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[A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration] Reflexôes sobre a amamentação no Brasil: de como passamos a 10 meses de duração.
Cadernos de Saude Publica. 2003; 19 Suppl 1:S37-S45.In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account. (author's)
[A guide to providing reproductive health services] Guia para prestacao de services em saude reprodutiva.
Fortaleza, Brazil, Secretaria da Saude, 1998. xxvi, 432 p.The Viva Mulher [Healthy Woman] Program developed by the Secretariat of Health of the State of Ceará (SESA-CE), in partnership with several local, national and international institutions, was conceived after recognition of the unfavorable health situation of women throughout the State. Sensitized by the size of the problem and encouraged by other successful initiatives, such as the Community Health Agent program and the Healthy Child program, the results of which were translated into a reduction in infant mortality and an increase in the coverage of Basic Health Actions, the State Government resolved to promote a broad mobilization of institutions interested in the problems so as to develop intensive joint efforts involving society as a whole in an attempt to make a significant change in the health profile of women in Ceará. The first concrete act was the holding of the "Woman, Health, Life" seminar in Fortaleza in August 1992, which had more than 1,000 participants, to launch the Healthy Woman program on the basis of directives from the Ministry of Health (PAISM). The Healthy Woman program was associated from the beginning with the United Nations Population Fund (FNUAP), which proposed to offer technical assistance and financial resources through a four-year cooperation project with the State Government. The Pan American Health Organization (PAHO), collaborating agencies of the U.S. Agency for International Development (AID) and other international entities later joined in the process and have been cooperating in various complementary manners. (excerpt)
[Highlights, consensuses and afterwards. Regional Seminar on "The Human Rights of Women in the World Conferences"] Cumbres, consensos y despues. Seminario Regional "Los Derechos Humanos de las Mujeres en las Conferencias Mundiales". Reuniao de cupula, consensos e depois. Seminario Regional "Os Direitos Humanos de Mulheres nas Conferencias Mundiais".
Lima, Peru, Comite de America Latina y el Caribe para la Defensa de los Derechos de la Mujer [CLADEM], 1996 Nov. 218, 214 p.The Second Regional Seminar of the Latin American and Caribbean Committee for Defense of Women’s Rights (CLADEM) was held in Lima in April 1996 on the theme of the human rights of women in the five UN international conferences from the 1992 environmental conference in Rio de Janeiro to the 1995 Beijing conference on women. Evaluation of advances achieved in the conferences was organized around the six priority interests identified by CLADEM in 1992 as the basic themes for women in the region: citizenship, sexual and reproductive rights, violence and peace, development, ethno-racial perspectives, and the environment. The work opens with reflections on the five conferences, with examination of the place of women in the structure of each conference, whether gender inclusive language was used, conceptual advances in the human rights of women, limitations of the paradigm of equality, mechanisms and resources for implementation of the various Declarations, international achievements and national realities, north-south differences, universality and cultural relativity, and challenges for the next millennium. Six presentations follow on citizenship of women as a challenge for the democracies of the region, sexual and reproductive rights, the struggle against gender violence and advances in international instruments, ethno-racial perspectives, gender and the economic rights of women, and women and the environment. Each presentation assessed progress over the course of the five international conferences, and each includes commentaries from two representatives of organizations in the region whose activities were related to the theme. The final section identifies points that should be considered and possible strategies in each of the six areas.
SEXUALIDADE E PLANEAMENTO FAMILIAR. 1995 Jul-Sep; (7):17-8.The Portuguese Association of Family Planning has learned about a study of the World Health Organization that associated certain types of combined oral contraceptives (OCs) with an increased risk of cardiovascular diseases, notably deep venous thrombosis. The position of the International Medical Advisory Panel (IMAP) of the IPPF, however, was that such conclusions were not definitive and new studies should be conducted to confirm or refute these conclusions. Furthermore, since the risk is rare, those using OCs should have regular medical examinations. For the majority of OC users the benefits outweigh the risks. The author of one of the two studies that hinted at the cardiovascular risks of third-generation progestagens stated that the British authorities incorrectly interpreted the data, which were preliminary. In fact, these data suggest that the new generation of OCs protects against cardiac attack and associated mortality. Even the WHO took the position that these results should be confirmed by independent studies. The polemic mounted when the British authorities issued an alert about the possible negative effects of seven types of OCs containing progestagens which putatively doubled the risk of venous thrombosis. This was based on the findings of three studies: two of them were incomplete, one was done at the initiative of the WHO, one was carried out in Europe, and the third one was done in the UK. At the meeting of the Committee of Pharmaceutical Specialties of the European Agency of Medicaments in October 1995 in London the position was taken that it is not appropriate to withdraw such OCs; investigators should analyze these data in depth and perform new studies; the three companies that manufacture such OCs should submit more information by the end of 1995; and physicians should take into account thromboembolic risk factors when prescribing such OCs.
