ABSTRACT Since the signing of the Paris Agreement, progress has been made in the institutionalization of a new climate governance model that articulates multiple actors in the construction of climate action. Thus, this article aims to present a case study of transnational climate action focused on adaptation to climate change in South America, the case of the Gran Chaco Proadapt Initiative. The objective of the work is to analyze the transnational and cross-border governance model of said initiative, as well as to study the impact that said initiative had on the human development of the communities that inhabit the region and have been active subjects in the construction of the initiative. For the purposes of this study, the proposed methodological strategy responds to an interpretive case study to generate contributions to the production of regional knowledge on climate action and transnational governance of climate change, adaptation to climate change, and links between climate action and development. The study is based on a regional reality where the need to promote development has been systematically understood as opposed to climate action. The case analysis shows that climate action developed within the polycentric and multi-scale governance networks can become a precious tool in promoting development, seen from the freedoms and capacities of individuals and communities.

RESUMEN Desde la firma del Acuerdo de París, se ha avanzado en la institucionalización de un nuevo modelo de gobernanza climática que prevé la articulación de múltiples actores en la construcción de la acción climática. Así, la finalidad del presente artículo es plantear un estudio de caso de acción climática transnacional centrado en la adaptación al cambio climático en América del Sur, el caso de la Iniciativa Gran Chaco Proadapt. El objetivo del trabajo es analizar el modelo de gobernanza transnacional y transfronteriza de dicha iniciativa, así como estudiar el impacto que dicha iniciativa tuvo sobre el desarrollo humano de las comunidades que habitan en la región y se han sido sujetos activos en la construcción de la iniciativa. Para los propósitos de este estudio, la estrategia metodológica propuesta responde a un estudio de caso interpretativo, con el objetivo de generar contribuciones a la producción de conocimiento regional sobre acción climática y gobernanza transnacional del cambio climático, adaptación al cambio cli- mático, así como vínculos entre acción climática y desarrollo. El estudio parte de una realidad regional donde la necesidad de promover el desarrollo ha sido entendida sistemáticamente como contrapuesta a la acción climática. El análisis del caso demuestra que la acción climática desarrollada en el marco de redes de gobernanza policéntricas y multiescalares tiene el potencial de constituirse como una herramienta de gran valor en la promoción del desarrollo, visto desde una perspectiva de las libertades y capacidades de los individuos y comunidades.

Resumo No Brasil, redes de apoio colaborativas têm sido estruturadas para conduzir o processo de reconhecimento de Indicação Geográfica (IG), junto ao Instituto Nacional de Propriedade Industrial. O objetivo do presente trabalho foi delinear uma revisão de literatura sobre o processo de implementação e a governança da IG no país para melhor compreensão deste cenário. A metodologia foi baseada em pesquisas nos periódicos da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e em bases de dados gratuitas como Google Acadêmico, com critérios de inclusão e exclusão para seleção das publicações. Das 109 publicações encontradas, 22 foram criteriosamente selecionadas para análise sob a ótica da dinâmica dos processos de implementação e governança de IG no Brasil. Observou-se que as redes colaborativas para condução dos processos de implementação e governança de IG foram estruturadas com dinâmicas diferentes em cada território, resultado de esforços e articulações realizadas por diferentes instituições brasileiras.

Abstract In Brazil, collaborative support networks have been structured to conduct the process of recognition of Geographical Indication (GI) together with the National Institute of Industrial Property. The objective of the present work was to outline a literature review on the implementation process and governance of GIs in the country for a better understanding of this scenario. The methodology was based on research in the journals of the Higher Education Personnel Improvement Commission and free databases such as Google Scholar, with inclusion and exclusion criteria for selecting publications. Of the 109 publications found, 22 were carefully selected for analysis from the perspective of the dynamics of GI implementation and governance processes in Brazil. It was observed that the collaborative networks to conduct the GI implementation and governance processes were structured with different dynamics in each territory, resulting from efforts and coordination carried out by different Brazilian institutions.

