Ethnophysiology and contraceptive use among low-income women in urban Brazil

Distrust and dissatisfaction with contraceptive methods among low-income Brazilian women contributes to incorrect contraceptive use, harmful health risks, and an extensive reliance on surgical sterilization. Data from ethnographic fieldwork in a low-income neighborhood in urban Brazil illustrate that women's concerns regarding contraception make sense in the context of their general health and illness beliefs and their understanding of reproductive physiology. Women interpret and experience biomedical concepts and contraceptive methods (such as "hormones" and oral contraceptives, respectively) according to an ethnophysiology of fecundity, menstruation, and conception. These popular representations of reproduction embody social relations and local experience and therefore persist despite the influence of biomedical models. Recognition of this ethnophysiology and greater emphasis on culturally appropriate counseling and education among health care professionals will improve women's experience and effective use of reversible contraception.     

Young women's attitudes toward continuous use of oral contraceptives: the effect of priming positive attitudes toward menstruation on women's willingness to suppress menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was "media," and their primary concern was "safety." Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.     

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

OBJECTIVE

To analyze temporal trends and distribution patterns of unsafe abortion in Brazil.

METHODS

Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis.

RESULTS

In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R²: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R²: 93.0%, p < 0.001), Southeast (R²: 92.0%, p < 0.001) and Central-West regions (R²: 64.0%, p < 0.001), whereas the North (R²: 39.0%, p = 0.030) presented an increase, and the South (R²: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions.

CONCLUSIONS

Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.     

Menstruation and amenorrhea: opinion of Brazilian women

Contemporary women experience more menstrual cycles than their predecessors, and their menstrual patterns are modified by contraceptives. Amenorrhea is one side effect that has recently been advocated as desirable. This qualitative study investigated Brazilian women's views regarding the suppression of menstruation using hormones. Data were collected through eight focus groups, following a semistructured guideline. Sixty-four women, 21-51 years old, all menstruating regularly and all of whom had already initiated sexual activity and had no perceived infertility participated. Discussions were recorded, transcribed and entered into the computer, using the Ethnograph V 5.0 software to aggregate similar patterns. Thematic content analysis revealed that menstruation and amenorrhea were both seen with ambiguity. Although regarded as a nuisance, menstruation was associated with femaleness, youth, fertility and health. Most women, although they would like to be free from menstruation, feared negative consequences of induced amenorrhea and even regarded the proposition as a male intrusion into what they consider a natural female condition.     

Association between characteristics of current menses and preference for induced amenorrhea

Background

Several studies suggest that many women would prefer to avoid menses altogether, but few studies have examined the social or clinical predictors of such preference.

Study Design

In total, 1224 healthy women of reproductive age were surveyed in Brazil, Germany and the United States regarding social, menstrual and reproductive characteristics and preferences for various dimensions of menstruation, including the ideal interval between menses. The extent to which a preference to never bleed was predicted by current experiences with menses was evaluated.

Results

Long menses, menstrual pain and a perceived high cost of pads and tampons were predictive of preferring amenorrhea over all other menstrual patterns after controlling for age, parity and education. Independent significant associations were also found with increasing degrees of life stress and ever use of injectable contraceptives.

Conclusion

A negative experience with menstruation, a high ranking of life stress and ever use of injectable contraception were independently associated with a preference to avoid menses altogether.     

苯及其同系物对职业女工生殖机能的影响

目的 :研究苯及其同系物对职业接触者月经及生殖机能的影响。方法 :对化工行业 2 6 8名苯作业女工月经及生殖机能进行回顾性调查 ,探讨职业接触对女工的影响。结果 :月经周期延长、经量增多、经期腰痛明显高于对照组 (χ2 =9.90 ,P<0 .0 0 5 ) ,且妊娠后自然流产、早产、胎儿失天缺陷等均高于对照组。结论 :苯职业接触可引起女工月经及生殖机能障碍。     

Health-seeking strategies and sexual health among female sex workers in urban India: Implications for research and service provision

This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta, India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent “non-compliant” therapeutic practices give cause for concern. Conventional approaches to the study of “health-seeking behaviour” are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural “beliefs” about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health.     

