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Amorim RV, Barbieri MA, Bôtto-Menezes C, Carmona F, Ferraro AA, Bettiol H. Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents? REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022060. [PMID: 37255109 DOI: 10.1590/1984-0462/2023/41/2022060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/21/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. METHODS A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. RESULTS Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. CONCLUSIONS EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.
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Affiliation(s)
| | | | - Camila Bôtto-Menezes
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Fábio Carmona
- Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Moreira LR, Blumenberg C, Caicedo Velasquez BE, Ewerling F, Balandrán A, Vidaletti LP, Varela AR, Hellwig F, Ponce de Leon RG, Barros AJ, Silveira MF, Wehrmeister FC. The role of gender inequality and health expenditure on the coverage of demand for family planning satisfied by modern contraceptives: a multilevel analysis of cross-sectional studies in 14 LAC countries. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100435. [PMID: 36950033 PMCID: PMC10025422 DOI: 10.1016/j.lana.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
Abstract
Background Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. Methods Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. Findings DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman's education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. Interpretation Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. Funding Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Laísa Rodrigues Moreira
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Corresponding author. Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
| | - Cauane Blumenberg
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Beatriz Elena Caicedo Velasquez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia
| | - Fernanda Ewerling
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Alejandra Balandrán
- Inter-american Conference on Social Security, Direction of Health Systems Evaluation & Research, San Ramón s/n, San Jerónimo Lídice, 10200, Mexico City, Mexico
| | - Luis Paulo Vidaletti
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | | | - Franciele Hellwig
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - 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
| | - Aluisio J.D. Barros
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Mariangela Freitas Silveira
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Fernando C. Wehrmeister
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Institute for Global Public Health (IGPH), Rady Faculty of Health Sciences, Community Health Sciences, R070 Med Rehab Bldg, 771 McDermot Avenue, University of Manitoba (Bannatyne Campus), Winnipeg, Manitoba, R3E 0T6, Canada
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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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Sserwanja Q, Turimumahoro P, Nuwabaine L, Kamara K, Musaba MW. Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey. BMC Womens Health 2022; 22:376. [PMID: 36114503 PMCID: PMC9479264 DOI: 10.1186/s12905-022-01974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone. Methods This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25. Results Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization. Conclusion In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01974-w.
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