Resumen En Brasil, se han estructurado redes de apoyo colaborativo para realizar el proceso de reconocimiento de la Indicación Geográfica (IG), junto con el Instituto Nacional de Propiedad Industrial. El objetivo del presente trabajo fue esbozar una revisión bibliográfica sobre el proceso de implementación y gobernanza de las IG en el país para una mejor comprensión de este escenario. La metodología se basó en investigaciones en las revistas de la Comisión de Mejoramiento del Personal de Educación Superior y en bases de datos gratuitas como Google Scholar, con criterios de inclusión y exclusión para la selección de publicaciones. De las 109 publicaciones encontradas, 22 fueron cuidadosamente seleccionadas para el análisis desde la perspectiva de la dinámica de los procesos de implementación y gobernanza de las IG en Brasil. Se observó que las redes colaborativas para conducir los procesos de implementación y gobernanza de la IG se estructuraron con dinámicas diferentes en cada territorio, resultado de esfuerzos y articulaciones realizadas por diferentes instituciones brasileñas.

Abstract Political institutions such as the European Commission and the Government of Spain have expressed their interest and willingness to lay the foundations for ethical governance of Artificial Intelligence (AI). In particular, they have proposed the promotion of reliable Artificial Intelligence through a set of guidelines and strategies. Despite the benefit provided by these political initiatives, it is not possible to fully appreciate a specific educational strategy that contributes to the generation of an ethical AI ecosystem based on trust. In this sense, the main objective of this work is to demonstrate that the teaching of applied ethics in engineering studies constitutes a commitment to professional strengthening, ethical governance and responsible research and innovation. To achieve this objective, first of all, some of the essential aspects that give significant value to the teaching of applied ethics will be detailed, highlighting the social responsibility that universities present in this field. Secondly, a classification of ethics subjects related to engineering in the environment of Spanish public universities will be shown. And, thirdly, a theoretical framework rooted in discursive ethics will be offered, promoting a civic perspective in the educational context of the professions.

Resumen Instituciones políticas como la Comisión Europea y el Gobierno de España han manifestado su interés y predisposición para sentar las bases de una gobernanza ética de la Inteligencia Artificial (IA). En particular, han planteado el impulso de una Inteligencia Artificial confiable a través de un conjunto de directrices y estrategias. A pesar del beneficio que reportan estas iniciativas políticas, no es posible apreciar en su conjunto una estrategia educativa específica que contribuya a la generación de un ecosistema ético de IA fundamentado en la confianza. En ese sentido, el objetivo principal de este trabajo consiste en explicar que la enseñanza de la ética aplicada en los estudios de ingeniería constituye una apuesta para el fortalecimiento profesional, la gobernanza ética y una investigación e innovación responsables. Para alcanzar este objetivo, en primer lugar, serán detallados algunos de los aspectos esenciales que dotan de un valor significativo a la enseñanza de la ética aplicada, subrayando la responsabilidad social que presentan las universidades en este terreno. En segundo lugar, se mostrará una clasificación de las asignaturas de ética relacionadas con la ingeniería en el entorno de las universidades públicas españolas. Y, en tercer lugar, se ofrecerá un marco teórico enraizado en la ética discursiva, promoviendo una mirada cívica en el contexto educativo de las profesiones.

Resumen: La integración regional sudamericana forma parte de la retórica política de América del Sur desde la creación de las primeras organizaciones regionales en 1969. No obstante, cada subcontinente (América Central, Sudamérica, América del Norte) ha constituido sus propios sistemas de integración y gobernanza. En Sudamérica, salvo la Comunidad Andina de Naciones (CAN) y el Mercado Común del Sur (MERCOSUR), se ha tenido un componente político importante, de modo que su fortalecimiento y permanencia están directamente relacionados con la convergencia política entre los Gobiernos de la región, los cuales tienen la competencia constitucional de la formulación y ejecución de la política exterior. En ese orden de ideas, el presente artículo analizó a través de un Análisis Cualitativo Comparado (QCA) si efectivamente es la dimensión política la que explica la promoción, el fomento y la consolidación de la integración regional en el subcontinente. Para tal efecto, se plantearon dos dimensiones: a) económica, medida a través de dos variables como son la complementariedad e interdependencia comercial; y b) la dimensión política, medida a través de dos variables, como la distancia ideológica. Finalmente, se examinó si el fomento a la integración es parte de las constituciones de cada país.

