Interrupciones voluntarias de embarazos en un Hospital Universitario de Uruguay: reporte de situación 2019-2020 / Voluntary interruption of pregnancies at the University Hospital of Uruguay: situation report 2019-2020 / Interrupções voluntárias de gravidez no Hospital Universitário de Uruguay: relatório de situação 2019-2020

Objetivo: el objetivo de este estudio es conocer el estado de situación de los procesos de las usuarias que asistieron a la policlínica de interrupción voluntaria del embarazo en el Hospital de Clínicas en un período de agosto de 2019 a agosto de 2020. Metodología y materiales: estudio descriptivo y retrospectivo, a partir de la entrevista clínica de salud mental y una ficha de uso interno utilizada para relevar el proceso de toma de decisión. En muestra de 78 usuarias se analizan variables sociodemográficas, ginecoobstétricas y asociadas al proceso de interrupción, antecedentes psicológicos y/o psiquiátricos y motivos de interrupción. Resultados: el promedio de edad es de 25 años, la mayoría en pareja y ciclo básico educativo finalizado. El promedio de edad gestacional fue de 7,36 semanas. El 81% de las mujeres no había realizado un IVE. Un 65.4% de las mujeres no tienen antecedentes psicológicos y/o psiquiátricos. No existe relación significativa entre haber realizado un IVE previamente y tener antecedentes psicológicos y/o psiquiátricos.Utilizaban anticonceptivos 78.2%. Conclusiones: la interrupción del embarazo supone una situación vital estresante para quienes la transitan, se encuentran atravesadas por múltiples motivos que inciden en la toma de decisión de interrumpir. Se infiere que la realización de uno o más procedimientos de IVE no necesariamente está relacionada con tener un antecedente psicopatológico o cursar una psicopatología al realizar el proceso. Es pertinente promover la atención focalizada en las pacientes, integrando la perspectiva de género y derechos humanos, mejorar los procesos de atención, asesoramiento en salud mental, sexual y reproductiva de las usuarias y sus acompañantes.

Objective: The objective of this study is to know the status of the processes of the users who attended the polyclinic for voluntary termination of pregnancy at the Hospital de Clínicas in a period from August 2019 to August 2020. Methodology and materials: The study used descriptive and retrospective methods based on interviews with mental health professionals and a form that was used to ask about how people make decisions. In a sample of 78 users, sociodemographic, obstetric and gynecological variables associated with the discontinuation process, psychological and/or psychiatric history and reasons for discontinuation were analyzed. Results: The average age is 25 years, most people are married and have finished their elementary education. The average gestational age was 7.36 weeks. 81% of the women had not undergone an IVE. 65.4% of women have no psychological and/or psychiatric history. There is no significant relationship between having previously performed an IVE and having a psychological and/or psychiatric history. 78.2% used contraceptives. Conclusions: The interruption of pregnancy is a stressful life situation for those who go through it; they are faced with multiple reasons that influence the decision to terminate. It is inferred that carrying out one or more IVE procedures is not necessarily related to having a psychopathological history or experiencing psychopathology when carrying out the process. It is pertinent to promote patient-focused care, integrating the gender and human rights perspective, improve care processes, and provide advice on mental, sexual, and reproductive health of users and their companions.

Objetivo: O objetivo deste estudo é conhecer a situação dos processos das usuárias que compareceram à policlínica de interrupção voluntária da gravidez do Hospital de Clínicas no período de agosto de 2019 a agosto de 2020. Metodologia e materiais: estudo descritivo e retrospectivo, baseado na entrevista clínica de saúde mental e em formulário de uso interno utilizado para levantamento do processo de tomada de decisão. Numa amostra de 78 usuárias foram analisadas variáveis ​​sociodemográficas, obstétricas e ginecológicas associadas ao processo de descontinuação, histórico psicológico e/ou psiquiátrico e motivos de descontinuação. Resultados: a idade média é de 25 anos, a maioria vive em casal e completou o ciclo educativo básico. A idade gestacional média foi de 7,36 semanas. 81% das mulheres não realizaram IVE. 65,4% das mulheres não têm antecedentes psicológicos e/ou psiquiátricos. Não há relação significativa entre ter realizado EIV anteriormente e ter antecedentes psicológicos e/ou psiquiátricos, 78,2% faziam uso de anticoncepcional. Conclusões: a interrupção da gravidez é uma situação estressante de vida para quem passa por ela, pois se deparam com múltiplos motivos que influenciam na decisão de interrompê-la. Infere-se que a realização de um ou mais procedimentos de IVE não está necessariamente relacionada a ter histórico psicopatológico, ou vivenciar psicopatologia na realização do processo. É pertinente promover cuidados centrados no paciente, integrando a perspectiva de gênero e direitos humanos, melhorar os processos de cuidados e aconselhamento sobre saúde mental, sexual e reprodutiva dos utentes e dos seus acompanhantes.

Analysis of the impact of COVID-19 pandemic on women ́s care in an abortion situation in Latin America and the Caribbean / Análisis del impacto de la pandemia del COVID-19 en la atención de las mujeres en situación de aborto en América Latina y el Caribe / Análise do impacto da pandemia de COVID-19 sobre a atenção a mulheres em situação de aborto na América Latina e Caribe

Objective: to understand the influence of the COVID-19 pandemic on aspects of quality of care provided to women in abortion situations in sentinel centers of the CLAP MUSA-Network (a multicenter network with international cooperation with the aim of encouraging good practices in Latin America and the Caribbean). Methods: cross-sectional study between January/2017 and December/2021 with women of any age admitted for abortion or miscarriage. We analyzed the total number of cases and the proportion of legal abortions. The dependent variables were complications and use of contraceptives after abortion. The independent variables were COVID-19 pandemic, clinical and sociodemographic data. Statistical analysis was carried out using linear regression, multiple Poisson regression, Cochran-Armitage, chi-square, Mann-Whitney and Cohen tests. Results: we analyzed data from 93689 women assisted in 12 sentinel centers of the CLAP MUSA-Network, 64.55% in the pre-pandemic period (NP) and 35.45% in the pandemic period (PP) (22.73% received post-abortion care and 77.27% legal abortion). We found no differences in the number of cases over the period, regardless of the legal context. We observed a significant increase in the proportion of legal abortions in liberal and moderate contexts. In NP, 46.46% of women underwent medical abortion, while 62.18% of women underwent medical abortion in PP (h-Cohen 0.32). We found no increase in the number of complications during PP. In NP, 79.12% started contraceptives after abortion, while in PP, 70.39% started contraceptives after abortion (h-Cohen 0.20). Conclusion:the COVID-19 pandemic was not associated with a decrease in the number of cases, a decrease in the proportion of legal interruptions, or an increase in complications in sentinel centers of the CLAP MUSA-Network.

