Assistência à puérpera adolescente nas unidades de saúde do Sistema Único de Saúde no município do Rio de Janeiro

Abstract

Adequate outpatient care for postpartum adolescents is essential in order to promote and maintain exclusive breastfeeding, guidance on contraception, prevention and diagnosis of breast disease and postpartum infection, as well as emphasizing the importance of childcare. According to parameters established by the Ministry of Health (MS), municipal, state and federal public health services must guarantee a minimum of two consultations during the postpartum period, which must be carried out during the first week and between the 30th and 42nd day after the birth of the child. The aim of this study was to gather information on and to analyze the postnatal and post-abortion outpatient care available to adolescents in National Health System centers in the City of Rio de Janeiro (RJ). This investigation was carried out through two approaches: the first a quantitative cross-sectional study using structured interviews with SUS health center coordinators in RJ that provide care in the area of sexual and reproductive health for adolescents. The coordinators were asked questions on the characteristics of the postnatal and postabortion care available to adolescents at the health centers where they work. The second, involved qualitative semistructured interviews with postpartum adolescents seen at these health centers, including questions on the guidance on contraception and breastfeeding they were provided and the postnatal consultations overall. The results demonstrate the wide range of postnatal care on offer (95.9%); however, just 67.4% of these comply with MS guidance that two consultations should be carried out, one in the first week and the other between the 30th and 42nd day after the birth. Consultations are not scheduled for the first week in 22.7% of the centers, and there is no consultation scheduled between the 30th and 42nd day after birth in 17.7%. In addition, only 7.8% carry out consultations for the age bracket set out by the World Health Organization and the MS (between 10 and 19). The overall opinion of postpartum adolescents on the postnatal outpatient care they received was that it was inconsistent, with a lack of guidance on contraception despite the demand for this among adolescents and a lack of promotion of breastfeeding with a focus on the health of the newborn. The postnatal care offered by health centers focuses on the newborn and is primarily conducted by a pediatrician. It was concluded that although a large supply of health centers provide postpartum care, MS guidelines that guarantee two postpartum consultations for adolescents are not being fulfilled. The data suggests that after birth, adolescents are classified by the health service primarily as mothers and are seen as a lower priority than their child, not as individuals in need of care during this important phase in order to prevent future pregnancy and common health complications during this time. Inadequate postnatal and post-abortion care represents the loss of an important opportunity in improving the health of adolescents. For these reasons, complying with MS recommendations specifying that two postpartum consultations should be carried out and expanding and improving postnatal care for adolescents represent a huge challenge.