Assessment of contraceptive use in Puerto Rico during the 2016 Zika virus outbreak.

OBJECTIVES: The objectives of this analysis were to 1) estimate prevalence of contraceptive use among women at risk for unintended pregnancy and 2) identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services in Puerto Rico during the 2016 Zika virus (ZIKV) outbreak. STUDY DESIGN: We conducted a cell-phone survey July-November, 2016. Women aged 18-49 years living in Puerto Rico were eligible. We completed 3059 interviews; the overall response rate was 69.2%. After weighting, the data provide population-based estimates. For this analysis, we included women at risk for unintended pregnancy, and assessed ongoing or potential need for contraceptive services in this group, excluding women using permanent contraceptive methods. RESULTS: Most women reported using contraception (82.8%), and use increased with age. Female sterilization and male condoms were most frequently reported (40.8% and 17.1%, respectively). Among women with ongoing or potential need for contraceptive services, 24.7% talked to a healthcare provider about ZIKV, and 31.2% reported a change in childbearing intentions due to ZIKV. Most women were at least a little worried about getting infected with ZIKV (74.3%) or having a baby with a birth defect (80.9%). Being very worried about getting infected with ZIKV and already having Zika were significantly associated with use of any contraception (adjusted prevalence ratio: 1.19, 95% CI: 1.03-1.38 and 1.32, 95% CI: 1.01-1.72, respectively). CONCLUSIONS: These findings underscore the need for regular contraceptive prevalence studies to inform programs about contraceptive needs, especially during public health emergencies. IMPLICATIONS: When the 2016 Zika virus outbreak began in Puerto Rico there were no recent population-based data available on contraceptive prevalence. To fill this information gap, we conducted a population-based survey. Our findings provided baseline contraceptive prevalence estimates to support response planning and allocation of health resources.

Social inequalities in the use of contraceptives in adult women from Southern Brazil / Desigualdades sociais no uso de contraceptivos em mulheres adultas no Sul do Brasil

ABSTRACT OBJECTIVE: To describe the contraceptive methods used by adult women and the associated socioeconomic and demographic factors. METHODS: Population-based cross-sectional study with 20 to 49-year-old women from São Leopoldo, state of Rio Grande do Sul, in 2015. Three outcomes were considered to analyze the association with demographic and socioeconomic characteristics: use of oral contraceptive pills, tubal ligation and male condom. The crude prevalence ratios, stratified by age, and 95% confidence intervals (95%CI) were obtained using Poisson regression, taking the experimental error into account. RESULTS: A total of 736 women, aged from 20 to 49 years old, were evaluated. The prevalence of the use of oral contraceptive pills, tubal ligation and male condom were respectively 31.8% (95%CI 28.4-35.3), 11.1% (95%CI 9.0-13.6) and 10.9% (95%CI 8.7-13.3). In addition, 10.5% (n = 77) of the women reported making combined use of oral contraceptive pills and condom. In the stratified analysis, younger women with lower education level and from lower social classes reported less use of oral contraceptive pills. Tubal ligation was more prevalent among the lower social classes, but only in the age group from 30 to 39 years old. No differences were found in relation to male condom. CONCLUSIONS: The results indicated that differences persist in relation to contraception, which can be associated with both the difficulties of access to these inputs and the frailty of actions in reproductive health to achieve the needs and preferences of women who are more socially vulnerable.