Objetivo: compreender a influência da pandemia de COVID-19 nos aspectos da qualidade da assistência prestada às mulheres em situação de abortamento nos centros sentinela da Rede CLAP-MUSA, uma rede multicêntrica com cooperação internacional visando encorajar boas práticas na América Latina e no Caribe. Metodologia: estudo transversal entre janeiro/2017 e dezembro/2021 com mulheres de qualquer idade admitidas por abortamentos espontâneos ou induzidos. Analisamos o número total de casos e a proporção de abortos legais. As variáveis dependentes foram complicações e uso de anticoncepcionais após o aborto. As variáveis independentes foram a pandemia de COVID-19, dados clínicos e sociodemográficos. A análise estatística foi realizada por meio de regressão linear, regressão múltipla de Poisson, testes de Cochran-Armitage, qui-quadrado, Mann-Whitney e Cohen. Resultados: foram analisados dados de 93.689 mulheres, atendidas em 12 centros sentinelas da Rede CLAP-MUSA, 64,55% no período pré-pandêmico (NP) e 35,45% no período pandêmico (PP) (22,73% receberam atendimento pós-aborto e 77,27%,aborto legal). Não encontramos diferenças no número de casos ao longo do período, independentemente do contexto legal. Observamos um aumento significativo na proporção de abortos legais em contextos liberais e moderados. No NP, 46,46% das mulheres realizaram aborto medicamentoso, enquanto 62,18% das mulheres realizaram aborto medicamentoso no PP (h-Cohen 0,32). Não encontramos aumento no número de complicações durante o PP. No NP, 79,12% iniciaram anticoncepcionais após o aborto, enquanto no PP, 70,39% iniciaram anticoncepcionais após o aborto (h-Cohen 0,20). Conclusão: a pandemia de COVID-19 não se associou à diminuição do número de casos, à diminuição da proporção de interrupções legais ou ao aumento de complicações nos centros sentinelas da Rede CLAP-MUSA

Objetivo: comprender la influencia de la pandemia de COVID-19 en aspectos de la calidad de la atención brindada a las mujeres en situación de aborto en los centros centinela de la Red CLAP-MUSA (una red multicéntrica de cooperación internacional con el objetivo de fomentar buenas prácticas en América Latina y el Caribe). Metodología: estudio transversal entre enero/2017 y diciembre/2021 con mujeres de cualquier edad ingresadas para abortos espontáneos o inducidos. Se analizó el número total de casos y la proporción de abortos legales. Las variables dependientes fueron las complicaciones y el uso de anticonceptivos después del aborto. Las variables independientes fueron pandemia de COVID-19, datos clínicos y sociodemográficos. El análisis estadístico se realizó mediante regresión lineal, regresión múltiple de Poisson, pruebas de Cochran-Armitage, chi-cuadrado, Mann-Whitney y Cohen. Resultados: se analizaron datos de 93689 mujeres atendidas en 12 centros centinela de la Red CLAP-MUSA, 64,55% en el período prepandemia (NP) y 35,45% en el período pandemia (PP) (22,73% recibieron atención postaborto y 77,27% aborto legal). No encontramos diferencias en el número de casos durante el período, independientemente del contexto legal. Observamos un aumento significativo en la proporción de abortos legales en contextos liberales y moderados. En NP, el 46,46% de las mujeres se sometieron al aborto con medicamentos, mientras que el 62,18% de las mujeres se sometieron al aborto con medicamentos en PP (h-Cohen 0,32). No encontramos aumento en el número de complicaciones durante el PP. En NP, 79,12% inició anticonceptivos después del aborto, mientras que en PP, 70,39% inició anticonceptivos después del aborto (h-Cohen 0,20). Conclusión:la pandemia de COVID-19 no se asoció con una disminución en el número de casos, una disminución en la proporción de interrupciones legales o un aumento en las complicaciones en los centros centinela de la Red CLAP-MUSA

Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience / Assistência a vítimas de violência sexual em um serviço de referência: Uma experiência de 10 Anos

Abstract Objective To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy. Methods A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages. Results A total of 867medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from10 to 77 years old, most of them selfdeclared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis. Conclusion In the present cohort, the profile of victims of sexual violence was loweducated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.

Resumo Objetivo Avaliar a assistência prestada às mulheres vítimas de violência sexual e seu acompanhamento após o evento traumático, caracterizando o perfil sociodemográfico, antecedentes ginecológicos e circunstâncias do evento, além de relatar a aceitação e os efeitos colaterais da profilaxia para infecções sexualmente transmissíveis (ISTs) e a ocorrência de gravidez resultante da violência sexual. Métodos Estudo de coorte retrospectivo compreendendo o período entre 2007 e 2016. Foram incluídas todas as mulheres em acompanhamento médico e clínico após episódio de violência sexual. Foram excluídos registros de violência doméstica, vítimas do sexo masculino e crianças e adolescentes que relataram atividade sexual consensual. O estudo incluiu estatísticas descritivas, com frequências e percentuais. Resultados Foram revisados 867 prontuários e 444 casos de violência sexual foram incluídos. A faixa etária foi 10 a 77 anos; a maioria das vítimas se autodeclarou branca, com entre 4 e 8 anos de escolaridade, e negou ter um parceiro sexual fixo. A violência sexual ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A maioria foi atendida no serviço de referência em até 72 horas após a violência, possibilitando profilaxias preconizadas. Houve alta aceitação da terapia antirretroviral (TARV), embora metade das usuárias relatasse efeitos colaterais. A soroconversão para o vírus da imunodeficiência humana (HIV, na sigla em inglês) ou para o vírus da hepatite B (HBV, na sigla em inglês) não foi detectada entre as vítimas. Conclusão Nesta coorte, o perfil das vítimas de violência sexual foi de mulheres brancas, de baixa escolaridade, e jovens. O evento traumático ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A assistência nas primeiras 72 horas após a violência sexual permite que o serviço de saúde realize intervenções profiláticas contra ISTs e gravidez indesejada.

