miscarriage or incomplete abortion

The criminalization of abortion and restricted access to misoprostol in Brazil force women to seek unsafe methods to terminate a pregnancy. Hospital care for miscarriage or abortion is standard. In contrast, telemedicine for the medical management of miscarriage and abortion is the gold standard of care internationally. This article presents the Atenas Program ‒ an unprecedented initiative for first trimester abortion/miscarriage care, aiming at a humanized out-of-hospital service based on telephone monitoring by nurses, allowing women to choose the method of uterine evacuation (expectant, medical or surgical). For this purpose, ethnographic research was carried out in a northeastern public maternity hospital, between 2014 and 2021. In the context of structural and conjunctural difficulties, among the 723 Atenas participants, 73,6% dispensed with hospital admission for miscarriage and abortion resolu- tion: 58,4% occurred spontaneously and 15,2% through hospital misoprostol. No complications were registered. Telephone monitoring by nurses provided the basis for continuity of individualized care for this invisibilized public. Atenas Program, initiative of a SUS institution run without external financial support, represents an advance in humanized care for women with miscarriage and abortion. It should be extended to the entire public health network, to expand access to rounded and humanized care for abortion and miscarriage.Peer reviewe

Personal experiences with induced abortions in private clinics in Northeast Brazil

Based on a qualitative study conducted in 2012, the article analyzes middle-class individuals' experiences with induced abortions performed in private clinics. Thirty-four stories of induced abortions were narrated by 19 women and five men living in two state capitals in Northeast Brazil. Thematic analysis revealed differences in types of clinics and care provided by the physicians. The article shows that abortion in private clinics fails to guarantee safe or humane care. The narratives furnish descriptions of diverse situations and practices, ranging from flaws such as lack of information on medicines to others involving severe abuses like procedures performed without anesthesia. The article concludes that criminalization of abortion in Brazil allows clinics to operate with no state regulation; it does not prevent women from having abortions, but exposes them to total vulnerability and violation of human rights.Publisher PDFPeer reviewe

Atenas ProgramPioneer Brazilian service of outpatient care by telemedicine for women with miscarriage or incomplete abortion

The criminalization of abortion and restricted access to misoprostol in Brazil force women to seek unsafe methods to terminate a pregnancy. Hospital care for miscarriage or abortion is standard. In contrast, telemedicine for the medical management of miscarriage and abortion is the gold standard of care internationally. This article presents the Atenas Program ‒ an unprecedented initiative for first trimester abortion/miscarriage care, aiming at a humanized out-of-hospital service based on telephone monitoring by nurses, allowing women to choose the method of uterine evacuation (expectant, medical or surgical). For this purpose, an ethnographic research was carried out in a northeastern public maternity hospital, between 2014 and 2021. In the context of structural and conjunctural difficulties, among the 723 Atenas participants, 73,6% dispensed with hospital admission for miscarriage and abortion resolution: 58,4% occurred spontaneously and 15,2% through hospital misoprostol. No complications were registered. Telephone monitoring by nurses provided the basis for continuity of individualized care for this invisibilized public. Atenas Program, initiative of a SUS institution run without external financial support, represents an advance in humanized care for women with miscarriage and abortion. It should be extended to the entire public health network, to expand access to rounded and humanized care for abortion and miscarriage.Peer reviewe

PERDAS FETAIS EM UMA ÁREA RURAL ENDÉMICA PARA A DOENÇA DE CHAGAS NO ESTADO DA BAHIA

No presente trabalho foi analisada a história obstétrica de um grupo de 47 mulheres com sorologiapositiva para a infecção pelo Trypanosoma cruzi e de 42 sor o negativas, com o objetivo de estudara relação entre soropositividade para o T. cruzi e a ocorrência de perdas fetais. As mulheresincluídas no estudo residem em uma área endémica para a doença de Chagas na Bahia. As mulheressoronegativas apresentaram uma taxa geral de perdas fetais (idade gestacional até 6 meses) de 93,3por 1000 gestações, enquanto as mulheres soropositivas apresentaram uma taxa de 105,3 por 1000gestações. A distribuição da taxa de perdas fetais por idade materna revelou aue as mulheres soropositivasentre 15 e 24 anos de idade apresentaram uma frequência ae perdas fetais maior que as soronegativasna mesma faixa etária

