Introdução: O uso de métodos anticonceptivos modernos pela maior parte das mulheres brasileiras não diminuiu, conforme esperado, assim como a ocorrência de gestações não desejadas, abortamentos e, consequentemente, mortes maternas, o que revela uso com perfil irregular e descontínuo. No Brasil, há pouca informação sobre os padrões e os determinantes da ocorrência dessas descontinuidades contraceptivas. Devido às inconsistências no uso de métodos serem relativamente comuns, é necessário mensurar o quanto as mulheres interrompem seu uso a despeito de não desejarem engravidar e/ou os alternam inúmeras vezes, nem sempre com opção por um método mais eficaz. Objetivo: Analisar os padrões e os determinantes das descontinuidades contraceptivas no uso da pílula oral, do hormonal injetável e do preservativo masculino. Método: Estudo longitudinal retrospectivo, conduzido com amostra probabilística de 1.551 mulheres de 18 a 49 anos de idade, usuárias de 57 Unidades Básicas de Saúde da cidade de São Paulo/SP (2015) e Aracaju/SE (2016). Os dados foram coletados por entrevista face a face usando o calendário contraceptivo. No Stata 14.2, as análises das taxas de descontinuidade contraceptiva no período de doze meses foram realizadas pelo método de Kaplan-Meier e dos fatores associados por meio dos Modelos de Riscos Proporcionais de Cox, ambos para descontinuidade total, abandono, troca para método menos eficaz e troca para método mais eficaz. Resultados: A taxa de descontinuidade total no uso de métodos foi 41,9% aos doze meses, sendo maior entre usuárias do preservativo masculino (48,1%), seguida de hormonal injetável (39,0%) e pílula oral (38,6%). Entre as usuárias de pílula oral, a taxa de abandono foi a maior; entre as usuárias do hormonal injetável, foi a troca para um método menos eficaz; e, entre as usuárias do preservativo masculino, foi a troca para um método mais eficaz. Os aspectos associados às descontinuidades variam segundo o tipo de método. A descontinuidade no uso da pílula oral foi associada à idade (18-24 anos), vivência de abortamento, incerteza quanto à intenção reprodutiva e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do hormonal injetável foi associada ao maior número de parceiros sexuais, à vivência de abortamento e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do preservativo masculino foi associada à idade (25-34 e 35-49 anos), à união conjugal, ao menor poder aquisitivo (classe econômica D/E) e ao maior número de filhos vivos. Conclusões: Foram observadas altas taxas de descontinuidades no uso de métodos contraceptivos, que variaram conforme o tipo de método. Chama a atenção o papel dos efeitos colaterais na determinação da ocorrência de descontinuidade no uso dos métodos hormonais. Por sua vez, a troca por método mais eficaz foi pouco frequente, com exceção das usuárias de preservativo masculino. Sugere-se ampliar o acesso aos métodos contraceptivos mais eficazes e de longa duração e melhorar a assistência em contracepção nos serviços do Sistema Único de Saúde, de forma a contemplar as necessidades de saúde das mulheres e seus direitos sexuais e reprodutivos. / Introduction: Use of modern contraceptive methods by the majority of Brazilian women did not reduce the occurrence of unintended pregnancies, abortions or maternal deaths as expected, which means that it might be an irregular and discontinuous use. In Brazil, there is a little information on the patterns and determinants of the occurrence of these contraceptive discontinuations. Because inconsistencies in the use of methods are relatively common, it is necessary to measure how much women discontinue their use despite they are willing to get pregnant and/or switching them countless times, not always with the option of a more efficient method. Objective: Our purpose is to investigate patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injection and condom. Method: We conducted a retrospective longitudinal study with probabilistic sample of 1,551 women among 18-49 year old who are primary users of 57 health care facilities, both in Sao Paulo (2015) city and Aracaju city (2016). Data were collected by face-to-face interview in line with contraceptive calendar. In Stata 14.2 analyzes of 12-month contraceptive discontinuation rates were performed using the Kaplan-Meier Survival Estimates method and associated factors using the Cox Proportional Hazards Models, both for total discontinuation, abandonment, and switching to a less efficient method and switching to more efficient method. Results: The discontinuation rate in the use of methods was 41.9% at 12 months, being higher among male condom users (48.1%), followed by hormonal injection (39.0%) and oral pill (38.6%). Among oral pill users, the abandon rate was the highest; among users of hormonal injections, was the switching to a less efficient method; and among male condom users, it was the switching to a more efficient method. The aspects associated to the discontinuations varied according to the type of method. Discontinuation of oral pill users was associated with age (18-24 years old), experience of abortion, uncertainty about reproductive intention and side effects/health concern. Discontinuation in the use of hormonal injections was associated with a greater number of sexual partners, the experience of abortion, and the side effects/health concern. Discontinuation of condom users was associated with age (25-34 and 35-49 years old), marital union, lower income and the highest number of live children. Conclusion: High discontinuation rates were observed in the use of contraceptive methods, which varied according to the type of method. The role of side effects/health concern in determining the occurrence of discontinuation in the use of hormonal methods is noteworthy. On the other hand, switching to more efficient method was infrequent, except for the male condoms users. It is suggested to amplify access to the more effective methods as well as long active also improving care in contraception in the all health care facilities services, in order to take into account both women health needs and their sexual and reproductive rights.