Race and inequality among women: an example in southern Brazil

This study uses epidemiological data to investigate socioeconomic proportions of distinctions raised by "racism" in Brazilian society. A population-based cross-sectional study was conducted with a sample of 2,779 women ages 14 through 49, living in a southern Brazilian city. Black and mixed-race women had less schooling, lower family income, and worse housing conditions than white women. They also used contraceptive methods less frequently, had more children, and had higher spontaneous abortion and stillbirth rates than white women. Virtually all of the results show a linear relationship between such categories, i.e., the "darker" the woman's skin color, the worse her socioeconomic and reproductive conditions. We also observed that black women were either separated, divorced, or widowed, another apparent factor for black women's impoverishment, related mainly to their limited employment opportunities. The results of the current study indicate that racial relations among women are an issue that should foster a discussion concerning citizenship in Brazil.     

The “U” technique: A new method for Norplant implants removal

The standard technique for Norplant implants removal was compared with a new technique called the “U” technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 (“U” removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the “U” technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0,p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the “U” technique. Our conclusion is that the “U” technique is a quicker and easier method of removing Norplant capsules than the standard technique.     

妈富隆用于防治人工流产术后并发症的疗效观察

目的探讨人工流产术后立即口服复方短效避孕药妈富隆的临床效果。方法选择人工流产终止妊娠的妇女240例,随机分组,研究组120例,于人工流产术后立即服用复方短效口服避孕药妈富隆、抗生素及益母草冲剂;对照组120例,仅在人工流产术后服用抗生素和益母草冲剂,并采取其他避孕方法。观察两组术后出血时间、出血量、月经恢复情况、避孕效果、生殖道感染等。结果术后出血时间、出血量、月经恢复情况、避孕效果、生殖道感染率,研究组均优于对照组（P〈0.05）。结论人工流产术后使用复方短效口服避孕药妈富隆既可做到有效避孕,降低反复人工流产率,又能明显缩短术后出血时间,减少出血量,促进月经周期的恢复,有效减少术后生殖道感染的发生。     

Surreptitious learning: menarche and menstrual product advertisements

The purpose of this study was to examine the messages conveyed in menstrual product advertisements with specific concern given to information that could be learned about menstruation and the female body by menarcheal girls. Over 200 advertisements from popular women's magazines were analyzed using constant comparative analysis. The core variable was Heightening Insecurities. The themes identified in menstrual product advertisements function to heighten insecurities in the female adolescent reader. The findings revealed that the advertisements were a reflection of the negative societal views of menstruation and, because the advertisements function to heighten insecurities, they also function to perpetuate and maintain the silence and shame which surrounds menstruation in our society.     

Traditional medicine and lead-containing preparations in Nigeria

Traditional medicine, its preparations and practices, plays a major role in the health care of the community of Nigeria. In many cases the native doctor (“Babalawo”) and the local herbalist (“Eleweomo”) are the only practitioners available for the treatment of illness. Even in the towns where allopathic medicine is available the limited facilities it offers make many patients rely on traditional methods. Little is known of the pharmacological action of these traditional remedies which the native doctor prescribes. Our own studies have concentrated on the metal content of such materials. Here we report on the material known as “tiro” which is used for the treatment of eye infections and disease as well as an “eye cleaner” and cosmetic. On analysis we found that all samples of tiro measured contained lead ranging from 12·8 to 81·1% (w/w), with a mean concentration over all samples determined of 50·1% (w/w). In addition, it was also found that tiro is used by some members of the Nigerian community in Britain and is brought in in decorative containers as a gift. The extent of use in this country still remains to be determined, however. The use of lead-containing preparations^* in traditional practices presents a significant health hazard to a substantial section of the world's population. We suggest urgent steps are required to encourage governments to establish education programmes to eliminate this avoidable source of morbidity among their populations.     

