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Araújo FG, Abreu MNS, Felisbino-Mendes MS. [Contraceptive mix and factors associated with the type of method used by Brazilian women: a population-based cross-sectional study]. CAD SAUDE PUBLICA 2023; 39:e00229322. [PMID: 37820236 PMCID: PMC10566557 DOI: 10.1590/0102-311xpt229322] [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: 12/01/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 10/13/2023] Open
Abstract
This study aims to describe the contraceptive mix and analyze the factors associated with the type of contraceptive used by Brazilian women of reproductive age. This is a cross-sectional, population-based study with data from 19,962 women aged 15 to 49 years. The outcomes were use and type of contraceptive, classified as: short-acting reversible contraceptives (SARC), long-acting (LARC), and permanent. The explanatory variables were characteristics of reproductive history, sociodemographic history, and access to health services. Multinomial logistic regression was used for odds ratio (OR) estimates, with SARC being the reference category. The analyses were performed in the Survey module of the Stata software, which considered the effect of the complex sampling plan of the 2019 Brazilian National Health Survey. The prevalence of contraceptive use was 83.7%. Of the total number of users, 72% used SARC, 23.2% permanent methods, and 4.8% LARC. Women with higher education, health insurance, who had deliveries, and who participated in reproductive planning groups had a higher chance of using LARC when compared with the use of SARC, while registration at the basic health unit was associated with a lower chance of use. Still, the higher the age and parity, in addition to living with the partner, the greater the chance of using permanent methods in relation to the use of SARC. Despite the high coverage of contraception, the contraceptive mix remains obsolete, with a predominance of the use of SARC. In addition, important inequalities in access were observed, with LARC being accessible only to women with better socioeconomic conditions, while permanent methods were associated with a profile of greater social vulnerability.
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Larrea S, Palència L, Assis MP, Borrell C. Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1040640. [PMID: 36560973 PMCID: PMC9764217 DOI: 10.3389/frph.2022.1040640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5-8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.
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Affiliation(s)
- Sara Larrea
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Carme Borrell
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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Felisbino-Mendes MS, Araújo FG, Oliveira LVA, Vasconcelos NMD, Vieira MLFP, Malta DC. Sexual behaviors and condom use in the Brazilian population: analysis of the National Health Survey, 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210018. [PMID: 34910072 DOI: 10.1590/1980-549720210018.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this research was to describe the sexual behaviors and condom use in the Brazilian population. METHODS This is a cross-sectional, descriptive study, which used data from 88,531 individuals aged 18 years old or older, who answered the second edition of the National Health Survey carried out in 2019. Prevalence was estimated with the respective 95% confidence intervals for each sexual behavior indicator and condom use according to gender, age, race/skin color, educational level, and region of residence. RESULTS The majority of the Brazilian population has had sexual intercourse at some point in their lives (93.9%). Mean age of initiation was 17.3 years. Prevalence of consistent condom use was only 22.8%, being even lower among women (20.9%). Moreover, 59% of the population reported not having used a condom in the past 12 months, the main reason being trusting their partner (73.4%). The use of health services to obtain condoms was only 10.7%. It was observed that women, individuals with a higher age group, less education, and income had worse results in relation to the analyzed indicators, in addition to regional disparities. CONCLUSION Low prevalence of condom use was observed in the Brazilian population. In addition, important socioeconomic and demographic disparities were observed, pointing out the need to revisit, strengthen and expand public policies in the sexual and reproductive health field in order to prevent risky sexual behaviors and promote condom use, including double protection.