Dilemas clínicos en la constitución de la tercera causal de la interrupción voluntaria del embarazo / Clinical dilemmas derived from the need to certify rape for voluntary pregnancy interruption

Since 2017, women in Chile are allowed to interrupt voluntarily a pregnancy on three grounds: 1) When a woman's life is at risk due to the pregnancy, 2) When there are fetal anomalies incompatible with life, or 3) When pregnancy is result of rape. Women who qualify for any of these three pregnancy interruption requirements are entitled to a psychosocial accompaniment program to promote an integrative approach. In this article we will discuss the role of the psychosocial team in cases of rape resulting pregnancy. Specifically, the clinical and ethical dilemmas posed by the need to certify the rape in a general hospital such as difficulties in assessment of the story's plausibility, clinician's dual role and the limits to confidentiality, are discussed.

Intencionalidad del embarazo y cuidados prenatales en Uruguay / Pregnancy intention and antenatal care services in Uruguay / Intencionalidade da gravidez e cuidado pré-natal no Uruguai

Resumen: Introducción: desde hace algunos años el número de embarazos no intencionales en Uruguay ronda el 40%; esta cifra es alta en comparación con otros países que también tienen baja fecundidad y da cuenta de las dificultades de acceso y uso eficaz de métodos anticonceptivos modernos. Además, varios estudios evidencian que los embarazos no intencionales están vinculados con cuidados prenatales insuficientes y peores desempeños de los recién nacidos respecto a los nacimientos resultantes de embarazos intencionales. Objetivo: analizar la asociación entre intencionalidad de los embarazos y los cuidados prenatales en Uruguay a partir del estudio de su incidencia sobre la captación temprana del embarazo y las prácticas no saludables durante la gestación (fumar y tomar alcohol). Método: se consideran los nacimientos no intencionales y a destiempo (no buscados en ese momento) como dos grupos de tratamiento y se comparan con el grupo de nacimientos intencionales. Se examina el efecto neto de la intencionalidad del embarazo sobre las prácticas de salud durante la gestación utilizando técnicas de Propensity Score Matching (PSM). Se utilizan datos provenientes de la Encuesta de Nutrición, Desarrollo Infantil y Salud (ENDIS), un estudio de panel que recoge información desde 2013 de madres con hijos de entre 0 y 3 años en hogares ubicados en localidades urbanas de Uruguay (mayores a 5.000 habitantes). Resultados: antes de realizar el emparejamiento por PSM, las diferencias entre grupos de intención de embarazos fueron significativas para captación temprana y haber fumado, mientras que haber bebido alcohol no se asoció a diferencias significativas entre grupos de intención de los embarazos.

Summary: Introduction: in Uruguay, the number of unintended pregnancies has been around 40% for several years. This is rather a high percentage if compared to other countries who also have low fertility rates and evidences difficulties in access to modern contraceptive methods or using them effectively. Likewise, several studies evidence unintended pregnancies are related to insufficient antenatal care services and worse outcome in the new-borns when compared to births resulting from intentional pregnancies. Objective: to study the relationship between pregnancy intentionality and antenatal care services in Uruguay, based on an analysis of its impact on the early engagement of pregnancies and non-healthy practices during pregnancy (smoking and alcohol consumption). Method: unintended and untimely births (not sought at that time) were included in the study as two treatment groups, and they are compared to the group of intentional births. The net effect of pregnancy intention on health practices during pregnancy was examined using the de Propensity Score Matching (PSM) techniques. We used data delivered by the Nutrition, Child Development and Health Survey, a panel study that has been collecting information from mothers of children between 0 and 3 years old who live in urban localities of Uruguay (with over 5,000 inhabitants) since 2013. Results: Prior to the PSM matching, the differences in early engagement and smoking were significant between pregnancy intention groups, whereas alcohol consumption was not associated to significant differences between pregnancy intention groups.

Resumo: Introdução: há anos, o número de gestações não intencionais no Uruguai gira em torno de 40%; este número é alto em comparação com outros países que também têm baixa fecundidade e explica as dificuldades de acesso e uso de métodos anticoncepcionais modernos. Além disso, diversos estudos mostram que a gravidez não intencional está associada ao pré-natal insuficiente e piores parâmetros do recém-nascido em comparação com o nascimento decorrente da gravidez intencional. Objetivos: analisar a associação entre intencionalidade da gravidez e assistência pré-natal no Uruguai, a partir do estudo de sua incidência na detecção precoce da gravidez e práticas não saudáveis durante a gravidez (tabagismo e etilismo). Método: os nascimentos não intencionais e prematuros (não desejados no momento) são considerados dois grupos de tratamento e comparados com o grupo de partos intencionais. O efeito líquido da intencionalidade da gravidez sobre as práticas de saúde durante a gravidez é examinado usando técnicas de correspondência de pontuação de propensão (PSM). São utilizados os dados da Pesquisa de Nutrição, Desenvolvimento Infantil e Saúde (ENDIS), um estudo de painel que coleta informações desde 2013 de mães com filhos de 0 a 3 anos em domicílios localizados em áreas urbanas do Uruguai (mais de 5.000 habitantes). Resultados: antes de realizar a comparação por PSM, as diferenças entre os grupos de intenção de gravidez foram significativas para recrutamento precoce e tabagismo, enquanto ter bebido álcool não foi associado a diferenças significativas entre os grupos de intenção de gravidez.

Pregnancy in university students / Embarazo en estudiantes universitarias

For the integral formation of college students requires strategies and programs that prepare them completely and committed to motherhood and fatherhood. Education as a preventive mechanism leads to improved family and social communication, and therefore prevents an unwanted pregnancy that could result in school dropouts.

Para la formación de estudiantes universitarios integrales se requiere de estrategias y programas que los preparen de manera completa y comprometida para la maternidad y paternidad. La educación como mecanismo de prevención conlleva a mejorar la comunicación familiar y social, y de esta manera se evita un embarazo no deseado que pudiera tener como consecuencia la deserción escolar.