RESUMO OBJETIVO: Descrever os métodos contraceptivos utilizados e fatores demográficos e socioeconômicos associados em mulheres adultas. MÉTODOS: Estudo transversal de base populacional com mulheres de 20 a 49 anos de São Leopoldo, RS, em 2015. Foram considerados três desfechos para analisar a associação com características demográficas e socioeconômicas: uso de anticoncepcional oral, ligadura tubária e uso de preservativo masculino. Foram obtidas razões de prevalências, brutas e estratificadas por idade, e intervalos de confiança de 95% (IC95%) por meio de regressão de Poisson, levando em conta o erro de delineamento. RESULTADOS: Foram avaliadas 736 mulheres com idades entre 20 e 49 anos. A prevalência de uso de anticoncepcional oral, de ligadura tubária e de uso de preservativo masculino foram, respectivamente, 31,8% (IC95% 28,4-35,3), 11,1% (IC95% 9,0-13,6) e 10,9% (IC95% 8,7-13,3). Além disso, 10,5% (n = 77) das mulheres relataram fazer uso combinado de anticoncepcional oral e preservativo masculino. Na análise estratificada, as mulheres mais jovens, de menor escolaridade e classe econômica mais baixa relataram menor uso de anticoncepcional oral. Já a ligadura tubária foi mais prevalente entre as de classe econômica mais baixa, mas apenas na faixa etária de 30 a 39 anos. Não foram encontradas diferenças quanto ao preservativo masculino. CONCLUSÕES: Os resultados indicaram que ainda persistem diferenças quanto à contracepção, o que pode se relacionar tanto a dificuldades no acesso a esses insumos como a fragilidades das ações em saúde reprodutiva para atingir as necessidades e preferências das mulheres em maior vulnerabilidade social.

Nicaragua 1998: results from the Demographic and Health Survey.

PIP: This article presents summary statistics gathered from the 1998 Nicaragua Demographic and Health Survey (Encuesta Nicaraguense de Demografia y Salud 1998, ENDESA-98). Data from the nationally representative ENDESA-98 were collected from 11,528 households. Interviews were conducted with 13,634 women aged 15-49 years and 2912 men aged 15-59 years between December 1, 1997, and May 31, 1998. The statistics presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, differentials in median age at first birth, postpartum variables, and infant mortality. In addition, statistical data on the health and nutritional status of children were also presented.^ieng

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.

Colombia 1995: results from the Demographic and Health Survey.

PIP: This summary report consists of tables and charts from the 1995 Colombia Demographic and Health Survey. The sample included 11,140 women aged 15-49 years. In 1995, population was an estimated 29.5 million. Life expectancy was 67.7 years. 3.8% had no education, 36.5% had a primary education, and 59.7% had a secondary or higher education. Fertility during 1990-95 was 3 children/woman compared to 2.9 during 1985-90. Fertility ranged from 4.3 in rural areas to 2.5 in urban areas, and from 5.0 among uneducated women to 2.5 among women with a secondary or higher education. The mean ideal number of children ranged from 2.2 among women aged 15-19 years to 3.1 among women aged 45-49 years and from 2.1 among women with no children to 3.9 among women with 6 or more children. 40.9% desired a stop to childbearing. The proportion desiring a stop to childbearing hovered between 50.8% among women with 2 children and 46.5% among women with 6 or more children. 54.4% of births were wanted, 24.4% were wanted later, and 21.1% were unwanted. Contraceptive use stood at 59.3% for modern methods and 12.9% for traditional methods; 67.0% in rural areas and 74.4% in urban areas. The proportion of use ranged from 26.2% among women with no children to 82.5% among women with 3 children. Knowledge of modern and traditional methods was high. 13.0% of never users and 17.7% of previous users did not intend to use. 26.3% of nonusers were sterilized or infecund, 31.9% were menopausal or had hysterectomies, and 9.6% desired more children. 9.7% were nonusers due to infrequent sexual intercourse. 32.2% were single, and 54.7% were in a union. The median age at first birth was 22.1 years. Infant mortality had declined. 1.4% of children were moderately to severely acutely undernourished, and 15.0% were moderately to severely chronically undernourished. 3.5% were severely chronically undernourished.^ieng

[IUDs and oral contraceptives: the most used methods in the world]. / Dispositivos intrauterinos y pildora: usados mas popularmente en el mundo.

