Hellwig Franciele, Barros Aluisio Jd
International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
Postgraduation Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
Gates Open Res. 2023 Jan 20;6:59. doi: 10.12688/gatesopenres.13570.3. eCollection 2022.
Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced an important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recent years, especially among women from the more disadvantaged groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most disadvantaged in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.
背景 普遍获得计划生育服务是一项公认的人权，多个国家和组织都致力于实现这一目标。我们的目标是确定在过去40年中提高了计划生育覆盖率的国家，并调查促成这些进展的背景情况。 方法 分析基于自1986年以来在埃及、埃塞俄比亚、卢旺达、阿富汗、巴西和厄瓜多尔进行的公开可用的国家卫生调查数据，这些国家是根据先前的证据选定的。我们估计了每个国家对现代方法满足的计划生育需求（mDFPS），并探讨了在财富、妇女教育和妇女年龄方面的不平等情况。我们还探讨了在妇女赋权、生活在极端贫困中的人口百分比以及每种避孕方法的份额方面的背景差异。为了更好地理解政治和社会文化背景，基于文献综述纳入了国家案例研究。 结果 在选定的国家中，mDFPS的增长模式各不相同。目前mDFPS的覆盖率在巴西为94%，在阿富汗为38%之间。所有国家在性别不平等和极端贫困方面都有了显著减少。根据每种避孕方法的份额，大多数国家使用短效可逆方法的比例较高。例外情况是厄瓜多尔，其最常用的方法是绝育，以及埃及，其长效可逆方法的使用比例较高。在分析的最初几年，所有国家在覆盖率方面根据财富、妇女教育和妇女年龄都存在巨大差距。近年来，所有国家都成功提高了覆盖率，尤其是在处境较为不利群体的妇女中。 结论 计划生育覆盖率随着贫困和性别不平等的减少而提高，近年来最弱势群体的覆盖率大幅增加。涉及初级卫生保健服务、提供各种方法以及对卫生保健提供者进行高质量培训的政策对于提高覆盖率至关重要。
