Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries

Abstract

ObjectiveTo identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico).Study designWe analyzed baseline data of 7049 women of childbearing age (15–49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013).ResultsWomen in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59–0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58–0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39–0.64). 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 1.64, CI: 1.13–2.36).ConclusionsOur 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.ImplicationsWe 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.

Qualitative stocktaking on assessment of barriers and facilitators to contraceptive and post-abortion care services use following Zika epidemic in Tegucigalpa, Honduras.

“…intrauterine device, sterilization, injectables, hormone implants, patches, diaphragms, spermicidal agents, and emergency contraception. Coinciding with previous reports (11,20), women were knowledgeable and supportive of a range of contraceptive methods. However, many informants revealed that their pregnancies were not planned.…”

“…During the Zika epidemic, women in our study did not mention having received specific information on Zika when they used emergency care and that information on counselling was inconsistent; in fact, information seems to be distributed only during specific campaigns against diseases such as Zika or dengue. Counselling at health facilities is a crucial intervention for the promotion of contraceptive use; however, as seen in our study, visiting a health facility per se does not necessarily mean that a woman would receive counselling (20). Coinciding with another report from Brazil (24), women in our study were not fully aware that Zika could be sexually transmitted and counselling about this issue was limited.…”

“…Information sharing norms exist around sexual and reproductive health (12). In the past years, due to the support by international organizations, Honduras has been implementing family planning programs to improve contraceptive supply chains and information flows (20).…”

Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey

“…The analysis used data from the 2012 nationally representative population-based household survey conducted using a multistage stratified design described in detail elsewhere [10]. Briefly, a probability sample of 15 households drawn from 1000 randomly selected randomly selected enumeration areas (EAs) was used.…”

“…For example, low contraceptive use has been associated with sociodemographic factors such as women coming from rural areas, those with low educational qualification, low socio-economic status, limited knowledge on accessibility, and awareness of contraceptives [9]. Previous findings also associated poor contraceptive usage with poor knowledge [10]. Furthermore, lack or low contraceptive use was associated with the fear of being labelled wayward and promiscuous for carrying or demanding usage of condoms by their partners [11].…”