Abstract: South American regional integration has been part of the political rhetoric of South America governments since the creation of the first regional organizations in 1969. However, in each subcontinent (Central America, South America, North America), they have established their own systems of integration and governance. In South America, except for the Andean Community of Nations and Mercosur, the rest have had an important political condition, and their strengthening and permanence are related to the political convergence between the governments of the region, because they have the constitutional attributions about the formulation and execution of foreign policy. This article analyzes through the QCA, whether it is indeed the political dimension that effectively explains the promotion, encouragement, and consolidation of regional integration in the subcontinent. For this purpose, two dimensions are proposed: the first is economic, measured through two variables such as complementarity and commercial interdependence, and the political dimension, measured through two variables: ideological distance and whether the promotion of integration is part of the constitutions of each country.

Resumen: La capacidad jurídica o las instituciones del Estado de derecho (RL) se han convertido en un factor clave para el desarrollo económico inclusivo, pero las principales corrientes de la literatura involucran expectativas impulsadas teóricamente. Por lo tanto, el estudio buscó examinar el impacto de la capacidad jurídica en el desarrollo económico inclusivo en la región de la Comunidad de Desarrollo de África Austral (SADC). Si bien los estudios existentes se centraron en el efecto de la gobernanza en la producción nacional, el presente estudio va más allá del crecimiento al incluir indicadores de bienestar. El estudio empleó un enfoque de retardo distribuido autorregresivo (ARDL) de panel para datos de los 16 Estados miembros de la SADC de 1996 a 2019. La interpretación de los resultados y las implicaciones políticas se basan en los resultados del estimador PMG, que la prueba de Hausman consideró como el mejor y estimador más eficiente sobre la familia del grupo de medias (MG) y DFE de estimadores ARDL de panel. Los resultados del panel restringido revelan que el fortalecimiento de las instituciones del RL conduce a una mejora en el desarrollo económico inclusivo entre los Estados de la SADC. Por lo tanto, se sostiene que las leyes comerciales deben integrarse a nivel nacional e integrarse en las leyes nacionales de la SADC y que se deberían establecer tribunales comunes para dirimir los desacuerdos sobre el cumplimiento. También se propone que la SADC introduzca incentivos para aumentar la participación de los actores legales en toda la región.

Abstract: The legal capacity or, otherwise, the institutions of rule of law (RL), have become a key factor for inclusive economic development, but the main strands of the literature involve theoretically driven expectations. Therefore, the study sought to examine the impact of legal capacity on inclusive economic development in the Southern African Development Community (SADC) region. While extant studies focused on the effect of governance on national output, the present study goes beyond growth by including welfare indicators. The study employed a panel autoregressive distributed lag (ARDL) approach for data from all 16 SADC member states from 1996 to 2019. The interpretation of results and policy implications are based on the outcomes of the pooled mean group (PMG) estimator, which was deemed by the Hausman test as the best and most efficient estimator over the MG and the DFE family of the ARDL panel estimators. The results of the restricted panel reveal that strengthening the institutions of the RL leads to an improvement in inclusive economic development among SADC states. Therefore, we argue that trade laws should be domestically integrated and embedded in SADC’s national laws, and that common courts should be set to adjudicate disagreements over compliance. We also propose that SADC introduce incentives to increase legal stakeholders' participation across the region.

RESUMEN Dado que China se ha convertido en un actor de gran importancia en América Latina y el Caribe (ALC), investigadores en esta región han mostrado un creciente interés en estudiar los retos resultantes de esta situación. Los trabajos más recientes se han centrado en la economía (comercio entre China y ALC, y financiamiento proveniente de China), o en las consecuencias de esta relación para temas ambientales, sociales y de gobernanza, aunque algunos académicos también se han enfocado en los impactos del conflicto entre los Estados Unidos de América y China en la región. En todos los casos, la cuestión tiende a consistir en si los países de ALC se están beneficiando de una mayor presencia de China, o si los problemas exceden los potenciales beneficios. Señalamos los principales centros de investigación y académicos que analizan estos temas, y discutimos los debates centrales que los ocupan. Concluimos con un conjunto de recomendaciones para mejorar la calidad de las investigaciones, incluida la necesidad de contar con mejores datos y mayor colaboración con colegas chinos, así como la importancia de la transparencia respecto a fuentes de financiamiento y potenciales sesgos que aparecen al trabajar en esta área de cada vez mayor interés.

