Araújo Fernanda Gontijo, Velasquez-Melendez Gustavo, Felisbino-Mendes Mariana Santos
Graduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, School of Nursing at the Universidade Federal de Minas Gerais, Belo Horizonte, state of Minas Gerais, Brazil.
Heliyon. 2024 Jul 17;10(14):e34833. doi: 10.1016/j.heliyon.2024.e34833. eCollection 2024 Jul 30.
To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity.
Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units.
Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women.
The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies.
The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.
调查个体和背景社会经济因素是否与18至49岁巴西女性的避孕措施使用情况相关，并按生育状况分层。
基于人群的横断面研究，分析了2013年全国健康调查中16879名18至49岁女性的数据。考虑了个体因素，如生育史、获得医疗服务的机会和社会人口学特征；作为背景因素，纳入了人类发展指数（HDI）、社会人口学指数（SDI）、初级卫生保健覆盖率（PHC覆盖率）和月平均收入。估计了多水平逻辑回归模型，按生育状况分层，女性为第1级单位，州和联邦区为第2级单位。
与经产妇和多产妇（88.7%）相比，未产妇使用避孕措施的患病率较低（77.9%），且使用避孕措施的可能性差异更大（组内相关系数分别为2.1和1.1）。生活在HDI、月平均收入和SDI水平较高州的女性更有可能使用避孕措施。较高的PHC覆盖率与经产妇/多产妇使用避孕措施呈正相关，与未产妇呈负相关。此外，高等教育增加了未产妇和经产妇/多产妇使用避孕措施的可能性。
巴西较高的避孕措施覆盖率掩盖了获取方面的重要不平等现象，除个体因素外，还突出了与避孕措施使用相关的背景特征。社会脆弱性较大的未产妇使用避孕措施的患病率和可能性较低，这揭示了公共政策中的不平等现象和优先事项。
强调了改善避孕措施获取机会的必要性，要考虑到女性的个体和背景脆弱性，这意味着要确保及时、有质量地获取避孕方法，特别是对于社会脆弱性较高的年轻未产妇。
