Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries

Diego Rios-Zertuche,Laura C Blanco,Paola Zúñiga-Brenes,Erin B Palmisano,Danny V Colombara,Ali H Mokdad,Emma Iriarte

doi:10.1016/j.contraception.2017.01.005

Diego Rios-Zertuche, Laura C Blanco + Show 5 more

Open Access

https://doi.org/10.1016/j.contraception.2017.01.005

Copy DOI

Abstract

ObjectiveTo identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico). Study designWe analyzed baseline data of 7049 women of childbearing age (15–49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013). ResultsWomen in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59–0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58–0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39–0.64). Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility (OR 1.64, CI: 1.13–2.36). ConclusionsOur study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities. Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use. ImplicationsWe show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need.

Highlights

Despite generalized efforts to offer universal access, family planning is still among the most inequitable interventions for women in the poorest quintile of women [1]
We examined interactions to test if the effect of visiting a health facility and using contraception was modified by insurance, advice in the health facility, or being indigenous, and to test if being indigenous and using contraception was modified by receiving advice at a health facility or from the community health worker (CHW)
Our study revealed that contraceptive use was substantially lower in the poorest areas compared to national averages

Summary

Introduction

Despite generalized efforts to offer universal access, family planning is still among the most inequitable interventions for women in the poorest quintile of women [1]. Low contraceptive use and high fertility endure among indigenous, poor and rural populations [2,3,4,5,6,7]. These countries are among the most inequitable in the world [8,9] and have the highest levels of extreme poverty in Latin America [10]. Ministries of health need to increase access to and use of effective contraception among the poor, which continues to be a central strategy to reduce maternal mortality [13]

Methods

Results

Conclusion