Alcohol misuse among women in Brazil: recent trends and associations with unprotected sex, early pregnancy, and abortion

Abstract

Objective:This study compared the rates of binge drinking (BD) and alcohol use disorder (AUD) reported for 2006 with those reported for 2012, exploring their associations with unprotected sex, early pregnancy, and abortion in a representative sample of women in Brazilian households.Methods:This was a descriptive analysis of data from a cross-sectional study involving randomized multistage cluster sampling of the population ≥ 14 years of age. Weighted prevalence rates and odds ratios were estimated, and serial mediation analysis was performed.Results:A total of 4,256 women were analyzed. The BD prevalence was 35.1% and 47.1% in 2006 and 2012, respectively, a significant increase, especially among women 40-59 years of age. There was no significant difference in AUD prevalence. BD (without AUD) was found to increase the odds of unprotected sex and abortion. The path analysis showed that early pregnancy was a mediator of the relationship between alcohol consumption and abortion.Conclusion:Among women in Brazil, the harmful use of alcohol is increasing, which has an impact on female reproductive health and exposure to risks. There is a need for specific prevention initiatives focusing on alcohol-related behaviors in women.

Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018

“…Approximately one fourth of the scientific production on unsafe abortions in the period was composed of quantitative studies that analyzed the three aspects addressed in this review. Direct estimates of usafe abortions prevalence in national-scope studies varied between 2.3% 11 and 16.3% 14 . In local studies, these estimates varied between 1.2% among women aged 15-24 years 26 and 81.9% among sexually active girls aged 12-19 years who had been pregnant 28 .…”

“…Twenty five articles presented data on abortion estimates (Table 1), eight of which had a national scope: two derived from the Brazilian National Survey of Demography and Health (PNDS, in Portuguese), from 1996 and 2006 10,11 ; two from the Brazilian National Abortion Survey (PNA, in Portuguese), conducted in 2010 and repeated in 2016 12,13 ; one from the National Alcohol and Drugs Inquiry (LENAD, in Portuguese) 14 ; two used secondary data from the SIH-SUS 15,16 ; and the remaining articles was a survey of maternity hospitals from 24 states 17 .…”

“…It found the occurrence of unsafe abortions among 16.3% (14.5%-18.3%) of women, and a dose-response effect according to alcohol use. Among women who did not binge drinking (BD), defined as consuming 4 or more drinks in approximately 2 hours, or who did not have an alcohol use disorder (AUD measured by the DSM-5 scale), unsafe abortions prevalence was of 15% (13.2%-17%), reaching 24.9% (16.3%-36.2%) among those with BD and AUD 14 .…”

“…Twenty-two studies addressed the characteristics of women who have abortions and/or factors associated with unsafe abortions 10,11,14,17,21,22,23,24,25,27,28,30,31,34,35,36,37,38,39,40,41,42 (Table 2).…”

“…In population studies or in studies carried out in primary health care services, including women of different age groups, the following were found to be positively associated with unsafe abortions: increased age 10,22,24,30,31 , non-white race/color 10,23,30,42 , low income 24,42 , living in rural areas 10 or being a migrant 42 , having paid work 10 , not being religious 10 , being single/not living with a partner 21,22,31 , early onset of sexual activity 23,30 , have more than one or two partners in the last year 23 , greater number of sexual partners in life 30,31 , use of alcohol 14 and illicit drugs 30 . Two studies found an association between unsafe abortions and low educational level 23,42 and in Campinas, São Paulo State 41 , São Paulo State, and in Rio Grande do Sul 31 researchers found a positive association between high educational levels and termination of unwanted pregnancies.…”