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Social determinants of health - from concept to practice in not intended pregnancies outcomes that result in induced abortion

Grant number: 14/11568-0
Support Opportunities:Scholarships in Brazil - Post-Doctoral
Effective date (Start): September 01, 2014
Effective date (End): August 31, 2016
Field of knowledge:Health Sciences - Collective Health - Epidemiology
Acordo de Cooperação: Coordination of Improvement of Higher Education Personnel (CAPES)
Principal Investigator:Rebeca de Souza e Silva
Grantee:Carmen Linda Brasiliense Fusco
Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil


Social Determinants of Health (SDH), according to the National Commission on SDH, are understood as social, economic, cultural, ethnic/racial, psychological and behavioral factors, among others, which influence the occurrence of health problems and their risk factors in the population. In a research on unsafe abortion (UA) held in a community in the outskirts of São Paulo, from a cross-sectional study aimed at estimating the prevalence of women with unsafe abortion, as well as at identifying their sociodemographic characteristics (SDC) to which they are associated to, and their morbidity , a critical analysis was performed in order to evaluate the influence exerted by Social Determinants of Health (SDH) in the occurrence of UA and associated SDC and the health inequities generated by them, taking the UA as the main health outcome, along with its consequences, the latter seen both in terms of morbimortality when regarding Reproductive Health, Reproductive Rights and family planning. In the cross-sectional study, all women between 15 and 54 years of age, living in the community, were interviewed, and in the statistical analysis of the data, after association measures, univariate and multiple analysis of Multinomial Logistic Regression (MLR) were made for the IA/UA (induced and unsafe abortion) and SA (spontaneous abortion), having as a reference the NA category (no abortion).It was found by the analysis made that the UA and the associated SDC are influenced by the SDH described, generating health inequities of various proportions in this population, affecting mainly black women, with lower income, low education and single (or living alone). The prevalence of women who induced UA was also significantly higher among those women, in the studied population.The objective of this research project is to compare the data obtained in this studied population to data from new populations of women, also in SP, subjected to 1) safe and legal abortion (cases of sexual violence) and 2) illegal induced abortion in private practices - comparing the conditions of the abortion's occurrence, sociodemographic characteristics associated to them, outcome and morbidity in these populations both statistically and at the light of the Social Determinants of Health (SDH) involved and inequities generated by them among women in these populations.Seeking for a referential framework which would support the use of health interventions, given the macro and social determinants of health (SDH), especially those responsible for inequities, researchers have been using the social-ecological approach, based on the recently proposed model by the WHO through the International Commission of Social Determinants of Health, which identifies four relevant levels of action: social stratification, differential exposure, differential vulnerability and differential consequences. The frame of reference of the Commission adopts these four "entry points" (or of access) and adds a fifth one, related to the access to health services. Blas E., Sommerfeld J. and Kurup AS, 2011, on the other hand, adopting the concepts of the WHO and based on these 5 "entry points", sought to demonstrate through 13 study cases on diseases and health hazards how to study and how to put into practice the SDH concepts. That is what we intend to do, comparing the "Unsafe Abortion" (data already collected - 51 women with UA) to the "Legal and Safe Abortion" (sample of women with Legal Abortion already performed from the Pérola Byington Hospital) and the "Illegal Volunteered Abortion" performed in private practices of appropriate standards. This comparison will be performed in terms of outcomes and SDC, of morbidity (post-abortion complications) and of social determinants implied in the occurrence of IA, generating health inequities. Action and/or intervention plans concerning the entry points related to these findings will also be drawn up. (AU)

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