No Brasil, a saúde, como direito do cidadão e dever do Estado, é garantida pela constituição de 1998. Em 1983 foi criado o PAISM, propondo a perspectiva de atendimento integral à saúde da mulher, com o objetivo de considerar, no âmbito da saúde, também o entorno social, emo cional e psicológico da mulher, bem co mo as questões relacionadas à contra cepção. No entanto, sua implantação ainda não se realizou efetivamente até o momento atual, o que pode ser observa do pela alta prevalência de gestações indesejadas, dificuldade de acesso a informações sobre planejamento familiar, predomínio da esterilização cirúrgica feminina como método contraceptivo e da cesárea como via de parto, aspectos que ferem os direitos sexuais e reprodu tivos das mulheres. Um novo contexto tem se desenhado a partir da implanta ção da Lei 9 263, que regulamenta o planejamento familiar, e pela qual a este rilização cirúrgica é aprovada e passa a ser ofertada pelo sistema público de saúde, o que,por sua vez, permite a desvinculação da esterilização com o parto. O presente estudo tem por objeti vo conhecer as características das mu lheres que se esterilizaram pelo SUS, em Ribeirão Preto, entre 2000 e 2004, segun do o tipo de parto, cesárea e parto vagi nal. A amostra foi composta por 235 mulheres esterilizadas nos primeiros cinco anos de oferta da esterilização cirúrgica (2000-2004). Os dados foram coletados através de entrevistas domici liares, utilizando-se questionário estrutu rado. Os resultados demonstraram que a maioria das mulheres esterilizadas era branca, casada, com escolaridade até o ensino fundamental e pertencia à catego ria socioeconômica C e D. A maioria foi esterilizada entre 30 e 39 anos de ida de, com média de 33,3 e mediana de 33 anos, 52,3% faziam uso da pílula como método contraceptivo antes da esteriliza ção. Elas têm, em média, 3,2 filhos e 51,7% teve o primeiro filho entre 13 e 19 anos de idade. Este estudo indicou que as mulheres esterilizadas, em sua maioria, têm mais filhos, começaram a ter filhos mais cedo, usaram mais contra ceptivos enquanto esperavam pela cirurgia e se esterilizaram mais tarde quando comparadas aos resultados de outros estudos. Em relação ao tipo de parto, 71,2% dos partos ao longo da trajetória reprodutiva dessas mulheres foram vaginais, enquanto 28,8% cesáre as, o que aponta para o importante aspecto da desvinculação da esteriliza ção com a cesárea, como objetiva a Lei, e que essas mulheres que tiveram, em sua maioria, partos vaginais, estão tendo melhor acesso à esterilização. / The Brazilian Constitution of 1998 guarantees that health is a citizen right and a duty of the State. The PAISM (Women Health Comprehensive Program) was created emphasizing a comprehensive approach aiming to consi der the social, emotional and psychologi cal issues as part of health condition as well as contraception. However its imple mentation has not been completed up to now. This can be observed by the high prevalence of unwanted pregnancies, difficult access to family planning information, predominance of female surgical sterilization as a contraceptive method and the cesarean section. All these aspects are obstacles to sexual and reproductive rights. Since the implementation of the Federal Legal Act 9263 which regulates Family Planning Provision and approves surgical steriliza tion offering it in the public health system it is possible a disconnection between birth delivery and the surgical procedu re of sterilization. The objective of this study is to know the characteristics of women sterilized by SUS (Unified Health System) in Ribeirão Preto, betwen 2000 and 2004, according to the type of delive ry, cesarean or vaginal. The sample in cludes 235 sterilized women during the first five years of the surgical sterilizati on provision (2000-2004) Data was col lected through household interviews using a structured questionnaire. The results showed that the most sterilized women were white, married, with 8 years of schooling or less and belonged to socioeconomic category C or D. They were sterilized between 30 and 39 years old, with the average of 33.3 years old and median age of 33, 52.3% were using oral contraceptives before sterilization. They were found to have an average of 3,2 children and 51.7% had the first child between 13 and 19 years old. This study indicated that steri lized women had more children, started giving birth earlier and used contracepti ves while they waited for the surgery, and were sterilized later when compa red to the results of other studies. As to delivery types, 71,2% of deliveries along the reproductive history of these women were vaginal while 28% were cesarean what points out the important aspect of the disconnection between sterilization and the cesarean, as deter mined by law, and that these women who had mostly vaginal deliveries are having a better access to sterilization.

