Construir, implementar y ¿TRANSformar? Orientaciones y lineamientos de atención preconcepcional, prenatal y postparto para hombres transgénero en Bogotá
Thesis
Applying a critical framework to public health, we show how the process of constructing and implementing periconceptional, prenatal, and postpartum guidelines for transgender men took place within the Resolution 3280 of 2018 in Bogotá, Colombia. This is a qualitative and interpretative study. The field information was gathered between September 2022 and February 2023, which included 12 semi-structured interviews. Additionally, a critical analysis was carried out to the technical guideline for preconception care in individuals on reproductive age, as well as the technical guidelines of the comprehensive route for maternal perinatal care and specific events with a differential line in the district. The point of view we used was intersectionality. We focus on three important findings:1) we identified how the construction and implementation of paternal-perinatal guidelines took place, including the participation, discussions held within the team, actions, milestones, events, as well as the difficulties and barriers faced throughout the process. Regarding the training sessions, we described the meanings, the training process, challenges, and lessons learned, difficulties, barriers, and perceptions related to the construction and implementation of the documents.2) we identified the challenges and lessons learned by health entities and health insurance companies, the bureaucratic itineraries of the healthcare system during the construction and implementation of the guidelines, and the institutional and obstetric violence experienced by transgender men.3) within the analytical category of differential health care, we found opportunities for improvement, transformations in health care with inclusive strategies and alternative perspectives, as well as the health/Illness/attendance/care culture and society process, which allowed us to have a contextualized understanding, recognizing the social, cultural, and behavioral change aspects from frameworks of diversity, difference, and inequality. In the critical analysis from the intersectionality view of the periconceptional guideline, there is a non-binary gender conception, but there is a unidimensional approach, as it does not intersect categories such as gender, race, and social class/income/socioeconomic position. In summary, the document develops a differential approach but not an intersectional one. In the critical analysis of prenatal guidelines, the document lacks an intersectional perspective and does not fully develop a differential approach. Finally, within public health, we should not only focus on the appropriate use of language, but also make trans parenthood part of public and private health institutions agenda. Thus, one of the most interesting challenges is the transformation of healthcare protocols with a gender perspective, working from a health perspective rather than disease.