Características del aborto adolescente en un hospital de Chiclayo, Perú 2018 / Characteristics of adolescent abortion in a hospital in Chiclayo, Perú 2018

Introducción: El embarazo no deseado en un adolescente es un problema social cada vez más frecuente a nivel mundial. Objetivos: Estimar la prevalencia del aborto adolescente en un hospital de Chiclayo, Perú. Material y Métodos: pacientes que ingresen al servicio de ginecoobstetricia por diagnóstico de aborto entre las edades de 14 ­ 19 años en el 2018. Resultados: se encontró un total de 73 menores de 19 años que acudieron por algún tipo de aborto que fue el 14,17% de la población que fue diagnosticada con aborto. Los datos demográficos que provienen las pacientes fueron con una mayor frecuencia de los distritos que predominaron fueron de Chiclayo 50,68%), La Victoria (8,22%) y José Leonardo Ortiz (9,59%). El diagnóstico de ingreso que predominó fue el aborto incompleto (76,71%), seguido de aborto frustro (17,81%). Los tratamientos que se dieron a las pacientes fueron medico (4,11%) y en su mayoría quirúrgico (95,98%), que se dividió en AMEU (42,65%), LU (55,88%) y Cesárea (1,47%) con una media de 1,5 días de estancia hospitalaria. Conclusión: se encontró un 14% de aborto adolescente en un hospital de la ciudad de Chiclayo. (AU)

Introduction: Unwanted pregnancy in adolescents is an increasingly common social problem worldwide. Objectives: estimate the prevalence of adolescent abortion in a hospital in Chiclayo, Peru. Materials and methods: patients admitted to the gynecologyobstetric service for diagnosis of abortion between the ages of 14-19 years in 2018. Results: a total of 73 children under 19 years of age who attended some type of abortion were found. , 17% of the population that was diagnosed with abortion. The demographic data that came from the patients were with a higher frequency of the districts that predominated were from Chiclayo (50.68%), La Victoria (8.22%) and José Leonardo Ortiz (9.59%). The predominant diagnosis of admission was incomplete abortion (76.71%), followed by frustrous abortion (17.81%). The treatments that were given to the patients were medical (4.11%) and mostly surgical (95.98%), which was divided into MVA (42.65%), LU (55.88%) and Caesarean (1, 47%) with an average of 1.5 days of hospital stay. Conclusion: a 14% adolescent abortion was found in a hospital in the city of Chiclayo.(AU)

Postpartum depression among women with unintended pregnancy / Depressão pós-parto entre mulheres com gravidez não pretendida

OBJECTIVE To analyze the association between unintended pregnancy and postpartum depression.METHODS This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis.RESULTS The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97).CONCLUSIONS Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy.

OBJETIVO Analisar a associação entre gravidez não pretendida e depressão pós-parto.MÉTODOS Estudo de coorte prospectivo realizado com 1.121 mulheres grávidas de 18 a 49 anos, acompanhadas no pré-natal pela Estratégia de Saúde da Família, Recife, PE, entre julho de 2005 e dezembro de 2006. Durante a gravidez e após o parto foram entrevistadas, respectivamente, 1.121 e 1.057 mulheres. A gravidez não pretendida foi avaliada durante a primeira entrevista e os sintomas depressivos após o parto foram avaliados utilizando-se a Edinburgh Postnatal Depression Screening Scale. Foram estimados os odds ratios simples e ajustados para a associação estudada, utilizando-se análise de regressão logística.RESULTADOS A frequência de gravidez não pretendida foi de 60,2%; 25,9% apresentaram sintomas depressivos após o parto. Aquelas com gravidez não pretendida tiveram maior chance de apresentar esse desfecho, mesmo após ajuste para variáveis de confundimento (OR = 1,48; IC95% 1,09;2,01). Ao se incluir a variável Self Reporting Questionnaire (SRQ-20), a associação diminuiu, mas manteve-se estatisticamente significativa (OR = 1,42; IC95% 1,03;1,97).CONCLUSÕES Gravidez não pretendida mostrou-se associada a sintomas depressivos após o parto. Isso sugere que valores elevados na Edinburgh Postnatal Depression Screening Scale podem resultar de gravidez não pretendida.

Uso de condón en la primera relación sexual en estudiantes entre 18 y 26 años de una universidad pública / Usage of condoms by public college studentsaged 18-26 during initial act of intercourse / Uso de preservativo na primeira relação sexual entre os estudantes entre 18 e 26 anos de uma universidade pública

Introducción: El conocimiento de las prácticas sexuales en los adultos jóvenes es necesario para ejecutar acciones preventivas enfocadas a la disminución de infecciones de transmisión sexual y embarazos no deseados. Objetivo: Determinar la prevalencia de uso de condón en la primera relación sexual en estudiantes universitarios. Materiales y métodos: Se realizó un estudio descriptivo trasversal con análisis de prevalencias de momios, en estudiantes universitarios entre 18 y 26 años de edad, el tamaño de la muestra fue de 580 participantes. Resultados: Aproximadamente la mitad de los estudiados refirieron haber usado el condón, durante la primera relación sexual; no se encontró asociación entre el género masculino y el uso del preservativo en la primera relación sexual, similar tendencia se encontró con el estrato y la religión. Conclusiones: El porcentaje de personas que usaron preservativo en su primera relación sexual es bajo, ya que los resultados indican que aproximadamente una de cada dos personas se exponen a infecciones de trasmisión sexual y embarazos no deseados, desde el momento en que se inician en la vida sexual activa. [Martínez J, Parada L, Duarte Kl. Uso de condón en la primera relación sexual en estudiantes entre 18 y 26 años de una Universidad Pública.