PIP: Fertility in developing countries has declined by about 1/3, from an average of 6 children per woman in the 1960s to 4 in 1990. 38% of reproductive-age women in the developing countries excluding China use a family planning method, as do over 70% in developed countries. 81% of contraception in the developing world is provided by the IUD, male or female sterilization, and oral contraceptives (OCs). 25% of couples in the developing world who use contraception use IUDs, 12% use OCs, and 44% use voluntary sterilization. Injectables are used by approximately 12 million women in developing countries, 3% of married women currently using a method. Almost 1/2 sterilized couples are in China and 1/4 in India. Sterilized women outnumber sterilized men by 3 to 1 worldwide, and voluntary female sterilization is the world's most widely used method. Nearly 138 million women of reproductive age have been sterilized. Voluntary female sterilization is less popular in developed countries except the US, where 23% of married women of reproductive age have undergone the procedure. 42 million couples worldwide use vasectomy. Some 120 million married women in developing countries are estimated to have unsatisfied needs for family planning. Each year, over 20 million women are believed to undergo unsafe abortions, and approximately 70,000 die as a result. Each day, nearly 1 million persons are believed to be infected with sexually transmitted diseases. Approximately 19 million persons had been infected by HIV by late 1994.^ieng

[Mobile family planning units]. / Brigadas moviles.

PIP: The family planning organization Profamilia established its mobile clinic program in 1976 with the purpose of reaching remote rural and urban areas with voluntary surgical contraceptive services. The success of the mobile clinical-surgical program depends on surveying the area where the work is to be provided, determining the date of activities to start, providing information and education to motivate the community, selecting the contraceptive method and service, and providing follow-up service after the intervention. Profamilia was founded in September 1965, and 30 years later it provides 70% of family planning services in Colombia. Initially, the mobile programs of Profamilia offered only voluntary surgical contraception for women and men. Clients who were far from a family planning center were reached by the mobile clinic and transported to a nearby center. Since 1992 Profamilia has also begun a mobile program with a wide variety of services: temporary methods of family planning, cervical-uterine cytological tests, gynecological and prenatal consultations, infertility tests, and pregnancy tests. This has allowed the recovery of the costs of the program to increase from 50% when only surgical services were offered to 85% currently. This effort is one of the reasons why Colombia has a contraceptive prevalence rate of 72%, one of the highest in Latin America.^ieng

[Demography and health: a survey for the socioeconomic development of the country]. / Demografia y salud. Una encuesta para el desarrollo socioeconomico del pais.

PIP: The Colombian National Survey of Demography and Health was conducted in 1995 within the third round of world Demographic and Health Surveys. This survey was realized with the participation of 10,112 households containing 11,140 individuals in 5 regions of the country. It showed that 99.6% of women in Columbia were familiar with family planning methods and 72% of married women or those living in consensual union used contraceptives, especially those who were more educated and lived in urban areas. 58% of uneducated women used contraceptives vs. 77% of those who had higher education. Uneducated women preferred sterilization, while better educated women preferred IUDs and the condom. The Colombian women thought that the ideal number of children was 2 or 3 vs. a real fertility rate of 3. In Colombia there has been a significant decline of fertility since the 1960s. According to the 1995 National Demographic Survey (ENDS-95) fertility had declined by 23% in the previous 5 years and by 14% in the previous 10 years. In the Pacific region of the country the total fertility rate stayed high at 5, while in the large cities like Bogota, Medellin, and Cali the average number of children was 2.5. 17% of girls 15-19 years old were either mothers or pregnant with their first child. 9% of girls 19 years old had at least 2 children. With regard to sex behavior, 1 of every 5 rural women and 6% of those in urban areas did not know how to avoid HIV infection. 82% of women did not change their sex behavior after having learned about AIDS; 5% demanded to know the sex history of their partners; and 3% decided not to have sexual relations. Regarding sexual violence, 72% of the women said that verbal abuse is also violence. 26% of adolescent girls had been sexually abused by a relative, half of them by stepfathers, in a country where second and third unions are increasingly frequent. Among women who were victims of violence, the percentage who complained to the authorities increased from 11% to 27% between 1990 and 1995.^ieng

Unmet need for family planning in Jamaica.

This study updates and extends estimates for unmet need and total demand for family planning for Jamaican women in the reproductive age group, 15-49. The findings suggest that, as yet unmet need for family planning was 22.7%, compared to 16% previously estimated.

