Osmara Alves dos Santos

Evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy in Brazilian Portuguese

BackgroundEstimates of unplanned pregnancy worldwide are of concern, especially in low and middle-income countries, including Brazil. Although the contraceptive prevalence rate is high in Brazil, almost half of all pregnancies are reported as unintended. The only source of nationally representative data about pregnancy intention is the Demographic and Health Survey, as with many other countries. In more recent years, however, it has been realized that concept of unintended pregnancy is potentially more complex and requires more sophisticated measurement strategies, such as the London Measure of Unplanned Pregnancy (LMUP). The LMUP has been translated and validated in other languages, but not Portuguese yet. In this study, we evaluate the psychometric properties of the LMUP in the Portuguese language, Brazilian version.MethodsA Brazilian Portuguese version of the LMUP was produced via translation and back-translation. After piloting, the mode of administration was changed from self-completion to interviewer-administration. The measure was field tested with pregnant, postpartum, and postabortion women recruited at maternity and primary health care services in Sao Paulo city. Reliability (internal consistency) was assessed using Cronbach’s alpha and item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Scaling was assessed with Mokken analysis.Results759 women aged 15–44 completed the Brazilian Portuguese LMUP. There were no missing data. The measure was acceptable and well targeted. Reliability testing demonstrated good internal consistency (alpha = 0.81, all item-rest correlations >0.2). Validity testing confirmed that the measure was unidimensional and that all hypotheses were met: there were lower LMUP median scores among women in the extreme age groups (p < 0.001), among non-married women (p < 0.001) and those with lower educational attainment (p < 0.001). The Loevinger H coefficient was 0.60, indicating a strong scale.ConclusionThe Brazilian Portuguese LMUP is a valid and reliable measure of pregnancy planning/intention that is now available for use in Brazil. It represents a useful addition to the public health research and surveillance toolkit in Brazil.

Women’s reproductive health knowledge, attitudes and practices in relation to the Zika virus outbreak in northeast Brazil

Objectives To assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil. Methods We interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak. Results Awareness about Zika congenital syndrome was high, but knowledge about sexual transmission was low. Few women had changed pregnancy intentions or contraceptive practices in response to Zika. Pregnant women were more likely to access counseling about family planning, condom use and pregnancy postponement due to Zika virus than non-pregnant women, which may suggest that health system responses followed pregnancy occurrence. Conclusions We observed missed opportunities for prevention of perinatal transmission of Zika virus through behavioral change, including effective contraception to prevent pregnancy and condoms to prevent perinatal transmission, as a complement to vector control.

Determinants of emergency contraception non-use among women in unplanned or ambivalent pregnancies

Objective To analyze the determinants of emergency contraception non-use among women in unplanned and ambivalent pregnancies. Method Cross-sectional study with a probabilistic sample of 366 pregnant women from 12 primary health care units in the city of São Paulo, Brazil. A multinomial logistic regression was performed, comparing three groups: women who used emergency contraception to prevent ongoing pregnancies (reference); women who made no use of emergency contraception, but used other contraceptive methods; and women who made no use of any contraceptive methods at all. Results Cohabitation with a partner was the common determinant of emergency contraception non-use. No pregnancy risk awareness, ambivalent pregnancies and no previous use of emergency contraception also contributed to emergency contraception non-use. Conclusion Apart from what is pointed out in the literature, knowledge of emergency contraception and the fertile period were not associated to its use.Objective To analyze the determinants of emergency contraception non-use among women in unplanned and ambivalent pregnancies. Method Cross-sectional study with a probabilistic sample of 366 pregnant women from 12 primary health care units in the city of Sao Paulo, Brazil. A multinomial logistic regression was performed, comparing three groups: women who used emergency contraception to prevent ongoing pregnancies (reference); women who made no use of emergency contraception, but used other contraceptive methods; and women who made no use of any contraceptive methods at all. Results Cohabitation with a partner was the common determinant of emergency contraception non-use. No pregnancy risk awareness, ambivalent pregnancies and no previous use of emergency contraception also contributed to emergency contraception non-use. Conclusion Apart from what is pointed out in the literature, knowledge of emergency contraception and the fertile period were not associated to its use.

