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To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America.We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad.We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively).Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.

Objetivo. Identificar cómo se implementa la estrategia de anticoncepción posevento obstétrico (APEO) y analizar las barreras, acciones y recomendaciones para prevenir embara­zos subsecuentes en adolescentes. Material y métodos. Estudio cualitativo a través de análisis de contenido de 21 en­trevistas semiestructuradas a personal de salud de instituciones de atención a población sin seguridad social de la Ciudad de México y Morelos. Resultados. La APEO se promueve du­rante el embarazo, parto, posaborto, puerperio y hasta 12 me­ses después del evento obstétrico. La consejería debe abordar, además de información técnica sobre métodos anticonceptivos, otras temáticas clave en relación con los derechos sexuales y reproductivos de los adolescentes. Se identifican barreras personales, institucionales y sociales para la implementación de la estrategia; el personal refiere acciones y recomendaciones específicas para su consolidación. Conclusión. La estrategia de APEO se debe fortalecer para garantizar la oferta de un servicio acorde con las necesidades de las mujeres menores de 20 años, así como diseñar intervenciones basadas en las buenas prácticas y recomendaciones de los prestadores de salud para superar las barreras y lograr periodos intergenésicos más allá de la adolescencia.

To analyze how adolescent perceptions on the risks of pregnancy for physical health and self-development in this stage of life are associated with five personal tools. Methods: We conducted a cross...

This study aims to conduct a search of public-policy instruments seeking explicit references to subsequent adolescent pregnancy, as well as to discern what kinds of actions have been proposed as part of the international and national agendas to facilitate subsequent adolescent pregnancy prevention and care. During June 2021, we used an integrative review to search and to analyze national and international public policy instruments along with other documents related to subsequent adolescent pregnancy. We observed, for each, the presence of statements on subsequent adolescent pregnancy. The research team was then divided into triads to discuss and to classify each reference under one of the following categories: (a) a symbolic statement, that is, an intention not implying a specific action but rather presenting a vision for the future; (b) a substantive-material statement concerning an action intended to solve a problem; and (c) a procedural-material statement indicating specific actions, processes, budgets, and actors. We analyzed a total of 135 public-policy documents: 102 in Mexico and 33 internationally. Only four national and six international documents contained either symbolic or substantive-material references to the subject of interest and only one specified a procedural-material statement. The prevention and care of subsequent adolescent pregnancy are addressed only secondarily on the public agendas. Only a minimal number of actions comprise specific and standardized measures to prevent subsequent adolescent pregnancy according to the different actors involved. Designing a greater number of procedural-material policies will help to reduce morbidity and mortality in the mother-child binomial and promote a comprehensive development of this population. El objetivo de este estudio fue realizar una búsqueda de instrumentos de políticas públicas que hagan referencia explícita a los embarazos subsecuentes en adolescentes, así como distinguir qué tipo de acciones forman parte de las agendas internacionales y nacionales para su prevención y atención. Durante el mes de junio de 2021, realizamos una revisión integradora para buscar y analizar instrumentos de políticas públicas nacionales e internacionales, junto con otros documentos relacionados a los embarazos subsecuentes en adolescentes. Para cada uno, registramos la presencia de declaraciones sobre embarazos subsecuentes en adolescentes. El equipo de investigación se dividió en tríadas para discutir y clasificar cada referencia en una de las siguientes categorías: (a) declaración simbólica, es decir, intención que no implica una acción específica, sino una visión hacia el futuro; (b) declaración material-sustantiva, hace referencia a una acción enfocada en resolver un problema; y (c) declaración material-procedimental, indica acciones, procedimientos, presupuestos y actores específicos. En total se analizaron 135 documentos de políticas públicas: 102 de México y 33 a nivel internacional. Solamente cuatro documentos nacionales y seis internacionales contenían referencias simbólicas o materiales sobre el tema de interés, únicamente uno refirió una declaración material-procedimental. La prevención y la atención de embarazos subsecuentes en adolescentes son temas secundarios en las agendas públicas. Pocas son las acciones que comprenden medidas específicas y estandarizadas para prevenir los embarazos subsecuentes en adolescentes de acuerdo con los diferentes actores involucrados. La elaboración de más políticas procedimentales y sustantivas contribuirá a una reducción de la morbimortalidad en el binomio madre-hijo y a una promoción del desarrollo integral de este grupo poblacional. O objetivo foi realizar uma busca de instrumentos de políticas públicas que busquem referências explícitas a gestações sucessivas na adolescência, bem como discernir que tipos de ações têm sido propostas como parte das agendas internacionais e nacionais para facilitar sua prevenção e cuidado. Durante junho de 2021, utilizamos uma revisão integrativa para pesquisar e analisar instrumentos de políticas públicas nacionais e internacionais, juntamente com outros documentos relacionados a gestações sucessivas na adolescência. Para cada um, registramos a presença de declarações sobre gestações sucessivas na adolescência. A equipe de pesquisa então se dividiu em tríades para discutir e classificar cada referência sob uma das seguintes categorias: (a) uma declaração simbólica, ou seja, uma intenção sem implicação de uma ação específica, mas uma apresentação de visão para o futuro; (b) uma declaração substantiva sobre uma ação destinada a resolver um problema; e (c) uma declaração processual-material indicando ações, processos, orçamentos e atores específicos. Foram analisados um total de 135 documentos de políticas públicas: 102 no México e 33 internacionalmente. Apenas quatro documentos mexicanos e seis internacionais continham referências simbólicas ou substantivas ao tema de interesse e apenas um especificava uma declaração processual-material. A prevenção e o cuidado de gestações sucessivas na adolescência são abordados como secundários nas agendas públicas. Apenas um número mínimo de ações compreende medidas específicas e padronizadas para prevenir gestações sucessivas na adolescência de acordo com os diferentes atores envolvidos. A elaboração de um maior número de políticas processual-material ajudará a reduzir a morbidade e a mortalidade no binômio mãe-filho e promover um desenvolvimento abrangente desse grupo populacional.

Objetivo: Evaluar los procesos de una intervención de actividad física durante el embarazo y postparto. Métodos: En el contexto de un programa social que combate la pobreza extrema, las beneficiarias (n=927) recibieron una intervención que consistió en la promoción de la práctica de actividad física, a través de consejería, talleres y materiales educativos. En 2008-9, 2010 y 2012 se visitaron unidades de salud urbanas y rurales, seleccionadas aleatoriamente, de cuatro entidades federativas de México. Se recolectó información de procesos a través de prestadores de servicios de salud, observación en consulta y aplicación de encuestas de salida a beneficiarias. Se estudiaron cuatro indicadores de implementación de la intervención: fidelidad a actividades planeadas; dosis entregada a la población; alcance de la población objetivo; y recepción de la intervención por embarazadas y en el posparto de las participantes. Resultados: Se visitaron unidades de salud en la etapa inicial (n=91), intermedia (n=47) y final (n=82) del estudio. La dosis liberada presentó un nivel del 81-86% de implementación. La fidelidad presentó

In this exploratory study, a survey was carried out with 902 junior high-school students in localities with medium to high degree of marginalization in two states of central Mexico. This article describes the family, reproductive, and educational aspirations and expectations of this sample of students from disadvantaged areas, and explores mechanisms contributing to forming future plans. Two main plans are outlined in this sample: one oriented towards prioritizing family formation and an elevated risk of dropping out of school, and another oriented towards postponing unions and child-raising to look for educational/career development. Several factors appear to influence the development of educational/career ideals among men, however, the mechanisms driving the formation of future plans in women are less clear. The findings add to a limited body of knowledge measuring both educational and reproductive aspirations of students in low-resource settings in Latin America.