[Breastfeeding: a right of the mother and child] Aleitamento materno: um direito da mae e da crianca.
REVISTA PAULISTA DE MEDICINA. 1987 Mar-Apr; 105(2):103-7.The laws concerning the protection of working women who nurse and the outcome of the breast feeding program at the state university of Campinas (UNICAMP), Brazil, are discussed. The International Labor Organization (ILO) was founded in 1919 with the objective of improving the working conditions and lives of workers worldwide. At a 1952 convention, the right of women to interrupt work to nurse was accepted. In 1975, the declaration on the equal opportunity and treatment of working women was passed. ILO's recommendation was adopted in 30 countries which allowed working woman to nurse for 30 minutes or more. In Italy and Bulgaria, 60 minutes is assigned for nursing. A 1923 Brazilian law decreed that nurseries must be near the work place where mothers could nurse regularly. ILO's 1952 convention was ratified in 1966 in Brazil, and, in 1986, a paid nursery scheme was passed. UNICAMP has been dealing with nursing programs since 1975, focusing on education, breastfeeding techniques, presentations, and group discussions. The mothers were monitored until weaning or until the child reached 9 months of age. The program had a higher impact among women >25 and married, than among women >30 with less education. In a follow-up program, 100 women 7 months pregnant received prenatal assistance and were asked to fill out a questionnaire. 76 complied: 28 nursed their present child but not the previous one, and 22 nursed their first child (50% for less than 6 months). A 1977 survey in the city of Paulinia on breast feeding duration of children up to 2 years of age showed that 12.1% of 610 were never nursed. 57% were exclusively breast fed in the first month, but only 18% were nursed by the 6th month. In 1982, an infant center was inaugurated by UNICAMP where a child could nurse 5 times a day up to 6 months of age. In the first 4 years, 334 children attended and were nursed for 12 months, although 8.8 months was the expected duration, and the previous child had been nursed for only 6 months.
Injectable progestogens - officials debate but use increases. Les progestatifs injectables : les autorites en debattent, mas l'usage s'en repand.
Population Reports. Series K: Injectables and Implants. 1975 Mar; (1): p.A report on the status of the injectable contraceptive agents, Depo-Provera (depot medroxyprogesterone acetate) and Norigest is presented. Depo-Provera is distributed in 64 countries, though it is not available in the U.S., the United Kingdom, and Japan. The drug is usually administered in single 150 mg injections every 3 months, and doses of 300-400 mg every 6 months have been studied. The contraceptive effect of Depo-Provera is primarily through its ability to inhibit ovulation. Norigest exerts its effect by altering the cervical mucus. The suppression of ovulation is most likely caused by action on the hypothalamus-pituitary axis, resulting in inhibition of the luteinizing hormone surge. Depo-Provera causes an atrophic endometrium, while Norigest has varying endometrial effects. The reported pregnancy rates for Depo-Provera are usually less than 1%, while those for Norigest are slightly higher. Most method failures occur either shortly after the 1st injection or at the end of an injection interval. Menstrual disorders have been the primary reason for discontinuation. The injectables can cuase shorter or longer cycles, increased or decreased menstrual flow, and spotting. Depo-Provera users experience increased amenorrhea with continued use, while normal cycles increasingly reappear in Norigest users. Cyclic estrogen therapy has been effective in treating excessive or irregular bleeding and amenorrhea. Long-acting estrogen injections have been administered in combination with Depo-Provera or Norigest, though the studies are limited in number. Weight gain of up to 9 pounds has been reported for users of Depo-Provera. Some researchers have found that Depo-Provera raises blood glucose levels, while others have reported it does not. No adverse effects have been reported for injectables on blood clotting, adrenal or liver function, blood pressure, lactation, and metabolic or endocrine functions. The continuation rate for Depo-Provera is reportedly higher than that for oral contraceptives. Generally, 60% of the acceptors will use the method for at least 1 year. Effective counseling on the menstrual alterations resulting from injectables can increase continuation of the method. The return of fertility in Depo-Provera users usually requires 13 months from the time of the last injection, while the afertile period in Norigest users is about 6 months from the time of the last injection. Instances of fetal masculinization as a result of Depo-Provera use have not occurred. The possibility that Depo-Provera can cause cervical carcinoma in situ has not been substantiated by the evidence; doubt about this possible association has prevented its approval as a contraceptive method in the U.S. Although Depo-Provera and Norigest have caused breast nodules in laboratory animals, there is no evidence to suggest that this effect would occur in human. Despite the advantages of injectables, family planning officials have been reluctant to permit its unrestricted use, primarily because it cannot be withdrawn guickly enough if problems arise and because the actual effect on fertility is not yet known. Nonetheless, the use of Depo-Provera has increased in recent years. The IPPF and the U.N. Fund for Population Activities currently supply the drug.