CONTRACEPTION PATTERNS IN BRAZIL: 2012 NATIONAL SURVEY DATAMinowa,E 1; Julian, GS1; Pomerantz, D2; Sternbach, N3; Feijo, LFA1; Annunziata, K4

PIH4

Poster Presented at the ISPOR 5th Latin America Conference 6 -8 September 2015 Santiago, Chile ©Copyright 2015 Evidências Credibilidade Científica, A Kantar Health Company Alameda Lorena, 131, Conj. 115 e 117, Jardim Paulista São Paulo, SP - 01424-001 Brazil + 55-11-3884-0942

www.evidencias.com.br www.kantarhealth.com

1Evidencias – Kantar Health, São Paulo, Brazil; 2Kantar Health, Horsham, PA, USA;3Kantar Health, New York, NY, USA ; 4Kantar Health, Princeton, NJ, USA

Unmet need for modern contraceptive should be addressed in Brazil.

Little is known regarding barriers to contraception in the country. Further studies are required in order to access contraceptive determinant choices and factors limiting the use of modern method use in Brazil.

Optimization of educational and awareness programs for women and family planning is required.

In conclusion, the present study showed a critical need to develop strategies in order toimprove politics of reproductive health in Brazil.

CONCLUSION

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Data are self-reported and cannot be verified by patients’ medical charts or other objective data.

The data are cross-sectional in nature and do not allow for causal explanations to be made.

LIMITATIONS

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Although modern contraceptives represent highly effective methods, traditional methods excluding condom (e.g. rhythm) are still used as contraceptive alternative in Brazil.

Patterns reported worldwide previously from 2013 were consistent when compared toupdated information of Brazilian contraceptive use from NHWS, with lower prevalence use compared to developed countries.

The present study showed disparities among regions regarding contraceptive prevalence rates and corroborates with prior studies. 2,5-7

DISCUSSION

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METHODOLOGY

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Sample data were extracted from the Brazil National Health and Wellness Survey (NHWS) an Internet based general health survey.

Data was collected from November to December 2012.

Of 12,000 total respondents, 4,560 were women from 18-49 years old, to whom contraceptive methods related questions were applied. Information about women whose partners hadvasectomy was not captured.

Invitations to participate were sent to a sample, stratified according to gender and age.

Weights were calculated to be representative of the Brazilian adult population and analyses were based on the weighted data. Weighting variables consist of age and gender, from the International Data Base of the U.S. Census Bureau and Organization for Economic Cooperation and Development and socioeconomic status from the Brazilian Institute of Geography and Statistics.

Means were reported for continuous variables and percentages and weighted counts were reported for categorical variables.

Descriptive analyses and contraceptive prevalence rate (CPR) were based on the weighted data.4

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Data Collection

Sample Analysis

Figure 1. Contraceptive Prevalence Rate

Figure 5. Prevalence Rate of Modern and Traditional Contraceptive Methods

Figure 4. About Sexual Intercourse (Past 6 Months)

Figure 3. Age Distribution of Contraception Users

71,8M 18,4M 31,1M(n=6,017) (n=1,516) (n=3,044)

Mean Age 41.6 35.4* 31.0% Married 35 34 39% Single, never married 30 40* 33% College graduate or more 19 19 22% White 51 49 51% Non-White 48 50 48% Annual Household Income <R$2K 43 46 45% Over Weight/Obese 50 52* 43% Currently Smoke Cigarette 17 17 14% Drink Alcohol 42 42 51*Mean days exercising in the past month 5.8 5.5 6.9*

Brazilian Adult Women (Age 18-49)Total Brazil

Adult Women(Age 18+)

UsingContraceptives

(P6M)(C)

Not Using Contraceptives

(P6M)(B)

Table 1. Demographics and Life Style

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M).

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RESULTS

Overall, 63% of the surveyed women from 18-49 years old used any contraception method in the past 6 months, including married (39%) and single (33%) women (see Table 1 and Figure 1).

CPR regardless of marital status and CPR only for married women were 63 % and 66%,respectively.

Further broken down by state projected estimates, excluding those with small sample size, reveal the highest contraception prevalence in the South with 73.84%, opposed to thelowest in the North with 29.8% (see Figure 2).

Contraception prevalence rate Sample description and contraception prevalence rate

ReferencesWorld Health Organization. Fact sheet nº 351 Family planning. Available on: http://www.who.int/mediacentre/factsheets/fs351/en/.Schor S, Ferreira AF, Machado VL, et al. Mulher e anticoncepção: conhecimento e uso de métodos anticoncepcionais Cad. Saúde Pública. 2000;16(2).Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher. Brasilia 2006 available at: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf viewed on 01 Jun 2015.United Nations, Indicators of Sustainable Development: Guidelines and Methodologies, Contraceptive prevalence rate, acess on July 2015 available from http://www.un.org/esa/sustdev/natlinfo/indicators/methodology_sheets/health/contraceptive_prevalence.pdf.da Costa JSD, D’Elia PB, Moreira MR. Prevalência de uso de métodos contraceptivos e adequação do uso de anticoncepcionais orais na cidade de Pelotas, Rio Gran-de do Sul, Brasil. Cad. Saúde Públ. 1996;12(3):339-344.de SouzaI JMM, PellosoII SM, UchimuraIII NS, de Souza F. Utilização de métodos contraceptivos entre as usuárias da rede pública de saúde do município de Marin-gá-PR Rev. Bras. Ginecol. Obstet. 2006;28(5).D’Antona Aea. Contraceptive discontinuation and non-use in Santarem, Brazilian Amazon. Cad. Saúde Pública. 2009;25(9).