Study Objective: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. Results: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. Conclusion: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.

Adolescent pregnancy is considered a priority public health issue because of its implications in the lives of young mothers, their children, and the well-being of the general population. In this paper, we describe an intervention targeting adolescents (aged 11–19 years old) in a rural context and estimate its impact on key outcomes relevant to early pregnancy prevention: knowledge and self-efficacy concerning sexual and reproductive health, knowledge of sexual and reproductive rights, and attitudes toward gender roles. Our study used a quasi-experimental design comprising 747 adolescents. Three difference-in-differences models (raw, adjusted, and by exposure level) with fixed effects estimated the changes in all outcome measures. Our results showed that the intervention community had a significant improvement in all outcomes, and this improvement was larger in those who received the highest-exposure level of intervention compared to a control community. Our study provides evidence that a community-based intervention, founded on comprehensive sexual education, is a promising approach to improve key outcomes related to early pregnancy in rural contexts. Further research should be undertaken to test how similar strategies focusing on multi-layer early pregnancy determinants work on other sub-groups of vulnerable adolescents, such as school dropouts or those living in disadvantaged circumstances.

Antecedentes : La Escuela de Natacion Acuarela (Oaxaca-Mexico) adopto la teoria de la Tritemporalidad de la Motricidad Humana (filogenesis, ontogenesis y sociogenesis) para desarrollar su metodo de ensenanza en la Educacion Acuasomatica para bebes, en donde, para facilitar el proceso de aprendizaje, recurre a las competencias filogeneticas. Objetivos : Explorar si el metodo de Educacion Acuasomatica de la Escuela Acuarela, propicia que la madre experimente y se haga consciente de sus competencias en el agua y si esto facilita que el bebe adquiera habilidades fundamentales para interrelacionarse naturalmente con el agua. Metodo : Metodologia mixta para evaluar el desarrollo de cinco competencias filogeneticas: atencion sustentada, gestualizacion, interaccion, afiliacion e imitacion durante el proceso ensenanza-aprendizaje. Curso de 3 meses con 14 diadas (madres-bebes) menores de 1 ano. Utiliza: entrevista, encuesta (pre-test/post-test), videograbacion y auto-observacion de las madres. Resultados : Inicialmente, 20% de las madres reportan no saber nadar, 58% haber tenido poco contacto con agua en la ninez y 30% algo de miedo. A lo largo de las sesiones, exploran, de manera teorico-vivencial y progresiva, las nociones de la Tritemporalidad de la Motricidad Humana y sus competencias filogeneticas; todas mostraron un incremento progresivo. Su autobservacion conlleva un aumento de emociones positivas en relacion con su experiencia en el agua. Senalan gran satisfaccion con la escuela y metodologia implementada. Conclusiones : La Educacion Acuasomatica prepara a la madre para abordar conscientemente las competencias filogeneticas que garantizan en el bebe la adquisicion de habilidades basicas para su adaptacion natural al agua y facilitar el aprendizaje de la natacion. Palabras clave: Agua, Educacion Somatica, Habilidad, Maternal, Aprendizaje, Natacion, Bebes, Mexico. Title: Acuasomatic education: Benefits of phylogenetic competences in swimming for babies Abstract Introduction: The Acuarela Swim School (Oaxaca-Mexico) has adopted the theory of the tritemporality of Human Motricity (phylogenesis, ontogenesis and sociogenesis) to develop its teaching method in Aquasomatic Education for babies, in which, in order to facilitate the learning process, turns to the phylogenetic competences. Goals: To explore whether the method of Aquasomatic Education of the Acuarela School propitiates a context in which the mother experiments and becomes conscious of her competences in the water and if this facilitates the baby’s acquisition of fundamental abilities to interrelate with the water. Method: Mixed methodology to evaluate the development of five phylogenetic competences: sustained attention, gestualization, interaction, affiliation and imitation during the teaching-learning process. Three-month course with 14 dyads (mothers-babies) less than one year old. Uses: interview, survey (pretest/posttest), video-recordings and self-observation of the mothers. Results: Initially, 20% of the mothers reported not knowing how to swim, 58% had little contact with water during their childhood and 30% have some fear. Throughout the sessions, they explore, in theoretical-experiential and progressive ways; all showed progressive increments. Their self-observations reflect a rise in positive emotions in terms of their experience in the water. They show great satisfaction with the school and the methodology that has been implemented. Conclusions: Aquasomatic Education prepares the mother to approach consciously the phylogenetic competences that guarantee the baby’s acquisition of basic abilities for its natural adaptation to the water and facilitate learning to swim. Keywords: Somatic Education, Maternal, Skills, Aquatic Adaptation, Baby, Mexico. Titulo: Educacao de Acuasomatic: Beneficios de competencias filogeneticas na natacao para bebes Resumo Introducao : A Escola de Natacao Acuarela (Oaxaca-Mexico), adotou a teoria da Tritemporalidade da Motricidade Humana (filogenese, ontogenese e sociogenese) para desenvolver seu metodo de ensino na educacao aquatica para bebes, onde, para facilitar o processo de aprendizagem, recorre as competencias filogeneticas. Objetivos: explorar se o metodo do Educacao Aquasomatica da Escola Acuarela, incentiva as maes a experimentar e tomar consciencia de suas proprias habilidades na agua e se isso permite que o bebe adquira habilidades fundamentais para se inter-relacionar naturalmente com a agua. Metodo: metodologia mista para avaliar o desenvolvimento de cinco competencias filogeneticas: atencao sustentada, gestualizacao, interacao, afiliacao e imitacao durante o processo de ensino-aprendizagem. Curso de 3 meses com 14 duplas (maes e bebes) com menos de 1 ano. Se utilizou: entrevista, pesquisa (pre-teste / pos-teste), gravacao de video e auto-observacao das maes. Resultados: Inicialmente, 20% das maes relataram nao saber como nadar, 58% tiveram pouco contato com a agua na infância e 30% tiveram algum medo. Ao longo das sessoes, exploraram, de maneira teorico-experimental e progressiva, as nocoes de Tritemporalidade da Motricidade Humana e suas competencias filogeneticas; Todas mostraram um aumento progressivo. A sua auto-observacao leva a um aumento das emocoes positivas em relacao a sua experiencia na agua. Elas indicam grande satisfacao com a escola e metodologia implementada. Conclusiones: A Educacao Aquasomatica prepara a mae para abordar conscientemente as competencias filogeneticas que garantem ao bebe a aquisicao de habilidades basicas para a sua adaptacao natural a agua e facilitar a aprendizagem da natacao Palavras-chave: Agua, Educacao Somatica, Habilidade, Materna, Aprendizagem, Natacao de Bebes, Mexico.

Women need to receive accurate information on the proper use of contraceptive methods (CM). The objective of our analysis was to evaluate the quality of CM counseling in health institutions of the public sector using the Lot Quality Assurance Sampling (LQAS) technique. We specifically analyzed whether health-service providers informed CM users of all the side effects they might experience, as specified under the Mexican health-care regulations. Our results demonstrated that, among the four CM analyzed -the intrauterine device, hormonal injection, condom and subdermal implant- only the users of the subdermal implant received complete information on side effects. Our findings thus indicate that the quality of family planning services in the institutions analyzed is deficient. We recommend that service providers be regularly trained in order to improve their performance and that LQAS methodology be adopted as an effective means of regularly monitoring the quality of health services in Mexico.