PIP: This paper updated and extended the unmet need for family planning services assessment for Jamaican women made by McFarlane and Warren (1989), and related this need to differences in background and socioeconomic characteristics. The data came from the 1989 Jamaican Contraceptive Prevalence Survey collected between June 1988 and November 1989. These analyses were restricted to 4451 women of reproductive age (15-49) if they had a common law or visiting partner relationship. Of the total sample, only 17% of women were legally married and living with their husband, compared to 23% in common law unions and 28% in visiting unions. While most women were not using a method to space births (8.4%) there was also a considerable proportion of women (3.8%) who were not using a method of contraception to delay the first pregnancy. Nearly one-third of spacers were delayers. Younger women had the greatest unmet need for family planning services to delay the first birth. Women with primary and secondary levels of education demonstrated high unmet need for family planning. Unmet need was slightly higher among urban than rural women, and the unmet need to delay was greatest among urban women. Women in visiting unions demonstrated a greater unmet need compared to women who were married and those who were in common law relationships. In addition, the greatest unmet need for the entire sample by parity was among women with 1 child (29.3%). Delayers were younger (83.2% aged 15-24 vs. 45.6% for spacers), better educated (82.0% with more than primary education vs. 66.8% for spacers), and more likely to be urban dwellers (39.5% vs. 31.6% for spacers). A slightly greater proportion of delayers was living in common law and visiting unions than spacers (92.8% and 86.6%, respectively). In all, 22.7% of women aged 15-49 who were in union and who were pregnant or amenorrheic as a result of an unintentional pregnancy had an unmet need for family planning compared to 16% previously estimated.

[Family planning. Regional differences in contraceptive practice]. / Planificacion familiar. Diferencias regionales en la practica anticonceptiva.

PIP: Great efforts have been made to measure contraceptive prevalence in Mexico and to assess various aspects of differential usage. At present, 63.1% of fertile aged women in union are estimated to use a method. State prevalence rates ranged from 77.2% of couples in Baja California Sub to 46.3% in Oaxaca. In general, northern states and Mexico City had the highest prevalence rates and states in the center and south had the lowest. Results of the 1988 Survey of Determinants of Contraceptive Prevalence permit identification of sociocultural variables related to contraceptive usage. The data show that residents of the northwestern states have a considerably higher educational level and proportion urban than do those of the center or southeast. The southeast lagged the center in indicators of household characteristics and services, income, and infant mortality, and also had a higher rate of female labor force participation. The states of the center had a lower rate of contraceptive usage at 54.8% than did those of the southeast at 56.4%. The rate for the northwest states was 71.8%. Knowledge of contraceptive methods in the northwest and center was nearly universal, but almost one-fourth of rural women in the southeast reported not knowing a method. Reasons for not using a method varied in the three regions. Problems of access, lack of knowledge, and fear of side effects were the principal factors in the southeast. Opposition of the woman or spouse or religious beliefs were the main factors in the center. No significant barriers of culture or access were identified in the northwest. The average ideal family size was around 3.5 children in all three regions. The survey results demonstrate that having children was highly valued in all three regions. Children were more highly valued in the southeast for companionship, aid, and economic contribution; in the center as sources of affective relations; and in the northwest for satisfaction or personal fulfillment of the woman.^ieng

Measuring university student satisfaction with a campus family planning clinic in Costa Rica.

Family planning clinics for university students play a valuable role in promoting health. This research project, a pilot study among women students who sought family planning services through a Costa Rican university clinic, introduced student evaluation of the family planning clinic, documented services provided in family planning visits, and identified issues for further study. Aged 18-33 years, the 53 respondents (a convenient sample) who completed a self-administered questionnaire were mostly (64%) single; all were sexually active; and 78% wished to have children (or more children) some day. Though all were sexually active at the time of their visit, only 62% were currently using contraception, and fewer than half of these were using effective methods. Nearly all students (96%) reported they learned new information during their appointment, and many received screening tests and examinations. Respondents rated their satisfaction with aspects of clinic service as high, citing the clinic's low visibility on campus as the most important area for improvement. All of the students said they would definitely return (85%) or would consider returning (15%). The results support the continuance of such a clinic on the campus, as well as of the practice of student evaluation. This collaborative study demonstrated areas for future research and stimulated interest in the university clinic as a research setting.