ABSTRACT As China has become a more important actor in Latin America and the Caribbean (LAC), scholars in this region have shown an increasing interest in studying the resulting challenges this poses. Most recent work has centered on economics (trade between China and LAC and finance from China), or on the consequences for environmental, social, and governance issues, although some scholars have focused on the impacts of US - China conflict in the region. In all cases, the question tends to be whether LAC countries are benefiting from the greater Chinese presence or whether problems outweigh the potential gains. We point out the leading research centers and scholars studying these questions and discuss the main debates around them. We conclude with a set of recommendations to improve the quality of research, including the need for better data and more collaboration with Chinese colleagues as well as the importance of transparency about the sources of finance and potential biases in work on this growing area of interest.

The structure of climate finance flows from donors (multilateral sources) to recipients (sub-Saharan African countries) was studied. This is the first study to provide a comprehensive network structure of the climate finance flows into Africa, based on the global public climate finance governance system. Network theory and decision tree techniques were employed. The results obtained generally fit the multilateral funding units (MFUs) into two categories: central funding units (CFUs), which simultaneously attend to the climate-related projects of many African countries, and the boundary funding units (BFUs), which cater to only a few countries at once. An isolated region with no BFUs was identified. African countries within this group could be more exposed to climate financial risk as they rely on only the CFUs. In general, with the exception of mitigation REDD (reducing emissions from deforestation and forest degradation) climate finance, a disproportionate distribution of climate themes, with particular reference to adaptation finance, was observed across sub-Saharan Africa. This has real implications for equitable resource allocation of climate funds. The need for African-bred region-wide MFUs is recommended. SIGNIFICANCE: Insights from this analysis expose the presence of contagion effects within the sub-Saharan African climate finance network structure and, consequently, the flow of climate finance-related risks. This knowledge is critical for future planning as it can provide African governments and interested stakeholders with informed evidence upon which they can make reliable and justifiable decisions, such as shaping of sectoral strategies and improving of climate finance flow coordination.

Resumo El turismo es una actividad que genera ingresos y que da soporte a las comunidades rurales para que puedan generar ingresos dentro de los parámetros sostenibles, sin embargo, con la pandemia producida por el COVID 19, los impactos han sido devastadores para el sector y las comunidades. No obstante, con una gobernanza capaz de asegurar las condiciones de interacción entre los diversos actores, el proceso de reestructuración del sector debería presentar mejores expectativas. Ante ello, se plantearon como objetivo general del presente artículo analizar las experiencias sobre la gobernanza turística, mientras que los específicos fueron el analizar los diseños metodológicos y las premisas teóricas propuestas de los artículos. Para lograrlo, se planteó una metodología cualitativa, utilizando análisis de contenido, en el que luego de depurar las bases de datos, y usando la metodología Prisma, se procesaron 17 artículos. Llegando a la conclusión de que la gobernanza es entendida un proceso dinámico en la cual interactúan varios elementos teniendo como actores a la sociedad civil, empresa privada y la comunidad, siendo las autoridades las que deben velar porque dicho espacio de interacción se realice con la mayor transparencia.

Abstract Tourism is an income-generating activity that helps rural communities generate income within sustainable parameters, but with the COVID-19 pandemic, the impacts were devastating for the sector and the communities. However, with governance capable of ensuring conditions for interaction among the various actors, the process of restructuring the sector should have better prospects. Therefore, the general objective of this article was to analyze tourism governance experiences, while the specific objectives were to analyze the methodological designs and theoretical premises proposed in the articles. To this end, a qualitative methodology was used, through content analysis, in which, after purifying the databases and using the Prisma methodology, 17 articles were processed. The conclusion reached was that governance is understood as a dynamic process in which various elements interact, with civil society, private initiative and the community as actors, and that the authorities must ensure that this space for interaction is as transparent as possible.

The sanctity of the doctor-patient relationship is deeply embedded in tradition - the Hippocratic oath, medical ethics, professional codes of conduct, and legislation - all of which are being disrupted by big data and 'artificial' intelligence (AI). The transition from paper-based records to electronic health records, wearables, mobile health applications and mobile phone data has created new opportunities to scale up data collection. Databases of unimaginable magnitude can be harnessed to develop algorithms for AI and to refine machine learning. Complex neural networks now lie at the core of ubiquitous AI systems in healthcare. A transformed healthcare environment enhanced by innovation, robotics, digital technology, and improved diagnostics and therapeutics is plagued by ethical, legal and social challenges. Global guidelines are emerging to ensure governance in AI, but many low- and middle-income countries have yet to develop context-specific frameworks. Legislation must be developed to frame liability and account for negligence due to robotics in the same way human healthcare providers are held accountable. The digital divide between high- and low-income settings is significant and has the potential to exacerbate health inequities globally.

