scholarly journals Access to prenatal care: inequalities in a region with high maternal mortality in southeastern Brazil

2016 ◽  
Vol 21 (5) ◽  
pp. 1647-1658 ◽  
Author(s):  
Katrini Guidolini Martinelli ◽  
Edson Theodoro dos Santos Neto ◽  
Silvana Granado Nogueira da Gama ◽  
Adauto Emmerich Oliveira
Keyword(s):  
Health Care ◽  
Prenatal Care ◽  
Health Services ◽  
Pregnant Women ◽  
Minimum Wage ◽  
Urban Areas ◽  
Access To Health Care ◽  
Universal Access ◽  
Southeastern Brazil ◽  
Cross Sectional

Abstract Aim This article aims to evaluate access to prenatal care according to the dimensions of availability, affordability and acceptability in the SUS microregion of southeastern Brazil. Methods A cross-sectional study conducted in 2012-2013 that selected 742 postpartum women in seven hospitals in the region chosen for the research. The information was collected, processed and submitted to the chi-square test and the nonparametric Spearman’s test, with p-values less than 5% (p < 0.05). Results Although the SUS constitutionally guarantees universal access to health care, there are still inequalities between pregnant women from rural and urban areas in terms of the availability of health care and among families earning up to minimum wage and more than one minimum wage per month in terms of affordability; however, the acceptability of health care was equal, regardless of the modality of the health services. Conclusion The location, transport resources and financing of health services should be reorganised, and the training of health professionals should be enhanced to provide more equitable health care access to pregnant women.

scholarly journals Pattern of oral diseases and associated contributing factors in pregnant women attending a maternity center in Dhaka city, Bangladesh

2021 ◽  
Vol 39 (1) ◽  
pp. 50-59
Author(s):  
Mumtahana Nabi ◽  
Abul Masud Md Nurul Karim ◽  
SM Mamun Ur Rashid
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Large Scale ◽  
Family Income ◽  
Oral Disease ◽  
Care Providers ◽  
Cross Sectional

Background: Oral health care in pregnancy is often neglected by women and is also not appropriately addressed by prenatal and other health care providers and justify appropriate attention. The purpose of this cross sectional study was to describe percentage of oral disease occurrence and underlying causes in this sample of pregnant women. Methods: The study included 147 women aged between 15 to 49 years receiving prenatal care at the outdoor department of Azimpur Maternal and Child Health Training Institute in Dhaka, Bangladesh were invited to participate in this study from January 2013 to April 2013. Semi-structured interviews were conducted for data collection. Clinical exam data were recorded using validated scales in a special form. Results: Majority (72%) of the women were  between  20 to 24 years.  57%  had secondary  school  education.  88% of the women were unemployed and 52% women had very low family income of BOT s;10000. More than 90% of the women had good oral hygiene practices. However, 68% liked to  have  sugary  snacks  or  drinks  in  between  main meals, 7% visited their dentists during pregnancy , only 3% received advice  for  routine  oral  health  screening  from their prenatal care providers and only 4% women started their antenatal check-up during first trimester.  All  these negative influences might expose expecting mothers to high level of dental caries (54%), dental  erosion  (52%),  gingivitis (100%) and periodontitis (27%). This study also showed that majority of the women acquired oral health information through watching television (61%) or reading  newspaper  (12%)  while  only  4%  received  information from doctors/dent ists throughout their lifetime. Conclusion: The undertaken research highlighted the importance of using media in modifying Bangladeshi pregnant woman's behaviours toward oral health. It also emphasizes the need for inclusion of oral health preventive programme as part of pre and postnatal care. Further study in this area on a large scale will facilitate formulation of appropriate oral health policy to achieve satisfactory oral and general health outcomes during pregnancy and ensure optimum oral health conditions of their offspring. JOPSOM 2020; 39(1): 50-59

scholarly journals Lack of access and continuity of adult health care: a national population-based survey

2015 ◽  
Vol 49 (0) ◽  
Author(s):  
Alitéia Santiago Dilélio ◽  
Elaine Tomasi ◽  
Elaine Thumé ◽  
Denise Silva da Silveira ◽  
Fernando Carlos Vinholes Siqueira ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Home Care ◽  
Emergency Care ◽  
Health Professionals ◽  
Urban Areas ◽  
Population Based ◽  
Adult Health ◽  
Access To Health Services ◽  
Cross Sectional

