Strategies in primary health care in prenatal and postpartum care: the role of community health agents

Role of ACS in women’s health

Abstract

Objective: Understand how community health agents identify primary health care strategies to capture recommendations for prenatal and postpartum services. Method: A multisite, qualitative research approach with a critical ethnography design to examine issues of culture, knowledge, and actions was conducted in the municipalities of the states of Rio de Janeiro, Minas Gerais, and Paraíba, from July 2019 to March 2020, conducted through in-person focus groups. The recognition of existing conditions that promote and maintain obstetric violence, and the indefinite process of referral-counter-referral of these cases guided the thematic analysis. Results: In the 5 focus groups, the accounts of 48 participants, predominantly women, perceptions of the practice emerged in identifying, monitoring, referring and counter-referring cases of obstetric violence. Participants also reported the effectiveness and feasibility of supportive actions, as well difficulties or gaps in these processes. Therefore, an undefined interprofessional practice was evidenced, whose effectiveness tends to be related to the personal success of individual agents in establishing excellent interprofessional relationships. Although on the frontline, agents deal with an absence of an identifiable network for referral and counter-referral of such cases in the community. Conclusion: Difficulties and ambiguities associated with the identification of obstetric violence, compounded by a lack of knowledge of the participants and precarious organization of the action network, causes gaps in care and discontinuance of follow-ups. Increasing the professional development and profile of such agents is a condition for promoting women’s empowerment based on their rights.