Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

Houvèssou, Gbènankpon Mathias; Farías-Antúnez, Simone; Bertoldi, Andréa D.; Silveira, Mariângela Freitas da

doi:10.11606/s1518-8787.2023057004863

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Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004863 copy

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort.

METHODS

Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors.

RESULTS

The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8–87.1) and 84.9% (95%CI: 83.7–86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7–11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5–0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4–2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4–0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3–2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0–3.6).

CONCLUSIONS

Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Contraceptive Agents; Needs and Demand, Family Planning Services; Contraception

Variables	n	%
Age (years)
< 25	693	19.4
25–29	873	24.4
30–34	882	24.7
≥ 35	1,129	31.5
Family income in minimum monthly wages (BRL 998.00)
< 1	382	10.8
1.1–3.0	1,689	47.6
3.1–6.0	944	26.6
6.1–10	271	7.7
> 10	258	7.3
Education level
0–5	285	8.0
5–9	1,023	28.6
10–11	1,069	29.9
≥ 12	1,2	33.5
Married or in union
No	623	17.4
Yes	2,952	82.6
Receipt of medical advice on how to avoid pregnancy
No	1,503	42.7
Yes	2,017	57.3
Possession of health insurance or health plan
No	1,909	54.2
Yes	1,614	45.8
Source of payment for hospitalization when the child was born
SUS	2,412	68.4
Healthcare insurance	753	21.4
Private	359	10.2
Watches TV often
No	743	20.8
Yes	2,825	79.2
Head of the household
Child´s father	1,765	51.2
Child´s mother	1,250	36.3
Other	431	12.5
Number of pregnancies
1–2	3,288	91.9
≥ 3	289	8.1
Number of stillborn children after birth of the child participating in the Cohort
None	3,534	98.8
At least one	43	1.2
Number of induced abortions or miscarriages after birth of the child participating in the Cohort
None	3,509	98.1
At least one	68	1.9

Variable	Prevalence of unmet need		Crude analysis			Adjusted analysis

	%	95%CI	OR	95%CI	p-valor*	OR	95%CI	p-valor*
Age (Years)					0.002			0.008**
< 25	14.6	12.1 – 17.4	Ref..			Ref..
25–29	10.9	9.0 – 13.1	0.7	0.5–0.9		0.8	0.5–1.0
30–34	9.0	7.2–11.0	0.6	0.4–0.8		0.6	0.4–0.8
≥ 35	9.4	7.8–11.3	0.6	0.5–0.8		0.6	0.5–0.9
Family income in minimum monthly wages (BRL 998.00)					0.007			0.130
< 1	14.1	11.0–18.1	1.9	1.3–2.8		1.5	1.1–2.4
1.1–3.0	11.6	10.2–13.2	1.5	1.2–2.0		1.4	1.0–1.9
3.1–6.0	7.9	6.4–9.9	Ref..		Ref..
6.1–10	10.7	7.5–15.0	1.4	0.9–2.2		1.4	0.9–2.3
> 10	9.7	6.6–14.0	1.2	0.8–2.0		1.3	0.8–2.1
Education level in years					0.007			0.117
0–5	16.5	12.6–21.3	Ref..			Ref..
5–9	11.3	9.6–13.5	0.6	0.4–0.9		0.6	0.4–0.9
10–11	9.7	8.1–11.7	0.5	0.4–0.8		0.6	0.4–0.9
≥ 12	9.5	8.0–11.3	0.5	0.4–0.8		0.7	0.5–1.0
Married or in a stable union					< 0.001			< 0.001
No	16.4	13.7–19.5	1.9	1.5–2.4		1.9	1.4–2.6
Yes	9.4	8.4–10.5	Ref.			Ref.
Received medical advice on how to avoid pregnancy					0.583		-
No	10.4	8.9–12.0	Ref.
Yes	11.0	9.7–12.4	1.1	0.9–1.3			-
Possessing health insurance or health plan					0.398		-
No	11.1	9.8–12.6	Ref.
Yes	10.2	8.8–11.8	0.9	0.7–1.1			-
Source of payment for hospitalization when the child was born					0.158			0.766
SUS	11.2	10.0–12.6	1.4	0.9–2.1		1.1	0.7–1.8
Healthcare insurance	10.2	8.3–12.6	1.3	0.8–2.0		1.2	0.7–1.9
Private	8.1	5.7–11.4		Ref.		Ref.
Watches TV often					0.803		-
No	10.9	8.9–13.4	Ref.				-
Yes	10.6	9.5–11.8	0.9	0.7–1.3			-
Head of the household					0.007			0.047
Child´s father	9.1	7.9–10.6	0.7	0.5–0.9		0.9	0.7–1.1
Child´s mother	12.7	11.0–14.7	Ref.			Ref.
Other	10.4	7.9–13.7	0.8	0.6–1.1		0.6	04–0.9
Number of pregnancies					< 0.001			0.001
1–2	9.9	8.9–11.0	Ref.			Ref.
≥ 3	19.0	14.9–24.0	2.1	1.6–2.9		1.9	1.3–2.6
Number of stillborn children after the birth of the child participating in the cohort					0.261		-
None		10.6	9.6–11.7	Ref.		-	-
At least one		16.3	7.7–31.1	1.6		-	-
Number of induced abortions or miscarriages after the birth of the child participating in the cohort								0.047
None	10.4	9.4–11.5	Ref.			Ref.
At least one	23.5	14.8–35.3	2.7	1.5–4.7		1.9	1.0–3.6

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[1] Correspondence: Gbènankpon Mathias Houvèssou Rua Marechal Deodoro, 1160, 3º piso – Centro 96020-220 Caixa Postal 464, Pelotas, RS, Brazil Email: gbemathg@gmail.com