Source : DRAC Spreadsheets — November 2013.

SISPRENATAL WEB

SISPRENATAL WEB is software developed by DATASUS in support of quality for women during the delivery and postpartum periods. It defines a minimum set of procedures for adequate antenatal care, allowing for support for pregnant women from the onset of pregnancy to the postpartum consultation.

As of December 2013, the result of this action was:

•4,666 municipalities using the system

•400,074 pregnant women

•1,013,032 total expectant mothers registered in the system.

A review was done in 2013 of the lump-sum financial incentives for 2,468 municipalities that entered pregnant women in SISPRENATAL WEB up to the twelfth week of gestation (early pregnancy detection). The review was authorized under Decree No. GM 752 of June of 2013, covering a total of R$ 2,374,380.00 for 118,718 pregnant women entered in the system up to the twelfth week of gestation.

Rede Cegonha user satisfaction research

The Ombudsman for Rede Cegonha has reported that from 10/05/2012 to 18/06/2013, 103,905 women were interviewed during the period extending to six months postpartum. The results are shown in the following table.

Per cent	Question evaluated	Challenge to be met
883	The woman received respectful treatment during childbirth	Quality public service. Progress in the policy of humane treatment of maternity
773	Delivery performed in the first health service she approached	A place always guaranteed for most pregnant women. Eliminate shopping around
999	No fee charged for delivery (fee-charging maternity hospitals were reported to DENASUS)	Obstetric care in the context of free, universal coverage
551	Child placed in her lap or on her chest for breastfeeding immediately after birth	Best practice that should be more widespread
449	She was informed at the antenatal stage where delivery would take place	Enhance liaison maps — guaranteed access
338	She was visited by the community health officer up until one month after childbirth	Ensure that the officer visits the woman and her baby in the first 48 hours — “golden time for visiting”
228	She had a birthing partner	Advance understanding of childbirth as a physiological event

Further strategic actions to reduce maternal mortality

1.Upgrading of care and management in 32 strategic maternity hospitals and local and regional networks, to accelerate the reduction of maternal mortality and promote safe motherhood:

(a)Thirty-two maternity hospitals with supporters, strategic groups established and action plans developed;

(b)Monitoring of plans and matricial support for implementation of arrangements: risk assessment on admission, birthing partner, co-management, horizontal care team, environment, monitoring and evaluation, implementation of best care practices for delivery and birth.

2.Support the development, implementation, monitoring and evaluation of action plans for priority maternity hospitals and local and regional networks:

(a)Seven provinces with approved PARs and resources reviewed in 2011, with an established monitoring process, offices in place, and visits undertaken to maternity hospitals receiving Rede Cegonha incentives.

3.Promote the establishment of support centres to generalize best practices in reference maternity hospitals:

(a)Six hospitals chosen to become support centres and develop best care practices for delivery and birth for other establishments;

(b)Six best practices seminars conducted at all six hospitals, involving 400 professionals from the 32 strategic maternity hospitals.

(a)Reducing maternal mortality

According to data from the Health Surveillance Secretariat, Ministry of Health, the maternal mortality ratio (MMR) per 100,000 live births in Brazil fell by 55.3 per cent between 1990 and 2011, that is, by 143 maternal deaths per 100,000 live births. From 2000 to 2008, the reduction was 16.2 per cent; from 2009 to 2010, it was 8.9 per cent; from 2010 to 2011, it was 8.6 per cent. In order to meet the goal of 75 per cent reduction by 2015, as envisaged in the MDGs, it will be necessary to achieve an annual reduction rate of 16 per cent.

(b)Expedite the review of legislation criminalizing abortion in order to remove punitive provisions imposed on women, as recommended by the Committee (CEDAW/C/BRA/CO/6, para. 3); and collaborate with all relevant actors in order to discuss and analyse the impact of the Statute of the Foetus in further restricting existing the existing narrow grounds for legal abortion, before it is adopted by the National Congress

In accordance with the President’s direction that there can be no loss of rights, the Secretariat for Women’s Policies, through Minister Eleonora Menicucci, has taken the position, in formulating and implementing policies for women, that women’s rights must be respected and guaranteed; these include sexual and reproductive rights of women. It has held that line in its actions and its statements to the National Congress and various Committees.