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ABSTRACT

OBJECTIVES: Contraception represents one of the hallmarks on women´s health. However, the most recent data reported related to contraceptive use in Brazil dates back to 2006. Therefore, our study aimed to describe contraceptive use patterns reported by Brazilian women in 2012.

METHODS: Sample data were extracted from the 2012 Brazil National Health and Wellness Survey (NHWS), an internet based general health survey, which is stratified to be representative of age and gender. Of 12,000 total respondents, 4,560 were women from 18-49 years old, of which, contraceptive methods related questions were applied. Information about women whose partners had vasectomy were not captured. Descriptive analyses and contraceptive prevalence rate (CPR) were based on the weighted data.

RESULTS: Overall, 63% of the surveyed women from 18-49 years old were using any contraception method during the past 6 months and included married (39%) and single (33%) women. Young women from 18-34 years (68%) were the most representative age group. Calculated CPR regardless of marital status and CPR only for married women were 63 % and 66%, respectively. Among contraceptive methods, modern contraception were most used, including condoms (44%), pill for birth control (44%), and injection (9%). Use of vaginal ring, patches and implant represented less than 1% each. Additionally, traditional methods were reported in more than 5% of the women. Pills for non-birth control use were reported by 20%.

CONCLUSION: Patterns reported worldwide previously from 2013 were consistent whencompared to updated information of Brazilian contraceptive use from NHWS, with lowerprevalence use compared to developed countries. Data was similar when evaluating the use of modern contraceptive methods and worldwide average of CPR for married women.In conclusion, awareness of contraception importance and related alternatives are needed in the country, which can lead to optimization of educational and awareness programs for women.

Improving reproductive health through access to safe and effective methods of fertilitycontrol can improve women´s health and reduce child mortality.1

More than 200 million women in developing countries would like to delay or stopchildbearing but are not using any method of contraception.1

Reasons for inequalities in contraception include1:

In 2006, 46% of the pregnancies in Brazil were not planned.2

Brazilian family planning politics was introduced only in 2007 with access to eight different contraceptive methods.3

Data regarding contraceptive use rate among woman dates back previously from theintroduction of family planning politics. Therefore, our study aimed to describe contraceptive use patterns reported by Brazilian women in 2012.

INTRODUCTION

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Limited choice of methods;Limited access to contraception;Fear or experience of side-effects;Cultural or religious opposition;Poor quality of available services;

Total Brazilian AdultWomen (Age 18+)

71.8 M(n=6,017)

Age 18-4949.6 M (69%)

(n=4,560)

Age 50+22.3 M (31%)

(n=1,457)

Not UsingContracep�ves (Past 6 Months)

18.4 M (37%)(n=1,516)

Using Contracep�ves (Past 6 Months)

31.1 M (63%)(n=3,044)

Using Contracep�ves orHad Tubal Liga�on or

Had Hysterectomy (35.8 M, 72%; n=3,388)

Mean age of the total sample, women using and not using contraceptives in the past 6 months were 41.6, 31 and 35.4 years, respectively (Table 1).

Young women from 18-34 years (68%) were the most representative age group amongpatients using contraception (Figure 3).

92% of the sample using contraceptives had sexual intercourse in the past 6 months (Figure 4).

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0%5%

10%

15%20%

25%30%

35%40%

45%

50%

Condoms, forbirth control

Pill, for birthcontrol

Pill, fornon-birth

control

Injec�on/Shot Rhythm (naturalfamily planning)

IUD Spermicidalcream or gel

PatchCondoms, for preven�on of

sexuallytransmi�ed

diseases

Modern contracep�ve methods

Tradi�onal contracep�ve method

44%41%

28%

20%

9%5%

3% 1% 1%

Among contraceptive methods, modern contraception were most used, including condoms (44%), pill for birth control (41%), and injection (9%).

Least common methods included the use of vaginal ring, patches and implant with less than 1% each.

Additionally, most common traditional methods used were rhythm reported by 5% of the women.

Pills for non-birth control use were reported by 20%.

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Types of contraceptive methods

Figure 2. Contraception Prevalence Rate per State

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M). Small sample sizes (< 20) were excluded.

29.4%53.2%

56.6%51.3% 62.6%

57.1%29.8%

61.9%

66.6%66.1%

65.1%62.0%

66.0%

76.5%

73.8%

64.2%

74.4%

71.3%

Had sexual intercouse

Did not have sexual intercouse

Decline to answer

1%

7%

92%

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M).

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M).

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M); *=p value <0.05

18-34

68%

25%

7%

35-44 45-49

Note: Contraceptive use was only asked of women 18-49 years (n=3,044; projected n=31.1 M)