1
|
Maceira D, Oizerovich S, Perrotta G, de León RGP, Karolinski A, Suarez N, Espinola N, Caffe S, Chandra-Mouli V. Acceptability and continuation of use of the subdermal contraceptive implant among adolescents and young women in Argentina: a retrospective cohort study. Sex Reprod Health Matters 2023; 31:2189507. [PMID: 37042700 PMCID: PMC10101666 DOI: 10.1080/26410397.2023.2189507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
A new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15-24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.
Collapse
Affiliation(s)
- Daniel Maceira
- Professor, Department of Economics; Universidad de Buenos Aires, and Independent Researcher, National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
- Senior Researcher, Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
- Board Member and Chair for The Americas, Health Systems Global (HSG). Correspondence:
| | - Silvia Oizerovich
- Professor, Faculty of Medical Sciences, Universidad Favaloro, Buenos Aires, Argentina
- President of the Ibero-American Network of Sexual and Reproductive Health Professionals, Buenos Aires, Argentina
- Member of the Scientific Committee of the Argentinian Pediatric and Adolescent Gynecology Society (SAGIJ) and Argentinian Medical Association for Contraception (AMAdA), Buenos Aires, Argentina
| | - Gabriela Perrotta
- Member of the Scientific Committee of the Argentinian Pediatric and Adolescent Gynecology Society (SAGIJ) and Argentinian Medical Association for Contraception (AMAdA), Buenos Aires, Argentina
- Professor, Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rodolfo Gómez Ponce de León
- Sexual and Reproductive Health Regional Advisor at Pan-American Health Organization / World Health Organization (PAHO/WHO), Latin-American Center of Perinatology and Women's Health (PAHO/CLAP), Montevideo, Uruguay
- Adjunct Professor School of Public Health of the University of North Carolina, Chapel Hill, NC, USA
| | - Ariel Karolinski
- Advisor, Family, Health Promotion and Life Course; Coordinator of Family, Gender and Life Course, Pan-American Health Organization/World Health Organization (PAHO/WHO), Brasilia, Brazil Representation
| | - Natalia Suarez
- Professor, Universidad Nacional de Hurlingham, Community Health Institute, Buenos Aires, Argentina
| | - Natalia Espinola
- Teaching Assistant Professor, Department of Economics, University of Buenos Aires, Buenos Aires, Argentina
| | - Sonja Caffe
- Regional Advisor on Adolescent Health, Healthy Life Course Family, Health Promotion and Life Course PAHO/WHO, Washington, DC, USA
| | - Venkatraman Chandra-Mouli
- Scientist, Adolescent Sexual and Reproductive Health, UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Brufatto JPT, Dias TM, D'abreu NB, Rehder PM. Reproductive Planning and the Choice of Long-acting Reversible Contraceptive Primary to Health: A Cross-Sectional Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e456-e464. [PMID: 37683657 PMCID: PMC10491473 DOI: 10.1055/s-0043-1772188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/21/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). METHODS This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). RESULTS Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). CONCLUSION It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.
Collapse
|
3
|
Yamaguti EMM, Sontag Dos Reis ET, Martins WP, Nadai MN, Soares NF, da Silva Costa F, Vieira CS. Ultrasound-guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:109-113. [PMID: 35793228 DOI: 10.1002/uog.26023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the feasibility of an ultrasound-guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. METHODS This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6-month follow-up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. RESULTS We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound-guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow-up. No uterine perforation or infection-related complications occurred within 6 months of the procedure. CONCLUSION The ultrasound-guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- E M M Yamaguti
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - E T Sontag Dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - M N Nadai
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - N F Soares
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - C S Vieira
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
4
|
Stein RA, Grayon A, Katz A, Chervenak FA. The Zika virus: an opportunity to revisit reproductive health needs and disparities. Germs 2022; 12:519-537. [PMID: 38021183 PMCID: PMC10660223 DOI: 10.18683/germs.2022.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 12/01/2023]
Abstract
First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.
Collapse
Affiliation(s)
- Richard A. Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Alexis Grayon
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Adi Katz
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| | - Frank A. Chervenak
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| |
Collapse
|
5
|
Harrison MS, Bunge-Montes S, Rivera C, Jimenez-Zambrano A, Heinrichs G, Bolanos A, Asturias E, Berman S, Sheeder J. Characteristics Associated with Choosing Long-Acting Reversible Contraception in Rural Guatemala: A Secondary Analysis of a Cluster-Randomized Trial. ACTA ACUST UNITED AC 2021; 4:131-139. [PMID: 34308356 PMCID: PMC8297978 DOI: 10.26502/ogr062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Design We conducted a secondary analysis of a cluster-randomized trial to observe characteristics associated with women who chose to use long-acting reversible contraceptives (LARC) compared to those who chose a short-acting method 12 months after enrollment. Methods The trial studied four control and four intervention clusters where the intervention clusters were offered contraception at their 40-day routine postpartum visit; control clusters received standard care, which included comprehensive postpartum contraceptive counseling. Women were followed through twelve months postpartum. Results The study enrolled 208 women; 94 (87.0%) were in the intervention group and 91 (91.0%) were in the control group. At twelve months, with 130 (70.3%) women using contraception at that time. 94 women (50.8%) were using a short acting method compared to 33 (17.9%) who chose a long-acting method, irrespective of cluster. In mixed effect regression modeling adjusted for cluster, characteristics associated with a reduced likelihood of choosing long-acting contraception in multivariate modeling included age (aRR 0.98 [0.96,0.99], p = 0.008) and any education (compared to no education; aRR 0.76 [0.60,0.95], p = 0.02). Women who were sexually active by their enrollment visit (40 days postpartum) were 30% more likely to opt for a long-acting method (aRR 1.30 [1.03,1.63], p = 0.03). Conclusion Older and more educated women were less likely to be using LARC a year after enrollment, while women with a history of early postpartum sexual activity were more likely to choose LARC.
