Abstract
BackgroundStudies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. However, few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. This paper assesses whether maternal mortality rates, antenatal care visits, and primary healthcare coverage are associated with pill and condom use among female adolescents in Brazil.MethodsWe used data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national, school-based cross-sectional study conducted in Brazil. A subsample of all female adolescents who had ever had sexual intercourse and were living in one of the 26 State capitals and the Federal District was selected (n = 7415). Multilevel mixed effects logistic regression models were estimated to examine the effect of contextual variables on pill and condom use.ResultsSixty-five percent of female adolescents reported using pill while 21.9% reported using condom during the last sexual intercourse. Adolescents living in municipalities with low maternal mortality and high antenatal care coverage were significantly more likely to use pill during the last sexual intercourse compared to those from municipalities with high maternal mortality and low antenatal care coverage. Primary healthcare coverage (proportion of the population covered by primary healthcare teams) was not significantly associated with either condom or pill use during the last sexual intercourse.ConclusionOur findings suggest that promoting the use of pill among female adolescents may require approaches to strengthen healthcare systems rather than those focused solely on individual attributes.
Highlights
Studies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use
This study presents new insights regarding the association between health indicators and use of contraceptives among female adolescents from cities of a middle-income country with advanced primary health care services but high levels of social inequality [23]
Our findings show individual-level variations in condom use, much of the variation in use among the municipalities remains unexplained, which is inconsistent with findings from other studies which showed that contextual factors, such as gross domestic product, population growth and Human Development Index are correlated with condom use [13, 14]
Summary
Studies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. Few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. Unintended pregnancies among adolescents remain a relevant public health challenge worldwide, especially in low and middle-income countries, where almost half of the pregnancies in individuals aged 15–19 years are estimated to be unintended [1]. (LARCs) because of a misconception that some LARCs are not appropriate for nulliparous women [6] This situation may increase adolescents’ preference for condoms, at least in sporadic relationships, or at the beginning of new ones [7]. Several studies have demonstrated that the use of condoms during the last sexual intercourse differs among regions and countries and ranges from far less than 20% in many African and Latin-American countries [8, 9] to 74% in some European countries [10]
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