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Affiliation(s)
- Mariana Santos Felisbino-Mendes
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Fernanda Gontijo Araújo
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Laís Vanessa Assunção Oliveira
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Nádia Machado de Vasconcelos
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Barbosa de Andrade R, Pirkle CM, Sentell T, Bassani D, Rodrigues Domingues M, Câmara SMA. Adequacy of Prenatal Care in Northeast Brazil: Pilot Data Comparing Attainment of Standard Care Criteria for First-Time Adolescent and Adult Pregnant Women. Int J Womens Health 2020; 12:1023-1031. [PMID: 33204175 PMCID: PMC7667512 DOI: 10.2147/ijwh.s272743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Adolescent pregnancy is a public health concern worldwide, particularly in low-income settings. Adolescent mothers face higher risks during pregnancy and delivery compared to adult mothers and yet, may also experience worse quality of obstetrical care. This study evaluates adherence to meeting Brazilian recommendations for prenatal care by comparing first-time adolescent versus adult mothers in a rural, low-income setting. Methods Using data from the Adolescence and Motherhood Research (AMOR) project, we evaluated adherence to national recommendations as documented in the prenatal cards of 39 adolescents (13-18 years) and 37 adults (23-28 years) from a low-income area in northeast Brazil. Recommendations included ≥6 prenatal consultations, gestational age ≤12 weeks at the first visit, participation in 3 educational activities, 2 serology for syphilis (VDRL) and HIV, 1 Toxoplasmosis serology, 2 urine tests, 2 blood glucose and 2 hemoglobin/hematocrit (Hb/Ht) exams. Chi-square tests were used to compare the proportions of adolescents and adults with a record of these procedures in the prenatal cards. Results Compared to adult women, the adolescent group had lower attainment of almost all recommended components of prenatal care compared to the adult group, with statistically significant differences for 2 blood glucose tests (46.2% vs 78.4%; p=0.004), 2 VDRL tests (30.8% vs 54.1%; p=0.040), 2 Hb/Ht exams (35.9% vs 83.8%; p<0.001), and at least 6 consultations (84.6% vs 100%; p=0.013). Conclusion Despite greater health risks of adolescent fertility, the prenatal cards of adolescent mothers presented a poorer record of adherence to recommendations for adequate prenatal care compared to adult mothers from a low-income setting of Brazil. Health policies for both health professionals and the target population are needed to ensure adequacy of prenatal care and appropriate risk reduction for this vulnerable population.
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Affiliation(s)
- Raísa Barbosa de Andrade
- Postgraduate Program in Public Health, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Diego Bassani
- Department of Paediatrics, Faculty of Medicine & Dalla Lana School of Public Health University of Toronto, Toronto, ON, Canada
| | | | - Saionara M A Câmara
- Postgraduate Program in Public Health, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil.,Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
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Shakya HB, Weeks JR, Christakis NA. Do village-level normative and network factors help explain spatial variability in adolescent childbearing in rural Honduras? SSM Popul Health 2019; 9:100371. [PMID: 31998822 PMCID: PMC6978495 DOI: 10.1016/j.ssmph.2019.100371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 11/19/2022] Open
Abstract
Adolescent childbearing rates are higher in Central America than almost anywhere else. However, in this research we discovered that adolescent childbearing exhibits variability from one village to another, and we might discover factors associated with this spatial variability that can help us understand key characteristics underlying the pattern of early childbearing. To do this, we assessed the village-level normative and network factors associated with adolescent birth (birth taking place before age 20 years) in rural Honduras and evaluated the geographic dispersion of these patterns. We used full population data from 24,937 people in 176 villages (81% of the eligible population) to assess prevalence and patterns of adolescent childbearing among women. We modeled the predictors of adolescent births among women younger than 21 years. After accounting for individual demographic characteristics, one of the strongest predictors of adolescent birth within the population was village-level collective norms about the acceptability of adolescent childbearing, based on aggregating normative measures from the entire population. The proportion of women in the village who had given birth as an adolescent was also strongly associated with an individual girl's likelihood of having given birth as an adolescent. We used full village-level network analyses to calculate social cohesion within the village. Normative pressure was strongly associated with the likelihood of an adolescent birth in villages with high cohesion (high network density) and was not associated or had a weak association in villages with low cohesion. On the other hand, the longer a girl had lived in the village, the stronger the association between the overall proportion of women in that village who gave birth as adolescents and the girl's own likelihood of having done so. Spatial analyses suggest that levels of adolescent births vary spatially across villages, as do the village-level normative factors associated with them.