Collapse
Affiliation(s)
| | - Saskia Bunge-Montes
- Fundación para la Salud Integral de los Guatemaltecos, Quetzaltenango, Guatemala
| | - Claudia Rivera
- Fundación para la Salud Integral de los Guatemaltecos, Quetzaltenango, Guatemala
| | | | | | - Antonio Bolanos
- Fundación para la Salud Integral de los Guatemaltecos, Quetzaltenango, Guatemala
| | - Edwin Asturias
- University of Colorado, Anschutz Medical Campus, Aurora, USA
| | - Stephen Berman
- University of Colorado, Anschutz Medical Campus, Aurora, USA
| | | |
Collapse
|
6
|
Luttges C, Leal I, Huepe G, González D, González E, Molina T. Pregnant again? Perspectives of adolescent and young mothers who and do not experience a repeat pregnancy in adolescence. Int J Qual Stud Health Well-being 2021; 16:1898317. [PMID: 33779521 PMCID: PMC8009116 DOI: 10.1080/17482631.2021.1898317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Teen pregnancy remains a major social and public health issue in developing countries. Each additional child compromises the development of both the mother and children. Scarce studies have been performed in Latin America. Purpose: This study explores and analyzes individual and family factors associated with repeat pregnancies during adolescence to better elucidate the phenomenon. Methods: Qualitative-descriptive study. Thirty semi-structured interviews were conducted with mothers 20 years of age or younger from urban areas of Santiago, Chile. Participants were divided into Repeat Pregnancy (RP) and No Repeat Pregnancy (NRP) groups. Qualitative data analysis was based on elements of grounded theory. Results: The RP group generally related life stories reflecting greater psychosocial vulnerability. Most of the RP group dropped out of school after their first pregnancy to focus on parenting and had a passive attitude towards contraception. In contrast, members of the NRP group actively sought long-term contraceptive methods, motivated largely by the desire to continue their education to improve their living conditions and achieve greater personal fulfilment. They tended to have family support networks that facilitated school retention. Conclusion: Key differences between groups included use of contraception, focus on life projects, and motivation to finish school. Prevention strategies should promote long-term contraceptive methods, offer strategies to help young mothers continue their education, facilitate achievement of personal projects, and provide support for parenting.
Collapse
Affiliation(s)
- Carolina Luttges
- Center for Reproductive Medicine and Comprehensive Attention of Adolescents (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente CEMERA), Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| | - Ingrid Leal
- Department of Psychiatry and Mental Health. Department of Bioethic and Medical Humanities, Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| | - Gabriela Huepe
- Center for Reproductive Medicine and Comprehensive Attention of Adolescents (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente CEMERA), Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile.,Department of Psychiatry and Mental Health. Department of Bioethic and Medical Humanities, Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| | - Daniela González
- Center for Reproductive Medicine and Comprehensive Attention of Adolescents (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente CEMERA), Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| | - Electra González
- Center for Reproductive Medicine and Comprehensive Attention of Adolescents (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente CEMERA), Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| | - Temístocles Molina
- Center for Reproductive Medicine and Comprehensive Attention of Adolescents (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente CEMERA), Faculty of Medicine, University of Chile (Universidad de Chile), Santiago de Chile, Chile
| |
Collapse
|
7
|
Franklin SG, O'Neal M, Arneus A, Colvin C, Aung M, Jolly PE. Effectiveness of an intrauterine device informative intervention among post-natal women in Western Jamaica. Reprod Health 2021; 18:17. [PMID: 33478528 PMCID: PMC7819219 DOI: 10.1186/s12978-021-01075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Intrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized. Methods A cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test. Results Most of the 299 women who participated were 18–29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant. Conclusion The intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.