Introduction: Knowledge of sexual practices in young adults is needed to implement preventive actions aimed at the reduction of sexually transmitted infections and unwanted pregnancies. Objective: To determine the prevalence of condom use at first intercourse among college students. Materials and Methods: A cross-sectional study was conducted in college students aged between 18 to 26 years; the sample size was 580 participants. Results: Approximately half of those surveyed reported having used a condom during the first sexual intercourse; however no association between male gender, social levels or religion was found in this study. When analysing sexual orientation, it was found that heterosexual couples were engaged in this practice. Conclusions: The percentage of people who used a condom at first intercourse is low, since the results indicate that about one in two people are exposed to sexually transmitted infections and unwanted pregnancy, since the time they start their active sexual life. [Martínez J, Parada L, Duarte Kl. Usage of condoms by public college students aged 18-26 during initial act of intercourse.

Introdução: O conhecimento das práticas sexuais nos adultos jovens é necesario para possibilitar a implementação de ações que permitam prevenir e diminuir as infecções de transmição sexual e a gravidez não desejada. Objetivo: Determinar a preferência ao uso de preservativo na primeira relação sexual nos estudantes universitários. Materiais e métodos: O estudo realizado foi descritivo e transversal com análises dos hábitos em estudantes universitários entre 18 e 26 anos, em uma amostra de 580 participantes. Resultados: Aproximadamente a metade dos estudantes usaram preservativo durante a primeira relação sexual; não se encontrou uma relação entre o gênero masculino e o uso do preservativo na primeira relação sexual, de igual maneira se deu com relação à religião e à classe social. O estudo mostrou que heterossexuais mantêm a mesma porcentagem. Conclusões: A porcentagem de pessoas que usam preservativos na primeira relação é baixa, já que os resultados mostram que aproximadamente uma de cada duas pessoas não tem o hábito de usar preservativos, expondo-se a infecções e doenças sexualmente transmissíveis e, também, à gravidez não desejada, desde o momento em que iniciam a vida sexual ativa. [Martínez J, Parada L, Duarte Kl. Uso de preservativo na primeira relação sexual entre os estudantes entre 18 e 26 anos de uma universidade pública.

Causas de abandono, cambio o fallo terapéutico de la anticoncepción hormonal en mujeres universitarias / Causes of dropout, change or therapeutic failure to hormonal contraception in university women

Introducción: los anticonceptivos hormonales son determinantes para el control de la natalidad. Pese a su uso, pueden aparecer embarazos no deseados, asociados al cambio o abandono terapéutico. Las causas de estos eventos deben ser identificadas para su intervención. Objetivo: medir la frecuencia de posibles causas asociadas al cambio y abandono terapéutico, que puedan desencadenar embarazos no deseados en mujeres universitarias entre los 17 y 30 años de edad, que usan o han usado anticonceptivos hormonales como método de planificación familiar. Materiales y métodos: Estudio de corte en mujeres matriculadas en alguno de los programas de la Universidad de Antioquia, que usan o usaron anticonceptivos hormonales como método de planificación familiar. Muestreo no aleatorio estratificado. Se diseñó e implementó una encuesta para recolectar los datos. Se analizó la estadística descriptiva de las variables. Resultados: se incluyeron 353 mujeres (edad promedio de 21,3 años). El 22,5% de las usuarias actuales y el 24,7% de las usuarias en el pasado del método anticonceptivo hormonal lo toman o tomaron por autoprescripción. Aunque la mayoría de ellas recibieron información sobre uso adecuado de la medicación, entre el 26,2 % y el 41,4 %, consideraron que la capacitación fue insuficiente. La causa más importante de abandono de la terapia fue los eventos adversos (48,6 %); de los cuales el dolor de cabeza y aumento de peso fueron los más relevantes. Las condiciones de acceso fueron la segunda causa de abandono terapéutico (23,6 %). Por su parte, el cambio de terapia se atribuyó a los eventos adversos y la incomodidad del uso. En total se reportaron siete fallos terapéuticos (2 %), sin causas destacables. Conclusiones: la alta incidencia de eventos adversos asociados a los anticonceptivos hormonales, puede ser una de las causas más importantes de cambio y abandono de la terapia. Otras causas, en orden de importancia, son la falta de acceso a los medicamentos ...

Hormonal contraceptives are decisive for birth control. Despite the use of these, undesired pregnancies could appear, associated with therapeutic change or dropout. The causes of these events must be measured to plan further interventions. Objectives: To measure the prevalence of possible causes associated with hormonal contraceptive change or dropout that can trigger therapeutic failure in university women between 17 and 30 years old. Women who use or have used some hormonal contraceptive for birth prevent. Materials and methods: A cross-sectional study was made. The target population was women enrolled in any of the programs of the University of Antioquia. Women included in this study use or have used hormonal contraceptives as a method of birth control. A non-randomized and stratified sampling was made. A poll to collect data was designed and implemented. The descriptive statistics of the variables was evaluated. Results: 353 women (average age of 21,3 years) were included. A 22,5 % of current users and 24,7 % of past users, take or took hormonal method for self-prescription. Although most of the women had received information of proper use of medication, between 26.2 % and 41.4 % believed that training was insufficient. The most important cause of dropout of therapy was adverse events (48,6% of total cases). Headache and weight gain were the most relevant. Access and economic issues were the second cause of dropout (23.6 % of total cases). Meanwhile, therapy change was attributed to adverse events and discomfort in use. In total there were 7 pregnancies (2 %) without any remarkable cause. Conclusions: The high incidence of adverse events associated to hormonal contraceptives, may be one of the most important causes of change and dropout therapy. Access problems and economic issues are other causes, in order of importance. With these findings, we can highlight the need for vigilance and education in hormonal contraceptive use.

Factores asociados con la búsqueda del servicio de interrupción legal del embarazo en la Ciudad de México, 2010 / Factors associated with the seeking of legal induced abortion services in Mexico City in 2010

OBJETIVO: Identificar factores asociados con la búsqueda del servicio de interrupción legal del embarazo (ILE) en la Ciudad de México. MATERIAL Y MÉTODOS: Se utilizó un diseño casos-controles. Usuarias del servicio de ILE fueron definidas como casos, y usuarias de control prenatal con 13 o más semanas de gestación con un embarazo no deseado constituyeron los controles. Se ajustaron modelos de regresión logística condicional. RESULTADOS: Los años de escolaridad (RM=1.47, IC:1.04-2.07), la ocupación (estudiante, RM=7.31, IC:1.58-33.95; tener empleo remunerado, RM= 13.43, IC:2.04-88.54) y número de interrupciones de embarazo previas (RM=11.41, IC:1.65-79.07) se asociaron con la búsqueda de ILE. El factor de mayor peso fue la ocupación; las mujeres que trabajan tuvieron 13.4 veces mayor posibilidad de demandar el servicio de ILE. CONCLUSIONES: En el contexto de la Ciudad de México, mujeres con más educación y participación laboral activa utilizan más los servicios de ILE. Se requieren estrategias dirigidas a incrementar el uso de estos servicios por mujeres menos favorecidas.