Rapid repeat pregnancy (RRP) is associated with adverse maternal and infant outcomes and a range of undesirable social and economic challenges for the mother, her baby, and society. Although the consequences of RRP are well known, Zimbabwe—a country with some of the poorest maternal health indicators—has not investigated or made efforts to directly address this problem. This is confirmed by the lack of targeted programs to curb RRP, the unavailability of documented evidence regarding RRP significant risk factors, and the lack of understanding of the extent of RRP in the country. Using social cognitive theory as the theoretical framework, an unmatched case-control study was conducted using data from the Zimbabwe Demographic and Health Survey of 2015 to determine the prevalence of RRP and to assess associations between sociodemographic, sexual-relational, women's health, fertility preference, previous birth outcomes, and social factors and having an RRP in Zimbabwe. Logistic regression analysis showed statistically significant associations between all factors except for women's health characteristics. The prevalence of RRP among women of reproductive age (15–49 years) in Zimbabwe was 50.2%. The high prevalence of RRP and the multiple statistically significant associations reported in this study affirm the need for Zimbabwe to make prevention of RRP a public health priority. Zimbabwe must develop targeted interventions that work in context and integrate these into an ongoing comprehensive family planning program. In-depth research is needed to establish and understand the underlying motivations for having an RRP among Zimbabwean women. Such information may help develop targeted interventions to create social change.

Background: Despite the contraceptive prevalence of 67.4% in Morocco, one woman out of 10 has unmet need for birth spacing or limiting and, only one woman out of two is using modern contraception. Although, Moroccan national family program [FP] was launched in the sixties and aimed to increase use of FP among married Moroccan women; the program is still facing some limits to improve couple’s contraceptive care. This paper examines to what extent women’s status, husband’s FP approval and mass media positive exposure to FP messages translate into increased modern contraceptive uptake. This study uses the socio ecological framework to assess factors that influence FP use among married women in Morocco. In this model factors from individual, interpersonal and programmatic levels were identified based on a review of the literature as having an effect on contraception use. Objectives: The main objectives of this study are to: (1) explore the effect of women’s status including their education, their occupation and, their FP decision making on women’s desire for more children, (2) examine if husbands’ FP approval impacts women’s fertility desire, (3) assess how positive mass media FP messages ‘exposure influences women’s desire for children, (4) explore the effect of women’s fertility desire on women’s FP approval and,(5) assess if women’s FP approval increases modern contraception adoption. Methods: This analysis is based on secondary data from the 2004 Demographic Health Survey and, 2011 Morocco National Survey on Population and Family Health which were conducted among married women aged between 15 and 49 years old. Data were collected using a two-stage sampling scheme and the study population was 8,106 women in 2004 and 9,317 women in 2011. Path analysis, using series of multiple regression modeling analyses, was conducted to investigate the relationship between women’s desire for more children and predictors related to women’s status, husbands’ FP approval and, women’s exposure to FP messages via mass media. Full models were fitted to test the relationships between women’s desire for more children and women’s FP approval; women’s approval of FP and modern contraception use. Results: Descriptive analysis between 2004 data and 2011 data analysis showed similar results for women’s and husbands’ predictors. Women in 2011 who used modern contraception were mostly aged more than 35 years old (51%), lived in urban areas (56%), mostly rich (40.3%), educated (46%), with no occupation (89%), did not decide FP use alone (73.3%), whose husbands discussed FP with them (62%) and, approved contraceptive use (98%). Positive exposures to FP messages on mass media were measured only in 2004 data and showed that among women who adopted modern contraception, only 2.9% read FP messages in newspapers, 12.6% heard them in the radio and 25.5% heard them on television. Path analyses showed some differences between 2004 data and 2011data. In 2011 data educated women were 1.42 (O.R. = 1.42, C.I. 1.26–1.6) more likely to desire more children than those with no education. Women with occupation were 1.25 (O.R. = 1.25, C.I. 1.01–1.47) times more likely to desire children than those with no occupation. However, women’s education and women’s occupation factors were not related to women’s fertility desire in 2004 data. Husbands’ FP approval was not significantly associated to women’s fertility desire in both 2004 and 2011 data analyses. Mass media exposure to FP messages was examined only in 2004 and showed no significant association with women’s fertility desire. Similar results were observed between 2004 data and 2011 data and showed that women who decided for FP were 0.75 (O.R. = 0.75, C.I. 1.01–1.47) times less likely to desire more children than those who were not FP decision makers. Moreover, in 2004 women who decided for FP were 2, 32 times more likely to use modern contraception than women who were not FP decision makers [O.R. 2, 31 (CI 1.79-3.01)]. In 2011 data analysis, women who approved FP were 5.72 (O.R. = 5.72, C.I. 3.06–10.7) more likely to use modern contraception than those who did not approve FP. Furthermore, women whose husbands approved FP were 2.55 times more likely to adopt modern contraception (O.R. = 2.55, CI 1.845-3.513). Conclusions: This study results indicated women’s and, husband’s factors affecting women’s fertility desire and women’s contraceptive use. The factors effects varied between 2004 data and 2011 data. In 2011 data women’s education, women’s occupation, women’s FP decision making and, husbands’ FP discussion variables, had a significant effect on women’s fertility desire. However, in 2004 data only husband’s FP discussion had a positive effect on women’s fertility desire which had a positive effect on women’s FP approval. Women’s exposure to mass media FP messages did not have a significant effect on both women’s fertility desire and women’s contraceptive outcomes. Husbands’ FP approval and husbands’ FP discussion with their wives were highly predictive for women’s contraceptive use and remained essential factors for which Moroccan health policy makers should take into consideration in order to reduce unmet needs and improve couple’s contraceptive care in Morocco. / acase@tulane.edu

<p>The first objective of this study is to show if diffusion of contraception in areas of traditional high fertility has gone through profound changes. Indeed, we would like to know if contraceptive behaviours have evolved because of new fertility perceptions and also because partners now have greater freedom to make choices in a relationship. The second objective of this study is not only to highlight the levels and trends of contraception and the factors influencing their use (government policies, role of family planning, etc.) in developing countries, but also to consider the population of unmet-needs of contraception. Indeed, the level of contraceptive use depends obviously on users, but also on non-users with no needs and non-users with unsatisfied needs. The understanding of this last category of females is essential to a more accurate estimation of contraception levels, and, therefore for the estimation of fertility levels. This study analyses the contraceptive use in several developing countries in Africa and highlights the unsatisfied needs of contraception, to understand why such needs exist. To do so, we shall analyse available demographic data for thirty-five African countries by using the available Demographic and Health Surveys (DHS), from the 1980&rsquo / s to 2000&rsquo / s considering the DHS I, DHS II, DHS III and DHS IV. This great variety of surveys, seventy-nine in total, permits one to compare levels of contraception and &ldquo / unmet-needs&rdquo / from country to country. The surveys also, make it possible to compare the evolution over time of specific countries or specific regions, and to subsequently comprehend the determining factors of contraceptive use or non-use.</p>

Healthy Women, Healthy Families is a survey collection and story sharing project spearheaded by NARAL Pro Choice Texas. The reproductive justice based project asks survey respondents to rate how urgently their community needs a variety of health care services. While all Texas women are invited to participate, special attention was paid to targeting low income and minority women. In this report, I analyze the survey data and make both policy and internal recommendations for NPCT. Overall the survey results show that while all of the services in question are needed by women in Texas, there are differences in the strength of this need based on race and income. General health care services were most valued by all demographics, but NARAL’s priority services were valued most by upper class white women, while low income and minority women were more likely to support services aimed at specific populations (non-English speakers, women in prison, undocumented immigrants, those without transportation, etc.). Based on these survey results, I recommend that NARAL conduct follow up surveys as a way of illuminating some still unanswered questions. In addition, I recommend that NARAL reach out to coalition partners who advocate for the most needed services, expand outreach into low income and minority communities, and use outreach and messaging to try and frame NARAL’s services in a larger, more general health care context. / text

