Conhecimento e planejamento do uso de método contraceptivo após o parto
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Data
2023-09-25
Autores
Maia, Elaine Meireles Castro [UNIFESP]
Orientadores
Guazzelli, Cristina Aparecida Falbo [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Conhecer a escolha do método contraceptivo após o parto; verificar o conhecimento sobre métodos contraceptivos; identificar o motivo para a escolha; comparar a escolha do contraceptivo entre adolescentes e adultas; conhecer a incidência de uso do método de primeira opção após orientação; avaliar a taxa de continuidade de uso dos métodos de longa ação e avaliar a satisfação de uso da anticoncepção. Método: Estudo de coorte, prospectivo com mulheres após o parto atendidas em uma maternidade pública de ensino, de nível terciário, em Fortaleza-Ceará, entre novembro de 2019 a março de 2022. As mulheres foram acompanhadas em três momentos distintos, no pós-parto imediato (entrevista presencial), dois meses após o parto (contato por telefone ou aplicativo) e seis meses após o parto (também por telefone/aplicativo). Os dados foram coletados por meio da ferramenta REDCap e analisados usando o JAMOVI versão 2.3.28. Análises de regressão logística foram empregadas para estimar o odds ratio bruto e ajustado com intervalo de confiança de 95% e valor de P < 0,05 na análise multivariada considerada estatisticamente significativa. Tabelas de frequência e resumos descritivos foram utilizados para descrever as variáveis do estudo. Resultados: Participaram da primeira entrevista 402 mulheres e 294 delas completaram a pesquisa sendo, 166 (56,5%) adolescentes e 128 (43,5%) adultas. A maioria era, casada ou em união estável (75,8%), parda (74%), cristã (73%) e com renda familiar de até um salário mínimo (56%). Todas realizaram pré-natal e 48% delas não compareceu à consulta de revisão de parto. A gravidez não foi planejada para 72,4% delas e 92,5% (197) não faziam uso de nenhum método de prevenção. Entre os métodos, os mais conhecidos eram a pílula (99,3%) e o injetável hormonal (99,3%), mas a maioria das adolescentes não sabia utilizar. Após ação edicativa foi evidenciada uma maior tendência pela escolha por métodos de longa ação (p<0,001). Na análise de motivações para escolha do método contraceptivo especialmente entre as adultas, prevaleceu a justificativa de ser acessível, fácil e prático. Após 6 meses do parto, 169(57,5%) mulheres não estavam utilizando o método que haviam escolhido na primeira entrevista e a dificuldade de acesso aparece como a principal razão para o não uso. Na análise multivariada ajustada foi possível observar que fatores como faixa etária, raça, início precoce e escolha por métodos de curta ação, estiveram significativamente associados à maior adesão ao método desejado. O início precoce da anticoncepção no pós-parto foi fator fortemente associado (OR=6,35, p<0,001). Ao final da pesquisa, a maioria das entrevistadas (79%) estava satisfeita com o método em uso, independentemente de ser ou não o de primeira escolha. A taxa de continuidade de uso do implante foi de 100%, do DIU e do injetável trimestral 60%. A adesão ao método de primeira escolha foi fator fortemente associada à maior continuidade (OR=4,16). Conclusões: Puérperas buscavam por métodos acessíveis, fáceis, práticos e seguros. O pós-parto imediato consistiu em momento oportuno para aconselhamento e oferta desses contraceptivos contribuindo para o ganho de adesão especialmente entre os métodos de longa ação.