Background Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. Methods: Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. Results According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88–6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14–5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29–5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26–4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21–4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10–3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03–3.11). Conclusions Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.

Objective To explore demographic, socio-economic, and reproductive factors associated with pregnancy desire among adolescents in five Latin American countries. Design Secondary analysis using nationally representative, cross-sectional data from UNICEF Multiple Indicator Cluster Surveys (MICS). Setting Cuba, the Dominican Republic, El Salvador, Mexico, and Panama. Population Adolescents 15-19 years old who were pregnant or mothers (n = 4207). Methods Chi-square tests, simple linear regressions, and multilevel Poisson regression models were used to estimate associations between individual- and country-level factors associated with pregnancy desire among adolescents. Main outcome measures Desire for pregnancy among adolescents who were pregnant or had given birth in the last 2 years. Results The proportion of adolescents who reported they desired their last pregnancy ranged from 79.3% in Cuba to 37.6% in Panama; approximately half the adolescents in Mexico, El Salvador, and the Dominican Republic desired their last pregnancy. The multilevel analysis shows that pregnancy desire was more likely among adolescent women who were less educated [prevalence ratio (PR) = 0.97, 95% confidence interval (CI) 0.96-0.98], older (PR = 1.39, 95% CI 1.04-1.09), married or cohabiting with a partner (PR = 0.70, 95% CI 0.53-0.93), and had low parity (PR = 0.67, 95% CI 0.58-0.76). Conclusions Adolescents with less education, who are older, married or cohabiting, and with low parity were more likely to desire their pregnancy. These data constitute evidence that, in conjunction with qualitative and implementation research, can be used to better design services for adolescents so they can exercise their sexual and reproductive rights, and plan healthier and more satisfying futures. Funding All the databases used on the performance of this study are open access. We did not receive any funding for the present analysis. Tweetable abstract Parity and marital status showed the strongest association with adolescent pregnancy desire in five Latin American countries.

To identify the association between knowledge about pregnancy risk and self-efficacy in condom use with parental support and school factors in adolescent men.Cross-sectional study with 448 students in Puebla and Morelos. Two logistic models were adjusted.Knowledge about pregnancy risk is associated with communication about sexuality between parents and sons (OR = 2.45, 95%CI 1.35-4.47), satisfaction with school (OR=2.18, 95%CI 1.15-4.13), if teachers talk about gender equity frequently/very frequently (OR=1.69, 95%CI 1.06-2.67) and with age (OR=1.77, 95%CI 1.26-2.50). Self-efficacy in condom use is statistical related with communication about sexuality between parents and sons (OR=1.80, 95%CI 1.01-3.20), satisfaction with school (OR=2.60, 95%CI 1.42-4.77), belong to middle socioeconomic level (OR=1.82, 95%CI 1.07-3.11) and live in a community with a high degree of marginalization (OR=0.47, 95%CI 0.30-0.73).To study family and school support, considering the influence of the social environment, allows a greater understanding of skills acquisition for a preventive sexual behavior, in males during early adolescence.Identificar la asociación entre conocimiento sobre riesgo de embarazo y autoeficacia en el uso del condón, con el apoyo parental y factores escolares, en hombres.Estudio transversal con 448 estudiantes en Puebla y Morelos. Se ajustaron dos modelos logísticos.Los conocimientos sobre riesgo de embarazo se asocian con el que los padres hablen sobre sexualidad (RM=2.45, IC95% 1.35-4.47), con el agrado por asistir a la escuela (RM=2.18, IC95% 1.15-4.13), con el que los profesores hablen frecuentemente/muy frecuentemente sobre equidad de género (RM=1.69, IC95% 1.06-2.67) y con la edad (RM=1.77, IC95%1.26-2.50). La autoeficacia en el uso de condón se relaciona con el que los padres hablen sobre sexualidad (RM=1.80, IC95% 1.01-3.20), con el agrado por asistir a la escuela (RM=2.60, IC95% 1.42-4.77), con el nivel socioeconómico medio (RM=1.82, IC95% 1.07-3.11) y con alto grado de marginación (RM=0.47, IC95% 0.30-0.73).Estudiar el apoyo familiar y escolar, considerando la influencia del entorno social, permite mayor entendimiento de la adquisición de habilidades para una conducta sexual preventiva en hombres durante la adolescencia temprana.

Factors that have a bearing on adolescent pregnancies have been widely documented worldwide. However, rarely has the adolescents’ own perception on the ideal timing to transit into adulthood-related events, such as family formation, been considered. Neither has it been widely investigated if these aspirations are linked to the risk of early pregnancies. Using data from a cross-sectional study with a sample of adolescents in Mexico City and Morelos, Mexico, we explored expectations regarding the ideal timing for family formation (marriage and childbearing) and their link to sexual behavior. We surveyed 3,332 adolescents in eight middle schools and high schools. Four types of aspirations were identified: (a) early plan: desire to marry at age 21 and have children at 22; (b) middle plan: desire to marry and have children at ages 25 and 26 respectively; (c) late plan: desire for a stable partner at age 29 and children at 31; and (d) non-traditional plan: adolescents that do not want to marry and/or have children. Those adolescents that aspire to postpone family formation particularly until 29 years of age (late plan) are more likely to report condom use at first intercourse and to have fewer sexual relations during all their life. Adolescents’ expectations about their life in the future affect their present sexual and reproductive decisions. Identifying their aspirations should enhance the design of more viable and successful policy strategies to prevent adolescent pregnancies.

Objective. To analyze the perception in relation to when and how to perform actions for the early detection of breast and cervical cancer among women and health care providers in communities with a high percentage of indigenous population in Morelos, Mexico. Materials and methods. Ten health providers and 58 women users of health services were interviewed which have a first level of attention in five communities. The analysis was developed under the approach of the Grounded Theory. Results. Providers are poorly informed about current regulations and specific clinical indications for the detection of cervical and breast cancer. Few propitiate health literacy under intercultural sensitization. The users have imprecise or wrong notions of the early detection. Conclusions. The need for training in adherence to norms is evident. It is urgent to assume a culturally relevant approach to enable efficient communication and promote health literacy for early detection of these two cancers.

Objective. This study aims to explore adolescents’ intentions related to the early formation of a family. Materials and methods. We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974). Results. Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents’ expectations for their child’s education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13). Conclusions. In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

Objective. To explore the opinions of Mexican male adolescents regarding teenage pregnancy and analyze its association with sexual behavior. Materials and methods. This is a cross-sectional study using a self-administered questionnaire among a conventional sample of male students (15-19 years old) in eight public schools in Morelos and Mexico City. Analyses include multivariate models to identify the association between opinions and sexual behaviors. Results. Overall, 68% agree that a teenage pregnancy is a negative event. In a hypothetical case, if a girlfriend got pregnant in this moment 56% would continue in the school whereas 18% would definitely abandon it. Those who affirm that a teenage pregnancy is something very bad have greater odds of using condoms (OR=1.8; p menor que 0.05). Conclusions. Male adolescents’ views about teenage pregnancy are associated with some sexual behaviors; however their opinions reflect several contradictions. The design of surveys directed exclusively to explore male adolescents’ opinions about reproductive health is urgent.

