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Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training. In this integrative review using a gender-oriented approach, we searched the Scielo database and the Ministry of Health’s (MofH) publications and edicts for institutional and research papers on SM initiatives addressing disrespect and abuse in the last 25 years (1993-2018) in Brazil, and their impact on public policies and training programmes. We analyse these groups of interrelated initiatives: (1) political actions of SM resulting in changes in public policies and legislation; (2) events organised by SM for diffusion of information to the public; (3) MofH policies to humanise childbirth with participation of SM; and (4) initiatives to change providers’ training, including legal actions based on obstetric violence reports. To promote real change in maternity care, the progression of policies and enabling environment of laws, regulations, and broad dissemination of information, need to go hand in hand with changes in all health providers’ training - including a solid base in ethics, gender and human rights. [ABSTRACT FROM AUTHOR]

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Background: Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective: To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design: In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results: For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions: This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs. [ABSTRACT FROM AUTHOR]

Brazil has a historical gap regarding information on violence against women. Herein we aimed to evaluate the association of socioeconomic and demographic characteristics with physical violence against women in Brazil, as well as the possible escalation of violence to severe patterns of violence. We analysed data from the 3rd Brazilian Household Survey on Substance Use, in 2015. The main outcomes were reporting any physical violence and being stabbed/shot in the last 12-months. Logistic regressions were fitted to assess the association between socioeconomic and demographic variables with the outcomes. We estimated 3.8 million women reported any physical violence (5.52%): 3.79% reported threats to beat/ push/kick, 1.87% threats with knife/gun, 2.49% were beaten/pushed/kicked, 0.63% were spanked/ choked, and 0.21% were stabbed/shot. The higher the severity of violence, the higher the number of types of violence experienced. The likelihood of reporting any violence was higher among women 18–24 years, without a stable partner, who were at an informal job or unemployed, and who live in urban areas. The sociodemographic characteristics associated with reporting any violence reinforce the importance of addressing gender inequalities. Evidence of escalation violence reinforces the need to protect and care for women who report any type of violence. [ABSTRACT FROM AUTHOR]