ABSTRACT: In the last decade, the Vilcanota River sub-basin (Cusco, Peru) has shown high water vulnerability due to climate change and anthropogenic pressures typical of the economic model. In a context of pandemic and ecological crisis, addressing the complexity of the value of water becomes pertinent in order to overcome the exclusive use of mechanisms to calculate monetary value or sustain environmental governance based on cost-benefit analysis. The main objective of the study was to analyze water consumption rates in the Vilcanota River sub-basin to integrate management with a vision from ecological economics. To do this, the dynamic factors, impacts and responses of water governance were analyzed, and the problem of value was addressed through the analysis of hydrological flows with the ecological economy approach. A high consumption of the household sector was found (urban: 265151.71 m3/h, rural: 163087.50 m3/h), mainly due to urban expansion, change in land use and other local problems in a mainly agricultural area. where an analysis of the social metabolism in the Vilcanota River sub-basin and the inclusion of complexity management in environmental public policy is necessary.

RESUMEN: En la última década, la subcuenca del río Vilcanota (Cusco, Perú) ha mostrado una alta vulnerabilidad hídrica debido al cambio climático y a las presiones antrópicas propias del modelo económico. En un contexto de crisis pandémica y ecológica, abordar la complejidad del valor del agua se hace pertinente a fin de superar el uso exclusivo de mecanismos para calcular el valor monetario o sostener una gobernanza ambiental basada en el análisis costo-beneficio. El objetivo principal del estudio fue analizar las tasas de consumo de agua en la subcuenca del río Vilcanota para integrar la gestión con una visión desde la economía ecológica. Para ello se analizaron los factores dinámicos, impactos y respuestas de la gobernanza hídrica, y se abordó el problema del valor mediante el análisis de los flujos hidrológicos con el enfoque de la economía ecológica. Se encontró un alto consumo del sector hogares (urbano: 265151,71 m3/h, rural: 163087,50 m3/h), principalmente debido a la expansión urbana, cambio de uso de suelo y otras problemáticas locales sobre una zona principalmente agrícola, donde se hace necesario un análisis del metabolismo social en la subcuenca del río Vilcanota y la inclusión de la gestión de la complejidad en la política pública ambiental.

Resumo O surgimento de mecanismos de governança privada tem sido destacado como um instrumento fundamental para evitar a flexibilização dos direitos trabalhistas e defender condições de trabalho decentes nas cadeias agrícolas. Este artigo analisa o impacto dos Padrões de Sustentabilidade Voluntária (VSSs, da sigla em inglês) nos direitos trabalhistas no setor de produção de café no Cerrado Mineiro, uma importante região produtora no Brasil. Em 2017, o Brasil passou por uma reforma abrangente de suas leis trabalhistas e instituições legais que regulam tais relações. Com base em pesquisa qualitativa utilizando dados primários e secundários, esta pesquisa investiga se os VSSs foram eficazes em preservar os direitos trabalhistas dos trabalhadores rurais em um ambiente institucional mais desregulamentado após a reforma trabalhista de 2017. Os resultados indicam que os VSSs não garantem os direitos trabalhistas e que a flexibilização das leis trabalhistas pode ameaçar os trabalhadores rurais do setor de café.

Abstract The rise of private governance mechanisms has been highlighted as a critical instrument to avoid labor rights flexibilization and defend decent work conditions in agricultural chains. This paper analyzes the impact of Voluntary Sustainability Standards (VSSs) on labor rights in the coffee production sector of Cerrado Mineiro, a traditional region in Brazil. In 2017, Brazil underwent a comprehensive reform of its labor laws and legal institutions. Based on qualitative research using primary and secondary data, this research investigates whether VSSs were effective in preserving labor rights for rural workers in a more deregulated institutional environment following the 2017 labor reform. Results indicate that VSSs do not guarantee labor rights, and that labor law relaxation may endanger rural coffee workers.

