Contraceptive use and fertility in the Republic of Panama.

Panama has a high prevalence of contraception, with surgical sterilization being the dominant method. Use of contraception is fairly high even in rural areas. Seventy-one percent of users named a public sector source for their contraception. High use of contraception is part of an overall program of public sector maternal and child health services that also shows substantial penetration of rural areas. The high reliance on public sector sources in panama distinguishes it from other Latin American populations with comparable levels of contraceptive use, such as Sao Paulo state, Brazil, and Costa Rica. These populations also differ in that oral contraceptives are the most prevalent method of contraception. The survey results indicate that the risk of unplanned pregnancy is greatest for unemployed married women who have children. It is particularly important to expand program coverage in rural areas, where two-thirds of those at risk of unplanned pregnancies reside; risk of an unplanned pregnancy for rural women is more than twice that for urban women. While unmarried teenage women do not appear to constitute an important group by this definition, there are other compelling reasons, some supported by other results of the survey, for a special effort oriented toward teenagers. The experience of Panama may be unique in many ways. It shows that an integrated MCH-FP public sector program can meet a high demand for surgical contraception and achieve a fairly high level of contraceptive use. Finally, the results illustrate the value of periodic surveys to gauge the impact of public health programs by monitoring trends in contraceptive use, fertility, breastfeeding, and other aspects of reproductive health.