Objectives: The study aimed to Know about the choice of contraceptive method by postpartum women; check the knowledge about contraceptive methods; identify the reasons for the choice; compare the choice of contraceptive between adolescents and adult women; know the incidence of use of the first-choice method after guidance; evaluate the continuity rate of use of long-acting methods and evaluate satisfaction with the contraception in use. Method: Cohort, prospective study with postpartum women attended at a tertiary public teaching maternity hospital in Fortaleza-Ceará, between November 2019 and March 2022. The women were followed up at three different times, in the immediate postpartum period (face-to-face interview), two months after delivery (contact by phone or application) and six months after delivery (also by phone/application). The data was co llected by using the REDCap tool and analyzed using JAMOVI version 2.3.28. Logistic regression analyzes were used to estimate the crude and adjusted odds ratios with a 95% confidence interval and P value < 0.05 in the multivariate analysis considered statistically significant. Frequency tables and descriptive summaries were used to describe the study variables. Results: 402 women participated in the first interview and 294 of them completed the survey, 166 (56.5%) adolescents and 128 (43.5%) adults. Most were married/cohabitant (75.8%), brown (74%), Christian (73%) and with monthly family income of one Brazilian minimum wage (56%). All of them underwent prenatal care however six months afther giving birth only 52% of them appearded to the postnatal care atte ndancendance. Pregnancy was not planned for 72.4% of them and 92.5% (197) did not use any prevention method. Among the methods, the most known were the pill (99.3%) and the hormonal injection (99.3%), but most adolescents did not know how to use them. After the edicative intervention, there was a greater tendency to choose long-acting methods (p<0.001). In the analysis of motivations for choosing the contraceptive method, especially among adults, the justification of being accessible, easy and practical prevailed. 6 months after delivery, 169 (57.5%) women were not using the method they had chosen in the first interview and the difficulty of access appears as the main reason for not using it. In the adjusted multivariate analysis, it was possible to observe that factors such as age group, race, early initiation and choice of short-acting methods were significantly associated with greater adherence to the desired method. Early initiation of contraception in the postpartum period was a strongly associated factor (OR=6.35, p<0.001). At the end of the survey, most women (79%) were satisfied with the method they being used, regardless of whether or not it was the first choice. The rate of continuity of use for the implant was 100%, for the IUD and the quarterly injectable 60%. Adherence to the first-choice method was a factor strongly associated with greater continuity (OR=4.16) Conclusions: Postpartum women were looking for accessible, easy, practical and safe methods, so the immediate postpartum period was a good moment for counseling and offering these contraceptives, contributing to the gain of adherence, especially among long-acting methods.
Objectives: The study aimed to Know about the choice of contraceptive method by postpartum women; check the knowledge about contraceptive methods; identify the reasons for the choice; compare the choice of contraceptive between adolescents and adult women; know the incidence of use of the first-choice method after guidance; evaluate the continuity rate of use of long-acting methods and evaluate satisfaction with the contraception in use. Method: Cohort, prospective study with postpartum women attended at a tertiary public teaching maternity hospital in Fortaleza-Ceará, between November 2019 and March 2022. The women were followed up at three different times, in the immediate postpartum period (face-to-face interview), two months after delivery (contact by phone or application) and six months after delivery (also by phone/application). The data was co llected by using the REDCap tool and analyzed using JAMOVI version 2.3.28. Logistic regression analyzes were used to estimate the crude and adjusted odds ratios with a 95% confidence interval and P value < 0.05 in the multivariate analysis considered statistically significant. Frequency tables and descriptive summaries were used to describe the study variables. Results: 402 women participated in the first interview and 294 of them completed the survey, 166 (56.5%) adolescents and 128 (43.5%) adults. Most were married/cohabitant (75.8%), brown (74%), Christian (73%) and with monthly family income of one Brazilian minimum wage (56%). All of them underwent prenatal care however six months afther giving birth only 52% of them appearded to the postnatal care atte ndancendance. Pregnancy was not planned for 72.4% of them and 92.5% (197) did not use any prevention method. Among the methods, the most known were the pill (99.3%) and the hormonal injection (99.3%), but most adolescents did not know how to use them. After the edicative intervention, there was a greater tendency to choose long-acting methods (p<0.001). In the analysis of motivations for choosing the contraceptive method, especially among adults, the justification of being accessible, easy and practical prevailed. 6 months after delivery, 169 (57.5%) women were not using the method they had chosen in the first interview and the difficulty of access appears as the main reason for not using it. In the adjusted multivariate analysis, it was possible to observe that factors such as age group, race, early initiation and choice of short-acting methods were significantly associated with greater adherence to the desired method. Early initiation of contraception in the postpartum period was a strongly associated factor (OR=6.35, p<0.001). At the end of the survey, most women (79%) were satisfied with the method they being used, regardless of whether or not it was the first choice. The rate of continuity of use for the implant was 100%, for the IUD and the quarterly injectable 60%. Adherence to the first-choice method was a factor strongly associated with greater continuity (OR=4.16) Conclusions: Postpartum women were looking for accessible, easy, practical and safe methods, so the immediate postpartum period was a good moment for counseling and offering these contraceptives, contributing to the gain of adherence, especially among long-acting methods.