Resumen: El paisaje milpa es un territorio con una marcada relación entre las poblaciones mayas y las selvas que se manifiestan en estrategias de manejo de los agroecosistemas locales: la milpa, el huerto familiar y la vegetación secundaria. El paisaje milpa enfrenta múltiples presiones socioambientales que requieren de marcos analíticos transdiciplinarios que permitan su comprensión integral. El objetivo de este trabajo fue analizar en las interacciones que establecen los componentes humanos y biofísicos. Se utilizó el marco de sistemas socioecológicos, para su operacionalización se revisó información secundaria y se aplicaron 257 encuestas en dos municipios. Los resultados muestran que las relaciones socioecológicas son influenciadas por aspectos de gobernanza y la tenencia de la tierra. El sistema milpa prevalece en los medios de vida, pero coexistiendo con factores que amenazan su estabilidad como la pérdida de la lengua maya, el bajo relevo generacional, la economía de mercado, el alto empleo de agroquímicos y los patrones climáticos. Se concluye que esfuerzos basados en la revalorización de la milpa, la integración participativa de conocimientos y el desarrollo de esquemas de gobernanza adaptativa podrían repercutir positivamente en la sostenibilidad de este paisaje cultural.

Abstract: The milpa landscape is a territory where there is a close relationship between the Mayan populations and the forest manifested in agroecosystem management strategies such as: the milpa, the home garden and the secondary vegetation. The milpa landscape faces multiple socio-environmental pressures that require transdisciplinary analytical frameworks that allow its comprehensive understanding. The objective of this work is to analyze through variables that allow us to deepen into the socioecological relationships established by the human and biophysical components of southern Yucatán. The framework of socio-ecological systems was used, for its operationalization secondary information was reviewed and 257 surveys were applied in two municipalities. The results show that socioecological relationships are influenced by aspects of governance and land tenure. The milpa system prevails in livelihoods, but coexists with factors such as the loss of the Mayan language, the low generational change, the market economy, the high prevalence of agrochemicals and weather patterns. It is proposed that efforts based on the revaluation of the milpa, the participatory integration of knowledge and the development of adaptive governance schemes could have positive repercussions on sustainability if this biocultural landscape.

Abstract: This article aimed to understand how governance structures and the search for value protection influence transaction costs in the relationship between dairy producers and processors in Paraná, Brazil. These aspects are treated by Transaction Cost Economics (TCE) and by Measurement Cost Economics (MCE). For data collection, 30 semi-structured interviews were conducted and Content Analysis was used for data treatment and results analysis. For the theory, the study contributed demonstrating that although the alignment between transaction attributes and governance structures contribute for value protection as proposed by TCE, in the absence of complete information, this alignment is still not enough to guarantee economic rights, as predicted by MCE. Empirically, it contributed suggesting the use of formal contracts and the importance of formal information available to milk producers and processors to improve their results in the activity. Thus, considering the governance structures in Paraná’s dairy AGS, it is predicted that even if the hybrid structure is adequate, under TCE view, due to its alignment with transaction attributes, MCE concepts help to explain why agents still need guarantee mechanisms. Those mechanisms, such as long-term relationships, normative instructions and informal agreements, attempt to protect value, given informational problems.

Resumo: O objetivo do artigo foi compreender como as estruturas de governança e a busca pela proteção do valor influenciam nos custos de transação na relação entre produtores e processadores de leite no Paraná. Esses aspectos são tratados pela Economia dos Custos de Transação (ECT) e pela Economia dos Custos de Mensuração (ECM). Para a coleta de dados, foram realizadas 30 entrevistas semiestruturadas e os mesmos foram tratados pela Análise de Conteúdo. Para a teoria, o estudo contribuiu demonstrando que, embora o alinhamento entre atributos da transação e estruturas de governança contribuam para a proteção de valor, conforme se espera pela ECT, na ausência de informações completas, esse alinhamento não é suficiente para garantir direitos econômicos, como previsto pela ECM. Empiricamente, o estudo contribuiu sugerindo o uso de contratos formais e a importância da distribuição de informações formalizadas aos produtores e processadores de leite, a fim de que melhorem seus resultados na atividade. Assim, conclui-se que mesmo que a estrutura de governança híbrida seja adequada, devido ao alinhamento com os atributos da transação, os conceitos da ECM explicam porque ainda são necessários mecanismos de garantia (relações de longo prazo, instruções normativas e acordos informais) dados os problemas de informação.

