Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160 - 3rd floor. Centro, Pelotas, 96020-220, Brazil.
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
Reprod Health. 2019 Oct 11;16(1):148. doi: 10.1186/s12978-019-0805-7.
Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women).
We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman's age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones.
On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were "health concerns" and "infrequent sex," but the prevalence of each reason varied substantially across countries. Nonuse due to "opposition from others" was higher among married than unmarried women; in turn, the prevalence of nonuse due to "lack of access" or "lack of knowledge" was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to "lack of access." Pro-rich inequality was detected for reasons "health concerns," "infrequent sex," and "method-related", while the reasons "other opposed," "fatalistic," "lack of access," and "lack of knowledge" were linked to patterns of pro-poor inequality.
Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).
需要避孕的女性不使用避孕方法可能会影响她们的性健康和生殖健康。本研究的目的是描述在避孕需求未得到满足的中低收入国家的女性中，不使用避孕方法的原因（同时考虑到所有国家和不同女性亚组）。
我们使用了来自 47 个国家的最新人口与健康调查数据。对避孕需求未得到满足的有性行为的女性不使用避孕方法的原因进行了描述性分析。还根据婚姻状况、女性年龄和受教育程度、居住地、财富指数和生育次数评估了每种报告原因的流行率。还使用不平等斜率指数评估了每种原因的与财富相关的绝对不平等。富有倾向不平等模式意味着该原因在最富裕的女性中更为普遍，而贫困倾向不平等模式则意味着该原因在最贫困的女性中更为普遍。
平均而言，40.9%有避孕需求的女性未使用任何避孕方法来避免怀孕。总体而言，不使用避孕药具的最常见原因是“健康问题”和“性生活不频繁”，但各国之间的流行率差异很大。由于“他人反对”而不使用避孕药具的已婚女性多于未婚女性；相反，由于“无法获得”或“缺乏知识”而不使用避孕药具的农村地区女性比例约为城市地区的两倍。受教育程度较低的女性更常因“无法获得”而不使用避孕药具。“健康问题”、“性生活不频繁”和“方法相关”等原因存在富有倾向不平等，而“他人反对”、“宿命论”、“无法获得”和“缺乏知识”等原因则与贫困倾向不平等模式有关。
计划生育促进政策必须考虑到每个国家确定的不使用避孕方法的不同原因，以及与育龄妇女有关的背景差异（如社会规范和阻碍妇女获得和使用避孕方法的障碍）。