Ethnophysiology and Contraceptive Use Among Low-Income Women in Urban Brazil

Distrust and dissatisfaction with contraceptive methods among low-income Brazilian women contributes to incorrect contraceptive use, harmful health risks, and an extensive reliance on surgical sterilization. Data from ethnographic fieldwork in a low-income neighborhood in urban Brazil illustrate that women's concerns regarding contraception make sense in the context of their general health and illness beliefs and their understanding of reproductive physiology. Women interpret and experience biomedical concepts and contraceptive methods (such as “hormones” and oral contraceptives, respectively) according to an ethnophysiology of fecundity, menstruation, and conception. These popular representations of reproduction embody social relations and local experience and therefore persist despite the influence of biomedical models. Recognition of this ethnophysiology and greater emphasis on culturally appropriate counseling and education among health care professionals will improve women's experience and effective use of reversible contraception.     

Authorship: Can you Claim a Byline?

Decisions about bylines, although seemingly straightforward, can “breed ill-will,” “wreck friendships,” and “even damage careers” if decisions are not in accord with professional guidelines and common sense. Editors have attempted to promote responsible authorship by creating Uniform Requirements. According to the International Committee of Medical Journal Editors, each author must have made a substantial contribution to all 3 of the following conditions to qualify for authorship: conceiving and designing the work represented by the article or analyzing and interpreting data; drafting the article or revising it critically for important intellectual content; and giving final approval of the version to be published. Despite these guidelines, bylines continue to include grafters and guests. Researchers believe guidelines for authorship are necessary but suggest the existing Uniform Requirements may be overly restrictive and easily misinterpreted. Editors will need to work with researchers to reach consensus on realistic and appropriate guidelines for authorship. J Am Diet Assoc. 1999;99:77-79.     

Perimenstrual chocolate craving. What happens after menopause?

About half of American women crave chocolate, and approximately half of the cravers crave it specifically around the onset of menstruation. This study examines whether the primary cause of this “perimenstrual” craving is a direct effect of hormonal changes around the perimenstrum, or rather if the craving is a general response in some individuals to stress or other notable events. Insofar as there is a direct hormonal effect, one would predict a substantial decrease of 38% in total chocolate craving in women post-menopause, corresponding to the proportion of women pre-menopause who report craving chocolate exclusively perimenstrually. Based on a survey of pre- and post-menopausal alumnae of the same University, we report a significant but small decrease in prevalence of chocolate cravings post-menopause. The decrease is only 13.4% and thereby much smaller than a 38% drop predicted by a purely hormonal explanation, suggesting that female reproductive hormones are not the principal cause of perimenstrual chocolate craving.     

Interacting Effects of Toxicants and Organic Matter on the Midge Chironomus riparius in Polluted River Water

Toxicants and organic matter in river water have contrasting impacts on macrofauna. Through manipulations of both factors, their interactive effects on organisms were evaluated. This way, an attempt was made to clarify the presence or absence of pollution-“tolerant” and -“sensitive” species in rivers affected by mixed sources of pollution. Under controlled conditions, larval growth of the “tolerant” midge Chironomus riparius was measured in different types of river water containing varying levels of particles (obtained by selective filtration) and toxicants (either complex mixtures or metals). Exposure of first-instar larvae to water from the polluted rivers Meuse and Dommel revealed that growth was less inhibited by toxicant levels in river water than expected based on laboratory toxicity tests. Factors present in polluted river water stimulated growth of midges to such an extent that inhibiting effects of high toxicant concentrations were neutralized, and at low toxicant levels, were overcompensated for. It was found that particulate matter has great potential to reduce inhibiting effects of toxicants on C. riparius, not (only) by reducing the bioavailability of toxicants, but by serving as a supplementary, superior food source. The success of the “pollution-tolerant” midge was not explained by tolerance of this species to toxicants, but by its ability to take advantage of coinciding organic enrichment. It is hypothesized that the extent to which beneficial effects of organic compounds on organisms occur is species specific.     

Joint effects of density dependence and toxicant exposure on Drosophila melanogaster populations

Risk assessment of environmental contaminants is usually based on experiments on well-fed individuals held at low population densities. However, field populations are often subject to resource limitation. Individuals who are already stressed by crowding or food limitation may show greater susceptibility to toxicants. But density dependence could also reduce population-level impacts as toxicant-related mortalities may reduce competition for resources. This study examines the joint effects of toxicants and food availability on populations of Drosophila melanogaster. The interactions between the effects of food limitation and toxicant stress were dose dependent and strongly influenced by toxicity mechanisms. In food-limited conditions, a compensatory effect often occurred, with toxicant exposure having a lower proportional impact than at higher food levels. This provides further evidence that density-dependent population processes can produce an assimilative capacity for the effects of toxicants. But synergistic food–toxicant effects were also common and the interaction often switched between synergistic and compensatory at different toxicant concentrations and food supplies. There is no simple “less-than-additive”, “additive” or “more-than-additive” relationship between density and toxicant effects, even for a single toxicant.     