OBJECTIVE: To identify factors associated with the seeking of the legal-interruption-pregnancy (LIP) services in Mexico City. MATERIALS AND METHODS: We used a case-control design. Users who utilized the LIP were defined as cases, while users of the antenatal care service with gestational age 13 or more weeks and who reported having an unwanted pregnancy were defined as controls. Logistic regressions were fitted to estimate odds ratios. RESULTS: Higher level of education (OR=1.47, 95% CI:1.04-2.07), women's occupation (being student OR=7.31, 95% CI:1.58-33.95; worker OR=13.43, 95% CI:2.04-88.54), and number of previous abortions (OR=11.41, 95% CI:1.65-79.07) were identified as factors associated with the lookup of LIP. CONCLUSIONS: In Mexico City context, empowered women with a higher level of education, or having a work activity are the users of LIP services. Strategies for improving access of women with low empowerment conditions are needed.

Mecanismo de ação da anticoncepção de emergência: [revisão] / Emergency contraception action mechanism: [review]

Introdução: A anticoncepção de emergência (AE) é método contraceptivo reservado para situações especiais em que outros métodos não são utilizados, falham ou não podem ser empregados. Sua inclusão nas políticas públicas de saúde é estratégica para reduzir a incidência da gravidez indesejada e diminuir a ocorrência do abortamento induzido, clandestino e inseguro. Contudo, persistem barreiras contra o método pautadas no desconhecimento de seu mecanismo de ação e na suposição de efeito abortivo. Objetivo: Revisão dos mecanismos de ação demonstráveis da AE, incluindo efeitos para o endométrio e relação com a implantação do blastocisto. Método: Consulta nas bases de dados do Medline, Lilacs, Scielo e JCR-ISL, incluindo artigos indexados publicados entre 1970 e 2011. Resultados: Evidências diretas e indiretas indicam que a AE impede exclusivamente a fecundação por suprimirou postergar a ovulação, e/ou por interferir na migração sustentada e capacitação dos espermatozoides. Não há evidência de efeito para a morfologia ou receptividade do endométrio, ou efeito sobre a nidação do blastocisto. Conclusão: O mecanismo de ação da AE não interfere nos eventos posteriores à fecundação, não impede ou prejudica a nidação e não se associa com a eliminação precoce do embrião.

Introduction: The emergency contraception is a contraceptive method reserved for special situations, where other methods are not used, fail or cannot be applied. Its inclusion into the public health policies has a strategic nature aiming at reducing the incidence of the undesired pregnancy and minimizing the incidence of the induced, illegal and unsafe abortion. However, barriers persist against the method, based on the ignorance about its action mechanism and on the assumption of its abortive effect. Objective: Review of the emergency contraception demonstrable action mechanisms including their impact on the endometrium and their relationship with the blastocyst implantation. Method: Consultation to the Medline, Lilacs, Scielo e JCR-ISL database, including indexed articles published between 1970 and 2011. Results: Direct and indirect evidence indicate that the emergency contraception blocks only the fecundation by suppressing or postponing ovulation, and/or interfere in the sperm capacity and sustained migration. There is no evidence of effect on the morphology or on the endometrium, or of impact on the blastocyst nidation. Conclusion: The emergency contraception action mechanism does not interfere on the post-fecundation events, does not impede or harm nidation and does not associate with the embryo early elimination.

Prevalencia del intento de interrumpir el embarazo y factores asociados en una comunidad urbano marginal de Lima-Perú, 2006 / Prevalence of the attempts to stop pregnancy and associated factors in a marginal suburban comunnity in Lima-Peru, 2006

Objetivos. Estimar la prevalencia y determinar los factores asociados al intento de interrumpir el embarazo en mujeres con antecedente de embarazo. Material y métodos. Se realizó un estudio transversal durante el año 2006. La muestra incluyó a 1057 mujeres con antecedente de embarazo que habitaban en Pamplona Alta, seleccionadas a través del muestreo probabilístico sistemático. Se realizó análisis estadístico descriptivo e inferencial, incluyendo un modelo deregresión logística. Resultados. La prevalencia de la intención de interrumpir su embarazo fue 13,9 por ciento (IC99 por ciento: 11,1- 16,7). Al efectuarse un análisis multivariado, se encontró que los factores asociados fueron: embarazo no deseado (OR=5,7; IC: 1,9-16,7), la falta de atención prenatal (OR=4,7; IC: 1,8-12,2), la prostitución (OR=11,4; IC: 1,5-87,9), tener menos de 20 años (OR=2,9; IC: 1,1-7,9) y tener más de dos parejas (OR=3,3; IC: 1,1-10,2). Conclusiones. La prevalencia estimada del intento de interrumpir el embarazo en mujeres con antecedente de embarazo en una zona urbano marginal de Lima es baja si se compara al estimado nacional de abortos. Los factores asociados al intento de interrumpir el embarazo son: el embarazo no deseado, prostitución, tener menos de 20 años, tener más de dos parejas y la falta de atención prenatal.

Objectives. To estimate the prevalence for the attempts to stop pregnancy among women with history of previouspregnancies, and to determine the factors associated. Material and methods. A cross-sectional study was performed during 2006. Samples included 1057 women with background of pregnancy, living in Pamplona Alta, selected by a systematic random sampling. We applied descriptive and inferential statistics, including a logistic regression model. Results. The prevalence for the attempt to stop pregnancy was 13.9 per cent (99 per cent CI: 11.1-16.7). The factors associated identified by multivariate analysis were: Unwanted pregnancy (OR=5.7; CI: 1.9-16.7), lack of pre-natal care (OR=4.7; CI: 1.8-12.2), prostitution (OR=11.4; CI: 1.5-87.9), age below 20 years (OR=2.9; CI: 1.1-7.9), and having more than two partners (OR=3.3; CI: 1.1-10.2). Conclusions. The estimated prevalence for the attempt to stop pregnancy among women with history of previous pregnancies in a marginal suburban area from Lima was low when compared to the national estimated prevalence of abortion. The associated factors identified for the attempts to stop pregnancy are: unwanted pregnancy, prostitution, age below 20 years, having more than two partners and lack of pre-natal care.

