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      Assessing regional differences in contraceptive discontinuation, failure and switching in Brazil

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      1 , , 2
      Reproductive Health
      BioMed Central

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          Abstract

          Background

          Contraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). However, reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. The present study examines the factors associated with method discontinuation, failure and switching among current contraceptive users, with a focus on sub-national assessment.

          Methods

          Data for the analysis are drawn from the Brazil Demographic and Health Survey, notably the calendar module of reproductive events. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition after a given duration of contraceptive use.

          Results

          Contraceptive continuation was found to be highest for the contraceptive pill, the most popular reversible method. Probabilities of abandonment while in need of family planning and of switching to another method were highest for injections. Failure, abandonment and switching were each higher among users in the Northeast region compared to the more prosperous Southeast and South.

          Conclusion

          Findings point to seemingly important disparities in the availability and quality of family planning and reproductive health care services across regions of the country. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.

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          Most cited references31

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          Pesquisa Nacional sobre Demografia e Saúde, 1996

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            Determinants of contraceptive discontinuation in six developing countries.

            This analysis investigates the determinants of contraceptive discontinuation in six developing countries, using data from Phase I surveys of the DHS programme. Cumulative probabilities of discontinuation at 24 months for reasons other than the desire for another child were examined. By this time, typically about 40% of couples have stopped use and most are subsequently at risk of an unwanted conception. Discontinuation of IUD use was found to be less common than for other methods, partly perhaps because cessation of use requires a deliberate decision to have the device removed. The most important results are negative ones. Neither the schooling of couples nor their type of residence exerted appreciable influence on discontinuation. The policy and programme implications are discussed. Prior use of a method, fertility preferences and the related demographic factors of age and family size emerged as pervasive predictors of discontinuation.
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              Contraceptive Discontinuation in Six Developing Countries: A Cause-Specific Analysis

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                Author and article information

                Journal
                Reprod Health
                Reproductive Health
                BioMed Central (London )
                1742-4755
                2007
                10 July 2007
                : 4
                : 6
                Affiliations
                [1 ]Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
                [2 ]Health Systems and Services, World Health Organization, Geneva, Switzerland
                Article
                1742-4755-4-6
                10.1186/1742-4755-4-6
                1976606
                17623076
                1ce566d5-1354-4a7f-aa1c-1da986f20b2d
                Copyright © 2007 Leite and Gupta; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 January 2006
                : 10 July 2007
                Categories
                Research

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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