Impacts of sensory attributes and emotional responses on the hedonic ratings of odors in dairy products

Consumers often decide to purchase certain items as a result of prompt emotional responses evoked by the products; therefore, it is important to investigate the emotional responses stimulated by food samples, as well as the sensory attributes of the products. The aim of this study was to examine influences of sensory attribute and emotional response on olfactory hedonic ratings of dairy products. Additionally, we compared this effect between women and men subjects. Sensory attributes of six natural odors produced by commercial dairy products were evaluated by 9 trained panelists. In addition, 100 untrained panelists (50 women and 50 men) rated the emotional response stimulated by the 6 odors using 25 paired semantic differential scales and the hedonicity using a 9 cm line scale, respectively. Untrained panelists more liked “sweet aromatics,” “sour aromatics,” “fermented aromatics,” and “rich aromatics” over the other sensory attributes of dairy products. The olfactory hedonic ratings were increased when the odor was more characterized as “fragrant,” “attractive,” “comfortable,” “familiar,” “faint,” “natural,” or “modern.” Specific sensory attributes were found to be related to specific adjective pairs representing the emotional response. Moreover, the ratings of adjective pairs representing emotional response of odors and their influences on hedonic ratings differed significantly between sexes. In conclusion, our findings suggest that the emotional responses as well as the sensory attributes affect the hedonic ratings of odors in dairy products.     

Considering and submitting to abortion among young people in the context of legal prohibition: the hidden side of teenage pregnancy

This article aims to unveil the notion of abortion as an element in young people's thoughts on teenage pregnancy. The study analyzes data from semi-structured interviews with 123 young men and women 18-24 years of age in Porto Alegre, Rio de Janeiro, and Salvador, Brazil, belonging to different social strata. Based on information concerning their affective, sexual, and reproductive circumstances, an abortion typology was established with a gradient ranging from considering the act to the attempt to materialize it, actually submitting to abortion, and even ruling out the possibility of interrupting the pregnancy. According to the data, 73% of interviewees had considered the possibility of an abortion, demonstrating an important presence of this notion as a recourse vis-à-vis an unpredicted pregnancy, even in the Brazilian context where abortion is illegal. Among the 86 young people who had experienced a pregnancy, 27 reported having resorted to abortion (20 males and seven females). The results indicate gender differences and contribute to an understanding of teenage pregnancy by examining induced abortion, a hidden dimension in the public and scientific debate on this issue.     

Body image in Brazil: recent advances in the state of knowledge and methodological issues

OBJECTIVE

To analyze Brazilian literature on body image and the theoretical and methodological advances that have been made.

METHODS

A detailed review was undertaken of the Brazilian literature on body image, selecting published articles, dissertations and theses from the SciELO, SCOPUS, LILACS and PubMed databases and the CAPES thesis database. Google Scholar was also used. There was no start date for the search, which used the following search terms: “body image” AND “Brazil” AND “scale(s)”; “body image” AND “Brazil” AND “questionnaire(s)”; “body image” AND “Brazil” AND “instrument(s)”; “body image” limited to Brazil and “body image”.

RESULTS

The majority of measures available were intended to be used in college students, with half of them evaluating satisfaction/dissatisfaction with the body. Females and adolescents of both sexes were the most studied population. There has been a significant increase in the number of available instruments. Nevertheless, numerous published studies have used non-validated instruments, with much confusion in the use of the appropriate terms (e.g., perception, dissatisfaction, distortion).

CONCLUSIONS

Much more is needed to understand body image within the Brazilian population, especially in terms of evaluating different age groups and diversifying the components/dimensions assessed. However, interest in this theme is increasing, and important steps have been taken in a short space of time.