PIP: In Costa Rica, a nurse researcher or a nurse clinician interviewed 53 female students aged 18-33 at the family planning clinic at the Universidad Nacional Heredia. This 6-month, descriptive pilot study aimed to learn what services are covered during family planning visits, the students' evaluation of the clinic, and their demographic characteristics. 36% of the students were either married or in a consensual union. Just 25% of the women had children. 78% of the students wanted to be mothers (mean ideal family size = 1.8). All the women were sexually active, yet only 26% had previously sought family planning advice. 62% currently used birth control. 62% of family planning users used natural family planning methods or barrier methods. Referral by a health provider was more common than referral by a friend (17% vs. 7.3%). 34% of all students had used other services in the student health department. The most common services covered during family planning visits were pelvic exam (59%) and contraceptive information (51%). Other relatively common services were sexuality counseling (26%), breast exam (24%), and blood pressure check (23%). 96% of the students received new information mainly on contraceptive methods (65%), breast self-examination (39%), and sexuality education (35%). The students were satisfied with all clinic services (3.9-4.9, with 5 equaling very satisfied), especially, with the opportunity to ask questions, counseling provided, and advice given by clinicians. 22% of the students wanted greater clinic outreach, especially about family planning. 85% said that they would definitely return to the university clinic. 91% would recommend it to a friend wanting family planning advice. The field of family planning needs of and services to university students is an open field for nurse researchers.

New family planning center serves 60,000 Nicaraguans.

PIP: In Nicaragua, the recently opened Regional Family Planning (FP) Center in the capital of Chontales Province provides a variety of FP services to the 60,000 citizens of Juigalpa. These services include counseling, laboratory exams, gynecologic exams, and voluntary sterilization. the Asociacion Pro Bienestar de la Familia Nicaraguense (PROFAMILIA) opened the center, since FP services have been neglected in this province as compared to access to these services in the large population centers of Managua and Leon. A recent contraceptive prevalence survey shows that contraceptive prevalence in urban areas of Nicaragua is 62%, while it is just between 13-15% in rural regions, like Chontales and Zelaya. The center will also run a community distribution program for Chontales. As of May 1993, it had 25 community distribution posts in the region, providing contraceptives and training volunteers. PROFAMILIA hopes to open another regional center in Chinandega in the western part of Nicaragua in 1993. It plans on opening a central clinic in Grenada, the third largest city, to serve 120,000 people from Grenada and the small communities surrounding Grenada.^ieng

Contraceptive use and sterilization among Puerto Rican women.

A comparison of contraceptive use in the early to mid-1980s among married Puerto Rican women aged 15-49 in the New York City area reveals that island-born Puerto Rican women living in New York rely on female sterilization to nearly the same extent as do women living in Puerto Rico (45% and 41%, respectively) and that mainland-born Puerto Rican women use sterilization as much as do all women in the United States (19% for both groups). Puerto Rican women in New York use reversible methods to a greater extent than do women in Puerto Rico (22% v. 16%), but to a lesser extent than do all women in the United States (37%). Although mainland-born Puerto Rican women in New York use reversible methods more than do island-born women in New York (42% v. 23%), they tend not to adopt these methods to the same extent as do all U.S. women during the early reproductive years, when education and employment are critical to socioeconomic attainment.

