Abstract
BackgroundContraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). However, reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. The present study examines the factors associated with method discontinuation, failure and switching among current contraceptive users, with a focus on sub-national assessment.MethodsData for the analysis are drawn from the Brazil Demographic and Health Survey, notably the calendar module of reproductive events. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition after a given duration of contraceptive use.ResultsContraceptive continuation was found to be highest for the contraceptive pill, the most popular reversible method. Probabilities of abandonment while in need of family planning and of switching to another method were highest for injections. Failure, abandonment and switching were each higher among users in the Northeast region compared to the more prosperous Southeast and South.ConclusionFindings point to seemingly important disparities in the availability and quality of family planning and reproductive health care services across regions of the country. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.
Highlights
Contraceptive prevalence is relatively high in Brazil (55% among women of reproductive age)
Brazilian women who wanted to limit their fertility were protected by effective contraception, the total fertility rate (TFR) in 1996 would have stood at 1.8 children per woman – one-third lower than the observed rate [1]
The objective of this paper is to analyze the factors associated with contraceptive discontinuation, failure and switching across regions of Brazil, drawing on data from the 1996 Demographic and Health Survey (DHS)
Summary
Contraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). Reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. Brazilian women who wanted to limit their fertility were protected by effective contraception, the total fertility rate (TFR) in 1996 would have stood at 1.8 children per woman – one-third lower than the observed rate [1] This proportion was about the same as that observed ten years earlier, despite the occurrence of rapid fertility decline (Figure 1). Important differences persist across sub-regions in reproductive health-related behaviours and outcomes
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