Abstract
BackgroundIn Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months.MethodsThis retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models.ResultsAltogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1–1.8]) and male condom discontinuation (OR = 1.3 [1.0–1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1–1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom.ConclusionFrequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.
Highlights
In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies
We focus our analysis on monthly odds of method discontinuation among women who have used contraception within 12-months period and who remain at risk of unintended pregnancy in order to identify sociodemographic and sexual health characteristics that are related to method discontinuation, which it can contribute increased risk of unintended pregnancy
Contraceptive discontinuation is a frequent event among undergraduate students in Brazil, who mostly rely on short-acting methods for pregnancy prevention
Summary
In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Despite dramatic advances in contraceptive coverage and low unmet need for modern contraception (6%), 55.4% of pregnancies were reported as unintended in Brazil [3], a situation that is comparable to other countries with high contraceptive coverage [4,5,6]. In countries with moderate to high contraceptive prevalence, the majority of unintended pregnancies occur as a result of contraceptive discontinuation (defined as switching a method of contraception, stopping a method altogether, or failures due to inconsistent use) [7,8,9]. Considering all methods, 27.8% of all methods are discontinued for method-related reasons within 12-months in Brazil; 21.6% of women switching their method and 10.3% abandon the method within the first year of use [10]. A study carried out with Brazilian women observed that method switching was more common among married users than their unmarried counterparts, and abandonment was positively associated with the parity, and inversely associated with educational level [10]
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