Desafios para a garantia do acesso de mulheres usuárias do Sistema Único de Saúde ao DIU de cobre em um município da Baixada Fluminense

Abstract

This monograph aims to understand the difficulties and challenges in the work processes in Primary Health Care (PHC) that hinder full access of women users of the Unified Health System (SUS) to the Copper Intrauterine Device (IUD) in a municipality in Baixada Fluminense, in the metropolitan region of the State of Rio de Janeiro. The theoretical framework of Reproductive Justice is used, which proposes an expanded view of women's reproductive rights, considering a fundamentally structural approach to social change, emerging from the experiences of women who experience a complex set of reproductive oppressions and hierarchies. Understanding PHC as the gateway and coordinator of care in SUS, Basic Health Units stand out as a strategic place to implement sexual and reproductive health care for women, as well as to democratize access to contraceptive methods such as the Copper IUD. Thus, a socio-anthropological qualitative study was conducted using ethnographic methods to understand the dynamics of PHC regarding the implementation of the device offering in the municipality. For this purpose, everyday work processes related to promoting the availability of the method were followed, and the observed experiences were recorded in written form in a field diary. The analysis of the collected materials focused on five main elements, and the results obtained point to the presence of barriers to access to the Copper IUD, related to: 1) the exclusivity of medical professionals for device insertion; 2) absence of qualified professionals to insert the IUD and lack of medical category adherence to training and procedure performance; 3) difficulties in management and planning of method offering in PHC; 4) structural and material issues in the health care network; 5) other factors that hinder access to the Copper IUD, mainly myths and taboos about the device. Faced with the identification of factors hindering method offering, possible ways to address them were evaluated, such as the development of a municipal protocol for Copper IUD insertion, authorization for device insertion by nurses, and provision of high-quality training and updates on family planning for PHC professionals. In this sense, overcoming barriers to method availability within Primary Health Care is crucial to expanding access to the Copper IUD and for SUS to continue advancing in women's health care and ensuring sexual and reproductive rights.