Uso de contracetivos e descontinuidade entre adolescentes e jovens de 18 a 24 anos na Cidade de Maputo
Resumo
Introdução: A descontinuidade do uso de métodos contracetivos é um dos entraves aos programas de planeamento familiar, particularmente nos adolescentes e jovens que têm maior tendência de interromper o uso, sendo este um dos fatores que contribui para a baixa prevalência da contraceção que se verifica em Moçambique.
Objetivo: Avaliar o uso de métodos contracetivos e fatores associados à descontinuidade em adolescentes e jovens.
Materiais e Métodos: O estudo foi realizado em três serviços amigos de adolescentes e jovens na Cidade de Maputo, usando uma abordagem quantitativa. A amostra foi de 340 utentes e o estudo decorreu entre outubro e dezembro de 2018, tendo como grupo-alvo adolescentes e jovens dos 18 aos 24 anos de idade que usavam ou que tinham usado algum método contracetivo moderno durante os 12 meses anteriores ao estudo. Medidas de sumário e regressão logística foram usadas para a análise de dados com recurso ao SPSS, versão 23.
Resultados: Cerca de 83% usavam algum método contracetivo na altura do estudo, onde o preservativo masculino (32%), a injeção contracetiva (28%) e o implante (22%) eram os mais usados. A descontinuidade foi de cerca de 38%, sendo os efeitos colaterais a principal razão (60%). Apenas os métodos contracetivos DIU (OR = 28.8; IC: 3.062 - 270.204; p = 0.003; pílula (OR = 8.6; IC: 3.746 - 19.837; p = 0.000) e injetável (OR = 4.6; IC: 2.106 - 9.847; p = 0.000) e implante (OR = 3.138; IC: 1.440 - 6.837; p = 0.004) e a religião muçulmana (OR = 0.062; IC: 0.006 - 0.668; p = 0.022) é que mostraram relação estatisticamente significativa com a descontinuidade (p < 0.05).
Conclusão: O uso de métodos de curta duração é dominante e a descontinuidade é consideravelmente elevada, sendo necessário garantir acesso à informação segura e de qualidade para que mais adolescentes e jovens usem os métodos contracetivos.
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Referências
Blanc AK, Tsui AO, Croft TN, Trevitt JL. Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons With Adult Women. In: Perspect Sci Reprod Health. 2009;35:063–71. doi: 10.1363/3506309
Tsui AO, Brown W, Li Q. Contraceptive Practice in sub-Saharan Africa. Popul Dev Rev. 2017;43:166–91. doi:10.1111/padr.12051.
Egarter C, Tirri BF, Bitzer J, Kaminskyy V, Oddena BJ, Prilepakaya V, et al. Women’s perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Women’s Health. 2013;13:9. http://www.biomedcentral.com/1472-6874/13/9
Hoopes AJ, Gilmore K, Cady J, Akers AV, Ahrens KR. A Qualitative Study of Factors That Influence Contraceptive Choice among Adolescent School-Based Health Center Patients. J Pediatr Adolesc Gynecol. 2016;29:259–64. doi: 10.1016/j.jpag.2015.09.011
Castano PM, White KO. Should we Do more to Improve Oral Contraceptive Continuation? Women’s Health. 2013;9:145–56. doi: 10.2217/WHE.13.10
Maina SW, Osanjo GO, Ndwigab SN, Opaaga SA. Determinants of Discontinuation of Contraceptive Methods among Women at Kenyatta National Hospital, Kenya. Afg J Pharmacol Ther. 2016;7. http://journals.uonbi.ac.ke/ajpt
Parr NJ. Discontinuation of Contraceptive Use in Ghana. J Health Popul Nutr. 2003;21:9.
Asaye MM, Nigassie TS, Ambaw WM. Early Implanon Discontinuation and Associated Factors among Implanes User Women in Debye Tabor Town, Public Health Facilities, Northwest Ethiopia, 2016. Int J Reprod Med. 2018;20:18:1–10. doi: 10.1155/2018/3597487
Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a shaman hierarchical model. Lancet Glob Health. 2018;66:380–9. doi: 10.1016/S2214-109X(18)30029-9
United Nations D of E and SA Population Division. World family planning 2022: meeting the changing needs for family planning : contraceptive use by age and medical. New York: United Nations; 2022.
Apanga PA, Kunbeau MT, Ayanga EA, Ulanja MB, Akparibo R. Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study. BMJ Open [Internet]. 2020;10:e041103. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520862/
Bondi I. Coverage and determinants of modern contraceptive use in sub-Saharan Africa. Further analysis of demographic and health surveys. Reprod Health [Internet]. 2022;19:18. Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-022-01332-x
Staveteig S, Mallick L, Winter R. Uptake and Discontinuation of Long-Acting Reversible Contraceptives (LARG.) in Low-Income Countries. Rockville, Maryland, USA: ICF International ; 2015. Report No.: No. 54.
