Determinants of emergency contraception non-use among women in unplanned or ambivalent pregnancies

Objective To analyze the determinants of emergency contraception non-use among women in unplanned and ambivalent pregnancies. Method Cross-sectional study with a probabilistic sample of 366 pregnant women from 12 primary health care units in the city of São Paulo, Brazil. A multinomial logistic regression was performed, comparing three groups: women who used emergency contraception to prevent ongoing pregnancies (reference); women who made no use of emergency contraception, but used other contraceptive methods; and women who made no use of any contraceptive methods at all. Results Cohabitation with a partner was the common determinant of emergency contraception non-use. No pregnancy risk awareness, ambivalent pregnancies and no previous use of emergency contraception also contributed to emergency contraception non-use. Conclusion Apart from what is pointed out in the literature, knowledge of emergency contraception and the fertile period were not associated to its use

Knowledge of pregnant adolescents about reproductive anatomy and physiology in a municipality of southern Brazil

Objectives. To study knowledge of some aspects of the female reproductive anatomy and physiology and their association with socio-demographic and reproductive "choices" of pregnant adolescents. METHODS. A cross-sectional study was performed with 200 first dine pregnant adolescents who attended a public women's health clinic in the municipality of lndaiatuba, Sao Paulo, Brazil. During their first prenatal care visit, face-to-face interviews were conducted using a structured questionnaire and a three-dimensional handmade female model. Bivariate data analyses were performed using Person's Chi-square or fisher Exact test. Data were also analyzed using multivariate logistic regression models to test for associations of indicators of knowledge of female reproductive anatomy, physiology of female reproductive organs and physiology of reproduction with socio-demographic characteristics and reproductive "choices". RESULTS. The majority had little knowledge of anatomy (55.5%), with external organs more easily identified and placed than the internal,, of physiology of reproductive organs (61.0%), and of physiology of reproduction (76.5%). Associations were found between knowledge and age of partner, couple difference of age, maintenance of the relationship with partner after pregnancy, religious affilliation, and level of education. No association was found between indicators of knowledge with use of contraceptives at first intercourse and with intention of having the baby at that time. CONCLUSION. This study addressed the complexity of the relationship between knowledge of reproductive anatomy and physiology and the theme of adolescent pregnancy, and emphasized the need for more contextuallzed approaches of programmatic contents on sexual education, in view of the intention to reduce early pregnancy.541293

Factors associated with access to health services prior to pregnancy by pregnant adolescents

OBJECTIVE: To assess determinants of access to primary care services prior to pregnancy by pregnant adolescents. METHODS: Theory-based cross-sectional study conducted to examine access to heath services at five dimensions: geographic, economic, administrative, psychosocial and information. There were included in the study 200 first-time pregnant adolescents (aged 10 to 19 years) who attended a primary care unit in the municipality of Indaiatuba, Southeastern Brazil, in 2003. Data was collected using a semi-structured questionnaire applied in face-to-face interviews conducted just before their first pre-natal care visit. Data analyses were performed through Person's chi-square or Fisher's exact test, and by a multivariate logistic regression model including all five dimensions of access. RESULTS: More than half (63.7%) of the adolescents utilized some gynecological care service. Information (43.8%) or psychosocial feelings of embarrassment or fear (37.0%) barriers were the most frequent reasons given for not having sought care before. The main barrier to health service access was related to the psychosocial dimension, reported by 77.0% of the adolescents studied. CONCLUSIONS: Among all barriers to health service access, the most important were those related to the psychosocial dimension. There is a need for new strategies to facilitate access to health services by adolescents, including actions to reduce gender-based barriers taking into consideration sociodemographic characteristics of this population and the relationship they have with their partners.42

Características sociodemográficas e de assistência à gestação e ao parto no extremo sul do Brasil

This study aimed to compare prenatal and childbirth care received by teenagers and older mothers in Rio Grande, Rio Grande do Sul State, southern Brazil. From January 1st to December 31st 2007, all mothers were interviewed with a standardized questionnaire on the care they received. The chi-square test was used to compare proportions between adolescent and non-adolescent mothers. One-fourth (516) of the infants were born to adolescent mothers. Compared to older mothers, teenagers showed lower rates of the following: completion of at least six prenatal visits (61% x 75%), initiation of prenatal care in the first trimester (58% x 77%), tetanus vaccination (81% x 85%), and completion of prenatal visits with the same health professional (70% x 78%). Meanwhile, teenage motherhood was associated with more: supplementation for iron deficiency (66% x 57%), use of forceps (11% x 6%), and episiotOmy (86% x 66%). The findings show that teenage mothers received worse prenatal and childbirth care than older mothers.Este estudo teve por objetivo comparar a assistência à gestação e ao parto entre mães adolescentes e não adolescentes residentes no Município de Rio Grande, Rio Grande do Sul, Brasil. Entre 1o de janeiro e 31 de dezembro de 2007 aplicou-se questionário padronizado a todas as mães destes recém-nascidos buscando informações sobre cuidados recebidos do inicio da gravidez até momento do parto. Utilizou-se teste do qui-quadrado para comparar proporções. Um quarto (516) dos recém-nascidos era filho de mães adolescentes. Em relação às demais mães, uma menor proporção de adolescentes completou seis ou mais consultas de pré-natal (61% x 75%), iniciou o pré-natal no primeiro trimestre de gravidez (58% x 77%), recebeu vacina antitetânica (81% x 85%) e fez todo o pré-natal com o mesmo profissional (70% x 78%); no entanto, foram mais comumente suplementadas com sulfato ferroso (66% x 57%), submetidas a fórcipe (11% x 6%), à episiotomia (86% x 66%), e atendidas no SUS (92% x 76%). Estes dados mostram que a assistência recebida pelas mães adolescentes foi sistematicamente pior àquela recebida pelas demais mães