Barriers to Implementing and Consolidating a Family Planning Program that would meet Brazilian Needs

Abstract

Rev Bras Ginecol Obstet 2017;39:373-375.Around 50-55% of all births in Brazil are unplanned, and these figures include both unwanted and mistimed pregnancies. 1,2 The overall rate of induced abortion is estimated at 1.5%, with all induced abortions resulting from unplanned pregnancies culminating in an adjusted abortion rate of 2.7%. In many cases, unplanned pregnancies terminate in induced abortions and, since abortion in Brazil is restricted and only allowed under certain circumstances, many of these procedures are unsafe. Indeed, unsafe abortions are estimated to account for 13% of all maternal deaths. 3,4 The cost of unplanned pregnancies weighs not only on the healthcare system but also on society, and involves the cost of abortion care and of unplanned childbirth. When the pregnancy is unplanned, the likelihood of preterm births and low birthweight infants increases, and this scenario implies high costs associated with neonatal care and longterm disabilities. 5,6 The total fertility rate in Brazil has fallen significantly in recent decades, and today stands at 1.8 births per woman. Over the same period, the use of contraceptives has increased. 7,8 Preventing unplanned pregnancies through publicly funded programs is a strategy that has proven to be effective in significantly cutting costs for health services. 9 In this editorial, we will discuss the current situation in Brazil, providing an insight into the inequalities that exist in the provision of contraceptive methods, particularly long-acting reversible contraceptive (LARC) methods, and highlighting the causes and consequences of unplanned pregnancies in Brazil, where fertility planning services are vastly different to those provided in developed countries, and where abortion legislation is restrictive.The Brazilian National Healthcare Service (SUS, in the Portuguese acronym) covers the cost of around 70-75% of all procedures performed in the country, including those related to reproduction. An estimated 1.79 million unplanned pregnancies and 1.47 million planned pregnancies occur annually, with 351 maternal deaths, of which 49 (14%) are attributed to abortions, and 302 to complications resulting from miscarriages and childbirth. The number of infant deaths in the first year of life is estimated at 32,864. The model estimates the number of preterm deliveries attributed to unplanned pregnancies at 122,523. The estimated number of neonatal admissions associated with unplanned pregnancies was 224,631 for 2010, including all preterm deliveries and 7.6% of all term deliveries. 10 Consequently, the total annual costs attributed to unplanned pregnancies are estimated at R$4.1 billion or more, depending on the exchange rate. Approximately R$4.07 billion (99.2%) of that total amount is attributed to childbirth and its resulting complications. Based on national cost estimates and the number of unplanned pregnancies per year, the cost per unplanned pregnancy is calculated at R $4,439. However, this is based only on cases occurring within the public healthcare sys...

Factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices

“…This rate is likely related to low access to interval IUD insertion by Brazilian women. Although the TCu380A IUD is free of charge, Brazilian women face many access barriers, including misinformation and lack of providers trained to provide counseling and IUD insertion 18 . For this reason, the prevalence of IUD use in Brazil is very low (2%), despite the high overall contraceptive prevalence (82%) 19 …”

“…As we only placed TCu380A IUDs, we cannot generalize our findings to levonorgestrel‐containing IUDs. The TCu380A IUD is the only IUD available in the Brazilian public health system, through which approximately 75% of the population receives healthcare services 18 …”

“…The TCu380A IUD is the only IUD available in the Brazilian public health system, through which approximately 75% of the population receives healthcare services. 18 Some strengths of our study include that it is one of the largest studies of postplacental TCu380A IUD insertion and factors associated with missing strings and expulsions. Trained providers used standard techniques to place the TCu380A IUD.…”

Educação médica em saúde: relato de experiência em simpósio sobre mulher, planejamento familiar e direitos reprodutivos, no contexto da COVID-19

“…É fundamental para os direitos sexuais das mulheres e/ou próprio casal propiciar esses conhecimentos científicos sobre planejamento familiar a fim de garantir uma liberdade e autonomia para uma organização familiar que, aglutina-se os valores tanto sociais pessoais quanto os valores econômicos de renda de cada família. Anualmente 122.523 partos prematuros são atribuídos a gestações não planejadas, dados que consolidam a tese de que no intuito de minimizar danos na saúde pública, são necessárias políticas públicas e ações de promoção em saúde sexual no Brasil (Bahamondes et al, 2017).…”

Practical Recommendations on the Management of Issues Related to the Levonorgestrel 52mg Intrauterine System: A Delphi Panel

“…However, despite the high contraceptive efficacy, few side-effects, non-contraceptive benefits, and a large body of evidence in the scientific literature [5], it is still underutilized in many settings including adolescent girls and young women, a population with high risk of unplanned pregnancy [6]. There are several reasons for this underutilization: lack of training of healthcare providers in intrauterine device (IUD) placement, lack of reimbursement or incomplete insurance coverage, refusal by the women who do not have enough knowledge about the safety and efficacy, and the unavailability of the product in the majority of the Brazilian public health institutions [7,8].…”