title: Expanding contraceptive choice: findings from Brazil.
abstract: This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.
authors.affiliation: Department of Education, Training and Communication, CEMICAMP, Campinas, SP, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Díaz
authors.forename: R
authors.initials: R
authors.lastname: Simmons
authors.forename: J
authors.initials: J
authors.lastname: Díaz
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez
authors.forename: M Y
authors.initials: MY
authors.lastname: Makuch
authors.forename: D
authors.initials: D
authors.lastname: Bossemeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002755:Choice Behavior; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015397:Program Evaluation; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology*