Uso de métodos contraceptivos modernos e planejamento da gravidez: um estudo de coorte
DOI:
https://doi.org/10.11606/s1518-8787.2025059006248Palavras-chave:
Contraception, Unplanned Pregnancy, Family Planning, Socioeconomic Factors, Health InequalitiesResumo
OBJECTIVES: To investigate the association between unplanned pregnancy and use of modern contraceptive methods at 3-, 12-, and 24-months postpartum using an intersectional approach for examining inequalities, in the 2015 Pelotas birth cohort, Brazil. METHODS: We evaluated the use of modern contraceptives after delivery, comparing women who had planned and unplanned pregnancies in 2015. The number of women included in this study was: 4,021, 3,687, and 3,558, at 3-, 12-, and 24-month postpartum follow-ups, respectively. Analyses were restricted to women who needed contraception by the time of each postpartum follow-up interview. Sociodemographic indicators were also investigated. Descriptive (absolute and relative frequencies), bivariate, and multivariate statistical analyses were conducted. These analyses included the main exposure and the sociodemographic variables. In the three follow-up interviews, double stratification was used to investigate for intersectionalities between pregnancy planning and family income, and pregnancy planning and living with partner. RESULTS: Women who had unplanned pregnancies presented the lowest use of modern contraceptives. A negative association between unplanned pregnancy and use of modern contraception was found at 3- (PR = 0.97, 95%CI: 0.95–0.99) and 24-months postpartum (PR = 0.96, 95%CI: 0.94–0.98). In general, women who did not live with a partner, with lower schooling level, and who were 35 or older presented lower use of modern contraception. Women who had unplanned pregnancies with lower family income and who did not live with a partner presented a lower prevalence of modern contraceptive use. CONCLUSIONS: Despite the possible benefits of the use of modern contraception in the postpartum period, women who had unplanned pregnancies presented the lowest prevalence. No consistent pattern was identified for this association over time. It is necessary to consider important sociodemographic factors such as living with partner as well as possible pathways to reduce inequalities.
Referências
Theme-Filha MM, Baldisserotto ML, Fraga ACSA, Ayers S, da Gama SGN, Leal M do C. Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012. Reprod Health. 2016;13(Suppl 3):118. https://doi.org/10.1186/s12978-016-0227-8.
Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301-14. https://doi.org/10.1111/j.1728-4465.2014.00393.x.
Currao A, Mezuk B. Association between unintended pregnancy and internalizing disorders among Latina and Asian American mothers. J Affect Disord. 2019;258:117-24. https://doi.org/10.1016/j.jad.2019.07.068.
Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39(1):18-38. https://doi.org/10.1111/j.1728-4465.2008.00148.x.
Khan MN, Harris ML, Shifti DM, Laar AS, Loxton D. Effects of unintended pregnancy on maternal healthcare services utilization in low-and lower-middle-income countries: systematic review and meta-analysis. Int J Public Health. 2019;64:743-54. https://doi.org/https://doi.org/10.1007/s00038-019-01238-9.
Le HH, Connolly MP, Bahamondes L, Cecatti JG, Yu J, Hu HX. The burden of unintended pregnancies in Brazil: a social and public health system cost analysis. Int J Womens Health. 2014 Jul;6:663.https://doi.org/10.2147/IJWH.S61543.
Matsuda Y, Masho S, McGrath JM. The Relationship Between Repeated Unintended Pregnancies and Current Contraceptive Use: National Survey of Family Growth (NSFG) 2006-2008 data. J Community Health Nurs. 2012;29(3):163-72. https://doi.org/10.1080/07370016.2012.697848.
Bellizzi S, Sobel HL, Obara H, Temmerman M. Underuse of modern methods of contraception: Underlying causes and consequent undesired pregnancies in 35 low-and middle-income countries. Human Reproduction. 2015;30(4):973-86. https://doi.org/10.1093/humrep/deu348.
Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T. Missed opportunities for family planning: An analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries. Contracept. 2015;92:31-9. https://doi.org/10.1016/j.contraception.2015.03.007.
Guzzo KB, Eickmeyer K, Hayford SR. Does Postpartum Contraceptive Use Vary By Birth Intendedness? Perspect Sex Reprod Health. 2018;50(3):129-38. https://doi.org/10.1363/psrh.12074.
Oduyebo T, Zapata LB, Boutot ME, D’Angelo DV, Marchbanks PA, Whiteman MK et al. Factors associated with postpartum use of long-acting reversible contraception. Am J Obstet Gynecol. 2019 Jul;221: 43.e1–43.e11. https://doi.org/10.1016/j.ajog.2019.03.005.
World Health Organization. Report of a WHO Technical Consultation on Birth Spacing. Geneva: WHO; 2005.
Conde-Agudelo A, Rosas-Bermudez A, Castaño F, Norton MH. Effects of Birth Spacing on Maternal, Perinatal, Infant, and Child Health: A Systematic Review of Causal Mechanisms. Stud Fam Plann. 2012;43(2):93-114. https://doi.org/10.1111/j.1728-4465.2012.00308.x.
Santos IS, Barros AJD, Matijasevich A, Domingues MR, Barros FC, Victora CG. Cohort profile: the 2004 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2010;40(6):1461-8. https://doi.org/10.1093/ije/dyq130.
Hallal PC, Bertoldi AD, Domingues MR, da Silveira MF, Demarco FF, da Silva ICM et al. Cohort profile: the 2015 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2017;47(4):1048-1048h. https://doi.org/10.1093/ije/dyx219.
Hubacher D, Trussell J. A definition of modern contraceptive methods. Contraception. 2015;92(5):420-1. https://doi.org/10.1016/j.contraception.2015.08.008.
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(21). https://doi.org/10.1186/1471-2288-3-21.
Rossier C, Bradley SEK, Ross J, Winfrey W. Reassessing Unmet Need for Family Planning in the Postpartum Period. Stud Fam Plann. 2015;46(4):355-67. https://doi.org/10.1111/j.1728-4465.2015.00037.x.
Moniz M, Chang T, Heisler M, Dalton VK. Immediate postpartum long-acting reversible contraception: the time is now. Contraception. 2017;95(4):335-8. https://doi.org/10.1016/j.contraception.2016.11.007.
Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A et al. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health. 2019;7(2):E227-E235. https://doi.org/10.1016/S2214-109X(18)30481-9.
Moreira LR, Ewerling F, Barros AJD, Silveira MF. Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys. Reprod Health. 2019;16(148). https://doi.org/10.1186/s12978-019-0805-7.
Bertoldi AD, Barros FC, Hallal PRC, Mielke GI, Oliveira PD, Maia MFS et al. Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982–2015. Int J Epidemiol. 2019;48(Supplement 1):i4-i15. https://doi.org/10.1093/ije/dyy170.
Silveira MF, Victora CG, Horta BL, Da Silva BGC, Matijasevich A, Barros FC. Low birthweight and preterm birth: Trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol. 2019;48(Supplement 1):i46-i53. https://doi.org/10.1093/ije/dyy106.
Kuroki LM, Allsworth JE, Redding CA, Blume JD, Peipert JF. Is a previous unplanned pregnancy a risk factor for a subsequent unplanned pregnancy? Am J Obstet Gynecol. 2008;199(5):517.e1-517e7. https://doi.org/10.1016/j.ajog.2008.03.049.
Maravilla JC, Betts KS, Couto e Cruz C, Alati R. Factors influencing repeated teenage pregnancy: a review and meta-analysis. American Journal of Obstetrics and Gynecology. 2017;217(5):527-45. https://doi.org/10.1016/j.ajog.2017.04.021.
Santelli J, Rochat R, Hatfield-Timajchy K, Gilbert BC, Curtis K, Cabral R et al. The Measurement and Meaning of Unintended Pregnancy. Perspect Sex Reprod Health. 2003;35(2):94-101. https://doi.org/10.1363/3509403.
Hall JA, Barrett G, Copas A, Stephenson J. London measure of unplanned pregnancy: guidance for its use as an outcome measure. Patient Relat Outcome Meas. 2017;8:43-56. https://doi.org/10.2147/PROM.S122420.
Kennedy KI, Visness CM. Contraceptive efficacy of lactational amenorrhoea. The Lancet. 1992;339(8787):227-30. https://doi.org/10.1016/0140-6736(92)90018-X.
Santos IS, Barros FC, Horta BL, Menezes AMB, Bassani D, Tovo-Rodrigues L et al. Breastfeeding exclusivity and duration: Trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol. 2019;48(Supplement 1):i72–i79. https://doi.org/10.1093/ije/dyy159.
Santos IS, Matijasevich A, Tavares BF, Barros AJD, Botelho IP, Lapolli C et al. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study. Cad Saude Publica. 2007;23(11):2577-88. https://doi.org/10.1590/s0102-311x2007001100005.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Laísa Rodrigues Moreira, Fernanda Ewerling, Andréa Dâmaso Bertoldi, Mariângela Freitas Silveira
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