ABSTRACT The article examines the way the categorization of patients as “difficult patients” impacts their access to reproductive care in primary healthcare clinics. Using an ethnographic approach, it focuses on three public clinics in Rio de Janeiro and analyzes 57 interviews with health professionals conducted between 2015 and 2017. The analysis draws on intersectional approaches to inequality, reproductive stigmas, and the governance of vulnerable populations to show how the “difficult” label and its semantics, primarily applied to black and poor women who depend on public services, has led to a social differentiation of healthcare users based on reproductive stigmas and service eligibility from an assessment of their behavior. The notion of “difficult” combines with inadequate rules and decision-making by health clinic teams to promote discriminatory experiences through exclusionary mediations in their access to reproductive healthcare. The findings contribute to a better understanding of the way exclusionary bureaucratic mediation transforms distinctions into inequalities.

RESUMEN El artículo analiza la categorización de usuarias de unidades básicas de salud como “registradas difíciles” y cómo esa distinción repercute en vivencias para acceder a los cuidados reproductivos en esas burocracias. Se evidencia que la semántica “difícil” produjo una diferenciación social entre las usuarias a partir de estigmas reproductivos y de la elegibilidad de los servicios a partir de su evaluación comportamental, mayoritariamente a negras, pobres y dependientes de los servicios públicos. Se identifican vivencias discriminatorias de las mujeres en las burocracias con la idea de “difícil”, reglas inapropiadas de los servicios y procesos de toma de decisiones de los equipos produjeron mediaciones excluyentes para su acceso a los cuidados reproductivos. El artículo se basa en una etnografía de tres unidades de atención en Rio de Janeiro y 57 entrevistas con profesionales de salud realizadas entre 2015 y 2017. El análisis está orientado por abordajes interseccionales de las desigualdades, de estigmas reproductivos y de la gobernanza de vulnerables, contribuyendo a la reflexión sobre cómo las mediaciones excluyentes transforman distinciones en desigualdades.

RÉSUMÉ L’article analyse la catégorisation des utilisateurs des unités de santé de base comme «difficiles à enregistrer» et comment cette distinction affecte les expériences d’accès aux soins de reproduction dans ces bureaucraties. Il est évident que la sémantique « difficile » a produit une différenciation sociale entre les utilisateurs en fonction des stigmates reproductifs et de l’éligibilité aux services en fonction de leur évaluation comportementale, principalement noire, pauvre et dépendante des services publics. Leurs expériences discriminatoires dans les bureaucraties sont identifiées lorsque l’idée de règles « difficiles », inappropriées des services et des processus décisionnels des équipes, a produit des médiations d’exclusion pour qu’elles accèdent aux soins de reproduction. L’article est basé sur une ethnographie de trois unités à Rio de Janeiro et sur 57 entretiens avec des professionnels de la santé réalisés entre 2015 et 2017. L’analyse est guidée par des approches intersectionnelles des inégalités, des stigmates reproductifs et de la gouvernance des personnes vulnérables, contribuant à la façon dont l’exclusion les médiations transforment les distinctions en inégalités.

RESUMO O artigo analisa a categorização de usuárias de unidades básicas de saúde como “cadastradas difíceis” e como essa distinção repercute em vivências para acessar os cuidados reprodutivos nessas burocracias. Evidencia-se que a semântica “difícil” produziu diferenciação social entre as usuárias a partir de estigmas reprodutivos e da elegibilidade aos serviços pela avaliação comportamental delas, majoritariamente, negras, pobres e dependentes dos serviços públicos. Identificam-se vivências discriminatórias delas nas burocracias quando a ideia de “difícil”, regras inapropriadas dos serviços e processos decisórios das equipes produziram mediações excludentes para que elas acessassem os cuidados reprodutivos. O artigo se baseia em uma etnografia de três unidades, no Rio de Janeiro, e em 57 entrevistas com profissionais de saúde realizadas entre 2015 e 2017. A análise é orientada por abordagens interseccionais das desigualdades, de estigmas reprodutivos e da governança de vulneráveis, contribuindo sobre como mediações excludentes transformam distinções em desigualdades.