Desafios enfrentados por enfermeiras(os) no planejamento reprodutivo no contexto da Atenção Primária à Saúde: uma revisão de escopo

Abstract

Reproductive Planning (RP) is a fundamental human right essential to sexual and reproductive health and autonomy. In Brazil, despite the legal framework provided by the Unified Health System (UHS), millions still lack access to modern contraceptive methods, resulting in unplanned pregnancies. Socioeconomic, cultural, and service-related barriers persist, further exacerbated by the COVID-19 pandemic. Objective: To synthesize national scientific knowledge regarding the challenges faced by nurses in implementing Reproductive Planning in Primary Health Care (PHC) in Brazil. Methods: A scoping review was conducted based on the Joanna Briggs Institute and PRISMA-ScR guidelines. Searches were performed between March and April 2024 in the BVS, Scopus, Web of Science, CAPES Journals, and ERIC databases, using descriptors in Portuguese, English, and Spanish. Inclusion criteria comprised primary studies, systematic reviews, and meta-analyses addressing RP actions carried out by nurses in PHC. Incomplete studies or those not focused on the topic were excluded. From 1,524 initially identified records, 10 studies were selected for full-text reading after screening by two independent reviewers. Data analysis included a narrative-descriptive synthesis and thematic analysis focusing on convergences and divergences. Results and Discussion: The studies revealed that nursing is recognized as playing a key role in RP, although the effectiveness of its practices varies between structured and fragmented approaches. The inclusion of partners in RP is a consensual need, but its implementation remains incipient, reflecting a limited view of female responsibility and little attention to gender diversity. Continuing professional education is considered essential, but it remains a barrier or proves ineffective in the face of organizational obstacles. Structural failures in services, such as shortages of supplies, bureaucratic hurdles to access methods like the DIU, and the predominance of oral contraceptive use, were identified as problematic. Health education, crucial for user autonomy, is often reported as sporadic. Nursing practice frequently tends to be individual and biologicist, diverging from national policy principles and WHO recommendations, directly impacting access to and adherence to RP. The findings highlight the urgent need to reorganize services, strengthen continuing health education, and expand the gender approach to build more effective and inclusive PHC. Conclusions: Although RP is a fundamental right, it still faces persistent challenges to its effective implementation in Brazilian PHC. Nursing plays a leading role in this context, but its performance is limited by organizational barriers, insufficient training, and fragmented educational practices. Investment in continuing health education, service reorganization, expanded access to diverse contraceptive methods, and the inclusion of partners and other gender identities in RP are essential. Public policies must ensure equity and comprehensive care, aligning health practices with sexual and reproductive rights, aiming to build fairer and more effective PHC.