PIP: Researchers compared data from 1985 on 1998 15-49 year old Puerto Rican women living in the greater New York City area with data from 1982 on 3174 15-49 year old women living in Puerto Rico and with data from 1982 on 7969 15-44 year old women living in the US to examine their contraceptive practices. Women who were born in Puerto Rico and later lived in New York City had almost the same sterilization rate as those women still living in Puerto Rico (44.7% vs. 40.5%). On the other hand, about the same proportion of Puerto Rican women born and raised in New York City used reversible methods (42.1%), especially oral contraceptives (18.5%) and the IUD (11%). Only 18.5% of the US-born Puerto Rican women had undergone female sterilization which basically equalled that for all US women (18.7%). A higher proportion of Puerto Ricans in New York City used reversible methods than did those in Puerto Rico (21.7% vs. 15.7%), but not as high a proportion as all US women (36.8%). US-born Puerto Ricans did not accept reversible methods as early in the reproductive years as did all US women (42.2% vs. 58.4% for 15-24 year olds). Puerto Rican women, regardless of residence or place of birth, reported fewer male sterilizations and less condom use by their partners than all US women (0% male sterilizations for all Puerto Rican women in New York City, 4.6% for those in Puerto Rico vs. 10.8% and 2.8% of partners using condoms for island-born Puerto Ricans, 5.1% for US-born Puerto Ricans, and 4.4% for those in Puerto Rico vs. 9.8%). These findings on partner responsibility for contraception may reflect the cultural definition of women as rearers of children. The researchers hoped that the results of this descriptive study would motivate others to conduct further research to determine socioeconomic correlates of contraceptive practice and cultural and religious variables.

[The impact of family planning on reproductive health]. / El impacto de la planificacion familiar sobre la salud reproductiva.

PIP: Until relatively recently, sheer survival has been a more pressing concern of most human populations than has control of population growth through contraception. Today family planning with its varied technologies has become an accepted behavior of the majority of fertile couples. Colombia has achieved a satisfactory contraceptive prevalence rate largely due to private institutions. The decline from 6.5 to 3.5 children per woman that required 58 years in the US (1842-1900) required just 15 years in Colombia, according to UN data. Other UN publications demonstrate that family planning prevalence is strongly correlated with quality of life as measured by income, life expectancy, and education, with family planning and quality of life tending to improve simultaneously and coherently. Reproductive health might more appropriately be considered sexual health, since most couples wish to continue sexual relations without fear of unwanted pregnancy. Reproductive health defined as referring to fertile-aged women and children under 15 concerns around 2/3 of the population in developing countries. Although the reproductive health of a country depends in large measure on the physical and mental well-being of its women, discrimination against women in education health, employment, and participation is a serious problem in many countries. Accessibility of family planning is another indicator of women's status. The potential health benefits of avoiding births before age 20 and after 35, high parity births, and closely spaced births are well known. Avoiding all such births would reduce maternal mortality by 20-25% worldwide, saving 100,.000-125,000 maternal lives. Proper spacing would also combat infant mortality. Infant survival programs that omit family planning as a component are short sighted. Family planning has the important benefits of reducing recourse to abortion and of allowing savings in public services including health care, education, and nutrition. In the area of family planning, Colombia's PROFAMILIA continues to prefer a cafeteria approach in which numerous contraceptive options are available. It has been demonstrated that each new method increases the number of acceptors by 6% on average. The especially for women who want to terminate childbearing. Morbidity and mortality rates of the different contraceptive methods, even in the worst conditions, are lower than they would be if contraception were not used. Oral contraceptives, for example, are 4-5 times less risky than nonuse of contraception. PROFAMILIA is currently seeking authorization to use a new combined monthly injectable contraceptive called Cyclofem. The subdermal implant NORPLANT has been well accepted in Colombia.^ieng

[Changes in the contraceptive method mix during fertility decline: Latin America and the Caribbean]. / Cambios en la combinacion de metodos anticonceptivos durante la transicion de la fecundidad: America Latina y el Caribe.

"This paper reviews survey-based data regarding contraceptive prevalence and methods employed in Latin America and the Caribbean, with an emphasis on changes in the mix of methods over time. The most striking recent trend is the rise in use of female sterilization.... By contrast, use of male sterilization remains negligible in most countries. The oral contraceptive pill is by far the most popular of the temporary methods, though its prevalence has more often declined than increased in recent years. Together female sterilization and the pill make up around [two-thirds] of contraceptive practice in Latin America and the Caribbean." (SUMMARY IN ENG)

Birth control and free choice in Brazil.

