为了调查18至49岁的巴西女性使用避孕药具的个体和背景社会经济因素是否相关,按平价分层。
■横截面,基于人群的研究分析了16879名18至49岁女性的数据,2013年全国健康调查的受访者。个体因素,如生殖史,获得卫生服务,和社会人口统计学特征被考虑;作为环境因素,人类发展指数(HDI)包括社会人口统计学指数(SDI)初级卫生保健覆盖率(PHC覆盖率)和平均月收入。估计了多水平Logistic回归模型,按平价分层,妇女为一级,州和联邦区为二级单位。
■与初产妇和经产妇(88.7%)相比,未产妇女使用避孕药具的患病率较低(77.9%),以及使用避孕药的机会更大的变异性(ICC=2.1vs.ICC分别=1.1)。生活在人类发展指数水平较高的州的妇女,平均月收入和SDI更有可能使用避孕药具。更高的PHC覆盖率与初产/多产妇女使用避孕药具呈正相关,与未产妇女使用避孕药具呈负相关。此外,高等教育增加了使用避孕药的机会,对于未产和初产/多产妇女。
■巴西的高避孕覆盖率掩盖了获取方面的重要不平等,突出与使用避孕药具相关的背景特征,除了个人因素。对具有更大社会脆弱性的未产妇女使用避孕药具的流行率和机会较低,这表明公共政策中的不平等和优先地位。
■强调了改善避孕方法的必要性,考虑到女性的个人和环境脆弱性,这意味着确保及时和合格地获得避孕方法,特别是对于社会上更脆弱的年轻和未产妇女。
UNASSIGNED: To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity.
UNASSIGNED: Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units.
UNASSIGNED: Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women.
UNASSIGNED: The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies.
UNASSIGNED: The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.