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A history of contraception and the inequality of its focus on women

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  • The second most widely used method by women was the oral contraceptive, which was mentioned as the preferred method at some point in their lives or for the future 11;
  • The criterion for exclusion was users who were not of reproductive age;
  • Reprod Health Matters [Internet];
  • The effect of the interaction did not remain after excluding Chiapas.

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  • Only insurance modified the odds of visiting a health facility and contraceptive use;
  • The analysis of these variables did not expressively represent the experiences of the women with contraception;
  • To maintain the reliability of the reports, the interviews were fully transcribed and the resulting data were organised and categorised according to the guiding study question;
  • We calculated population estimates for factors potentially associated with contraceptive use;
  • Birth control pills, used mostly without prescription or monitoring from health professionals, are purchased with their own resources and, despite contraindications, are often used erroneously;
  • Inequalities are particularly noticeable in Mesoamerica, an area encompassing the south of Mexico and Central America.

This article has been cited by other articles in PMC. Abstract Objective To identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Results Women in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility OR 1.

Conclusions Our study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities.

Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use. Implications We show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need. Introduction Despite generalized efforts to offer universal access, family planning is still among the most inequitable interventions for women in the poorest quintile of women [1].

Inequalities are particularly noticeable in Mesoamerica, an area encompassing the south of Mexico and Central America.

Services on Demand

Low contraceptive use and high fertility endure among indigenous, poor and rural populations [2][3][4][5][6][7]. These countries are among the most inequitable in the world [8][9] and have the highest levels of extreme poverty in Latin America [10].

Health systems in Mesoamerica are highly segmented, and while ministries of health serve rural areas, the poor, and the uninsured, funds are unequally distributed among institutions [2][3][4][11][12]. Not everyone has regular access to services.

Ministries of health need to increase access to and use of effective contraception among the poor, which continues to be a central strategy to reduce maternal mortality [13]. We analyze factors associated with modern contraceptive use for women living in the poorest areas of Guatemala, Honduras, Nicaragua, Panama and the State of Chiapas in Mexico.

SDG 5: Achieve gender equality and empower all women and girls

We seek to provide information on contraceptive use to strengthen strategies and programs seeking to reduce the gap of unmet need. Materials and methods 2. Our household survey samples represent the poorest municipalities in five countries: Survey methodology has been explained in detail [15]. In summary, census segments were selected among poor municipalities, with probability proportional to size. Each segment had approximately 150 households, which were censused. A random sample was selected of 30 households with women 15—49 years old or children under five.

A history of contraception and the inequality of its focus on women

Field staff conducted computer-assisted personal interviews in Spanish or in indigenous languages. Our analysis focused on married or partnered women of childbearing age in need of contraception. We obtained informed consent from all informants. Institutional review boards at the University of Washington, data collection agencies and Ministries of Health reviewed and approved the study. Definition of women in need of contraception.

A woman has contraceptive needs if she is 15—49 years old and does not want to become pregnant or wants to postpone pregnancy for at least 2 years [16][17]. Women who became pregnant in the previous 2 years, or were pregnant when surveyed but did not want to get pregnant, are counted as in need.

  • Not everyone has regular access to services;
  • The women were notified of the manner of participation and subsequently signed an informed consent form;
  • Data were collected from January to May 2013.

Women who wanted a child within 2 years of the survey are classified as not in need. Definition of women using contraception Women are considered to be using contraception if they were using a modern contraceptive method at the time of the survey. Knowledge of each method was asked individually, including a description of its use. Women who had not heard of any method or were using only traditional methods such as postpartum amenorrhea, rhythm or withdrawal are classified as nonusers.

We analyzed contraceptive knowledge, most frequently used methods and reasons for nonuse. Women reporting interruptions in the year preceding the survey or not using any method on the day of the interview were asked follow-up questions to identify reasons for interruption or nonuse.

Data analysis We used SMI data to calculate contraceptive prevalence among those in need. We calculated population estimates for factors potentially associated with contraceptive use. Individual and household level characteristics included age, gravidity, fertility, abortions or still births, age at first pregnancy and delivery, and visit to a health facility in the previous 12 months.

  1. And so, apart from the other things everything was normal User 10. The analysis of these variables did not expressively represent the experiences of the women with contraception.
  2. Implications We show that unmet need for contraception is higher among the poorest and describe factors associated with low use.
  3. The male condom is used at the beginning of sexual relationships. The categories were analysed and interpreted in accordance with the studies that address gender, and sexual and reproductive health.

We considered indigenous ethnicity when the head of household reported speaking an indigenous language, or when the census or surveys were conducted in indigenous languages. We created a binary variable for knowledge of fertile period. We also included the woman's employment status employed or paid for work the previous weekyears of education, highest level of education, and health insurance.

Accessibility factors included living more than 30 min away from a health facility and receiving family planning advice at the health facility or from a community health worker. We used multivariate logistic regression to determine factors associated with contraceptive use among women in need.

We selected covariates using backward elimination. We performed the same analysis in our pooled sample and country by country. For the pooled sample, we included country as a fixed effect. We examined interactions to test if the effect of visiting a health facility and using contraception was modified by insurance, advice in the health facility, or being indigenous, and to test if being indigenous and using contraception was modified by receiving advice at a health facility or from the community health worker CHW.

To report interaction effects, we included the ratio of odd ratios and conditional odd ratios [18]. Only insurance modified the odds of visiting a health facility and contraceptive use. We compared our results using education completed and years of education, which did not affect our results. Finally, we excluded Chiapas from the analysis, where most respondents have health insurance, to test the association between contraceptive use and health insurance.

The effect of the interaction did not remain after excluding Chiapas. We analyzed observations with complete data. We used Stata SE 12. Only our final models are shown.

Study population Our pooled sample included 7049 observations see Table 1. Modern contraceptive use varied widely across countries. Nicaragua had the highest coverage 82. The only variable that did not differ significantly between countries was abortions or still births.

In all countries, most women had their first live birth between 15—19 years old. Most women were not employed and did not complete their primary education. The majority of the population in Chiapas, Guatemala and Panama had indigenous ethnicity. Table 1 Characteristics of women in the lowest income quintile in Mesoamerica 2012—2013.