Justiça reprodutiva na atenção puerperal: avaliação crítica das condições de atenção à saúde da mulher no período pós-parto no Brasil

Abstract

The puerperium is a critical moment for women's health. The care provided in the period of six weeks after childbirth is essential for the prevention of maternal morbidity and mortality and the promotion of women's health. In Brazil, actions such as postpartum follow-up and home visits have become part of the care line for pregnant women using the Unified Health System since the implementation of the Prenatal and Birth Humanization Program in 2000. In these aspects, the general objective of the thesis is to critically evaluate the conditions of women's health care in the puerperium, in the context of Brazilian public policies from 2000 to 2019. The research work is based on the theoretical conception of reproductive justice, which articulates the dimensions of reproductive health, human rights and social justice. Through data triangulation and research methods, qualitative and quantitative analysis techniques were used. The thesis consists of an introduction, six chapters and final remarks. In the first chapter, a qualitative characterization of the postpartum period is presented, based on interviews with 21 women. In the second, quantitative data on postpartum pain perception levels reported by Brazilian women interviewed in the Birth in Brazil survey (2011-2013) are discussed. In the third, a meta-analysis is carried out on the coverage of postpartum follow-up in the country based on an evaluative synthesis of scientific productions published between 2000 and 2019. The fourth chapter discusses the visit of a community health agent in the first postpartum week and the postpartum follow-up, within the scope of primary care of the Unified Health System, based on the quantitative data of the three cycles of the Improvement of Access and Quality of Primary Care Program (2012; 2014; 2017). The fifth chapter reflects on the trajectory of women's health policy in Brazil with a focus on human rights, having as an analysis device the qualitative review of evaluative studies on puerperal care. The last chapter condenses the theoretical-methodological reflections carried out during the course of the research, to propose an approach to health evaluation based on the triangulation between intersectionality, critical theory of human rights and reproductive justice. The results of the thesis indicate the predominance of the biomedical model in puerperal care; the persistence of inequities in the access and quality of postpartum care provided by primary care services; the scarcity of data on postpartum care guided by the identification of intersectional oppressions that condition the access and use of health services by Brazilian women. In summary, it is argued in favor of strengthening social policies in Brazil in order to expand the protection of women's human rights towards reproductive justice.