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Try out PMC Labs and tell us what you think. Learn More. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health SRH care services living in affected areas and their attitudes towards SRH needs and the available services.
This qualitative research used thematic analysis for data analysis. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.
Congenital Zika Syndrome is a novel syndrome due to in-utero Zika virus infection. It was discovered after Brazil had become the epicenter of the Zika epidemic in The mosquito born Zika virus has been shown to cause microcephaly and other severe abnormalities in the developing fetus and .
It can also affect the pregnancy. Due to its severe effects, the World health Organization declared a Public Health Emergency of International Concern in and efforts were made to learn more about the consequences of this infection. It has been found that the Zika virus is also transmitted sexually and that the most affected are young, poor, underserved afro and native Brazilian women.
This study investigates the sexual and reproductive health SRH needs of young women living in Zika affected areas. Ten out of 22 had their first pregnancy while still in adolescence; all of these pregnancies were unintended. Zika was not a health concern and they were not aware that Zika could be sexually transmitted.
Lack of information and barriers to access aggravated their unmet SRH needs. In order to improve SRH of women at most risk, they need to be placed at the center of any public health response to an emergency.
It is only by understanding their needs and the obstacles they face when seeking care that these issues will be adequately addressed. Zika virus is a mosquito borne virus that has been shown to cause microcephaly and other severe brain anomalies in newborns when the mother is infected prenatally [ 12 ]. The Brazilian Ministry of Health also encouraged women, planning to postpone pregnancies, to seek contraceptive methods at Basic Health Units [ 4 ].
This underserved Northeast Brazilian geographic region has the highest adolescent pregnancy rates, lowest levels of formal schooling and scarce access to health services [ 56 ]. This region has several social-economic challenges, where most of the population does not have access to basic services such as running water, access to health and information and where the mosquito vector Aedes aegypti and tropical diseases like dengue have been part of everyday life for generations [ 6 ].
All these factors influence the health of the population and make it vulnerable to outbreaks and other health related challenges. Given the consequences of Zika infection on pregnancy and fetal development, it has been understood as an enduring public health task. However, most of the efforts in response to the epidemic were related to vector control, development of adequate methods for diagnosis and the possibility of a vaccine. Little attention was given to the social impacts of Zika virus and how to provide information to a population with low literacy and little access to health services [ 7 ].
There is a general lack of information about sexual and reproductive health SRH and there are barriers to access public health facilities for family planning. Although studies show that Brazil has a relatively high modern contraceptive prevalence, there is low use of long-acting reversible contraceptives LARCs in the public sector, and inequities exists [ 910 ].
Despite the observed decline in live births in Brazil since the emergence of the epidemic, there were no changes in the health policies and no evidence that there was an increase in demand for long-term contraceptive methods [ 1214 ].
These findings demand attention and evaluation in order to develop evidence-based Sex woman brasilia for strengthening health systems and to prevent harmful practices. The Zika outbreak has exposed how access to sexual and reproductive health and its needs are a major public health issue, but there is a dearth of social and qualitative research. This qualitative research used the thematic analysis method. Because of that, this study did not intend to specify frequencies, nor produce generalizing statistical inferences.
This study will refer to its the participants which includes adolescents aged 10—19 and youths aged 15—24as young women. Health care workers invited women seeking sexual and reproductive health services at these sites between November and July to participate in the study. An informed opt-in procedure was used, participants were only contacted by the research team after providing their consent for the contact to the health care workers.
Women researchers performed individual, in-depth interviews with 22 participants. They were semi-structured interviews and followed a topic guide, but it took place as a conversation in which the researchers promoted a safe, comfortable environment to enable a comprehensive and candid record.
Initial questions were on sociodemographic data, such as age, color, ethnicity, occupation, level of education, marital status, of children, religion if any, and address. Questions about their attitude and knowledge on Zika virus, CZS, sexual transmission of Zika, contraception, abortion, pregnancy, and SRH needs and services, followed. Microanalysis is a type of detailed analysis of data in which line by line or sentence by sentence of documents are examined at the beginning of the study [ 15 ].
With an inductive approach to the analysis initial codes were generated. Codes were collated and those with similar pattern of meaning were grouped in order to identify themes [ 1516 ].