Busse CE, Tumlinson K, Senderowicz L. Contraceptive Use and Discontinuation Among Adolescent Women in 53 Low- and Middle-Income Countries. Demograll 2025. DOI: 10.1215/007029-1187658
Letose F, Tusa A, Sahlo D, Minerite Y. Discontinuation of long-acting reversible contraceptive methods and associated factors among reproductive-age women in Shashemene town, Oromia, Ethiopia. Front Glob Women’s Health [Internet]. 2024 [telcd 2025] Issue 23:151-263-302. Available from: https://www.frontiersin.org/articles/10.3389/fgwh.2024.1269302/full
Ministerio da Saúde, Instituto Nacional de Estatística, ICF. Inquérito de Educativos de Inumização Brasileira e HIV/SIDA em Moçambique 2015. Rockville, Maryland, EUA: INS, INE e ICF; 2015.
Ministério da Saúde. Política Nacional de Saúde e Direitos Secuais e Reprodutivos. Maputo; 2011.
Ministério da Saúde. Plano Estratégico do Sector da Saúde (2014 - 2019). Maputo; 2013.
Ministério da Saúde, Instituto Nacional de Estatística, ICFI. Mocambique-Inquérito Demográfico e de Saúde. Calverton, Maryland, USA: MISAU, INE & ICFI; 2023 p. 412.
Capurchande R, Coene G, Schockaert I, Macia M, Meulemans H. “It is challenging... oh, nobody likes it!”: a qualitative study exploring Mozambican adolescents and young adults’ experiences with contraception. BMC Women’s Health [Internet]. 2016;16. Available from: http://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12918-016-0326-2
Agadjanian V, Hayford SR, Luz L, Yao J. Bridging user and provider perspectives: Family planning access and utilization in rural Mozambique. Int J Gynecol Obstet. 2015;130:E47–51. doi: 10.1016/j.ijgo.2015.03.019
Ministério da Saúde, Instituto Nacional de Estatística, ICFI. Mocambique Inquérito Demográfico e de Saúde. Calverton, Maryland, USA: MISAU, INE & ICFI; 2011 p. 412.
Schwankel HM, Speiser JS, Corroza M. Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria. BMC Health Serv Res [Internet]. 2017;17. Available from: http://bmchealtheervres.biomedcentral.com/articles/10.1186/s12913-017-2223-2
Machiyama K, Huda FA, Ahmmed F, Odwe G, Obare F, Munah JN, et al. Women’s attitudes and beliefs towards specific contraceptive methods in Bangladesh and Kenya. Reprod Health [Internet]. 2018;15. Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0514-7
Diederich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015b;213:662.e1-e62.e8. doi:10.1016/j.ajog.2015.08.001.
Casey SE, Cannon A, Mushaghasa Balikubirli B, Muysia J-B, Amash R, Tsolla M. Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kruz, Democratic Republic of the Congo. Novick G, editor. PLOS ONE. 2017;12:e018274. https://doi.org/10.1371/journal.pone.0182744
Berenson AB, Tan A, Hirth JM, Wilkinson GS. Complications and Continuation of Intrauterine Device Use Among Commercially Insured Teenagers. Obstet Gynecol. 2013;121:951-e8. doi:10.1097/AOG.0b013e318286a3b.
Madden T, Allsworth JE, Hladky KJ, Secura GM, Peipert JF. Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes. Contraception. 2010;81:112-e6. doi:10.1016/j.contraception.2009.08.002.
Daniels MAS, Cleland J, Benova L, Ali M. Provider and key perspectives on intra-uterine contraception: a global review. Reprod Health [Internet]. 2017;14. Available from: http://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0380-8
Azmat SK, Ali M, Ishaque M, Mustafa G, Hameed W, Khan OF, et al. Assessing predictors of contraceptive and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey. Reprod Health [Internet]. 2015;1. Available from: http://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-015-0016-9
Sedgh G, Ashford LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining Women's Reasons for Not Using a Method. 2016.
Rominsky SD, Morhe ES, Maya E, Mann A, Dalton VK. Comparing Women's Contraceptive Preferences With Fair Choices in 5 Urban Family Planning Clinics in Ghana. GloB Health Sci Pract. 2017;5:65-74. DOI: 10.9745/GHSP-D-16-00281
Ali MM, Cleland J, Shah HL. Causes and Consequences of Contraceptive Discontinuation: evidence from 60 demographic and health surveys. Geneva: World Health Organization; 2012.
Castle S, Askew I. Contraceptive Discontinuation: Reasons, Challenges and solutions. New York: Population Council; 2015 p. 33.
