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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.

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.

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.

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...

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: 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.

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.¡

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 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.

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.