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. 2024 Jul 17;10(14):e34833.
doi: 10.1016/j.heliyon.2024.e34833. eCollection 2024 Jul 30.

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity

Fernanda Gontijo Araújo  1 , Gustavo Velasquez-Melendez  1 , Mariana Santos Felisbino-Mendes  1
Affiliations

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity

Fernanda Gontijo Araújo et al. Heliyon. .

Abstract

Objective: To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity.

Methods: Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units.

Results: Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women.

Conclusions: The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies.

Implications for practice: The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

Keywords: Contraception; Family planning; Health inequalities; Multilevel analysis; Parity; Sexual and reproductive health.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Prevalence of contraceptive use in Brazilian States and Federal District stratified by parity, PNS-Brazil, 2013.
Fig. 2
Fig. 2
Graphs of variance residuals, chance of using contraceptives stratified by parity, according to States and Federal District, Brazil, PNS 2013.
See this image and copyright information in PMC

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References

    1. Sully E.A., Biddlecom J.E., Darroch J.E., Riley T., Ashford L.S., Lince-Deroche N., et al. Guttmacher Institute; New York: 2020. Adding it up: Investing in Sexual and Reproductive Health 2019. - DOI
    1. Ewerling F., Victora C.G., Raj A., Coll C.V.N., Hellwig F., Barros A.J.D. Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind? Reprod. Health. 2018 Mar 6;15(1):42. doi: 10.1186/s12978-018-0483-x. PMID: 29510682; PMCID: PMC5840731. - DOI - PMC - PubMed
    1. Sully E.A., Biddlecom A., Darroch J.E. Not all inequalities are equal: differences in coverage across the continuum of reproductive health services. BMJ Glob. Health. 2019;4 doi: 10.1136/bmjgh-2019-001695. - DOI - PMC - PubMed
    1. França G.V., Restrepo-Méndez M.C., Maia M.F., Victora C.G., Barros A.J. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int. J. Equity Health. 2016;15(1):149. doi: 10.1186/s12939-016-0445-2. PMID: 27852276; PMCID: PMC5112713. - DOI - PMC - PubMed
    1. Cavenaghi S.A., Diniz J.E. The everlasting outmoded contraceptive method mix in Brazil and its legacy. Braz. J. Popul. Stud. 2019;36 doi: 10.20947/S0103-3098a0103. - DOI

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