Defining Family Planning in a São Paulo Clinic: Healthcare Providers and Patients’ Varied Conceptualizations of “Planned” and “Unplanned” Pregnancies Open Access
Gonzalez, Daniella (Spring 2019)
Published
Abstract
This honors thesis explores the varying conceptualizations healthcare providers and pregnant patients have about family planning. The thesis is a case study of the Bom Retiro UBS, a public primary healthcare clinic in the Bom Retiro neighborhood in São Paulo, Brazil. This thesis intends to demonstrate that the municipal government’s categorization of pregnancies as either planned or unplanned does not reflect the complexities of a woman’s pregnancy experience. This thesis also highlights the negative perceptions of providers and patients against unplanned pregnancies. These perceptions make the reporting of pregnancies as planned or unplanned problematic without a shared definition of both terms in the neighborhood. Lastly, this thesis provides proposed solutions to challenge the current family planning discourse in the clinic and community.
Table of Contents
Introduction……………………………………………………………………………...................................................................................................…….1
Valeria’s Story as a Young, Immigrant Women with an Unplanned Pregnancy.................................................................................................1
Methodology.....................................................................................................................................................................................................3
A Summary of the Chapters..............................................................................................................................................................................5
Chapter 1: The Significance of Family Planning and Brazilian Legislation on Family Planning Services in Public Policy...............................8
What is Family Planning and What is its Significance?....................................................................................................................................8
Family planning................................................................................................................................................................................................8
Poverty reduction through family planning……………………...........................................................................................................................10
Reducing maternal and infantile mortality through family planning………....................................................................................................12
The Maintenance of Healthy Pregnancies and Access to Contraception for Pregnancy Prevention...............................................................13
The female reproductive system and the maintenance of healthy pregnancies..............................................................................................13
Contraception methods and pregnancy prevention........................................................................................................................................14
The benefits of access to legal abortion and Brazil’s restrictive legislation on the practice...........................................................................19
Brazilian Federal Legislation on Women’s Health...........................................................................................................................................22
Pronatalist Brazil: Vargas’ “paternalistic” dictatorship and the creation of infant focused public health departments.................................22
Non-profit interventions for family planning: the introduction of the birth control pill to target regions of Brazil......................................24
PAISM and comprehensive women's care: shifts from materno-infantile women's care to women as independent entities
in healthcare in the 20th century.....................................................................................................................................................................27
Women’s health in the 21st century: Lula, Dilma, and the future of family planning in Brazil.......................................................................30
A Breakdown of The National Health System (SUS) and its Funding...............................................................................................................35
My First Impressions of the UBS and Bom Retiro Neighborhood.....................................................................................................................37
Bom Retiro and its UBS.....................................................................................................................................................................................37
Negative Attitudes in the Clinic: Maria’s First Pregnancy Test.........................................................................................................................40
Chapter 2: The Conceptualizations of Family Planning of the UBS Clinic and Patients...................................................................................44
Interviewing Providers: Acknowledging Differences Perceived between Planned and Unplanned Pregnancies...............................................45
Healthcare providers of the Bom Retiro UBS: physicians, nurses, and community agents................................................................................45
Providers’ definitions of family planning..........................................................................................................................................................48
Nurses and physicians: differences perceived between planned and unplanned pregnancies..........................................................................49
Community agents............................................................................................................................................................................................53
Pre-Natal Medical Files: Gaining a Greater Understanding of the Pregnant Female Patients..........................................................................55
Obtaining access to the prenatal medical files..................................................................................................................................................56
Demographic Information of all Pregnant Women Registered in the Bom Retiro UBS.....................................................................................58
Nationality........................................................................................................................................................................................................58
Race...................................................................................................................................................................................................................60
Marital status....................................................................................................................................................................................................61
Education level completed................................................................................................................................................................................63
“Planned” versus “unplanned” and contraception use.....................................................................................................................................65
Unplanned versus Planned: Are there Demographic Differences?....................................................................................................................68
Nationality.........................................................................................................................................................................................................69
Age.....................................................................................................................................................................................................................71
Monthly income.................................................................................................................................................................................................72
Race....................................................................................................................................................................................................................73
Marital status......................................................................................................................................................................................................75
Education level completed.................................................................................................................................................................................76
Contraception use..............................................................................................................................................................................................78
The Conceptualizations of Family Planning of Female Pregnant Patients of the Bom Retiro UBS....................................................................79
Women that did not have a definition for family planning: acknowledging and confronting informational gaps when providing
family planning services...................................................................................................................................................................................81
Family planning as a conversation between partners: gender relations in the clinic.......................................................................................84
Love and desire: the seemingly interchangeable nature of planning and loving in family planning discourse...............................................87
Miranda: sexual trauma in cases of planned pregnancies................................................................................................................................89
Conclusion.......................................................................................................................................................................................................93
Strengths, Limitations, and Future Directions................................................................................................................................................97
Appendix A: Common Questions for Female Patients during their Medical Appointments..........................................................................101
Appendix B: Common Questions for Physicians, Nurses, and Community Agents of the Bom Retiro UBS....................................................103
Appendix C: List of Figures.............................................................................................................................................................................105
Bibliography....................................................................................................................................................................................................106
About this Honors Thesis
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