The dilemma of a practiceExperiences of abortion in a public maternity hospital in the city of Salvador, Bahia

The article discusses abortion and miscarriage from the perspective of women admitted to a public maternity hospital in Salvador (BA), Brazil. Based on qualitative and quantitative research, it draws on participant observation of everyday hospital life. Taking an ethnographic approach, it addresses the hospital experiences of women who had miscarriages or induced abortions, also presenting the views of health professionals. It argues that the way the institution structures care for abortion and miscarriage involves symbolic processes that profoundly affect women’s experiences. The discrimination against women who have had abortions/ miscarriages is an integral part of the structure, organization and culture of these institutions, and does not derive solely from the individual actions of healthcare personnel.Publisher PDFPublisher PDFPeer reviewe

The dilemma of a practice: experiences of abortion in a public maternity hospital in the city of Salvador, Bahia

Discute o aborto pelas perspectivas de mulheres internadas em uma maternidade pública de Salvador (BA). Enfatiza a observação participante do cotidiano do hospital e descreve trabalho de campo com técnicas de pesquisa qualitativa e quantitativa. Por perspectiva etnográfica, aborda a experiência hospitalar de mulheres diante da interrupção, voluntária ou não, da gravidez e apresenta o ponto de vista dos profissionais de saúde, argumentando que a forma pela qual a instituição estrutura a atenção ao aborto e os processos de simbolização a ela imbricados afetam profundamente as experiências das mulheres. Aponta que a discriminação contra as mulheres que abortam está integrada a estrutura, organização e cultura institucionais, e não apenas a ações individuais dos profissionais. Artículo disponible en portugués y en inglés.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-59702016000100037&lang=p

Aspectos psicossociais do trabalho e distúrbios psíquicos entre trabalhadoras de enfermagem

OBJECTIVE: To evaluate the association between psychological demand and job control and demand with psychological distress among nurses. METHODS: A cross-sectional study included 502 female nurses working in a public hospital at the city of Salvador, state of Bahia, Brazil. The Demand-Control Model proposed by Karasek to evaluate the association between job control-demand and psychological distress was adopted. The SRQ-20 was used to measure psychological distress. RESULTS: The prevalence of psychological distress was 33.3%, ranging from 20.0% among lady nurses to 36.4%, among nurse assistants. Strong dose-response gradients were observed between demand and psychological distress and the negative association between job control and psychological distress. Prevalence of psychological distress was higher (PR=2.6; 95% CI: 1.81-3.75) among professionals in high-strain jobs (high demand, low control) when compared to professionals in low-strain jobs (low demand, high control), after adjustment by potential confounders in a logistic multiple regression model. CONCLUSIONS: Study findings reinforce the relevance of intervening in the organizational structure in order to increase control upon job and adjust the levels of psychological demands.OBJETIVO: Avaliar a associação entre demanda psicológica e controle sobre o trabalho e a ocorrência de distúrbios psíquicos menores entre trabalhadoras de enfermagem. MÉTODOS: Estudo de corte transversal, incluindo 502 trabalhadoras de enfermagem de um hospital público de Salvador, Bahia. O Modelo Demanda-Controle, de Karasek, foi utilizado para avaliar as dimensões psicossociais estudadas. Para mensuração de distúrbios psíquicos menores (DPM), utilizou-se o SRQ-20. RESULTADOS: A prevalência de DPM foi 33,3%, variando de 20,0% entre enfermeiras a 36,4% entre auxiliares. Observou-se nítido gradiente tipo dose-resposta de associação positiva entre demanda psicológica e DPM, e associação negativa entre controle sobre o trabalho e DPM. A prevalência de DPM foi mais elevada (RP=2,6; IC95%: 1,81-3,75) no quadrante de trabalho em alta exigência (alta demanda, baixo controle), quando comparado às profissionais em trabalho de baixa exigência (baixa demanda, alto controle), depois de ajustado, num modelo de regressão logística múltipla, por potenciais confundidores. CONCLUSÕES: Os achados reforçam a relevância da adoção de medidas de intervenção na estrutura organizacional, de modo a elevar o controle sobre o trabalho e redimensionar os níveis de demanda psicológica