Analysis of Advertising Pieces of the Ministry of Health about Congenital Syphilis in the Light of Freire ()
1. Introduction
Congenital Syphilis (CS), a chronic bacterial infection, has Treponema pallidum as its etiological factor, a preventable public health problem that particularly affects developing countries, given its correlation with the socioeconomic status of the population, educational factors and low investment in Public Policies, which favors the CS endemic in low-income countries.
CS can cause direct morbidity and mortality, increase the risk of HIV infection and cause lifelong morbidity in children born to infected mothers, in addition to irreversible neurological and cardiovascular complications [1]. Globally, maternal syphilis is the most common infection associated with stillbirths in poor countries, although there is potential for eradication of this disease [2] [3].
In this scenario, with the promoting Health Education objective in Brazil, the Ministry of Health (MS) developed advertising strategies to attenuate the syphilis vertical transmission, which have as aim a thoughtful action of communication, dialogue, reflection and respect for culturality, to prevent that Health Education becoming a mere slogan in the form of a “deposit” or, as cited by Freire, nonsense “directionism” [4].
Although communication is important in the field of health and public policies, it is a topic that is theoretically little explored in Brazil [5], particularly in the nursing area.
The link between pregnant women and motherhood, as well as access to whole health care, is a point to be strengthened in the country, despite the expansion of prenatal care coverage in recent years [6].
When compared to pregnant women with lower purchasing power in relation to pregnant women with better financial conditions, the inequalities within a single health system are evidenced by the increased risk of marginalization and incomplete prenatal care of the women with lower financial power. These factors reflect upon indicators of maternal-fetal morbidity and mortality and also an increase in the incidence of Sexually Transmitted Infections (STIs), such as CS. Thus, health education can become an essential instrument of citizenship, as it comprises the conscious awareness of a reality in order to intervene, act and emancipate oneself [7].
In Brazil, in 2020, the detection rate of syphilis in pregnant women was 21.6/1000 live births; the congenital syphilis incidence rate was 7.7/1000 live births; and the congenital syphilis mortality rate was 6.5/100,000 births alive. According to the WHO, the panorama of syphilis in Brazil is not differs from that of other countries. The case numbers are worrying, which demonstrates the need to reinforce surveillance actions, infection prevention and control [8].
In addition, the diagnosis, which relies essentially on bacteriological and immunological evidence, is not always easy as illustrated all syphilis cases; so, it was done by combining together the anamnesis, the maternal history and the newborn biology (i.e., blood count, CRP, TPHA, VDRL) at birth along with skeleton’s X-rays [9].
Due the increased syphilis number in Brazil, the follow question was addressed: How are communicated the publicity pieces of the MS about CS? Thus, the present study aims to analyze the publicity of the MS about Congenital Syphilis in the light of Freire.
2. Methodology
Documentary research was used as a methodology. The methodology choice was due to the documentary research enables to carry out a magnification of objects’ understanding in perspective of historical and sociocultural contextualization. In addition, this typology makes it possible to follow a temporal analysis of social understanding, as a documental analysis favors a vision of the process of development or evolution of processes, groups, concepts, knowledge, behaviors, mentalities, practices, others [10]. The object of analysis was advertising pieces about CS aired in MS campaigns, circulating throughout the national territory. All documents used as sources of information bring in their content guidelines and elucidations in order to clarify the most diverse research questions. In view of this dimension, the aforementioned method was chosen to carry out the analysis of the selected advertising pieces [10].
Data collection took place between February and March 2021. All pieces (posters) that had the CS theme were captured, excluding those that did not address this theme. The search took place on the MS website, Department of Chronic Conditions and Sexually Transmitted Infections.
The selected advertising pieces were placed in a folder on the computer with identification of the advertising campaign, with belongs, source and year indication. The visual and verbal content of each advertising piece was transcribed in order to make the reading and the message contained in the piece understandable. The analysis of verbal content considered slogans, catchphrases and easy phrases to remember, often present in advertising campaigns, which represent the main characteristics of what is being advertised. Regarding the visual content, the environments, characters and facial expressions were observed.
The thematic analysis method was used to obtain and discuss the results; and divided into four stages: pre-analysis, material study, treatment of the obtained results and interpretation, to display an intrinsic message of the contents presented, and to seek further appearance, what is being communicated. During the data processing and interpretation phase, we tried to formulate the results based on the main contents published in the advertisements, using theoretical references based on critical pedagogy.
3. Results
The results were obtained through an online survey, using as reference the advertising campaigns, exclusive to the Brazilian Ministry of Health, about congenital syphilis.
The results analysis, as described in the methodology section, was carried out in four stages, generating the final result that aimed to analyze the transcribed texts (verbal language), which were present in the campaign, as well as the image, the scenario and facial expression (non-verbal language), in an attempt to elucidate the implicit information.
Six campaigns focusing on the CS theme were identified, containing nine posters. Figure 1 outlines the posters of the Syphilis Transmission Campaign by MS, in Brazil, in the 2004 - 2017 period.
