Adequação de uso e necessidade não atendida de métodos contraceptivos modernos nas mães da Coorte de nascimento de 2015

Abstract

Family planning (FP) is an important contributing factor to child survival and to the reduction of maternal mortality. The use of modern contraceptives is safer and prevents thousands of maternal deaths per year, reducing the chance of pregnancy and associated complications, decreasing the risk of an unsafe abortion, postponing the first pregnancy in young women who may have premature pelvic development, reducing the risks of frailty due to high parity and short inter-pregnancies intervals. Although most women can safely use modern methods, specific medical conditions serve as relative or absolute contraindications, mainly due to concerns about the increased risk of thrombotic and cardiovascular conditions with the use of estrogen. The unmet need for contraception is routinely used to evaluate family planning policies and programs. Despite the significant implications of the family planning program for economic development, there is still an unmet need for modern methods, particularly in developing countries. Thus, few studies have been found here in Brazil on adequacy and unmet need for modern contraception. This thesis aimed to a) assess the available evidence on the prevalence of combined hormonal contraceptive (CHC) use by women with contraindications to their use b) describe the use of modern contraceptives in the presence of contraindications according to WHO medical eligibility criteria in the 2015 Pelotas birth cohort; c) determine the total demand and unmet need for contraception with modern methods and its determinants in mothers participating in the 2015 Pelotas Birth Cohort. The first article was a systematic review evaluating the prevalence of combined hormonal contraceptives use in users who had contraindications to their use. An extensive search was performed in PubMed, Lilacs and Web of Sciences databases. A total of 4363 articles were identified and 18 articles were selected for review. The most prevalent contraindications to the use of CHC were systemic arterial hypertension, migraine and smoking (in women aged 35 years or older). The prevalence of contraindications to the use of CHC ranged from 5.9% to 41.9%. To carry out articles 2 and 3, the data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. As a studied sample, only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who responded to the 48-month questionnaire were included. Then, the second article evaluated the use of modern contraceptives (CHC, progesterone only contraceptive and intrauterine devices) in the presence of contraindications according to WHO eligibility criteria. Of 3053 mothers who were using a modern contraception, the prevalence of contraindicated use of modern contraceptives was 25.9% (95%CI: 24.4-27.5). CHC users had the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8) and the most prevalent contraindication was migraine (17.9%; 95%CI: 16.6-19.3). The prevalence of contraindicated use of modern methods was higher in women with a family income between one and three minimum wages (29.2% CI95%: 26.9 – 31.7), with a body mass index between 25-30 kg / m2 (28.4%; 95%CI: 25.6 – 31.3), those who received indication of the method currently in use by family members or friends and a gynecologist (30.4%; 95%CI: 22.1 – 40 .1 and 29.8% (95%CI: 27.9 – 31.8 respectively) and women who obtained the modern contraceptive method through purchasing at a pharmacy (31.7%; 95%CI: 29.6 – 33. 8). The higher the woman's education level was, the lower the prevalence of contraindicated use of modern contraceptives was (p = 0.001). And the last article studied unmet need for contraceptives and its determinants. The studied sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and modern contraceptives was 86.0% (95%CI; 84.8 – 87.1) and 84.9% (95%CI; 83.7 – 86.1) respectively. The prevalence of unmet need was 10.7% (95%CI; 9.7 – 11.7), and the total demand for modern contraceptives through family planning calculated from the percentage of women with unmet needs plus the percentage of needs met, was 95.6%. As for the associated factors to unmet need, being over 34 years of age (OR=0.6, 95%CI: 0.5 – 0.8), not heads of household (OR= 0.6 CI95%; 0.4 – 0.9) were less likely to have an unmet need for modern contraception, while mothers without a husband or partner (OR= 1.9, 95%CI: 1.4 - 2.6), having three or more pregnancies (OR=1.9, 95%CI: 1.3 – 2.6), and reported at least one abortion after the birth of the child participating in the Cohort (OR=1.9, 95%CI: 1.0 – 3.6) they reported a greater chance of unmet need.