Research focused on adolescent pregnancy reports that this event acquires significance and has different consequences according to the context and social subjects who experience it. In this study, by means of a sample formed by adolescent women and men who are socially vulnerable in Mexico, with and without a history of pregnancy, we can see how this reproductive event turns into a factor of educational vulnerability and how their possibilities and expectations with respect to continuing in school are determined in a differentiated manner, according to gender. The findings show that adolescent pregnancy in vulnerable sectors is scarcely compatible with educational projects and that possibilities and expectations to continue in or re-enter the school system are determined by gender differences; these usually lead to fewer opportunities for adolescent women to return to school during or after pregnancy.

To measure the impact of an intervention on adolescents' knowledge of the phase of the menstrual cycle with more likelihood of pregnancy and identify its associated factors.A quasi-experimental study in two rural communities. Difference-in-differences analyses was performed.There was a 22.1% average reduction in wrong answers on the phase of the menstrual cycle with more likelihood of pregnancy in the intervention group versus the control group (p0.001). We founded six factors associated with this knowledge: marry and have children, right to receive education and information on sexual and reproductive health; gender equity; use of the condom; condom self-efficacy; emergency and contraceptive pills.There is a prevailing need to improve -among sexuality topics- basic knowledge of reproductive biology, while at the same time insisting on the benefits of using birth control methods provided for practicing responsible sexuality.Medir el efecto de una intervención en el conocimiento de los adolescentes sobre la fase del ciclo menstrual de mayor posibilidad de embarazo e identificar sus factores asociados.Estudio cuasiexperimental en comunidades rurales. Se realizó un análisis de diferencias en diferencias.Hubo una reducción promedio de 22.1% de respuestas incorrectas sobre la fase del ciclo menstrual de mayor posibilidad de embarazo en el grupo intervención vs. control (p0.001). Se encontraron seis factores asociados con este conocimiento: casarse y tener hijos; derecho a recibir educación e información sobre salud sexual y reproductiva; equidad de género; uso correcto del condón; autoeficacia del uso del condón y pastillas anticonceptivas y de emergencia.Entre las diferentes temáticas de sexualidad, prevalece la necesidad de mejorar los conocimientos básicos sobre biología de la reproducción, insistiendo a la vez sobre los beneficios que conlleva el uso de métodos anticonceptivos para ejercer una sexualidad responsable.

Objetivos: Describir las prácticas médicas realizadas en la atención prenatal en mujeres en Perú e identificar si las prácticas de control prenatal (CPN) recibidas por mujeres adolescentes y adultas fueron distintas. Material y métodos: Estudio descriptivo y comparativo. Se utilizaron datos recolectados por la Encuesta Demográfica y de Salud Familiar continua 2004-2008, con 994 adolescentes (15-19 años) y 12556 adultas (20-49 años). Se efectuaron comparaciones entre adolescentes y adultas en relación con las prácticas médicas efectuadas durante la atención prenatal. Resultados: El 50% de las adolescentes inició el CPN en el tercer mes de embarazo en comparación con la mitad de las adultas que lo inició en el segundo mes. La mitad de las adolescentes reportaron 7 visitas de CPN en total mientras que el 50% de adultas reportaron 8. Menor proporción de adolescentes reportó haber recibido algunas de las acciones y prácticas médicas que se efectúan durante la atención prenatal. Conclusiones: Las adolescentes inician la atención prenatal un poco más tarde que las mujeres adultas, tienen menos CPN y hay diferencias en las acciones efectuadas en los CPN. Esto sugiere que las adolescentes están en desventajas de recibir una atención prenatal que incluya todas las acciones recomendadas por la normatividad. Diversas estrategias deben ser planteadas para favorecer el acceso temprano a un control prenatal de calidad. Objective: To describe medical practices reported by women that received prenatal care (PNC) in Peru. Particularly, we aim to identify differences in the services provided to adolescents compared to adult women. Methods: Descriptive study. Data came from the Demographic Health Surveys 2004-2008 in Peru, which included information of 994 adolescents (15-19 years old) and 12 556 adult women (20-49 years old). Comparisons were made between adolescents and adult women regarding the practices received during prenatal care visits. Results: Among adolescents, 50% initiated PNC during the third month of pregnancy whereas half of the adult women started on the second month. Adolescents received 7 prenatal visits comparing to 8 in adult women. Comparing to adult women, adolescents reported in lower proportions that they received some of the medical practices during prenatal care. Conclusions: Adolescents accessed PNC later than adult women. This suggests that they have less opportunities of receiving services that include all the medical actions recommended. Effective strategies should be implemented in order to promote an adequate and early prenatal care.

Sexually transmitted infections and unplanned pregnancy among adolescents are important public health issues that can be tackled through the implementation of effective education strategies. Previous studies have documented the importance and effectiveness of parents as primary educators for their adolescents. A qualitative study based on grounded theory was undertaken in five different public high schools in Mexico and 33 interviews were carried out (18 parents and 15 first-year students). The primary prevention message that parents transmit to their adolescent children is abstinence. Prevention messages that include condom use and emergency contraception are scarce or absent. Promoting safer sexual behaviors among adolescents in Mexico is of critical importance. Nevertheless, the cultural scenario in the country is dictated mainly by a Catholic morality, which makes it difficult for parents to accept the possibility of their children being sexually active. Hence, the transmission of concrete information...

OBJETIVO: Revisar los efectos de intervenciones educativas que incorporan a padres de familia, para modificar el comportamiento sexual de sus hijos adolescentes. MATERIAL Y MÉTODOS: Búsqueda sistemática en cinco bases de datos electrónicas de estudios de evaluación de intervenciones educativas con padres (2002-2009). RESULTADOS: Diecinueve publicaciones evalúan a 15 programas que cumplen con los criterios de selección. Éstas encuentran un aumento en las intenciones de retrasar las relaciones sexuales y de usar anticonceptivos, reducción en el auto-reporte de relaciones sexuales e incremento en el uso de condón. También se encuentran resultados positivos en factores individuales protectores como conocimientos y actitudes; y en factores familiares como comunicación padres-hijos, percepción de reglas, monitoreo/supervisión de los padres y apoyo familiar. CONCLUSIONES: Las intervenciones educativas que incluyen a padres de familia favorecen comportamientos sexuales saludables en los adolescentes. La participación de padres es un elemento que puede ser incluido en cualquier intervención para adolescentes.OBJECTIVE: To examine the effects of educational interventions that incorporate parent participation to modify adolescent sexual behavior. MATERIAL AND METHODS: We conducted a systematic search of 5 electronic databases for articles published between 2002 and 2009 that evaluated educational interventions involving parents. RESULTS: Nineteen articles evaluated 15 interventions that met all the criteria for inclusion. They found a significant increase in adolescents' intentions to postpone sexual intercourse and use contraceptives, a reduction in self-reported sexual relations and an increase in condom use. Positive results were also found for individual protective factors such as knowledge and attitude, and family factors such as parent-child communication, perception of rules, monitoring/supervision by parents and family support. CONCLUSIÓN: Educational interventions that include parents support healthy sexual behavior among adolescents. Parental participation can be included in any intervention aimed at adolescents.

Integrating traditional midwives (TMs) as labor support in cline-based care may be an ideal solution to improving maternity services in the Mexico and worldwide. We conducted interviews and focus groups with 65 TMs and 24 interviews with public health system personnel to assess the acceptability and challenges of this proposal. Both TMs and personnel perceive this new role as having professional benefits. Challenges include TMs' and clinic personnel's previous negative experience with one another and unfamiliarity with the doula role. Interactive trainings introducing the doula role and improving professional relations between TMs and personnel are necessary to assure success of this proposal.

