Public Health Nursing Department, School of Nursing, University of São Paulo, São Paulo, Brazil.
School of Nursing, University of São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 419, São Paulo, SP, 05403-000, Brazil.
BMC Womens Health. 2021 Aug 19;21(1):307. doi: 10.1186/s12905-021-01447-6.
Studies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. However, few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. This paper assesses whether maternal mortality rates, antenatal care visits, and primary healthcare coverage are associated with pill and condom use among female adolescents in Brazil.
We used data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national, school-based cross-sectional study conducted in Brazil. A subsample of all female adolescents who had ever had sexual intercourse and were living in one of the 26 State capitals and the Federal District was selected (n = 7415). Multilevel mixed effects logistic regression models were estimated to examine the effect of contextual variables on pill and condom use.
Sixty-five percent of female adolescents reported using pill while 21.9% reported using condom during the last sexual intercourse. Adolescents living in municipalities with low maternal mortality and high antenatal care coverage were significantly more likely to use pill during the last sexual intercourse compared to those from municipalities with high maternal mortality and low antenatal care coverage. Primary healthcare coverage (proportion of the population covered by primary healthcare teams) was not significantly associated with either condom or pill use during the last sexual intercourse.
Our findings suggest that promoting the use of pill among female adolescents may require approaches to strengthen healthcare systems rather than those focused solely on individual attributes.
已有研究考察了情境因素对青少年使用避孕药具的影响，发现许多收入和社会不平等指标都与避孕药具的使用有关。然而，很少有研究关注母婴健康指标及其对青少年避孕药具使用的影响。本文评估了孕产妇死亡率、产前护理就诊次数和初级卫生保健覆盖率是否与巴西女性青少年使用避孕药和避孕套有关。
我们使用了巴西全国性学校为基础的横断面研究心血管风险青少年研究（ERICA）的数据。选择了所有有过性行为且居住在 26 个州首府和联邦区之一的女性青少年的一个子样本（n=7415）。使用多水平混合效应逻辑回归模型来检验情境变量对避孕药和避孕套使用的影响。
65%的女性青少年报告在上一次性交中使用了避孕药，而 21.9%的女性青少年报告使用了避孕套。与孕产妇死亡率高和产前护理覆盖率低的城市相比，孕产妇死亡率低和产前护理覆盖率高的城市中，青少年在上一次性交中使用避孕药的可能性显著更高。初级卫生保健覆盖率（初级卫生保健团队覆盖的人口比例）与上一次性交中使用避孕套或避孕药均无显著相关性。
我们的研究结果表明，促进女性青少年使用避孕药可能需要采取措施来加强医疗保健系统，而不仅仅是关注个人属性。
