Demanda insatisfeita por contracepção e gravidez não planejada em mulheres em idade reprodutiva

Abstract

Nonuse of contraceptive methods by women who need contraception may impact the lives of these women and their families. Unplanned pregnancies and short birth intervals may result from not using contraception, which affect sexual and reproductive health. Unplanned pregnancy, for example, is associated to late and suboptimal antenatal care, personal and society costs as well as costs to the health system. However, there are many reasons for nonuse of contraceptive methods, and inequalities may be present. Therefore, this thesis aimed to: 1) describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries; 2) investigate time trends in unplanned pregnancy and inequalities in family income and women’s skin color, in Pelotas; 3) verify the association between unplanned pregnancy and use of modern contraceptive methods in the postpartum period, in the 2015 Pelotas Birth Cohort, Brazil. To address the first aim, a study was conducted with data on sexually active women with demand for contraception not satisfied, who participated in Demographic and Health Surveys from 47 countries (paper 1). This study identified that on average 40.9% of women in need of contraception were not using any contraceptive methods. “Health concerns” and “infrequent sex” were the most common reasons for nonuse of contraceptives mentioned, with substantially variation across countries and inequalities. To identify trends and inequalities in unplanned pregnancy data from mothers of participants of the 1993, 2004, and 2015 Pelotas Birth Cohorts were investigated (paper 2). The results suggest that there was a decrease in the prevalence of unplanned pregnancy over time (from 62.7% in 1993 to 52.2% in 2015). Higher prevalences of unplanned pregnancies were identified among black or brown women and those women of lower socioeconomic status. Finally, a longitudinal study with data from mothers of participants of the 2015 Pelotas birth cohort (at perinatal, and three, 12 and 24 months follow-ups) investigated the association between unplanned pregnancies and the use of modern contraceptive methods after delivery (paper 3). We have founded a negative association between unplanned pregnancy and use of modern contraception at three and 24 months after delivery, with a reduction in family income and maternal schooling-related inequalities over time. These thesis results suggest that actions in family planning need to take into account the context in which the women are living, sociodemographic and reproductive indicators, as well as the decisions of women and their families, so that they may have a healthy human development regardless of intention to become pregnant.