OBJETIVO: Analizar experiencias relacionadas con el ejercicio de los derechos sexuales y reproductivos de personas heterosexuales que viven con VIH (PVVIH) en México. MATERIAL Y MÉTODOS: Estudio cualitativo donde se realizaron 40 entrevistas en profundidad a PVVIH en cuatro estados del país. Resultados. Vivir con VIH sin apoyo ni consejería limita el ejercicio de los derechos sexuales y reproductivos, especialmente en las mujeres. Las principales limitantes son sentimientos de frustración, falta de claridad en la información, temor a la reinfección, falta de poder para negociar el uso del condón, estigma, discriminación y falta de acceso a servicios y tecnología adecuados. CONCLUSIÓN: Para una mayor conciencia y ejercicio de los derechos de las PVVIH se necesita promover la educación sexual, cambios culturales que combatan la desigualdad de género, el estigma y la discriminación, e información oportuna y científica sobre prevención del VIH.

OBJETIVO: Analizar experiencias relacionadas con el ejercicio de los derechos sexuales y reproductivos de personas heterosexuales que viven con VIH (PVVIH) en México. MATERIAL Y MÉTODOS: Estudio cualitativo donde se realizaron 40 entrevistas en profundidad a PVVIH en cuatro estados del país. Resultados. Vivir con VIH sin apoyo ni consejería limita el ejercicio de los derechos sexuales y reproductivos, especialmente en las mujeres. Las principales limitantes son sentimientos de frustración, falta de claridad en la información, temor a la reinfección, falta de poder para negociar el uso del condón, estigma, discriminación y falta de acceso a servicios y tecnología adecuados. CONCLUSIÓN: Para una mayor conciencia y ejercicio de los derechos de las PVVIH se necesita promover la educación sexual, cambios culturales que combatan la desigualdad de género, el estigma y la discriminación, e información oportuna y científica sobre prevención del VIH.OBJECTIVE: To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. MATERIAL AND METHODS: Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. RESULTS: Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. CONCLUSION: To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

OBJETIVO: Mostrar, a través de un diagnóstico en América Latina y el Caribe, el panorama legislativo y curricular sobre sexualidad y prevención contra el virus de inmunodeficiencia humana (VIH) en el ámbito escolar, contrastándolo con los comportamientos sexuales reportados en encuestas demográficas y de salud. MÉTODOS: En mayo de 2008 se realizó, con el apoyo del Fondo de Población de las Naciones Unidas (UNFPA), una encuesta a informantes clave en 34 países de la Región. El cuestionario autoaplicado solicitó información sustantiva de agentes de las diferentes partes interesadas, como ministerios de educación y de salud, sobre los programas de prevención contra el VIH/ Sida que se están aplicando en las escuelas. RESULTADOS: Respondieron a la encuesta 27 países que representan 95,5% de la población objetivo (6 a 18 años de edad). La mayoría de los países informó tener al menos un libro de texto o un capítulo específico para enseñar los temas de educación sobre sexualidad y prevención del VIH. En la escuela secundaria se cubren la mayor parte de los temas pertinentes relevantes para la educación sobre sexualidad, pero no todos. Por ejemplo, el problema de la discriminación por orientación o preferencia sexual no se incluye en los programas escolares. CONCLUSIONES: El material educativo sobre sexualidad debe ser revisado y actualizado periódicamente de modo que refleje los avances en los temas y en la forma de tratar los contenidos. En cada país el currículo debe abordar el tema del respeto a la diversidad sobre orientación, preferencia e identidad sexuales, y en particular el manejo apropiado de la educación para prevenir infecciones de transmisión sexual (ITS) en hombres que tienen sexo con hombres. Los esfuerzos de evaluación de la efectividad de los programas deben contemplar desenlaces tales como marcadores biológicos (incidencia y prevalencia de ITS y embarazo) y no únicamente indicadores de conocimiento y comportamiento sexual auto-reportado.OBJECTIVE: To present, through an evaluation in Latin America and the Caribbean, the current regulatory and curricular landscape of sexuality and HIV prevention in the school setting, and contrast it with sexual behaviors as reported by demographic and health surveys. METHODS: In May 2008, with the support of the United Nations Population Fund (UNFPA), a survey was conducted involving key contacts in 34 countries of the Region. The self-administered questionnaire sought in-depth information on school-based HIV/AIDS prevention programs from the staff of various stakeholders, including ministries of education and of health. RESULTS: Twenty-seven countries responded to the survey, representing 95.5% of the target population (6-18 years of age). Most countries reported having at least one textbook or one specific chapter devoted to teaching sex education and HIV prevention. Many, but not all of the important sex education topics, were covered in secondary school; for example, the issue of discrimination based on sexual orientation/ preference is not included in school curricula. CONCLUSIONS: Sex education materials should be reviewed and updated periodically to reflect progress being made on the issues and the handling of the subject matter. In each country, the curriculum should address the issue of respecting differences in sexual orientation, preference, and identity, and especially, an appropriate approach toward sexually-transmitted infection (STI) prevention education among males who have sex with males. Efforts to assess the programs' effectiveness should consider outcomes, such as biomarkers (STI incidence and prevalence and pregnancy), not just indicators of self-reported sexual knowledge and behavior.

OBJETIVO: Identificar la influencia de las características reproductivas y el empoderamiento femenino en el uso de servicios de planificación familiar (PF). MATERIAL Y MÉTODOS: Diseño de casos y no casos pareado por controles vecindarios (147 usuarias y 146 no usuarias de servicios de PF de la Secretaría de Salud durante 2003), en dos municipios del estado de Guanajuato, México. Análisis logístico multivariado para identificar diferencias entre usuarias y no usuarias. RESULTADOS: El uso de servicios de PF se asoció positiva y significativamente con poder de decisión de la mujer (alto: RM=3.2; IC95% 1.4-7.4); comunicación con la pareja para el uso de métodos de PF (RM =3.5; IC95% 1.4-9.3), y número de embarazos en su vida (> 6 hijos: RM =4.4; IC95% 1.4-13.8). CONCLUSIONES: El desarrollo de estrategias que involucren a los hombres y que, por otra parte, fomenten y fortalezcan el empoderamiento femenino, puede contribuir a una mayor utilización de servicios de PF.OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95% 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95% 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95% 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