OBJECTIVE To describe the lack of access and continuity of health care in adults.METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas.RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care.CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

scholarly journals Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland

2021 ◽  
Vol 18 (5) ◽  
pp. 2229
Author(s):  
Katja Çilenti ◽  
Shadia Rask ◽  
Marko Elovainio ◽  
Eero Lilja ◽  
Hannamaria Kuusio ◽  
...  
Keyword(s):  
Health Care ◽  
General Population ◽  
Health Services ◽  
Access To Health Care ◽  
Health Care Services ◽  
Unmet Need ◽  
Medical Doctor ◽  
Cross Sectional ◽  
Care Services ◽  
Use Of Health Services

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor’s treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

scholarly journals EPIDEMIOLOGICAL PROFILE OF THE NOTIFIED CASES OF CONGENITAL SYPHILIS BY HEALTH REGION IN TOCANTINS

2018 ◽  
Vol 5 (4) ◽  
pp. 55-65
Author(s):  
Jayanne Silva De Alcantara ◽  
Guilherme Pansani Silva ◽  
Kleidir Hernâny Moreira Oliveira ◽  
Michelle de Jesus Pantoja Filgueira
Keyword(s):  
Health Care ◽  
Prenatal Care ◽  
Urban Areas ◽  
Congenital Syphilis ◽  
Cross Sectional ◽  
Notification System ◽  
Maternal Schooling ◽  
Performance Area ◽  
The One ◽  
Epidemiological Profile

ABSTRACT This is a descriptive, retrospective cross-sectional epidemiological study, on cases of Congenital Syphilis (CS) reported on the Information System for Notifiable Diseases (SINAN) from 2013 to 2017. This study aims to describe the epidemiological profile of CS cases reported in the eight health regions of the state of Tocantins. The health care regions were related to the variables maternal schooling, prenatal performance, area of residence, moment of diagnosis and treatment of the partner. Of the 1192 cases reported,the majority were in the Capim Dourado region. It was verified that in most cases the mothers studied until elementary or secondary school, performed prenatal care and resided in urban areas, and  that the diagnosis occurred during prenatal care, however, the partner was not treated. Only Amor Perfeito region showed a predominance of diagnosis performed at the time of delivery and Ilha do Bananal region was the one with the highest percentage of diagnosis carried out after birth. The increase in SC cases may reflect increase in it’s incidence and improvement in the notification system. The percentage of untreated partners and late diagnoses may suggest a qualitative and an access deficit  in prenatal care. Descriptors: congenital syphilis; epidemiology; health care regions.

FAKTOR - FAKTOR YANG MEMPENGARUHI KEPUTUSAN MASYARAKAT TERHADAP PEMILIHAN JASA PELAYANAN KESEHATAN DI KECEMATAN LATIMOJONG TAHUN 2016

2018 ◽  
Vol 5 (07) ◽  
pp. 55-64
Author(s):  
Lestari Lorna Lolo ◽  
Ny. Julma
Keyword(s):  
Health Care ◽  
Health Services ◽  
Significant Influence ◽  
Urban Areas ◽  
Health Care Services ◽  
Simple Random Sampling ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Care Services

Health services are any efforts that are held personal or together within an organization to maintain and improve health, prevent, and cure diseases and restore the health of individuals, families, groups, or society. Buntu Sarek villageis is one village in the village Latimojong district with the general state of the topografi. Buntu Sarek village is a plateau area and the hills and located at an altitude between 600-2500 m above sea level. Health services are always concentrated in urban areas alone and while it was preliminary study found the lack of utilization of health care services in the district Latimojong reasons long distances and can still be treated traditionally.The aims of the research to analyze the factors that influence decision of communities on the selection of a health care services in Latimojong district 2016. Descriptive analytic design with cross sectional study approach, the number of respondents as many as 61 heads of families who are assigned using method simple random sampling . Data collected by a questionnaire and analyzed using univariate and bivariate using Chi-Square statistical test.Conclusion of the research was prove there are significant influence on the distance of health care services selection (p= 0.006), there is a significant influence on the culture of health care services selection (p = 0.000) and there is significant effect on the information of health care services selection (p= 0.000). Suggestions in this research will wish governments and communities work together, care services in Latimojong district, so that people have the ability to reach quality health services and obtain health insurance.Key words : Distance, Culture, Information, Health Care Services Selection

scholarly journals BAGAIMANA PERAWATAN KESEHATAN DAN DUKUNGAN KELUARGA DENGAN IBU HAMIL BERPERAN DALAM PEMANFAATAN PELAYANAN KESEHATAN VCT