Projeto de lei relativo à interrupção voluntária da gravidez

A instalação da Comissão Tripartite para a revisão da legislação punitiva que trata da interrupção voluntária da gravidez pela Secretaria Especial de Políticas para Mulheres da Presidência da República, em abril de 2005, pela Ministra Nilceia Freire, teve um mérito indiscutível. Pela primeira vez na história do Brasil, um órgão ligado ao Poder Executivo manifestava claramente disposição para colocar a questão do aborto em discussão e promover amplo debate reunindo representantes dos poderes executivo, legislativo e representantes da sociedade civil. O objetivo final era apresentar um projeto de lei que revisse o dispositivo legal vigente em nosso anacrônico Código Penal, que data de 1940. Este só permite a interrupção da gravidez quando não há outro meio de salvar a vida da gestante ou quando a gravidez decorre de estupro

Association between contraceptive discontinuation and pregnancy intentions in Guatemala / Asociación entre la suspensión en el uso de anticonceptivos y las intenciones de embarazo en Guatemala

OBJECTIVES: To determine whether contraceptive discontinuation is associated with pregnancies that are conceived earlier than desired (mistimed) or are not wanted at the time of conception (unwanted). METHODS: Data were obtained from the 2002 Guatemala National Maternal and Child Health Survey. Pregnancies within the three years prior to and at the time of the survey (April 1999-November 2002) were classified as either "intended," "mistimed," or "unwanted." The key independent variable was whether the woman had used contraception within 12 months of the pregnancy and, for those who had used it, the reason for discontinuation (either to get pregnant or for another reason). A multinomial logistic analysis was used to determine the degree of association of discontinuation with pregnancy intentions. RESULTS: One of every five mistimed pregnancies and one of every six unwanted pregnancies followed discontinuations that were for reasons other than to become pregnant (e.g., contraceptive failure, side effects, and health concerns). Discontinuations for reasons other than to become pregnant were shown to be positively and significantly associated with a reported mistimed pregnancy (coefficient = 2.15; standard error = 0.27) or unwanted pregnancy (2.68; 0.37) compared to an intended pregnancy. Pregnancies preceded by discontinuations for reasons other than to become pregnant were also more likely to be reported as mistimed or unwanted than pregnancies of women who were not using contraception during the year prior to pregnancy. CONCLUSIONS: There is a need to increase contraceptive continuation. Any program should include an increased effort to reduce contraceptive failure and better address the side effects and the health concerns that women have that can lead to discontinuation. Non-users who want to delay or limit births should also be identified and targeted for outreach in order to reduce unintended pregnancies.

OBJETIVOS: Determinar si la suspensión del uso de anticonceptivos (SUA) está asociada con embarazos concebidos antes de lo deseado (inoportunos) o no deseados. MÉTODOS: Se usaron los datos de la Encuesta Nacional de Salud Materna e Infantil en Guatemala de 2002. Los embarazos registrados entre los tres años previos a la encuesta (desde abril de 1999) y el final de la misma (noviembre de 2002) se clasificaron como deseados, inoportunos o no deseados. La variable independiente principal fue si la mujer había usado algún anticonceptivo en los 12 meses previos al embarazo y, en ese caso, la razón de la SUA (para lograr un embarazo u otra razón). Mediante el análisis logístico polinominal se determinó el grado de asociación entre la SUA y el tipo de embarazo resultante. RESULTADOS: Uno de cada cinco embarazos inoportunos y uno de cada seis embarazos no deseados sucedieron a la SUA por razones ajenas al deseo de un embarazo (por ejemplo, fallas o efectos secundarios del anticonceptivo, o consideraciones de salud). Se encontró una asociación directa y significativa entre la SUA por razones ajenas al deseo de quedar embarazada y los embarazos clasificados como inoportunos (coeficiente = 2,15; error estándar = 0,27) o no deseados (2,68; 0,37), en contraste con los embarazos deseados. Las mujeres que suspendieron el uso de anticonceptivos por razones ajenas al deseo de un embarazo presentaron una mayor probabilidad de considerar sus embarazos inoportunos o no deseados que las mujeres que no emplearon medios anticonceptivos en el año previo a su embarazo. CONCLUSIONES: Es necesario promover el uso continuado de los anticonceptivos. Los programas deben hacer un mayor esfuerzo para reducir las fallas de los anticonceptivos, informar mejor sobre los efectos secundarios y aclarar las preocupaciones sanitarias que puedan llevar a la SUE. A fin de reducir el número de embarazos no programados, se deben identificar y captar a las mujeres que no usan anticonceptivos y quieren demorar o evitar un embarazo.

Knowledge of likely time of ovulation and contraceptive use in unintended pregnancies.

This investigation analyzed social and demographic characteristics of women having an unwanted or mistimed pregnancy (unintended pregnancies at the current time) in South America. A sample of 5135 women having had a normal non-malformed live-born infant were interviewed immediately postpartum at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations (Spanish acronym: ECLAMC). Half (2568/5135 = 50%) reported that their pregnancies had been unintended, and, of those, 59.3% (1522/2568 = 59.3%) declared that they were trying to avoid conception. The latter group (n = 1522) was the main sample for this study. Patients were asked about their knowledge of when during the menstrual cycle conception is most likely to occur, their biomedical and social characteristics, the type of contraceptive methods used, their opinion of reasons for contraceptive failure, and their reasons for not using contraceptive methods. Among women with unintended pregnancies who attempted to avoid conception, only 61.6% were using contraceptive methods. Reasons given for not using contraceptives included health problems, lack of knowledge and lack of access to contraception. Women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning when during the cycle pregnancy is most likely to occur. Thus, reproductive health policies should be aimed at this target group.