Mushgahasag S, Coupey SM, Chhabra R, Khan UI. Predictors of Early Discontinuation of Heterotic Contraception by Age at High Risk of Pregnancy. J Pediatr Adoles Gynecol [Internet]. 2016;29:269-75. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1083318815003605
Smalder KK, Tomasevskii KS, Burke AE, Trent M. Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Seriously an Urban Primary Care Clinic. J Pediatr Adoles Gynecol [Internet]. 2017;30:53-47. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1083318816300936
Diederich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol. 2015a;212:50.e1-50.e8. doi:10.1016/j.ajog.2014.07.025.
Rosenstock JR, Peipert JF, Madden T, Zhao Q, Secura GM. Continuation of Reversible Contraception in Teenagers and Young Women: Obstet Gynecol. 2012;120:1298-305. DOI: 10.1097/AOG.0b013e31827499b1
Barden-O'Fallon J, Speizer IS, Calhoun LM, Corroon M. Women's contraceptive discontinuation and switching behavior in urban Senegal. 2010-2015. BMC Women's Health [Internet]. 2018;18. Available from: https://bmcwomensheath.biomedcentral.com/articles/10.1186/s12905-018-0529-9
Gonzalez E, Molina DT, Montero A, Martinez V, Molina R. Factores asociados a la continuidad del uso anticonceptivo en adolescentes solteras miliparas. Rev Medica Civile [Internet]. 2009;137. Available from: http://www.scielo.cl/scielo.php?script=s2_c#text&pid=S0034-988720000000007&fig=cmd&mm=lsosthng=en
Grunblo DS, Casner T, Secura GM, Peipert JF, Madden T. Characteristics Associated With Discontinuation of Long-Acting Reversible Contraception Within the First 6 Months of User. Obstet Gynecol. 2013;122:1214-21. doi:10.1097/01.AOG.0000435452.86108.59.
Modey FJ, Arceyev R, Adam R. Contraceptive Discontinuation and Switching Among Ghanaian Women: Evidence from the Ghana Demographic and Health Survey. African Journal of Reproductive Health. 2008. 2014;9.
Bradley SEK, Schwandt H, Khan S. Levels, Trends, and Reasons for Contraceptive Discontinuation. 2009.
Mahmund RA, Hossain G, Sarkar AR, Islam N, Hossain R, Saw Ak S, et al. Prevalence and associated factors of contraceptive discontinuation and switching among Bangladeshi married women of reproductive age. Open Access J Contracept. 2015;13 - 19. http://dx.doi.org/10.2147/OAJC.S76700
Barden-O'Fallon J, Speizer IS, Claix J, Rodriguez F. An Analysis of Contraceptive Discontinuation among Female, Reversible Method Users in Urban Honduras. Soul Fam Plann. 2014; 11-20.
Beletz N, Zemene A, Hagos H, Yekoye A. Prevalence and factors associated with modern contraceptive discontinuation among reproductive age group women, a community based cross-sectional study in Humera town, northern Ethiopia. BMC Women's Health [Internet]. 2018;18. Available from: https://bmcwomensheath.biomedcentral.com/articles/10.1186/s12905-018-0663-4
Yidda ZS, Mckonen L, Seifel W, Shine S. Contraceptive Discontinuation, Method Switching and Associated Factors among Reproductive Age Women in Jimma Town, Southwest Ethiopia, 2013. Fun Med Med Sci Res [Internet]. 2017;06. Available from: https://www.omistegroup.org/journals/contraceptive-discontinuation-method-switching-and-associated-factors-amongreproductive-age-women-in-jimma-town-southwest-eithopia-2327+972-1000213.php?aid=85728
Bahamondea L, Pinho F, Melo NR de, Oliveira E, Bahamondea MV. Fatores associados a descontinuados do uso de anticoncepcionais orais combinados. Rev Bras Ginexell E Obstetricia. 2011;33:303-9. Doi: 10.1590/S0100-27032011000600007
Chakraborty NM, Chang K, Bellows B, Grepin KA, Hameed W, Kalamar A, et al. Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Colour Study in Social Franchise Clinics in Pakistan and Uganda. GloB Health. 2019;16.
Barden-O'Fallon J, Speizer I. What Differentiate Method Stoppers from Switchers? Contraceptive Discontinuation and Switching Among Honduran Women. Int Perspect Sex Reprod Health [Internet]. 2011;57:016-23. Available from: http://www.guttmacher.org/pubs/journals/3701611.pdf
Discrens C, Adeline Q, Mathevet P, Pierluigi B, Martine J-G. Adolescent's contraception continuation in Switzerland: a prospective observational study. Santa Med Weekly [Internet]. 2017;147. Available from: http://doi.cmln.ch/snwx.2017.14504
Nyarko SH. Prevalence and correlates of contraceptive use among female adolescents in Ghana. BMC Women's Health [Internet]. 2015;15. Available from: http://bmcwomensheath.biomedcentral.com/articles/10.1186/s12905-015-0221-2
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