Contraceptive discontinuation and non-use in Santarém, Brazilian Amazon

Abstract

In this paper we discuss the causes of non-adherence to reversible contraceptives, especially hormonal methods, among women in rural Santarém in the Brazilian Amazon. The analysis is based on questionnaires with 398 women and visits to health centers. We consider the motives reported by women who: never used contraception; used some method in the past; and who at the time of the survey were using a different method from the ones they used in the past. The results indicate a rejection of hormonal contraception and a preference for female sterilization, an option possibly influenced by the characteristics of health services in the region. The side effects of hormonal contraceptive use reported by part of the interviewees contribute to a generalized fear of the side effects even among women who have never used such methods. To improve women's health services in the Amazon, we recommend further studies of the relationship between reported side effects and available services and prescriptions, as well as an analysis of women's discourse and perceptions.

Acceptability of the combined oral contraceptive pill among Hong Kong women

“…Studies carried out in both developed and developing countries have also shown that the experience of side-effects as well as the fear of side-effects are major reasons for discontinuation. [7][8][9][10] It appeared that fear of side-effects was a unique barrier across different countries and cultures. Minor side-effects such as breast tenderness, fluid retention, nausea, and vomiting were transient and usually subsided after one to two cycles.…”

“…9 At our clinics, women are counselled about the common side-effects and complications of the COC pill. This prevents them from panicking when minor side-effects occur.…”

Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods

“…Answers are then often grouped into large ambiguous categories such as 'health concerns' or 'opposition to use' making it difficult to understand the nuances behind the reasons [14]. There have been several qualitative studies on attitudes towards contraceptive use that cite health concerns as a barrier to contraceptive use and continuation [15][16][17][18], but, similarly to DHS data, the distinction between unsubstantiated fears and the experience of side effects is not systematically articulated. This is problematic because it leads to the assumption that concerns about side-effects are grounded in myths and misconceptions that can be alleviated by counselling and education [5,8,9], disregarding the possibility that side-effects may be intolerable [19].…”

Padrões e determinantes das descontinuidades contraceptivas no uso de pílula oral, hormonal injetável e preservativo masculino

“…Estudos mostraram que, quando o relacionamento se torna mais estável, os casais tendem a trocar o preservativo masculino por um MAC hormonal, uma vez que se estabelece uma confiança maior entre o casal, e a preocupação com as ITS diminui (Bastos et al, 2008;Beltzer et al, 2011;D'Antona et al, 2009;Shih et al, 2011;Goldstein, Upadhyay, Raine, 2013;Mehra et al, 2014). Na França, as usuárias do preservativo masculino interromperam o uso ou trocaram de MAC assim que o relacionamento tornou-se estável (Beltzer et al, 2011).…”

“…No estudo de Gibbs et al (2014), quanto maior a idade, maior a inconsistência no uso do preservativo masculino, o que pode estar interligado com o tipo de relacionamento, já que é mais provável que as mulheres mais velhas estejam em uma união estável do que as mais jovens. Entre as mulheres deste estudo, uma maior proporção de mulheres casadas encontrava-se na faixa etária de 25 a 34 anos de idade (43,7%) em comparação com as de 18 a 24 anos de idade (24,7%) (dado não apresentado), e a estabilidade no relacionamento é elemento importante para descontinuar o uso do preservativo masculino (Bastos et al, 2008;D'Antona et al, 2009;Shih et al, 2011;Goldstein, Upadhyay, Raine, 2013;Mehra et al, 2014;Beltzer et al, 2011). Cabe ressaltar que isso pode estar somado às relações de gênero menos igualitárias, que também influenciam na negociação para usar o preservativo masculino (Gibbs et al, 2014;Mehra et al, 2014).…”