PIP: The high sterilization rates in Brazil infringe upon reproductive rights as human rights of women in view of the availability of contraceptives. Currently, 2/3 of married women between the ages of 15 and 44 years use contraception in Brazil. Age is a factor: according to 1986 information, 5.5% of the women had undergone a sterilization operation before reaching the age of 25, and 19.5% had done so before reaching 30 years of age. This means that 1 out of 5 Brazilian women have permanently lost the capacity of reproduction at 29 years of age. On the other hand, in 1986, 13% of the women between 35 and 39 years old and 11% of women aged 40-44 were using oral contraceptives (OCs). In a study of the University of Campinas, Sao Paulo, made public by the National Council of Women's Rights of Brazil in 1989, 50% of those women had some kind of contraindication against OCs, and 27% of them had definite contraindication against OC use. Another study has indicated that 3 years after having been sterilized, 50% of 25-year old women interviewed would have like to reverse the operation. Only 12% of Brazilian women acceptors use natural contraceptive methods compared with 61% in developed countries. In 1986, .9% used the IUD and only .5% used the diaphragm. 7 million Brazilian women are sterilized. In the 1960s, women of reproductive age has an average of 6.4 children, now women have 2.3 children. Regional sterilization rates are particularly high: 79.8% in Maranhao, 74.7% in Goias, 64.3% in Alagoas, and 64.1% in Pernambuco. The maternal mortality rate is 1/6366 in Brazil as compared with 1/9580 in European countries. According to WHO data 34,000 women died during pregnancy or within 42 days after delivery in Brazil in 1989, while in developed countries 6000 women died.^ieng

Impact of social marketing on contraceptive prevalence and cost in Honduras.

In 1984, the Honduran Family Planning Association launched a contraceptive social marketing program by introducing the oral contraceptive, Perla. This report examines the impact of the program on overall oral contraceptive use, use by particular subgroups, source of supply, and costs. Although use of oral contraceptives increased only slightly over the period 1984-87 (from 12.7 percent to 13.4 percent among women in union aged 15-44), the social marketing program significantly increased its share of the oral contraceptive market (from 7 percent in 1984 to 15 percent in 1987, and from 20 percent to 40 percent of sales at pharmacies). For the Honduran Family Planning Association to have realized cost savings as a result of clients switching from community-based distribution programs and commercial supply sources to contraceptive social marketing programs, the association would have had to reallocate its resources. Instead, the number of distributors in the community-based distribution program increased, while the amount of couple-years of protection from oral contraceptives decreased.

PIP: Researchers used data from 2 national surveys of maternal-child health and family planning (1984 and 1987) and from a 1989 study of economic costs by method and program to examine the impact of the contraceptive social marketing program of the Honduran Family Planning Association (ASHONPLAFA). ASHONPLAFA launched the program in 1984 by introducing the oral contraceptive (OC) Perla. Between 1984 and 1987, OC use increased minimally (12.7-13.4% among 15-44 year old women in union), yet the contraceptive social marketing program increased its share of the OC market (7-15% overall, 20-40% at pharmacies). The analysis showed that costs to ASHONPLAFA would fall if more women bought OCs from the contraceptive social marketing program instead of the community- based distribution (CBD) program, and if the resources earmarked to the CBD program in urban areas decreased. Yet, the number of distributors in the CBD program in urban areas actually increased, so ASHONPLAFA did not achieve cost savings. Further, the amount of couple-years of protection from OCs fell. The findings showed that market forces did not work and may not do so in like programs, where profit is not a goal and managers are not held accountable for cost increases. They also indicate that, in urban areas, the contraceptive social marketing program can serve more clients and the CBD program can be cut back. Further research is needed to examine whether and by how much ASHONPLAFA could reduce the CBD program without losing clients.

IPPF Brazil program confronts sterilization accusations.