<p>The first objective of this study is to show if diffusion of contraception in areas of traditional high fertility has gone through profound changes. Indeed, we would like to know if contraceptive behaviours have evolved because of new fertility perceptions and also because partners now have greater freedom to make choices in a relationship. The second objective of this study is not only to highlight the levels and trends of contraception and the factors influencing their use (government policies, role of family planning, etc.) in developing countries, but also to consider the population of unmet-needs of contraception. Indeed, the level of contraceptive use depends obviously on users, but also on non-users with no needs and non-users with unsatisfied needs. The understanding of this last category of females is essential to a more accurate estimation of contraception levels, and, therefore for the estimation of fertility levels. This study analyses the contraceptive use in several developing countries in Africa and highlights the unsatisfied needs of contraception, to understand why such needs exist. To do so, we shall analyse available demographic data for thirty-five African countries by using the available Demographic and Health Surveys (DHS), from the 1980&rsquo / s to 2000&rsquo / s considering the DHS I, DHS II, DHS III and DHS IV. This great variety of surveys, seventy-nine in total, permits one to compare levels of contraception and &ldquo / unmet-needs&rdquo / from country to country. The surveys also, make it possible to compare the evolution over time of specific countries or specific regions, and to subsequently comprehend the determining factors of contraceptive use or non-use.</p>

The increasing recognition that millions of women and children die every year as a consequence of the poor health of the mother coupled with inadequate care before, during, and after delivery, has highlighted the importance of seeking women's views of health services in order to contribute to improving women's health. In order to shed more light on women's views of health services, this study explores women's experiences of MCH and FP services in Cato Manor in KwaZulu-Natal. The study looked at a number of factors including knowledge of reproductive health services and interpersonal relations between women and health providers. In-depth interviews with service users and CBHWs as key informants were used to obtain information for the study. The results suggest that the majority of the MCH service users expressed overall satisfaction with the services. Discontent mainly rose from lack of contraceptive counseling and the long waiting times at the clinic. Thus, suggestions to improve service delivery included increasing contraceptive counseling especially with regard to the range of methods and their side effects. The study also argued for sustainable improvements in women's health and increasing involvement of men in ensuring positive reproductive health outcomes for women. / Thesis (M.Dev.Studies)-University of KwaZulu-Natal, 2006.

AIM. The aim of this study was to describe the utilization of family planning methods by the nursing students in the selected nursing education institution. METHODOLOGY. A non-experimental descriptive survey design with a quantitative approach was used to describe the utilization of family planning methods by the nursing students. For the study, the quota sampling technique where 106 nursing students were selected. A self-developed questionnaire based on a conceptual framework, study objectives, and existing questionnaires was used as a data collection instrument. FINDINGS. The results yielded by the study showed that 63.9% (n = 62) used family planning methods before coming to college which was the majority of the respondents. Of the total number of participants, 35.1% (n = 34) who never used family planning methods before were still not using any method. The majority of students using family planning methods perceive this as beneficial. The perceived self-efficacy by the users is also high. A recommendation for future practice is that there should be health information available to students during orientation. The name used for these services may also need to be looked at. The qualitative study on the topic may yield different or similar results. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.