OBJETIVO: Analizar factores de la relación con los médicos que afectan la adherencia terapéutica y la calidad de vida de las personas con VIH/Sida. MÉTODOS: Estudio cualitativo realizado en México en 2003 con informantes reclutados en grupos de autoayuda y organizaciones no gubernamentales de VIH/Sida y servicios de infectología de hospitales públicos. Fueron entrevistadas 40 personas viviendo con VIH/Sida y cinco líderes de grupos de autoapoyo. Para la recolección de datos los informantes respondieron un cuestionario sociodemográfico y entrevistas en profundidad sobre la experiencia de vivir con VIH/sida, incluyendo los tratamientos, la percepción de la enfermedad, la calidad de vida, la salud física y emocional y la relación con los médicos. Las respuestas fueron grabadas, transcritas y organizadas por temas en base a códigos, usando un análisis inductivo. RESULTADOS: La edad de la mayoría de los entrevistados varió entre 26 y 45 años. Los principales problemas durante la búsqueda de atención se relacionaron con la falta de conciencia de riesgo y de información entre las personas viviendo con VIH/Sida y los médicos. Los médicos mostraron falta de capacitación en VIH/Sida. En la etapa de continuidad de la atención, los problemas se relacionaron con una adherencia terapéutica deficiente, producto principalmente de la falta de comunicación con los médicos y de la discriminación en los servicios públicos. CONCLUSIONES: De manera general se observaron problemas de información; falta de capacitación y paternalismo por parte de los médicos, y estigma social de las personas viviendo con VIH/Sida asociado a la epidemia.OBJETIVO: Analisar fatores no relacionamento com médicos que afetam a adesão terapêutica e a qualidade de vida de pessoas com o (HIV/Aids). MÉTODOS: Estudo qualitativo realizado no México, em 2003, com informantes recrutados em grupos de auto-ajuda e organizações não-governamentais de HIV/Aids e serviços de infectologia de hospitais públicos. Foram entrevistadas 40 pessoas vivendo com HIV/Aids e cinco líderes de grupos de auto-ajuda. Para coleta de dados os informantes responderam um questionário sociodemográfico em entrevista realizada em profundidade sobre a experiência de viver com VIH/Sida, incluindo os tratamentos; a percepção da doença; qualidade de vida; saúde física e emocional; e a relação com médicos. As respostas forma gravadas, transcritas e organizadas por temas com base em códigos, usando análise indutiva. RESULTADOS: A idade da maioria dos entrevistados variou entre 26 e 45 anos. Os principais problemas durante a procura de assistência relacionaram-se à falta de consciência de risco e de informação entre as pessoas vivendo com HIV/Aids e os médicos. Os médicos mostraram falta de capacitação em HIV/Aids. Na continuidade da assistência, os problemas relacionaram-se à aderência terapêutica deficiente, decorrente principalmente da falta de comunicação com médicos e da discriminação nos serviços públicos. CONCLUSÕES: De modo geral foram observados problemas de informação; falta de capacitação e paternalismo por parte do médico; e de estigma social das pessoas vivendo com HIV/Aids associados à epidemia.OBJECTIVE: To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life. METHODS: Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis. RESULTS: Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services. CONCLUSIONS: Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.

The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician—patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

Objetivos. Describir las tendencias de la operación cesá-rea (OC) asociadas con factores no clínicos en mujeres queasistieron al Centro de Educación para el Parto (CEPAPAR)en la Ciudad de México. Material y métodos. Se analizóinformación de 992 nacimientos de 847 mujeres, ocurridosentre 1988 y 2000. Se utilizó el método de regresión linealpara identificar el comportamiento de factores no clínicoscon respecto a la tendencia de OC. Resultados. La inci-dencia global de OC fue de 32.8%, con 8% de incrementopromedio anual. El porcentaje de OC se mantuvo por de-bajo de 30% hasta 1994; durante los siguientes años se in-crementó hasta 40%. Al analizar la tendencia de OC enrelación con factores no clínicos se encontró que, a lo largodel periodo 1988-2000, el aumento en la incidencia de laOC fue mayor en nacimientos sin instructora presente, en-tre mujeres primigestas y en hospitales grandes (con másde 50 camas). Conclusiones. Los resultados muestran queel aumento en la incidencia de OC está asociado a factoresno clínicos, como el tamaño del hospital y la presencia deuna instructora. Un modelo de apoyo a mujeres, que cuentecon asesoría, información y presencia de una instructoradurante el trabajo de parto, puede contribuir a disminuir elriesgo de tener una OC innecesaria en poblaciones comola estudiada.¡

OBJETIVOS: Describir las tendencias de la operación cesárea (OC) asociadas con factores no clínicos en mujeres que asistieron al Centro de Educación para el Parto (CEPAPAR) en la Ciudad de México. MATERIAL Y MÉTODOS: Se analizó información de 992 nacimientos de 847 mujeres, ocurridos entre 1988 y 2000. Se utilizó el método de regresión lineal para identificar el comportamiento de factores no clínicos con respecto a la tendencia de OC. RESULTADOS: La incidencia global de OC fue de 32.8%, con 8% de incremento promedio anual. El porcentaje de OC se mantuvo por debajo de 30% hasta 1994; durante los siguientes años se incrementó hasta 40%. Al analizar la tendencia de OC en relación con factores no clínicos se encontró que, a lo largo del periodo 1988-2000, el aumento en la incidencia de la OC fue mayor en nacimientos sin instructora presente, entre mujeres primigestas y en hospitales grandes (con más de 50 camas). CONCLUSIONES: Los resultados muestran que el aumento en la incidencia de OC está asociado a factores no clínicos, como el tamaño del hospital y la presencia de una instructora. Un modelo de apoyo a mujeres, que cuente con asesoría, información y presencia de una instructora durante el trabajo de parto, puede contribuir a disminuir el riesgo de tener una OC innecesaria en poblaciones como la estudiada.OBJECTIVES: To describe the trends in caesarian sections (CS) associated with non-clinical factors in women who attended a birthing educational facility, also known as 'Centro de Educación,' (CEPAPAR) in Mexico City. METHODS: Data from 992 births of 847 women that occurred from 1988-2000 were analyzed using linear regression to identify the association between non-clinical factors and time-trends in CS. RESULTS: The overall incidence of CS was 32.8%, with an 8% average annual increase. Until 1994 the percentage of CS remained relatively steady at 30%, increasing to 40% in subsequent years. In analyzing trends in CS and their relationship with non-clinical factors from 1988-2000, the increased incidence of CS during this period was higher among births where no birth attendant was present, for first-time mothers, and in larger hospitals (>50 beds). CONCLUSIONS: Results show that the increased incidence of CS is associated with non-clinical factors such as size of the hospital and the presence of a birth attendant. A model of support for women which includes information, counseling, and the presence of a birth attendant during labor can contribute to reducing the risk of unnecessary CS in populations such as that studied.

Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of the curricula of three representative schools for the education and clinical preparation of three types of birth attendant - obstetric nurses, professional midwives and general physicians - National Autonomous University of Mexico (UNAM) School of Obstetric Nursing; CASA Professional Midwifery School; and UNAM School of Medicine, Iztacala Campus. All curricular materials were measured against the 214 indicators of knowledge and ability in the International Confederation of Midwives (ICM) skilled attendant training guidelines. The CASA curriculum covered 83% of the competencies, 93% of basic knowledge and 86% of basic abilities, compared with 54%, 59% and 64% for UNAM Obstetric Nursing School and 43%, 60% and 36% for UNAM School of Medicine, respectively. Neither the Obstetric Nursing School nor the School of Medicine documented the quantity or types of clinical experience required for graduation. General physicians attend the most births in Mexico, yet based on our analysis, professional midwives had the most complete education and training as measured against the ICM competencies. We recommend that professional midwives and obstetric nurses should be formally integrated into the public health system to attend deliveries.

Objective. To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. Materials and methods. A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. Results. A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). Conclusion. It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.

Objective: to assess the association between non-clinical factors and the incidence of caesarean section (CS); to estimate the effect of a prenatal instructor's presence during childbirth on birth outcome (vaginal or CS). Design: cross-sectional study from a register of women who attended prenatal classes. Multivariate logistic regression was used to measure the effects of each variable on whether the birth was vaginal or CS. Setting: Mexico City, Mexico. Participants: 992 births to 847 women from the register of the Birth Education Centre (CEPAPAR) between 1987 and 2000. Findings: the incidence of CS was 33%. The most commonly reported (by the women) reason for performing a CS was dystocia (53%). Most women were middle or upper-middle class professionals, and 85% of the women gave birth in private institutions. Odds of having a CS were higher among women who gave birth in a large hospital, women who were over 25 years of age, primigravidae, and women who were not supported by a prenatal instructor during childbirth. Conclusions: non-clinical factors considerably affect the type of birth outcome (vaginal vs. CS). A system in which a prenatal instructor provided support to the woman during childbirth could contribute significantly to reducing initial and repeat CS.

