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      Individual and context correlates of the oral pill and condom use among Brazilian female adolescents

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          Abstract

          Background

          Studies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. However, few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. This paper assesses whether maternal mortality rates, antenatal care visits, and primary healthcare coverage are associated with pill and condom use among female adolescents in Brazil.

          Methods

          We used data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national, school-based cross-sectional study conducted in Brazil. A subsample of all female adolescents who had ever had sexual intercourse and were living in one of the 26 State capitals and the Federal District was selected (n = 7415). Multilevel mixed effects logistic regression models were estimated to examine the effect of contextual variables on pill and condom use.

          Results

          Sixty-five percent of female adolescents reported using pill while 21.9% reported using condom during the last sexual intercourse. Adolescents living in municipalities with low maternal mortality and high antenatal care coverage were significantly more likely to use pill during the last sexual intercourse compared to those from municipalities with high maternal mortality and low antenatal care coverage. Primary healthcare coverage (proportion of the population covered by primary healthcare teams) was not significantly associated with either condom or pill use during the last sexual intercourse.

          Conclusion

          Our findings suggest that promoting the use of pill among female adolescents may require approaches to strengthen healthcare systems rather than those focused solely on individual attributes.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12905-021-01447-6.

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          Most cited references28

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          Our future: a Lancet commission on adolescent health and wellbeing

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            Contraception for adolescents in low and middle income countries: needs, barriers, and access

            Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.
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              Assistência pré-natal no Brasil

              O estudo tem por objetivo analisar a assistência pré-natal oferecida às gestantes usuárias de serviços de saúde públicos e/ou privados utilizando dados da pesquisa Nascer no Brasil, realizada em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar e dados do cartão de pré- natal. Os resultados mostram cobertura elevada da assistência pré-natal (98,7%) tendo 75,8% das mulheres iniciado o pré-natal antes da 16a semana gestacional e 73,1% compareceram a seis ou mais consultas. O pré-natal foi realizado, sobretudo, em unidades básicas (89,6%), públicas (74,6%), pelo mesmo profissional (88,4%), em sua maioria médicos (75,6%), e 96% receberam o cartão de pré-natal. Um quarto das gestantes foi considerado de risco. Do total das entrevistadas, apenas 58,7% foram orientadas sobre a maternidade de referência, e 16,2% procuraram mais de um serviço para a admissão para o parto. Desafios persistem para a melhoria da qualidade dessa assistência, com a realização de procedimentos efetivos para a redução de desfechos desfavoráveis.
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                Author and article information

                Contributors
                alvilela@usp.br
                Journal
                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central (London )
                1472-6874
                19 August 2021
                19 August 2021
                2021
                : 21
                : 307
                Affiliations
                [1 ]GRID grid.11899.38, ISNI 0000 0004 1937 0722, Public Health Nursing Department, School of Nursing, , University of São Paulo, ; São Paulo, Brazil
                [2 ]GRID grid.11899.38, ISNI 0000 0004 1937 0722, School of Nursing, , University of São Paulo, ; Avenida Doutor Enéas de Carvalho Aguiar, 419, São Paulo, SP 05403-000 Brazil
                [3 ]GRID grid.412182.c, ISNI 0000 0001 2179 0636, Faculty of Health Sciences, , University of Tarapacá, ; Avenida 18 de Septiembre, 2222, 1000000 Arica, Chile
                Author information
                http://orcid.org/0000-0002-2807-1762
                Article
                1447
                10.1186/s12905-021-01447-6
                8374415
                34412604
                24b7f239-ccfd-4eca-83e9-1e4322e9c0a8
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 26 August 2020
                : 6 August 2021
                Funding
                Funded by: Finep
                Award ID: 01090421
                Funded by: CNPq
                Award ID: 565037/2010-2
                Award ID: 405009/2012-7
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Obstetrics & Gynecology
                female adolescents,pill and condom use,individual and contextual factors,multilevel analysis,brazil

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