2018 ◽  
Vol 5 (2) ◽  
pp. 103-112
Author(s):  
Ni Putu Wiwik Oktaviani ◽  
Ni Luh Putu Devhy ◽  
I Made Sudarma Adiputra ◽  
Dewa Ayu Putri Widiastuti
Keyword(s):  
Health Care ◽  
Human Immunodeficiency Virus ◽  
Pregnant Woman ◽  
Health Services ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Family Support ◽  
Cross Sectional ◽  
Immunodeficiency Virus ◽  
The Family

Pendahuluan: AIDS adalah penyakit yang disebabkan oleh infeksi dengan virus yang disebut Human Immunodeficiency Virus (HIV), yang dimana kasus HIV pada ibu rumah tangga menduduki peringkat kedua. Penularan melalui perinatal menyumbang 5,1%. Penularan tersebut dapat dicegah jika ibu hamil sejak dini diketahui statusnya dan mendapat pengobatan dengan tepat. Integrasi program pencegahan HIV dari ibu kebayi pada pelayanan antenatal care telah dilakukan, namun keikutsertaaan ibu hamil untuk VCT masih rendah. Dukungan keluarga sangat penting dalam mendukung keikutsertaaan ibu hamil untuk VCT. Tujuan dari penelitian ini adalah untuk mengetahui gambaran fungsi perawatan kesehatan dan dukungan keluarga dengan ibu hamil dalam pemanfaatan pelayanan kesehatan VCT. Metode: Desain penelitian ini merupakan penelitian deskriptif dengan rancangan cross sectional. Studi dilakukan di Puskesmas I Susut, Bangli dengan jumlah sampel sebanyak 93 reponden dengan teknik non-probabiliti sampling dengan purposive sampling. Data yang diperoleh dianalisis dengan program komputerisasi dengan menggunakan analisis univariat. Hasil: Hasil menunjukan sebagian besar responden memiliki fungsi perawatan kesehatan tidak efektif 54,8% dan sebagian besar responden memiliki dukungan keluarga cukup 46,2%. Diskusi: Hasil penelitian ini dapat direkomendasikan diterapkan pada keluarga melalui peran kader kesehatan dan pihak puskesmas untuk meningkatkan kembali pelayanan kesehatan VCT terhadap Ibu hamil.   Kata Kunci : Perawatan Kesehatan, Dukungan Keluarga, Ibu Hamil   ABSTRACT Introduction: AIDS is a disease caused by infection with a virus called Human Immunodeficiency Virus (HIV), and the number of women who infected with HIV has increased year by year. Through perinatal transmission contributed 5.1%. The transmission can be prevented if pregnant woman know their status and get treatment appropriately. Integration of maternal to infant HIV prevention programs on antenatal care hip services is done, but the participation of pregnant women for VCT is still low. The family supports are important to support adherence participation of pregnant women for VCT. Method: This research aimed to description of the function health care and family support with pregnant woman on utilization of VCT health services. This study of description with cross sectional design. Study was conducted at Puskesmas I Susut Bangli with 93 samples was taken by non-probability sampling with purposive sampling. Obtained data was processing SPSS and analyzing by univariate test. Result: Research of study showard most respondents have a not effective Function health care 54,8% and most respondents have a enough family support 46,2%. Discussion: The results of this study research can be recommended to be applied to the family and the health community center or clinics to improve again the health services VCT to wards pregnant women.   Keyword : Health care, Family support, Pregnant women

HUBUNGAN ANTARA PENDIDIKAN DAN PEKERJAAN IBU HAMIL DENGAN PEMERIKSAAN KEHAMILAN DI PUSKESMAS MARIANA KECAMATAN BANYUASIN I KABUPATEN BANYUASIN TAHUN 2011

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Leny Leny
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Maternal Education ◽  
Statistical Tests ◽  
Univariate Analysis ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Health Organization