Este artículo es una reflexión sobre la problemática que viven las mujeres ante el VIH/SIDA. A través de estadísticas mundiales y nacionales que dan cuenta del incremento de la epidemia en las mujeres, se hace evidente la necesidad de atender el problema. Se argumenta cómo la estructura y relaciones de género favorecen la vulnerabilidad de las mujeres, y cómo la vulnerabilidad y el riesgo de infección se incrementan para muchas mujeres al transitar por diversas situaciones específicas, como la migración, la precariedad de empleo y la violencia doméstica, entre otras. Se enuncian los principales obstáculos que enfrentan las mujeres para hacer socialmente visible su situación y necesidades, así como la falta de poder para encarar de manera más eficaz su problemática. Se habla de las iniciativas de la sociedad civil organizada y de las estrategias gubernamentales que se han implantado, así como de sus principales logros, carencias, necesidades y retos. Finalmente, a manera de conclusión y recomendación, se destaca la necesidad de establecer y evaluar programas y políticas de prevención y atención bajo una perspectiva de género y de derechos humanos, que permita una mayor conciencia y mejores respuestas al problema de las mujeres frente al VIH/SIDA.This paper presents some thoughts on the problems endured by women facing HIV/AIDS. World and nationwide statistics show an upward trend of the epidemic among women, calling for the need to address this problem. A case is made for the way in which gender structure and relations facilitate the vulnerability of women to this disease, increasing their risk of infection related with specific factors like migration, employment unsafe conditions, and domestic violence, among others. Emphasis is made on the main obstacles faced by women to flag their concerns and needs in society, as well as on their lack of empowerment to cope effectively with their problems. Some initiatives advanced by the organized civil society and governmental strategies are presented, including accomplishments, deficiencies, needs, and challenges. Finally, conclusions and recommendations are given, highlighting the need to establish and evaluate preventative programs and policies from a gender and human rights perspective, to promote a greater awareness and improved responses to the problems imposed on women by the HIV/AIDS epidemic.

This paper presents some thoughts on the problems endured by women facing HIV/AIDS. World and nationwide statistics show an upward trend of the epidemic among women, calling for the need to address this problem. A case is made for the way in which gender structure and relations facilitate the vulnerability of women to this disease, increasing their risk of infection related with specific factors like migration, employment unsafe conditions, and domestic violence, among others. Emphasis is made on the main obstacles faced by women to flag their concerns and needs in society, as well as on their lack of empowerment to cope effectively with their problems. Some initiatives advanced by the organized civil society and governmental strategies are presented, including accomplishments, deficiencies, needs, and challenges. Finally, conclusions and recommendations are given, highlighting the need to establish and evaluate preventative programs and policies from a gender and human rights perspective, to promote a greater awareness and improved responses to the problems imposed on women by the HIV/AIDS epidemic.

Objetivo. Identificar la asociación entre conocimiento sobre riesgo de embarazo y autoeficacia en el uso del condón, con el apoyo parental y factores escolares, en hom­bres. Material y métodos. Estudio transversal con 448 estudiantes en Puebla y Morelos. Se ajustaron dos modelos logísticos. Resultados. Los conocimientos sobre riesgo de embarazo se asocian con el que los padres hablen sobre sexualidad (RM=2.45, IC95% 1.35-4.47), con el agrado por asistir a la escuela (RM=2.18, IC95% 1.15-4.13), con el que los profesores hablen frecuentemente/muy frecuentemente sobre equidad de género (RM=1.69, IC95% 1.06-2.67) y con la edad (RM=1.77, IC95%1.26-2.50). La autoeficacia en el uso de condón se relaciona con el que los padres hablen sobre sexualidad (RM=1.80, IC95% 1.01-3.20), con el agrado por asistir a la escuela (RM=2.60, IC95% 1.42-4.77), con el nivel socioeconómico medio (RM=1.82, IC95% 1.07-3.11) y con alto grado de marginación (RM=0.47, IC95% 0.30-0.73). Con­clusiones. Estudiar el apoyo familiar y escolar, considerando la influencia del entorno social, permite mayor entendimiento de la adquisición de habilidades para una conducta sexual preventiva en hombres durante la adolescencia temprana

In impoverished communities in Mexico, most adolescent mothers do not attend school; but typically, they become pregnant once they dropped out. Understanding the experiences of adolescents who have had a pregnancy and continue in school is complicated since few manage to do it. The goal of this study is to describe experiences within the family and school context and plans for the future of a sample of Mexican students who have had a pregnancy. We analyze information from the questionnaires of 68 women and 44 men and interviews to 6 women and 5 men. First intercourse was at age 15 and first pregnancy at 16; 39% of men and 57% of women already have a child; 54% of men and 19% of women work and study simultaneously. Dropping out because of a pregnancy/marriage was reported by 41% of women and 14% of men. The support of family and teachers is crucial to stay in school; but the institution remains indifferent to their plight. The immediate needs easily defeat their aspirations. It is fundamental to acknowledge and notice the experiences of these vulnerable young people in order to design focused strategies promoting their success in adult life.

This study aims to explore adolescents' intentions related to the early formation of a family.We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974).Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13).In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization.Qualitative analysis of 55 interviews with women of reproductive age living with HIV.Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms.Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

Background: Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents’ or children’s reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication. Objective: The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics. Subjects: A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study. Methods: The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents. Results: Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p Conclusion: Our findings suggest a low congruence between parents’ and adolescents’ reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.

To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula).The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care.A large social security hospital in Mexico City.Seven hundred and twenty-four women with a single fetus, no previous vaginal delivery,6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care.Breastfeeding practices, duration of labour, medical interventions, mother's emotional conditions, and newborn's health.Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes.The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I-C: 1.01-2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) = 1.52 to -0.51). There were no effects either on medical interventions, mothers' anxiety, self-esteem, perception of pain and satisfaction, or in newborns' conditions.Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.Studies in numerous countries have documented the positive contributions of doulas--women experienced in childbirth who provide continuous physical, emotional, and informational support to women before, during, and just after childbirth. The present study, conducted in a Mexican Institute of Social Security public hospital, explored the hypothesis that psychosocial support from a doula increases exclusive and full breast feeding by improving the mother's emotional status, shortening the duration of labor, and decreasing medical intervention. 724 women with no previous vaginal delivery and no indications for cesarean section delivery were randomly assigned to be accompanied by a doula (n = 361) or to receive routine care (n = 363). Blinded interviewers obtained outcome data from the clinical records, encounters with mothers in the immediate postpartum period, and home visits 40 days after delivery. The frequency of exclusive breast feeding 1 month after birth was significantly higher in the intervention group than the control group (12% vs. 7%; relative risk (RR), 1.64; 95% confidence interval (CI), 1.01-2.64). However, the program did not achieve a significant effect on full breast feeding (37% and 36%, respectively). The duration of labor was shorter in the intervention group than the control group (4.56 vs. 5.58 hours; RR, 1.07; 95% CI, -1.52-0.51). A significantly larger proportion of women in the intervention group than the control group perceived a high level of control over labor (79.8% vs. 77.1%; RR, 1.14; 95% CI, 1.03-1.27). There were no effects on medical interventions, maternal anxiety, self-esteem, perception of pain, maternal satisfaction, or newborn Apgar scores. Although the prevalence of exclusive breast feeding was low in both groups, these findings suggest that psychosocial support during labor and the immediate postpartum period should be part of a comprehensive strategy to promote breast feeding.