Collapse
Affiliation(s)
- Sarah G Franklin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Maya O'Neal
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Ambreanna Arneus
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Calvin Colvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Maung Aung
- Epidemiology and Research Unit, Western Region Health Authority, Ministry of Health and Wellness, Lot 31B, Fairview Shopping Centre, Montego Bay, Jamaica
| | - Pauline E Jolly
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA.
| |
Collapse
|
8
|
Garraza LG, Tobar F, Rodríguez Bernate I. Out-of-pocket spending for contraceptives in Latin America. Sex Reprod Health Matters 2020; 28:1833429. [PMID: 33131452 PMCID: PMC7887910 DOI: 10.1080/26410397.2020.1833429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Despite progress in increasing the use of modern contraceptives in most Latin American countries over the last few decades, important challenges remain, including the heavy reliance on out-of-pocket spending to access contraceptives, which may expose consumption to macroeconomic fluctuations. Out-of-pocket spending on contraceptives and/or the proportion of women aged 15-49 who received free contraceptives at a public health facility or as part of statutory health insurance were estimated for 13 Latin American countries using the most recently available household budget surveys and demographic and health or similar household surveys. Data on contraceptive retail sales in 12 countries over the 2006-2010 period and publicly available macroeconomic indicators were used to examine the relationship between changes in sales and macroeconomic indicators using multiple regression models. On average, women aged 15-49 spent close to US$1 per month out-of-pocket on contraceptives. However, almost three out of five women received them free of charge. A 1% increase in the percentage of the population living on less than US$ 3.2/day (2011 PPP values), or the percentage unemployed in the labour force, predicted about a 2% decrease in the growth of contraceptive retail sales (measured in couple-years of protection, CYP, per capita) the subsequent year. The analysis revealed the sensitivity of contraceptive retail sales to changes in macroeconomic variables, particularly changes in poverty levels. Achieving universal access to family planning by 2030 will require improving contraceptive financing schemes.
Collapse
Affiliation(s)
| | - Federico Tobar
- Regional Technical Advisor, Reproductive Health Commodity Security, United Nations Population Fund (UNFPA), Latin American and the Caribbean Regional Office, Panamá, Panama
| | - Iván Rodríguez Bernate
- Consultant Economist, Reproductive Health Commodity Security, United Nations Population Fund (UNFPA), Latin American and the Caribbean Regional Office, Panamá, Panama
| |
Collapse
|
9
|
Postplacental placement of intrauterine devices: A randomized clinical trial. Contraception 2020; 101:153-158. [DOI: 10.1016/j.contraception.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/22/2022]
|
10
|
Soriano-Moreno DR, Soriano-Moreno AN, Mejia-Bustamante A, Guerrero-Ramirez CA, Toro-Huamanchumo CJ. Factors associated with highly effective contraceptive use among reproductive-age women in Peru: Evidence from a nationwide survey. Eur J Obstet Gynecol Reprod Biol 2020; 245:114-120. [PMID: 31891894 DOI: 10.1016/j.ejogrb.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to assess the factors associated with highly effective contraceptive (HEC) use among reproductive-age women in Peru, using evidence from a nationwide survey. STUDY DESIGN We analyzed the data corresponding to a national representative sample of 30,169 Peruvian women aged 15-49 years, surveyed during the Demographic and Family Health Survey, 2017. Usage of HEC methods included pills, IUD, injections, sterilization and implant. We assessed the factors associated with its use using Poisson regression models, reporting the crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95 % confidence intervals (95 % CI). RESULTS The prevalence of HEC use was 29.9 %. Factors related to a more likely use of HEC methods were having one (aPR: 4.03; 95 % CI: 3.19-5.09) or more children (aPR: 5.60; 95 % CI: 4.42-7.09), and having a health insurance children (aPR: 1.14; 95 % CI: 1.05-1.24). Women from the highlands (aPR: 0.74; 95 % CI: 0.67-0.81), aged ≥35 years (aPR: 0.78; 95 % CI: 0.67-0.90), not currently married or cohabiting (aPR: 0.52; 95 % CI: 0.47-0.58), and who considered it really hard to have to take transportation when they need medical help or advice (aPR: 0.92; 95 % CI: 0.86-0.99) were less likely to use highly effective contraception. CONCLUSION Quality and access to reproductive health is still a challenge in Peru. Family planning programs should be better disseminated and integrated. Similarly, promotion of educational campaigns and easy access to HEC methods are needed.
Collapse
Affiliation(s)
| | | | | | | | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru; Association for the Study of Medical Education, Edinburgh, UK.
| |
Collapse
|
11
|
Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, Becerra-Posada F, Coll CVN, Hellwig F, Victora CG, Barros AJD. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health 2019; 7:e227-e235. [PMID: 30683240 PMCID: PMC6367565 DOI: 10.1016/s2214-109x(18)30481-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys. METHODS Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied. FINDINGS We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives. INTERPRETATION Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis. FUNDING Wellcome Trust, Pan American Health Organization.
Collapse
Affiliation(s)
- Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Fernanda Ewerling
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Suzanne Jacob Serruya
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Mariangela F Silveira
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Ali Moazzam
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland
| | | | - Carolina V N Coll
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Franciele Hellwig
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, RS, Brazil; Faculty of Medicine, Federal University of Pelotas, Pelotas, RS, Brazil.
| |
Collapse
|