ABSTRACT Prenatal care is health care by health personnel to care the pregnant according to standards. Worlrd Health Organization (WHO) estimates more than 500.000 women die during pregnancy or childbirth. Maternal mortality in Indonesia is 307 per 100,000 live births. The quantity of pregnant women’s visit in Kabupaten Banyuasin in 2009 of 89.1%. The purpose of this study to determine the relationship between education and occupation with prenatal care at Puskesmas Mariana  Kecamatan Banyuasin I Kabupaten Banyuasin in 2011. This study uses analytic approach survey by Cross Sectional methods, the population are 1.946 pregnant women and the samples as many as 332 people. The results of univariate analysis study of pregnant women who are higher education as much as 45.2%, and  low maternal education as much as 54.8%. In pregnant women who work of 43.4%, and pregnant women who do not work for 56.6%. From the results of bivariate analysis and Chi-Square statistical tests found a significant association between education of pregnant women with prenatal care with P Value = 0.000, and there was a significant association between occupation of pregnant women with prenatal care with P Value = 0.000. Can be concluded that there is a relationship between education and occupation of pregnant women with prenatal care. Expected to health workers to provide counseling on the importance of prenatal care in pregnant women and expected future studies may explore again the factors associated with prenatal care with the different variables.   ABSTRAK Pemeriksaan kehamilan adalah pelayanan kesehatan oleh tenaga kesehatan untuk memeriksakan ibu hamil sesuai standar. World Health Organization (WHO) memperkirakan lebih dari 500.000 ibu pertahunnya meninggal saat hamil atau bersalin. AKI di Indonesia 307 per 100.000 kelahiran hidup. Jumlah kunjungan ibu hamil di Kabupaten Banyuasin tahun 2009 sebesar 89,1%. Tujuan penelitian ini untuk mengetahui hubungan antara pendidikan dan pekerjaan dengan pemeriksaan kehamilan di Puskesmas Mariana Kecamatan Banyuasin I Kabupaten Banyuasin tahun  2011. Penelitian ini menggunakan metode survey analitik dengan pendekatan Cross Sectional, populasi ibu hamil dengan jumlah 1.946 orang dan jumlah sampel sebanyak 332 orang. Hasil penelitian Analisa Univariat adalah ibu hamil yang pendidikan tinggi sebanyak 45,2%, dan pendidikan rendah ibu hamil sebanyak 54,8%. Pada variabel pekerjaan ibu hamil yang bekerja sebesar 43,4%, dan ibu hamil yang tidak bekerja sebesar 56,6%. Dari hasil analisa bivariat dan uji statistik Chi-Square  didapatkan hubungan yang bermakna antara pendidikan ibu hamil dengan pemeriksaan kehamilan dengan  P Value = 0,000, dan ada hubungan yang bermakna antara pekerjaan ibu hamil dengan pemeriksaan kehamilan dengan P Value = 0,000. Dapat disimpulkan bahwa ada hubungan antara pendidikan dan pekerjaan ibu hamil dengan pemeriksaan kehamilan. Diharapkan kepada petugas kesehatan agar dapat memberikan penyuluhan tentang pentingnya pemeriksaan pada ibu hamil dan diharapkan penelitian yang akan datang dapat menggali lagi faktor-faktor yang berhubungan dengan pemeriksaan kehamilan dengan variabel yang berbeda.

scholarly journals Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mingming Cui ◽  
Xiao-Lin Lu ◽  
Yan-Yu Lyu ◽  
Fang Wang ◽  
Xiao-Lu Xie ◽  
...  
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Unplanned Pregnancy ◽  
Urban China ◽  
Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

scholarly journals Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elizabeth Hyde ◽  
Matthew H. Bonds ◽  
Felana A. Ihantamalala ◽  
Ann C. Miller ◽  
Laura F. Cordier ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Malaria Incidence ◽  
Universal Access ◽  
Surveillance Systems ◽  
Passive Surveillance ◽  
Transmission Season ◽  
Access To Health ◽  
Spatio Temporal ◽  
Geographic Access To Care

Abstract Background Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. Methods We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations’ financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

scholarly journals The Impact of Internalized Stigma on LGBT Parenting and the Importance of Health Care Structures: A Qualitative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5373
Author(s):  
Carolina Alday-Mondaca ◽  
Siu Lay-Lisboa
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Universal Access ◽  
Civil Society Organizations ◽  
Support Network ◽  
Internalized Stigma ◽  
Lgbt People ◽  
Mental Health Programs ◽  
The Impact

Research on LGBTIQ+ families has focused on the effects of being in a diverse family on the development of children. We seek to show the experience of parenthood from the perspective of LGBTIQ+ people, considering its particularities and the role that health care services play as a potential support network. We used the biographical method through open-ended interviews, participants were LGBT people, and key informants from Chile, Colombia, and Mexico were selected based on a sociostructural sampling. We found that internalized stigma impacts LGBTIQ+ parenting in five ways: the impossibility of thinking of oneself as a parent, fear of violating children’s rights, fear of passing on the stigma, fear of introducing their LGBTIQ+ partner, and the greater discrimination that trans and intersex people suffer. We identified gaps in health care perceptions: the need to guarantee universal access to health care, the need to include a gender perspective and inclusive treatment by health personnel, mental health programs with a community approach, access to assisted fertilization programs, and the generation of collaborative alliances between health services, civil society organizations, and the LGBTIQ+ community. We conclude that the health system is a crucial space from which to enable guarantees for the exercise of rights and overcome internalized stigma.

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