This article presents some of the most relevant qualitative results of a trial to evaluate the effects of the provision of psychosocial support to first-time mothers during labor, childbirth and in the immediate postpartum period in a social security hospital in Mexico City. The article focuses on the experiences of mothers who have received psychosocial support from a doula (the term doula is used to identify a woman who provides continuous support to a woman during labor. delivery and the immediate postpartum period) and compares them with the experiences of those women who gave birth following normal hospital routine. Sixteen in-depth interviews were held with women in the immediate post partum period (eight of whom had been accompanied by a doula and eight who had not) before they were discharged from hospital, and the results were analyzed using qualitative techniques. The interviews showed that the women accompanied by a doula had a more positive childbirth experience. The differences between both groups related to their perceptions of the childbirth experience; the treatment they received from hospital staff; the information they were given and how well they understood it; their perception of hospital routines; their feelings about cesarean sections and, spatial and temporal perceptions. The most important difference between the two groups was the way they expressed their feelings about their own labor, their sense of control and their self-perception.

La categoría de "apoyo social" ha permitido desarrollar toda una corriente de investigación que busca explicar algunas de las diferencias existentes en la distribución de ciertas enfermedades tanto físicas como mentales. El concepto de apoyo social presenta varios problemas que es preciso resolver. Este artículo discute algunos de estos problemas, y mostra la posibilidad de enriquecer el tema desde una perspectiva sociológica. Se discute el origen conceptual del término y se analizan diversas definiciones del mismo. Se analizar las formas en que la investigación reciente ha tratado de vincular la disponibilidad de apoyo social con la existencia de ciertos niveles de salud y enfermedad. Se discuten las diferencias entre el modelo del efecto directo y el modelo del efecto amortiguador. Se muestra la necesidad de estudiar al apoyo social no sólo como posible determinante de ciertas formas de enfermedad, sino también como una variable dependiente. Se subraya la importancia de buscar las determinantes del apoyo social en todos los niveles de la realidad social, dando especial importancia a las variables de clase social y género. Se presenta una discusión sobre los avances logrados en el estudio de los factores que se asocian a la disponibilidad de apoyo social por parte de los individuos. Se muestra que el apoyo social es a su vez producto de ciertos ordenamientos sociales que pueden ser identificados con claridad a través de un análisis sociológico del fenómeno. Para ilustrar este argumento, se discute el caso de la atención, entendida como una forma de apoyo social, y se muestra que la distribución de la misma está determinada socialmente. Se finaliza con una reflexión sobre la necesidad de integrar diversos enfoques teórico-metodológicos como condición necesaria para lograr nuevos avances en el estudio del apoyo socialOn the borderline between sociology and psychology, the concept of social support has made it possible to develop a whole research tradition aimed at explaining some of the differences existing in the distribution of mental and physical disease. The concept of social support itself, however, still presents some ambiguities which must be clarified. These problems are discussed and it is showed and shows that the topic can be enriched with the contribution of the social sciences. Different definitions of the concept itself, are briefly analysed and the complexity and multidimensional character of social support are highlighted. The association between social support and health is discussed. The differences and implications of the direct effect model and the buffering effect model are addressed, and the relevance of the construct of social support is enhanced. The need to study social support not only as a likely determinant of some forms of disease, but also as a dependent variable, is brought out. Some recent developments in the study of factors associated with the availability of social support are discussed. It is shown that social support is a product of certain social factors which can be clearly identified by sociological analysis. In order to illustrate this point, the structural determinants of a specific dimension of social support -attention- are discussed. The importance of structural variables like social class and gender in attempting to explain the differential distribution of certain forms of social support is emphasized. It is proposed, on the theoretical level, that the intersection between two related autonomous constructs -social class and social support- may better explain those aspects of these concepts that are of importance to observed heterogeneity in the distribution of mental and physical health. Different theoretical and methodological approaches to the understanding of the determinants of social support and its effect on health are suggested.

Objetivos. Ahondar sobre las causas y circunstancias particulares en que ocurren las experiencias sexuales de los migrantes centroamericanos en su tránsito por México e identificar cómo afecta esto al ejercicio de sus derechos sexuales. Material y métodos. Estudio cualitativo (2009- 2010). Se realizaron 22 entrevistas semiestructuradas a migrantes centroamericanos en tránsito por México y 10 a diversos actores clave. La sistematización, procesamiento y análisis de los datos se realizó a partir de algunos de los elementos de la teoría fundamentada. Resultados. Las experiencias sexuales de los migrantes en tránsito por México están vinculadas con aspectos de coerción, abuso, inequidad y violencia sexual. Los migrantes identifican riesgos a los que se enfrentan en el tránsito y tienen escaso acceso a servicios que les permitan hacer efectivos sus derechos, incluidos los sexuales. Su vulnerabilidad los hace asumir la violencia y las agresiones sexuales como parte ineludible del trayecto y de su destino como personas. Conclusiones. El tránsito de migrantes está relacionado con la violencia, incluida la sexual. Las diferencias entre migrantes y otros grupos, así como entre hombres y mujeres, son determinadas por las relaciones inequitativas de género y poder.

To describe the trend of cesarean section practice in Mexico, and its association with women's sociodemographic and reproductive characteristics.Based on the 2000, 2006 and 2012 National Health Surveys, information on c-section was analyzed. A multivariate logistic regression model was used in 2012.A 50.3% increase in the use of c-section was observed nationally from 2000 to 2012. Women more likely to undergo a c-section include those whose delivery care takes place in the private sector (OR=2.84, 95%CI:2.15-3.74). When associating women's age and parity, the greatest risks are observed among primiparous women between 12 and 19 years of age, and those aged 35 years and more (OR=6.02, 95%CI:1.24-29.26 and OR=5.20, 95%CI:2.41-11.21, respectively).Some recommendations to revert the increase of this clinical practice, especially when there is no full justification for its realization, are proposed.

Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM), obstetric nurses (ON) and general physicians (GP). A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to a clinical setting, is also questioned. Conclusions Hospitals in the Mexican public health sector have a heavy obstetric workload; physicians carry the additional burden of non-obstetric cases. The incorporation of a non- physician model at the primary health center level to attend low-risk, normal deliveries would contribute to the reduction of non-necessary referrals. There is also a role for these providers at the hospital level.

To explore the causes and circumstances that determine the way in which migrants experience their sexuality and how this impacts their sexual rights.Qualitative study conducted between April 2009 and July 2010 in Chiapas, Oaxaca, San Luis Potosí, and Tamaulipas. We conducted 22 in-depth interviews to migrants in transit and to ten different key actors. For the analysis we used elements of grounded theory.Migrants know and identify the risks they may encounter in their transit but have scarce access to services to effectively exercise their sexual and reproductive rights. Their vulnerability makes them internalize and accept the violence enacted on them as part of their destiny and as what they must suffer in order to reach the USA.Violence, including sexual violence, determines much of the experiences of their transit through Mexico. Differences between groups and between male and female migrants are determined by gender inequalities and power.