Assistência ao planejamento reprodutivo e à contracepção: uma análise socioecológica a partir das percepções das enfermeiras da atenção primária à saúde

Abstract

The rights to sexual and reproductive health have been one of the most difficult achievements in the national and international scenario in recent decades and have faced significant threats to their guarantee. The object of study of this research is assistance to reproductive planning and contraception from the perspective of Primary Health Care (PHC) nurses, with the general objective: to analyze the characteristics, challenges and potential of assistance to reproductive planning and contraception from the perspective of PHC nurses. And the specific objectives are: to understand the perceptions of nurses about assistance to reproductive planning and contraception in PHC; to describe the factors involved in this assistance from the perspective of these professionals; to identify the challenges and potential of assistance to reproductive planning and contraception according to nurses. This is a qualitative, descriptive research with 13 nurses who work in PHC in three cities in the metropolitan region of Rio de Janeiro. Data collection took place from May to September 2024, through semi-structured interviews, and the recruitment of participants was through the snowball sampling technique. Braun and Clarke's thematic analysis and the socioecological model in health guided the analytical process. The thematic categories of the study were: perceptions of reproductive planning and contraception care; factors involved in reproductive planning and contraception care; challenges and potential of reproductive planning and contraception care. The nurses consider that access to sexual and reproductive health care is provided by PHC teams and the pursuit of respect for health rights is valued. However, they face imposing professional attitudes regarding the use of contraceptive methods and discrimination and prejudices related to gender. Organizational barriers hinder access to contraceptive methods, especially long-acting reversible methods. However, they recognize the advances in the supply and availability of these methods. Work overload and restrictions on the professional autonomy of nurses emerged in the testimonies, but there was an expansion of the scope of their practice through policies to expand and strengthen PHC. The sociocultural and political context continues to be influential in sexual and reproductive health, especially due to gender issues and the emergence of sexist and heteronormative conservatism today, which restricts health rights and causes setbacks in health policies. Nurses perceive challenges in expanding access to information on sexual and reproductive health, such as in health services, schools and social environments. They believe that public policies in this area should be strengthened through measures that ensure sexual and reproductive rights, at an intersectoral level, and improved in terms of continuing education and the care process of professionals, in order to provide effective improvements in sexual and reproductive health in PHC.