Post-abortion contraception: care and practices

Objective to analyze assistance regarding contraception methods received by women during hospitalization due to abortion, and contraceptive practices the month after this episode. Methods a longitudinal study of women hospitalized due to abortion in a public hospital in the city of São Paulo. Face-to-face interviews (n=170) followed by telephone interviews in the subsequent month (n=147) were conducted between May and December of 2011. Results a small number of women reported they received guidance on, and prescription for, contraceptive methods at hospital discharge. A trend of statistical significance was identified for prescription of contraceptive methods at discharge and its use in the following month, when adjusted for age. Most women reported sexual intercourse (69.4%) with the use of contraceptive method (82.4%), but no health professional guidance (63.1%). Conclusion despite the fact that post-abortion contraception assistance was lower than the recommended guidelines by public health policies, women demonstrated willingness to use contraceptive methods.OBJETIVO: analisar a atencao em anticoncepcao recebida por mulheres durante a hospitalizacao por abortamento e suas praticas contraceptivas, no mes subsequente a esse episodio. METODO: estudo longitudinal com mulheres hospitalizadas por abortamento, em uma maternidade publica da cidade de Sao Paulo. Foram feitas entrevistas face a face (n=170) e, apos um mes, por contato telefonico (n=147) entre maio e dezembro de 2011. RESULTADOS: as orientacoes em anticoncepcao e a alta hospitalar com metodo anticonceptivo prescrito foram referidas por proporcao reduzida de mulheres. Houve tendencia de significância estatistica para a prescricao de metodo anticonceptivo, ajustado pela idade, na alta hospitalar e o seu uso no mes subsequente. A maioria das mulheres teve relacoes sexuais (69,4%) com uso de metodo anticoncepcional (82,4%), mas sem orientacao de profissional de saude (63,1%). CONCLUSAO: apesar da atencao em anticoncepcao pos-abortamento estar aquem das diretrizes estabelecidas pelas politicas publicas, as mulheres demonstraram disponibilidade para usar metodos anticonceptivos.

Preconception health behaviors associated with pregnancy planning status among Brazilian women

OBJECTIVE The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. METHOD This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. RESULTS Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. CONCLUSION The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. OBJETIVO Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. MÉTODO Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. RESULTADOS O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pré-concepcional e o planejamento da gravidez (ORajustado=16,77; IC95% 9,47-29,81). A idade acima de 30 anos, o trabalho remunerado e o intervalo de tempo entre a menarca e a primeira relação sexual também estiveram associados à realização do preparo pré-concepcional. CONCLUSÃO A baixa frequência de realização de preparo pré-concepcional, mesmo entre mulheres com gravidez planejada, indica a urgência de se incluir o cuidado pré-concepcional na agenda de políticas públicas de saúde.Medir la realizacion de la preparacion pre concepcional, describir las medidas adoptadas como preparacion pre concepcional y analizar el efecto de la planificacion del embarazo en la preparacion pre concepcional. METODO Estudio cuantitativo, del tipo transversal, conducido con 807 mujeres, de las cuales 649 tenian embarazo planificado o ambivalente. La preparacion pre concepcional fue medida mediante el London Measure of Unplanned Pregnancy , version Brasil. RESULTADOS La preparacion pre concepcional fue realizada por solo el 15,9% de las mujeres. Entre las que planificaron el embarazo, menos de la mitad realizo alguna preparacion (47,0%), siendo las mas frecuentes haber buscado asistencia medica y cambios en la alimentacion. El analisis de regresion logistica multiple mostro fuerte asociacion entre la realizacion de la preparacion pre concepcional y la planificacion del embarazo (ORajustado=16,77; IC95% 9,47-29,81). La edad superior a 30 anos, el trabajo remunerado y el intervalo de tiempo entre la menarca y la primera relacion sexual tambien estuvieron asociados con la realizacion de la preparacion pre concepcional. CONCLUSION La baja frecuencia de realizacion de preparacion pre concepcional, aun entre mujeres con embarazo planificado, senala la urgencia de incluirse el cuidado pre concepcional en la agenda de politicas publicas de salud.

Contraceptive patterns after use of emergency contraception among female undergraduate students in Brazil

Abstract Objective: The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in São Paulo, Brazil. Methods: This study was part of a larger project conducted in 2015 among 1679 female students aged 18–24 enrolled at the University of São Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use. Results: Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception. Conclusions: The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.

Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy

OBJECTIVE to examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women. DESIGN AND SETTING a prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014. PARTICIPANTS A total of 264 woman aged 15-44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum. MEASUREMENTS At baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status. FINDINGS Only 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97]. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Brazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect postpartum contraceptive use. Women with unintended pregnancies present an important opportunity to offer additional family planning counseling.

Satisfaction with the use of contraceptive methods among women from primary health care services in the city of São Paulo, Brazil

Objectives: to assess satisfaction with the use of contraceptive methods among women attending primary health care services in São Paulo, Brazil. Methods: cross-sectional study conducted with a sample of 668 women aged 18-49 years, who were enrolled in 38 primary health care facilities in São Paulo city, Brazil, in 2015. Exclusion criteria were no sexual initiation, use of irreversible contraceptive methods for more than five years, pregnancy and no contraceptive method use. Data were analyzed using chi-square and multivariate logistic regression. Results: in general, women were satisfied with current contraceptive method (78.7%). The higher percentage of satisfaction was observed among IUD users (94.7%), and female and male sterilization users (93.5% and 91.7%, respectively). Withdrawal users were less satisfied (52.9%). Contraceptive method itself was the only factor associated with satisfaction. Barrier or traditional method users were less likely to be satisfied with their contraceptive methods than irreversible method users. Conclusions: long acting contraceptive method and irreversible method users were more satisfied with their contraceptive methods. Efforts should be undertaken in order to make these contraceptives available and accessible in primary health care facilities in Brazil.