Sex education has been included in the National Curriculum of the Brazilian Ministry of Education since 1996 as a cross-cutting theme that should be linked to the contents of each school subject in primary and high schools. This paper presents a study of the implementation of this policy in the primary schools of Novo Hamburgo, Rio Grande do Sul, Brazil, based on interviews between January 2011 and April 2012 with 82 teachers working in those schools. We found that sex education was not being taught as a cross-cutting theme in any of the schools, and that any lessons were mostly dominated by a biomedical discourse focusing primarily on the reproductive organs, fertility, pregnancy, and contraception. Sexual health and relationships and non-heterosexual sex and relationships were being neglected. Sex education was also considered a possible means of correcting or controlling sexual identities and behaviours deemed abnormal or immoral. We recommend far more discussion of how to implement the National Curriculum recommendations. We call for education courses to provide theoretical and methodological training on sex education for teachers, and recommend that the boards of educational institutions take up sex education as a priority subject. Lastly, we suggest that each school studies local sexuality-related problems and based on the findings, each teacher presents a pedagogical proposal of how to integrate sex education into the subjects they teach. L'éducation sexuelle est au programme d'études national du Ministère brésilien de l'éducation depuis 1996 comme discipline transversale devant être liée aux contenus de chaque matière scolaire dans l'enseignement primaire et secondaire. L'article présente une étude sur la mise en łuvre de cette politique dans les écoles primaires de Novo Hamburgo, Rio Grande do Sul, Brésil, sur la base d'entretiens menés entre janvier 2011 et avril 2012 avec 82 enseignants de ces écoles. Nous avons constaté qu'aucune des écoles n'enseignait l'éducation sexuelle comme discipline transversale et que les cours étaient le plus souvent dominés par un discours biomédical se centrant principalement sur les organes reproducteurs, la fécondité, la grossesse et la contraception. Ils négligeaient la santé et les relations sexuelles, de même que les rapports non hétérosexuels. L'éducation sexuelle était aussi considérée comme un moyen possible de corriger ou de contrôler les identités et les comportements sexuels jugés anormaux ou immoraux. Nous recommandons d'intensifier les discussions sur la manière d'appliquer les recommandations relatives au curriculum national. Nous demandons que les cours dispensent aux enseignants une formation théorique et méthodologique sur l'éducation sexuelle et préconisons que les conseils d'administration des institutions éducatives considèrent l'éducation sexuelle comme une discipline prioritaire. Enfin, nous suggérons que chaque école étudie les problèmes locaux relatifs à la sexualité et, sur la base des conclusions, que chaque enseignant présente un projet pédagogique sur la manière d'intégrer l'éducation sexuelle dans la matière qu'il enseigne. En 1996, la educación sexual fue incluida en el Currículo Nacional del Ministerio de Educación de Brasil como un tema transversal que debería vincularse con el contenido de cada materia de enseñanza primaria y secundaria. En este artículo se presenta un estudio de la aplicación de esta política en las escuelas primarias de Novo Hamburgo, Rio Grande do Sul, en Brasil, basado en entrevistas realizadas entre enero de 2011 y abril de 2012 con 82 maestros que trabajaban en esas escuelas. Encontramos que en ninguna de las escuelas se estaba enseñando la educación sexual como un tema transversal y que, si había lecciones, éstas eran dominadas en su mayoría por un discurso biomédico centrado principalmente en los órganos reproductivos, fertilidad, embarazo y anticoncepción. Se hizo caso omiso de la salud y relaciones sexuales y del sexo y las relaciones no heterosexuales. Además, la educación sexual era considerada como un posible medio de corregir o controlar identidades sexuales y comportamientos considerados anormales o inmorales. Recomendamos discutir más a fondo cómo poner en práctica las recomendaciones del Currículo Nacional. Hacemos un llamado a que en los cursos educativos se ofrezca a los profesores formación teórica y metodológica sobre la educación sexual y recomendamos que los consejos de las instituciones educativas den prioridad a la educación sexual. Por último, sugerimos que cada escuela estudie los problemas locales relacionados con la sexualidad y, según los hallazgos, que cada maestro presente una propuesta pedagógica sobre cómo integrar la educación sexual en las materias enseñadas. [ABSTRACT FROM AUTHOR]

This paper addresses equity in health and health care in Brazil, examining unjust disparities between women and men, and between women from different social strata, with a focus on services for contraception, abortion and pregnancy. In 2010 women's life expectancy was 7Z6 years, men's was 69.7 years. Women are two-thirds of public hospital services users and assess their health status less positively than men. The total fertility rate was 1.8 in 2011, and contraceptive prevalence has been high among women at all income levels. The proportion of sterilizations has decreased; lower-income women are more frequently sterilized. Abortions are mostly illegal; women with more money have better access to safe abortions in private clinics. Poorer women generally self-induce abortion with misoprostol, seeking treatment of complications from public clinics. Institutional violence on the part of health professionals is reported by half of women receiving abortion care and a quarter of women during childbirth. Maternity care is virtually universal. The public sector has fewer caesarean sections, fewer low birthweight babies, and more rooming-in, but excessive episiotomies and inductions. Privacy, continuity of care and companionship during birth are more common in the private sector. To achieve equity, the health system must go beyond universal, unregulated access to technology, and move towards safe, effective and transparent care. [ABSTRACT FROM AUTHOR]

The concept of the 'nutrition transition' is widely used to explain the recent, rapid rise in overweight and obesity, and the co-existence of under- and over-nutrition, in low-income populations in 'middle-income' developing countries. This article provides an overview of the changes occurring in diets, physical activity, and nutritional status among children and adults in nutrition transition settings, explores the impact of these changes by gender, and discusses the long-term individual and social repercussions of such changes. It concludes by framing important questions for development practice and policy in nutrition transition settings through a gendered lens. [ABSTRACT FROM AUTHOR]