PIP: Even though Brazil's BEMFAM program stopped providing sterilization services over a year ago, many sources hostile to BEMFAM in the Brazilian government are still accusing it of misconduct. BEMFAM is sponsored by the International Federation of PLANNED Parenthood and was investigated and cleared of any wrong doing by the Brazilian government. In Brazil it is against the law to perform sterilization for the purposes of birth control, yet it is estimated that there are between 6-20 million such operations each year. Over 65% of the births in Brazil are by Caesarian section and it is common for women to ask their doctors to perform a tubal ligation at the same time. Abortion is illegal in Brazil, but there are an estimated 1.4-2.4 million abortions each year. 56% of Brazilian women use contraceptives, with 90% using either the pill or illegal sterilization. 90% of those who use the pill obtain it over the counter at pharmacies with inadequate knowledge on how to use it. 80% of the people receive their health care from the Brazilian government.^ieng

[Family planning among lower status women in Rio de Janeiro city]. / Planejamento familiar em mulheres de baixa renda no Municipio do Rio de Janeiro.

PIP: The National School of Public Health aided by WHO conducted a survey between 1984 and 1985 in 7 communities of Rio de Janeiro, Brazil, enlisting 1900 women aged 15-49 from 2019 households selected. 1783 were interviewed, yielding a response rate of 92%. 538 (30%) women were single, 7.2% of who had no sexual experience. 4.5% of the sample were widowed, divorced, or separated. Their familiarity with contraceptives was as follows: oral contraceptives, (OCs) 99.7%; female sterilization and the condom, 90%; coitus interruptus and vasectomy; 33%; the diaphragm, 27%; and natural methods; 22%. 83% of the women used OCs; less than 20% used the condom, coitus interruptus, or spermicides; and 5% had used the IUD. 8% of those 40 decided on tubal sterilization. 67% of the women in sexual unions used contraceptives vs. 35% of single women with sexual activity. Nonuse increased after age 35, while more than 50% of women 20 did not use contraceptives. Half of the sterilized women underwent the procedure before age 30 when they had 4 children. 66% of ligations were done during birth, and accompanied 63% Cesarean section. Only 28 of sterilizations were done by laparoscopy on another occasion. Misinformation about sterilization was rife, as 15% of sterilized women states that they wanted to bear a child in the future, and 11% thought that they could get pregnant. 42% of women aged 35 and over were sterilized by laparoscopy. In hospitals and clinics the average sterilized woman was 29.4 years old and had 3.5 children. Contraceptive prevalence was higher than the national average, it was comparable to the level in countries that have traditionally low fertility. The fact that OCs, the pill, and tubal ligation made up the predominant pattern of contraceptive use is the result of the inability of the health care system to provide an integrated family planning program with education about and provision of contraceptives.^ieng

Early sexual experience and traditional values in Colombia.

PIP: Results on adolescent's knowledge, attitude, and practice in sexuality and reproductive health are presented from 2 surveys of 1199 middle-class youths aged 13-18 years in main cities of Colombia. Survey populations were selected from high schools and users of Family Compensation Fund. While traditional values and customs prevail among these youths, they nonetheless tend to begin sex between ages 15-18, and have little concern over the consequences of their sexual behavior. They are, moreover, quite ignorant about reproductive health. Sexuality is not thought of as part of marriage, women are expected to be virgins at marriage, and a resounding 87% of the study population rejected abortion legislation. 90% of the young men had their 1st sexual encounter with either a prostitute or domestic servant, while 90% of the young women had their 1st encounters with friends from within their social groups. Sexual relations from adolescence on were supported by 35% of the girls and 60% of the boys, 72% of the girls and 38% of the boys supported virginity, yet less than 10% were in favor of the notion of open relationships. 20% of the girls and 25% of the boys had active sex lives, with homosexuality representing 1.6% and 3.1% of the two sex groupings, respectively. Sex education is practically non-existent. Most young women know little of contraception, and fail to use it out of misconceptions regarding method safety, and fear of one's parents finding out. The young men, on the other hand, cite forgetfulness and inability to obtain contraception as reasons for use failure. Accordingly, 5% of the girls fell pregnant between ages 15-17, with 66% ending in abortion, and 18.6% of the girls and 12.3% of the boys admitted to having had a sexually transmitted disease. 55% indicated that they would not use contraceptives.^ieng