Preparo pré-concepcional entre mulheres brasileiras e a relação com o planejamento da gravidez

OBJECTIVE The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. METHOD This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. RESULTS Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. CONCLUSION The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. OBJETIVO Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. MÉTODO Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. RESULTADOS O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pré-concepcional e o planejamento da gravidez (ORajustado=16,77; IC95% 9,47-29,81). A idade acima de 30 anos, o trabalho remunerado e o intervalo de tempo entre a menarca e a primeira relação sexual também estiveram associados à realização do preparo pré-concepcional. CONCLUSÃO A baixa frequência de realização de preparo pré-concepcional, mesmo entre mulheres com gravidez planejada, indica a urgência de se incluir o cuidado pré-concepcional na agenda de políticas públicas de saúde.Medir la realizacion de la preparacion pre concepcional, describir las medidas adoptadas como preparacion pre concepcional y analizar el efecto de la planificacion del embarazo en la preparacion pre concepcional. METODO Estudio cuantitativo, del tipo transversal, conducido con 807 mujeres, de las cuales 649 tenian embarazo planificado o ambivalente. La preparacion pre concepcional fue medida mediante el London Measure of Unplanned Pregnancy , version Brasil. RESULTADOS La preparacion pre concepcional fue realizada por solo el 15,9% de las mujeres. Entre las que planificaron el embarazo, menos de la mitad realizo alguna preparacion (47,0%), siendo las mas frecuentes haber buscado asistencia medica y cambios en la alimentacion. El analisis de regresion logistica multiple mostro fuerte asociacion entre la realizacion de la preparacion pre concepcional y la planificacion del embarazo (ORajustado=16,77; IC95% 9,47-29,81). La edad superior a 30 anos, el trabajo remunerado y el intervalo de tiempo entre la menarca y la primera relacion sexual tambien estuvieron asociados con la realizacion de la preparacion pre concepcional. CONCLUSION La baja frecuencia de realizacion de preparacion pre concepcional, aun entre mujeres con embarazo planificado, senala la urgencia de incluirse el cuidado pre concepcional en la agenda de politicas publicas de salud.

Preparación pre concepcional entre mujeres brasileñas y la relación con la planificación del embarazo

OBJECTIVE The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. METHOD This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. RESULTS Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. CONCLUSION The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. OBJETIVO Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. MÉTODO Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. RESULTADOS O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pré-concepcional e o planejamento da gravidez (ORajustado=16,77; IC95% 9,47-29,81). A idade acima de 30 anos, o trabalho remunerado e o intervalo de tempo entre a menarca e a primeira relação sexual também estiveram associados à realização do preparo pré-concepcional. CONCLUSÃO A baixa frequência de realização de preparo pré-concepcional, mesmo entre mulheres com gravidez planejada, indica a urgência de se incluir o cuidado pré-concepcional na agenda de políticas públicas de saúde.Medir la realizacion de la preparacion pre concepcional, describir las medidas adoptadas como preparacion pre concepcional y analizar el efecto de la planificacion del embarazo en la preparacion pre concepcional. METODO Estudio cuantitativo, del tipo transversal, conducido con 807 mujeres, de las cuales 649 tenian embarazo planificado o ambivalente. La preparacion pre concepcional fue medida mediante el London Measure of Unplanned Pregnancy , version Brasil. RESULTADOS La preparacion pre concepcional fue realizada por solo el 15,9% de las mujeres. Entre las que planificaron el embarazo, menos de la mitad realizo alguna preparacion (47,0%), siendo las mas frecuentes haber buscado asistencia medica y cambios en la alimentacion. El analisis de regresion logistica multiple mostro fuerte asociacion entre la realizacion de la preparacion pre concepcional y la planificacion del embarazo (ORajustado=16,77; IC95% 9,47-29,81). La edad superior a 30 anos, el trabajo remunerado y el intervalo de tiempo entre la menarca y la primera relacion sexual tambien estuvieron asociados con la realizacion de la preparacion pre concepcional. CONCLUSION La baja frecuencia de realizacion de preparacion pre concepcional, aun entre mujeres con embarazo planificado, senala la urgencia de incluirse el cuidado pre concepcional en la agenda de politicas publicas de salud.