Figure 1(A), from the campaign Launched as one of the visibility actions of the 2004 World AIDS Day Fight, this campaign focuses on women and their vulnerability in the face of the epidemic, with pregnant women and health professionals as the target audience, presents the image of a white woman kissing a white newborn, smiling, with the phrase “Require the test for AIDS and syphilis in prenatal care. It’s your and your baby’s right.” The note in smaller letters, from the MS informs: “If you need it, the treatment is free for you and the baby. Your child can be born healthy”.
Following, the 2013 Syphilis Campaign Poster (Figure 1(B)) presents the image of a white pregnant woman, smiling with her hands over her belly, there is a background drawing of a white mother looking at the white child in her lap, with a heart drawn between the mother and the child, with the phrase: “Your baby needs your protection even before it is born”. Below this sentence is another one that says: “Do the syphilis test in your prenatal”. In sequence have the following text: “From all the affection and protection that your baby deserves since the beginning of pregnancy. Take the syphilis test as soon as possible and prevent these diseases be transmitted to your baby. If it is positive, treatment is guaranteed by SUS. Syphilis is curable. Look for a health unit”.
The MS comments on this campaign: The 2013 Syphilis campaign is aimed to encourage the diagnosis of syphilis during pregnancy. The messages encourage diagnosis during prenatal care and are intended not only for pregnant women, but also for health professionals and managers. Motivated by the still high rate of cases of children with gestational syphilis, the campaign proposes the engagement of everyone to reverse this situation. One of the campaign slogans is “Do the prenatal syphilis test”, indicating that the role of mothers is fundamental for the initiative’s success, but does not exempt other professionals from the early diagnosis responsibility. The pieces will also be present on social networks,
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Source: Ministry of Health, Brazil.
Figure 1. Posters of the Syphilis Transmission Campaign by the Ministry of Health, in Brazil, 2004 - 2017. (A) HIV and Syphilis Transmission Campaign poster. Ministry of Health, Brasília (DF), 2004. (B) Syphilis Campaign Poster. Ministry of Health, Brasília (DF), 2013. (C) Mother’s Day Campaign poster: Testing for hiv, syphilis, hepatitis (B) and (C). Ministry of Health, Brasília (DF), 2015. (D) National Mother’s Day Campaign of CS Combat. Ministry of Health, Brasília (DF), 2016. (E) Congenital Syphilis Prevention Campaign. Ministry of Health, Brasília (DF), 2017. (F) Congenital Syphilis Prevention Campaign. Ministry of Health, Brasília (DF), 2017.
which facilitates the society dissemination.
Figure 1(C) presents the image of a white woman smiling for your baby, white, who smiles: “These smiles are the result of a complete prenatal care”. Below, there is a note from the MS: “Caring for your baby begins long before he be born. Doing complete prenatal care allows your baby to be born healthy” and another note in letters of another color, which indicate: “Require the tests of syphilis, aids and viral hepatitis B and C in prenatal care. Look for a health unit”.
On the MS website there are comments about this campaign: Campaign aimed for future mothers, so that they demand tests for HIV, syphilis and viral hepatitis B and C to prevent vertical transmission of these diseases. The campaign’s pieces are poster, video and graphic pieces for electronic use.
Figure 1(D) presents the image of a black pregnant woman smiling while her white partner kisses her belly, with the phrase: “Júlia did the syphilis test right at the beginning of prenatal care. Fábio too.” Below, there is a note from the MS: “A couple that matches in everything cannot fail to protect their baby” and another sentence: “Do the syphilis test as soon as possible and prevent the disease be transmitted to your baby. It is essential that your sexual partner also takes the test. If the result is positive, the treatment is guaranteed by the SUS (the Brazilian universal health care system). Syphilis has a cure, look for a health unit”.
The MS website comments on this campaign: The 2016 syphilis combat campaign focuses on the importance of prenatal care and the partner’s participation in the pregnancy process. With the slogan: “A couple that matches everything can not leave to protect their baby”, the campaign is aimed for social networks and present materials such as electronic posts, videos and posters.
Figure 1(E) and Figure 1(F) are from posters referring to the same Campaign for the Prevention of Congenital Syphilis, from 2017. Figure 1(E) shows the image of a white pregnant woman, smiling while her white partner, that caresses her belly and smiles; and Figure 1(F) presents the image of a father, white, who plays lifting the child, white, in a park while both smile, both posters have the phrase: “Son, do the prenatal care together with mommy was the first step to wait for you”. Below is a note from the MS: “Future daddy, accompany your partner to prenatal appointments. It’s important that follow-up starts in the first few months of pregnancy. The couple needs to get tested for syphilis. This ensures your baby is born healthy”. In this campaign, the comment on the MS website was: Informational materials about the Congenital Syphilis Prevention Campaign, 2017.
Figure 2 outlines the Syphilis Transmission Campaign Posters by the Ministry of Health, in Brazil, in 2017. Figures 2(A)-(C) are part of the same Campaign: National Day to Syphilis Combat, 2017, which is marked with the following comment on the MS website: Campaign that encourages partner participation during prenatal care.
