[Contraceptive discontinuities in the use of oral and injectable hormonal contraceptives, and male condoms]

Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey

OBJECTIVE

We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors.

STUDY DESIGN

This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19.

RESULTS

Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes.

CONCLUSIONS

Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use.

IMPLICATIONS

Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.

Contraceptive switch and abandonment among women using the pill, condoms and injectables in Brazil

OBJECTIVE

The aim of our study was to assess the covariates of contraceptive switching and abandonment among Brazilian women stratified by oral pills, condoms and injectables.

MATERIALS AND METHODS

Women attending primary health care services in three Brazilian mid- to large-sized cities were interviewed face-to-face about their contraceptive practices (n = 2,051). Data were collected using a contraceptive calendar. Analysis included estimates using Kaplan-Meier multiple-decrement life-table probabilities and discrete-time hazards modelling of switching from a method to another or to no method.

RESULTS

Among 3,280 segments of contraceptive use, we observed that five-year contraceptive switching rates ranged from 34.9% among injectable users to 56.1% among pill users. Of particular concern were the high discontinuation rates of abandonment, which ranged from 50.9% among injectable users to 77.4% among pill users. Covariates of method switching and abandonment varied by type of method, but age, race/ethnicity, religion and relationship status must be highlighted as key elements of discontinuation.

CONCLUSION

Contraceptive method switching and abandoning are frequent outcomes of contraceptive use. Understanding the factors that shape women's decisions to continue or discontinue the use of a contraceptive method can help tailoring comprehensive contraceptive counselling that meet their expectations and reproductive needs when starting using a method.

Prevalência de indicadores de saúde sexual e reprodutiva dos adolescentes brasileiros

Objetivo: comparar as estimativas de prevalência de indicadores de saúde sexual e reprodutiva dos adolescentes brasileiros que participaram das edições 2015 e 2019 da Pesquisa Nacional de Saúde do Escolar (PeNSE). Método: estudo transversal que analisou dados de adolescentes escolares de 13 a 17 anos respondentes da PeNSE 2015 e 2019. Estimou-se a prevalência para nove indicadores com intervalos de 95% de confiança de acordo com o sexo, faixa etária, dependência administrativa da escola e região do país. Resultados: observou-se manutenção da maior parte dos indicadores analisados. Destaca-se aumento da prevalência de iniciação sexual precoce, entre os mais novos, 171,2% entre os meninos e 425,2% entre as meninas. Também houve aumento da prevalência de gravidez na adolescência nas regiões Nordeste (376,9%) e Sudeste (416,6%), entre as mais jovens. Entre os adolescentes de 16 e 17 anos, houve redução do uso de preservativo na última relação e aumento na prevalência de recebimento de orientações sobre prevenção de gravidez e sobre HIV/Infecções Sexualmente Transmissíveis, entre os estudantes de escolas públicas. Houve redução na prevalência de acesso a essas orientações nas escolas privadas entre os mais jovens. Em 2019, observou-se redução no uso de pílulas anticoncepcionais entre as adolescentes mais novas das regiões Norte, Sudeste e Centro-Oeste. Conclusão: houve estabilidade para a maioria dos indicadores, porém, com aumento da iniciação sexual precoce, da história de gravidez na adolescência e das orientações recebidas nas escolas, apontando maior risco entre jovens que frequentam as escolas públicas, e que vivem no Nordeste e Norte do país.