The coding process was used in order to focus the data analysis on what emerged from the empirical evidence. The coding process was systematically discussed between the researchers and was initiated after each interview was transcribed in order to identify core information during the data collection phase. Transcribed interviews collected by two researchers were subsequently coded accordingly [ 1516 ]. Coded interviews and the data were tabulated in order to identify the patterns and review themes.
Standards of coding were compared, and, in case of discrepancy, the coding method was discussed by the research team. In this analysis two themes emerged: lack of information and barriers of access to reproductive and sexual health services. All the participants provided informed consent in order to participate in the study in accordance with Brazilian regulations which guarantee autonomy and confidentiality about the sexual and reproductive health decisions and practices of the individual.
Participants in the three municipalities had similar characteristics. Only one participant said she had no religion. Eight participants had a very low level of formal schooling: they stopped their studies while in elementary school, a higher proportion than expected for this age group. Among participants with very low formal schooling, only one had not experienced an adolescent pregnancy.
Twelve participants completed high school or discontinued their studies during high school. Two participants were currently attending undergraduate courses. Of the 22 participants, 12 had children. Then I had to accept it, right? I had to leave school. Now I have two children.
Access to information and adolescent-friendly health services are key factors to reduce unintended early pregnancies [ 19 — 21 ]. Generally, women are considered to have an unmet need for contraception if they are fertile or are sexually active and want to delay or avoid becoming pregnant but are not using a contraceptive method [ 22 ]. However, in this study it is understood that an unmet need could also be expressed as lack of information about SRH and barriers to access these kind of health services.
The lack of information unfolds in two main aspects: knowledge gaps about contraceptives use; and misconceptions on contraceptive methods adverse effects and their effectiveness. Communications failure and unawareness about Zika and its consequences were barriers women faced when seeking SRH in high risk areas. Despite the increase in use of contraceptives in Brazil [ 2324 ], the young women were unaware of how to use them effectively — or even how to access these contraceptive methods.
They reported having little trust in short acting contraceptive methods such as oral and injectable contraceptives — which are commonly offered by the Brazilian public health services and have the highest usage prevalence in Brazil [ 25 ]. That is why it happens that people get pregnant when they use condoms, right? That is what happened with me. Some young women reported that they were not using any contraceptive method, as described by an year-old adolescent who experienced a repeat pregnancy within one year of the birth of her first.
Studies suggest that adolescents who are not actively seeking to prevent pregnancy are predisposed to it [ 26 — 28 ]. Population studies in Brazil indicate a large proportion of unplanned or unwanted pregnancies [ 529 — 31 ]. In Brazil, more than half of all births were reported as unwanted or mistimed [ 112429 ].
The risk of an unintended pregnancy during contraceptive method changes was also not stressed and discussed with the women at risk. But I was only able to get out of Sex woman brasilia house after 40 days. Then I got there, and they said I could not have it inserted because more than 30 days had passed. That I would have to wait for my period to come.
This finding is ificant for an area that was affected by the Zika epidemic and continues to be at risk for the illness. Shared community perception about contraceptive methods matters in promoting its acceptance or refusal. Women who fear IUD insertion justify their fright based on stories heard in their communities. They also explain the fear of inserting a foreign object into their bodies and about the copper decomposing inside their womb. Other misconceptions were also related as demonstrated by the literature on the supposed side effects of the IUD such as abortion, pelvic inflammatory disease, infertility or pain [ Sex woman brasilia ].
At the same time, the copper IUD was considered by the young women a good contraceptive choice when they heard the experiences of other women of their community.
The experience of other women with whom they have interpersonal ties, close and trusting relationships is considered an important aspect before deciding whether to use the IUD. When I remember the amount of work this one gives me, and she is still a baby. The young women reported suspending the continued use of hormonal contraceptive methods due to unwanted side effects on their body or health. These professionals, however, did not provide any evidence-based explanations or offer an alternative method of birth control.
Studies demonstrated that Brazilian women — mainly among those with less years of schooling and low socioeconomic status — view menstrual bleeding as a of health, fertility, and of not being pregnant [ 35 ]. Planning when and if the young women want to experience pregnancy is an important issue, but they faced barriers to access SRH services. The wish to postpone pregnancy was highlighted by all young women who had experienced childbearing.
These young women, especially those with little schooling, reported experiences in which there was little understanding of the information offered by the health care professional. But there is also embarrassment to ask about the same thing again. Young women reported their appreciation of discussion groups and informative lectures on available contraceptive methods and SRH.Sex woman brasilia
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