PIP: This study analyzes the social and demographic characteristics of women having an unwanted or unintended pregnancy in South America between 1992 and 1994. The study was conducted among 5135 women who had a normal non-malformed live-born infant and were interviewed at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations. Patients were asked about their knowledge of when conception is most likely to occur during the menstrual cycle, their biomedical and social characteristics, the type of contraceptive methods used, their opinion and reasons for contraceptive failure, and their reasons for failing to use contraceptive methods. Results indicate that 50% of the respondents had unintended pregnancies, and about 59% declared that they were trying to avoid conception. However, among women with unintended pregnancies who attempted to avoid conception, only 61.6% were using contraceptive methods. Reasons for failure to use contraceptives include health problems, lack of knowledge, and lack of access to contraception. Meanwhile, women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning the likelihood that pregnancy will occur during menstrual cycle. This study implies that reproductive health policies should be aimed at this target group.

Adolescent women face triple jeopardy: unwanted pregnancy, HIV / AIDS and unsafe abortion.

PIP: This article reports the risks of unwanted pregnancy and unsafe abortion relative to HIV/AIDS by adolescent women. Data presented at the XI International Conference on AIDS indicated that adolescents aged 15-19 years form the highest risk group for newly acquired HIV infections and also with the highest rate worldwide of unwanted pregnancy. Contributing factors of this high rate includes physical violence and other forms of coercion; an earlier age of sexual initiation for girls than boys; so-called "sexual mixing", wherein young girls may have sex with older men for a variety of cultural and economic reasons; social pressures faced by young girls; the lack of access to formal education including sex education; the lack of access to contraception and reproductive health services; the high-risk sexual behavior of adolescent female partners; and young women's lack of power to negotiate terms of sex with their partners. When faced with an unwanted pregnancy, adolescent women have always found it difficult to obtain appropriate services to meet their needs, including safe abortion care. The AIDS epidemic exacerbates these difficulties and adds new medical, legal and ethical dimensions to the practice of unsafe and illegal abortion procedures that put young women's health and lives in danger.^ieng

Sexual behaviour of young people.

PIP: 20% of the world's population is aged 10-19 years. Annually, almost 15 million young women under age 20 become mothers. However, surveys in developing countries show that 20-60% of the pregnancies and births to women under age 20 are mistimed or unwanted. While later marriage age in many places has provoked a decline in birth rates among young women, levels of sexual relations before marriage are increasing. Such sexual behavior opens sexually active young women to the risks of unwanted pregnancies, unsafe abortion, and sexually transmitted diseases (STDs). Millions of young people become infected with STDs annually. Among all age groups in the US, young women aged 15-19 have the highest incidence of gonorrhea among females and young men aged 15-19 have the second highest incidence among males. At least half of all people infected with HIV are under age 25. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP) completed 9 studies in 1996 on adolescent reproductive health. 14 studies were completed before 1996, and 18 are still underway.^ieng

Messages for teens in Brazil.

PIP: Brazil launched sex education and contraception programs for teens through various methods, including peer counseling and group training, as early as the 1970s. While these programs achieved a great deal, Brazil in recent years has nonetheless witnessed an increase in unwanted teen pregnancy and illegal induced abortion. An estimated 4 million illegal induced abortions are conducted annually in Brazil, more than the country's 3.6 million annual births. An estimated one million induced abortions occur among teenagers annually, a figure which has tripled in two decades. The field of adolescent health education needs to close the awareness gap between teenagers and their parents who often do not know about the sexual activity of their children. Continuous education is needed not only to prevent unwanted pregnancy and abortion, but also sexually transmitted diseases including HIV/AIDS. As for AIDS, recent research identifies it as the major cause of death for women aged 22-35 years and the second major cause of death for men in the same age group. Brazil had 58,595 cumulative cases of AIDS in 1994, with unofficial estimates of up to 1% of the population of Sao Paulo State potentially HIV seropositive. The government and nongovernmental organizations have joined forces to combat AIDS, stressing education for attitudinal change.^ieng

Unintended and unwanted pregnancy in St. Lucia.

Among 200 mothers interviewed in St. Lucia, 82.5% described their pregnancy as unintended and 44% as unwanted; 80% of women having an intended pregnancy and 94.6% having an unintended pregnancy were unmarried and 18.5% were teenagers. Mothers of unintended pregnancies were significantly younger, were of significantly higher parity and had begun sexual relations at a significantly earlier age than mothers of intended pregnancies; and, unlike mothers of planned pregnancies, their desired interpregnancy interval was significantly longer than the actual interval. These results and the sporadic and ineffective use of contraception in St. Lucia emphasize the need for improvements in fertility regulation in that country.

PIP: Between June 13 and July 30, 1993, in St. Lucia, 200 mothers who had just delivered at Victoria Hospital were interviewed so researchers could examine unintended and unwanted pregnancies and their socioeconomic and demographic determinants. 165 pregnancies (82.5%) were unplanned. Unmarried women comprised 96.4% of women having an unintended pregnancy and 80% of those having an intended pregnancy. 18.5% of all pregnancies occurred to teenagers. Women who had completed an unplanned pregnancy were younger than those who had completed a planned pregnancy (20 years, 21.2% vs. 5.7%; p 0.01). Mothers of unintended pregnancies had a significantly higher parity than those of intended pregnancies (parity =or 4, 16.7% vs. 0; p 0.005). The actual interpregnancy interval among mothers of unintended pregnancies was much shorter than the desired interval (p 0.005). Women with unintended pregnancies were significantly younger at age of first intercourse than women with intended pregnancies (p 0.005). 88 of the unintended pregnancies (53.3%) (44% of all pregnancies) were unwanted pregnancies. Among unintended pregnancies, mothers who wanted their pregnancy were more likely than those who did not want their pregnancy to have had at least some post-primary school education (p 0.01) and have a high personal income (p 0.001). 87.9% did not use a consistent family planning method around the time of conception. 28% of women with unintended pregnancies had never used a contraceptive method. The leading reason for not using contraception effectively were carelessness (about 40%) and fear of side effects (26%). These findings suggest the need for a policy aimed to reduce the incidence of unintended pregnancy in St. Lucia. The policy should include counseling on use of contraceptives and the risks associated with unintended and unwanted pregnancy.