Figure 2(A) shows a black pregnant woman smiling while her white partner caresses her belly and smiles; Figure 2(B) shows the image of a pregnant woman, white, smiling while her partner, white, caresses her belly and also smiles; Figure 2(C) shows a black woman hugging a black man behind his back, kissing his cheek while he smiles, all figures have the phrase: “Do the syphilis test. Protect your child’s future”. Below, there is a note from the Ministry of Health: “Brazil is experiencing an epidemic of syphilis. The infection is sexually transmitted and can endanger not only your health but also be transmitted to the baby during pregnancy. Monitoring pregnant women and sexual partners during prenatal care prevents congenital syphilis. For this reason it is important that
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Source: Ministry of Health, Brazil.
Figure 2. Posters of the Syphilis Transmission Campaign by the Ministry of Health, in Brazil, in 2017. (A) National Day to Syphilis Combat. Ministry of Health, Brasília (DF), 2017. (B) National Day to Syphilis Combat. Ministry of Health, Brasília (DF), 2017. (C) National Day to Syphilis Combat. Ministry of Health, Brasília (DF), 2017.
you and your partner take the test as soon as possible, preferably in the first three months of pregnancy. If the result is positive, the treatment is offered free of charge by SUS.”
4. Discussion
Health Policies and Programs with the promoting people’s health perspective through education increases individual and community capacity in self-care, with improvement purpose. Thus, health promotion goes beyond disease prevention and includes intersectoral actions to ensure health as “an inalienable human right” [5]. The prevention of syphilis, a STIs, in Brazil has been guided through communication linked to campaigns and publicity promoted by the MS.
It can be observed that the six advertising campaigns on CS in the present study are aimed for women in pregnancy and/or with newborn children. In general, it is noteworthy that, initially, the campaigns suggest that child care is an exclusive woman responsibility and should occur at two different times: during pregnancy and after birth, especially in the first years of the child’s life, since most women are responsible for the baby’s health, as identified in the posters in Figures 1(A)-(C).
In Brazil, there are STIs prevention actions, including CS, during the gestational period, which are strongly linked to the Family Health Strategy (ESF) in Primary Health Care, such as prenatal care and the Rede Cegonha created in 2011 by the Federal Government, which ensures assistance to women during pregnancy, childbirth, puerperium and until the child is two years old, as a main purpose of maternal and infant death rate reduction, as well as fighting CS and other grievances, which ensure the individual’s reproductive rights [11].
The way used for this communication about SC is important to qualify Public Policies, direct actions and contribute more effectively to intersectoral actions, since dialogue implies criticality. Therefore, the communication of an advertising piece can go beyond the transmission-reception binomial and the visualization of the person as a mere object; and if so, it requires a new dialogic attitude [12].
Access to whole health care, as well as the link between pregnant women and motherhood, is a point to be strengthened in the country, even though the coverage of prenatal care has been expanded in recent years [6]. Health education, in this context, is more than the transmission of information; but it can be an essential instrument of citizenship, as it consists of the conscious appropriation of a reality in order to intervene, act and emancipate oneself [7].
Therefore, it is necessary to strengthen the Policies of Attention to the Women’s and Children’s Health, in a way that the speeches of the advertising posters “empower” the families’ fight for their rights; highlighting the representation of the most diverse social groups within the advertising pieces, including homosexual, transgender, bisexual and transsexual couples [13].
The high rates of CS were directly associated with low maternal education, black skin color, late start of prenatal care, reaffirming the need for these individuals to be represented in health education materials and in advertising material linked to the MS [14].
In contrast, studies reveal that the majority of pregnant women notified as a result of syphilis were white, had nine or more years of schooling, unpaid work and the vast majority had undergone prenatal care and the two main reasons for the CS diagnosis were the inadequate and late treatment of the pregnant woman; and the absence of the partner treatment [1].
Although syphilis is a transmitted disease with compulsory notification worldwide, some places do not report cases, which increases the possibility of underreported cases. To break the cycle of syphilis transmission, beyond early notification, it is necessary to provide adequate treatment associated with health education, with adequate strategies to inform your sexual partner(s) of the possible exposure and avoid transmission of these diseases; in addition, the health department must carry out the contact tracing and partner notification [3].
In this bias of CS prevention and combat, studies reveal a tendency for CS to increase in Argentina, in other Latin American countries and in the world [2].
The importance of individual analysis of actions that are related to the health-disease process of individuals, such as health promotion, disease prevention actions and their risk factors, in addition to treatment and rehabilitation for greater effectiveness in intervention strategies, should be highlighted [15] [16].
5. Conclusion
The relevance of advertising pieces to the entire context of health education is highlighted, since they are devices that can awaken a change in attitude; but beyond that, these pieces serve as contextualized instruments of dialogue between people and health professionals to increase ethical awareness and produce actions committed to reducing vulnerabilities and protecting life.