As regards the Statute of the Foetus, favourable opinions were given by two committees of the Chamber of Deputies: the Committee on Social Security and Family (on 19 May 2010); and the Tax and Finance Committee (on 5 June 2013). To be approved, the Statute must also pass the stage of the Constitution, Justice and Citizenship Committee, which has been studying it since June 2013, be voted on in the full Chamber, then sent to the Federal Senate. The National Council of Women’s Rights (CNDM), a collegial body made up of government agencies and civil society organizations and headed by the Secretariat for Women’s Policies, issued a public statement repudiating the Statute of the Foetus, on 27 May 2010, and another note, on 5 June 2013, addressed to the parliamentary Tax and Finance Committee. In that statement, it reaffirmed that the bill represents a step backwards for Brazilian women’s human rights; that it is unconstitutional; and that CNDM will continue its information and clarification work in tandem with parliamentarians and society at large.

It should be noted that the President of the Republic, Dilma Rousseff, assented to Decree No. 7,958, of 13 March 2013, which lays down guidelines for the treatment of victims of sexual violence by professionals of public safety and the treatment network of the Unified Health System. She also assented to Act No. 12,845, of 1 August 2013 and approved by the National Congress, which provides for compulsory comprehensive care for persons affected by sexual violence and requires hospitals to provide integrated, multidisciplinary emergency care, including emergency contraception, to victims of sexual violence, with a focus on the control and treatment of its physical and psychological sequelae, and referral when required to social assistance services. For the purposes of the Act, sexual violence is defined as any form of non-consensual sexual activity, while immediate, compulsory care at all hospitals belonging to the SUS network shall include the following: diagnosis and treatment of physical injuries in the genital tract and any other areas affected; immediate medical, psychological and social protection; facilitation of reporting of the occurrence and referral to the forensic service and specialized police departments, providing information that may help identify the perpetrator and substantiate the act of sexual violence; pregnancy prophylaxis; prophylaxis of sexually transmitted diseases (STDs); gathering of materials to conduct HIV testing for subsequent support and therapy; counselling of victims on their legal rights and all health services available.

(c)Include detailed information in its next periodic report on the Integrated State Plans to Combat the Feminization of the HIV/AIDS Epidemic and other STDs (reviewed in 2009), which aims at expanding women’s access across the country to prevention, diagnosis and treatment of sexually transmitted diseases and HIV/AIDS

The Integrated Plan to Combat the Feminization of HIV/AIDS and other STDs, developed as a joint initiative of the Secretariat for Women’s Policies and the Department of STDs, AIDS and Viral Hepatitis, in 2007, by the Office of the President of the Republic, is focused on the concept of vulnerability. It was revised in 2009 to improve its implementation, in view of Brazil’s classification as a “concentrated epidemic” country. The Plan is the result of the effort to develop an intersectoral policy to slow the progression of HIV/AIDS among Brazilian women; its guideline is the concept of vulnerability. With the development and implementation of the “State Plans to Combat the Feminization of HIV/AIDS and other STDs”, there was an attempt to define specific intersectoral actions and a dynamic response to the HIV epidemic among women through quality care from health services, and to strengthen that segment of the population. The national and state plans were implemented and monitored between 2007 and 2011 as laid down in the national document.

Final evaluation of this process indicated that the Plans had become an important fulcrum for the necessary mainstreaming of the gender perspective into the Government’s various policies and the (re)positioning of women at the centre of the discussion on development and equity, as well as a tool for deconstructing processes that stigmatize women in marginal situations, such as prostitutes, lesbians and transgender women as well as women prisoners. Added to this was the recognition of the greater vulnerability of women in prisons, quilombolas, indigenous women and those of other ethnic minorities. The Plan’s approach made for an intra- and intersectoral treatment of women’s vulnerability to HIV, within the Government, that was in tune with civil society.

Activities focusing on groups of women at increased risk and more vulnerable groups — sex workers, women living with HIV, women who have sex with women and transgender women — and proposals in line with affirmative agendas and developed by these groups themselves with the stimulus and support of the Department of STDs, HIV/AIDS and Viral Hepatitis, allowed progress to be made in promoting equality and integrity. Among the difficulties listed are those related to liaison with primary care units. Some reluctance to work with civil society also came to light, especially in relation to some segments still lacking organization and visibility in certain states, such as transgender women and prostitutes.

The Plan’s focused nature also posed a challenge in terms of linking the targeted actions with more general ones that remained on the agenda, such as advice and encouragement for testing and necessary activities for the reduction of vertical transmission of HIV, involving the participation of primary health-care services responsible for antenatal support.

Finally, the Plans became an important strategy for strengthening dialogue with civil society and integrating different sectors and areas of the health sector in order to develop actions aimed at population groups that are generally overlooked in routine SUS activities.