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Affiliation(s)
- Holly B. Shakya
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla CA, USA
| | - John R. Weeks
- Department of Geography, San Diego State University, San Diego CA, USA
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Câmara SM, Sentell T, Bassani DG, Domingues MR, Pirkle CM. Strengthening health research capacity to address adolescent fertility in Northeast Brazil. J Glob Health 2019; 9:010303. [PMID: 30774939 PMCID: PMC6359931 DOI: 10.7189/jogh.09.010303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Saionara Ma Câmara
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Diego G Bassani
- The Hospital for Sick Children, University of Toronto. Toronto, Canada
| | | | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
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Felisbino-Mendes MS, Paula TFD, Machado ÍE, Oliveira-Campos M, Malta DC. Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180013. [PMID: 30517464 DOI: 10.1590/1980-549720180013.supl.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/30/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. METHODS Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. RESULTS The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. CONCLUSION There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.
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Affiliation(s)
| | - Thayane Fraga de Paula
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Ísis Eloah Machado
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Maryane Oliveira-Campos
- Departamento Geral de Vigilância de Doenças e Agravos Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Béria JU, Schermann LB, Leal AF, Hilgert JB, Stein AT, Alves GG, Câmara S, Palazzo L. Motherhood in early adolescence: a case-control study in Southern Brazil. CIENCIA & SAUDE COLETIVA 2018; 25:439-448. [PMID: 32022185 DOI: 10.1590/1413-81232020252.10232018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 05/22/2018] [Indexed: 11/22/2022] Open
Abstract
This paper investigates factors associated with motherhood among adolescents from 14 to 16 years of age in Porto Alegre, Brazil. This is a case-control study with 431 adolescent mothers (cases) and 862 adolescents who had never given birth (controls). D. ata were obtained through home visits by an interviewer-applied questionnaire. Sociodemographic characteristics, quality of social and family relationships, lifestyle and history of abuse were studied as potential determinants to early adolescent motherhood. Conditional logistic regression was used for data analysis according to a two-stage hierarchical model. Results showed that lower economic class, schooling failure, tobacco consumption, alcoholic drunkenness at least once in life and having a mother who gave birth before 20 years of age were positively associated with early adolescent motherhood. Later menarche and having relatives or having friends in whom to trust remained as protective factors. Schooling failure, which obtained the highest risk, points to the important role of the school in this population's development and its potential to stimulate healthy life habits.
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Affiliation(s)
- Jorge Umberto Béria
- Programa de Pós-Graduação em Promoção da Saúde, Universidade Luterana do Brasil. Av Farroupilha 8001, Prédio 1/124. 92425-900, Canoas, RS, Brazil.
| | - Lígia Braun Schermann
- Programa de Pós-Graduação em Promoção da Saúde, Universidade Luterana do Brasil. Av Farroupilha 8001, Prédio 1/124. 92425-900, Canoas, RS, Brazil.
| | - Andréa Fachel Leal
- Programa de Pós-Graduação em Sociologia e em Políticas Públicas, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - Juliana Balbinot Hilgert
- Programa de Pós-Graduação em Odontologia e em Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - Airton Tetelbom Stein
- Curso de Pós-Graduação de Ciências da Saúde, Universidade de Ciências da Saúde de Porto Alegre. Porto Alegre, RS, Brasil
| | - Gehysa Guimarães Alves
- Programa de Pós-Graduação em Promoção da Saúde, Universidade Luterana do Brasil. Av Farroupilha 8001, Prédio 1/124. 92425-900, Canoas, RS, Brazil.
| | - Sheila Câmara
- Curso de Psicologia, Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre, RS, Brazil
| | - Lilian Palazzo
- Programa de Pós-Graduação em Promoção da Saúde, Universidade Luterana do Brasil. Av Farroupilha 8001, Prédio 1/124. 92425-900, Canoas, RS, Brazil.
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Borges ALV, do Nascimento Chofakian CB, Sato APS, Fujimori E, Duarte LS, Gomes MN. Erratum to: Fertility rates among very young adolescent women: temporal and spatial trends in Brazil. BMC Pregnancy Childbirth 2016; 16:204. [PMID: 27488056 PMCID: PMC4972993 DOI: 10.1186/s12884-016-0977-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ana Luiza Vilela Borges
- School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 419, Cerqueira César, CEP 05403-000, São Paulo, SP, Brazil.
| | | | - Ana Paula Sayuri Sato
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Fujimori
- School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 419, Cerqueira César, CEP 05403-000, São Paulo, SP, Brazil
| | - Luciane Simões Duarte
- School of Nursing, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 419, Cerqueira César, CEP 05403-000, São Paulo, SP, Brazil
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