Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

Houvèssou, Gbènankpon Mathias; Farías-Antúnez, Simone; Bertoldi, Andréa D.; Silveira, Mariângela Freitas da

doi:10.11606/s1518-8787.2024058005585

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Original Article • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058005585 copy

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria.

METHODS

The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI).

RESULTS

The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4–27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3–54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25–30 kg/m² body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women’s education, the lower the prevalence of inappropriate use of modern contraceptives.

CONCLUSION

In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women’s reproductive health should be strengthened.

Contraceptive Agents; Contraindications; Progesterone; Contraceptives, Oral, Combined; Intrauterine Devices

Variables	Contraceptive users (n = 3,053)	Prevalence of contraindicated use	p-value^a

	n (%)	% (95%CI)
Age (years)			0.860
< 25	541 (17.7)	25.3 (21.8–29.2)
25–29	737 (24.1)	25.9 (22.9–29.2)
30–34	781 (25.6)	25.2 (22.3–28.4)
≥ 35	994 (32.6)	26.9 (24.2–29.7)
Family income in minimum monthly wages (R$ 998.00)			< 0.001
≤ 1	1,423 (47.1)	23.5 (19.1–28.5)
1.1–3.0	836 (27.6)	29.2 (26.9–31.7)
3.1–6.0	233 (7.7)	24.8 (21.9–27.8)
6.1–10	217 (7.2)	25.3 (20.1–31.3)
>10	315 (10.4)	14.3 (10.2–19.6)
Education level			< 0.001
0–4	783 (25.6)	40.2 (30.8–50.4)
5–8	1,131 (37.0)	27.8 (24.8–31.1)
9–11	1,043 (34.2)	26.4 (23.9–29.1)
≥12	97 (3.2)	22.6 (20.2–25.3)
Body mass index (BMI) in kg/m²			0.015
< 25	1,083 (36.4)	23.2 (20.8–25.8)
25–29	956 (32.2)	28.4 (25.6–31.3)
≥ 30	935 (31.4)	27.6 (24.8–30.6)
Indication for the method currently in use			< 0.001
Gynecologist	2,080 (68.3)	29.8 (27.9–31.8)
General practitioner at PHU	230 (7.5)	26.5 (21.2–32.6)
Friend/relative	102 (3.4)	30.4 (22.1–40.1)
Other	634 (20.8)	12.6 (10.2–15.4)
Source for contraceptive method in use			< 0.001
Purchase at a pharmacy	1,928 (63.6)	31.7 (29.6–33.8)
Health center/donation from university	761 (25.1)	22.1 (19.3–25.2)
Health insurance	112 (3.7)	3.6 (1.3–9.3)
Other	230 (7.6)	2.2 (0.9–5.1)
Reason for choosing the contraceptive method			< 0.001
Indication of trustworthiness	808 (26.5)	31.9 (28.8–35.2)
Efficacy	719 (23.6)	25.2 (22.1–28.5)
Ease of use	623 (20.4)	27.8 (24.4–31.4)
Cost/accessibility/free-of-charge	111 (3.6)	23.4 (16.4–32.3)
Other	790 (25.9)	19.5 (16.9–22.4)
Feeling of security and adaptation to the method			0.085
No	355 (11.7)	29.9 (25.3–34.9)
Yes	2,683 (88.3)	25.5 (23.9–27.2)

Contraceptive method	n	%	95%CI
Combined hormonal contraceptive	1,275	41.8	40.0–43.5
Progesterone-only contraceptive	950	31.1	29.5–32.8
Male and female condoms	411	13.5	12.3–14.7
Ligature/ligation	180	5.9	5.1–6.8
Intrauterine devices
Copper-bearing	153	5.0	4.3–5.8
Levonorgestrel-releasing	18	0.6	0.4–0.9
Vasectomy undergone by partner	26	0.85	0.6–1.2
Rhythm (calendar)	11	0.4	0.2–0.6
Interrupted coitus	6	0.2	0.1–0.4
Emergency contraceptive pills	1	0.03	0.004–0.23
Other methods^a	22	0.72	0.5–1.1

Variable	Prevalence of contraindications			Prevalence of the incorrect use in the presence of such contraindication

	n	%	95%CI	n	%	95%CI
Contraindications
Smoking aged ≥ 35 years	170	5.6	4.8–6.5	59	1.9	1.5–2.5
Liver tumor	6	0.2	0.09–0.4	4	0.1	0.05–0.3
Acute hepatitis	43	1.4	1.0–1.9	17	0.6	0.3–0.9
Previous deep vein thrombosis	10	0.3	0.2–0.6	4	0.1	0.05–0.3
Acute venous thrombosis	4	0.1	0.05–0.3	0	0.0	-
Stroke	3	0.1	0.03-0.3	0	0.0	-
Heart attack or angina	17	0.6	0.3–0.9	14	0.5	0.3–0.8
Controlled hypertension	306	10.1	9.0–11.2	123	4.0	3.4–4.8
Decompensated hypertension	91	3.0	2.4–3.6	5	1.8	1.4–2.3
Diabetes	69	2.3	1.8–2.9	31	1.0	0.7–1.4
Migraine headache	1,348	44.2	42.4–46.0	547	17.9	16.6–19.3
Migraine headache with aura	283	9.3	8.3–10.4	195	6.4	5.6–7.3
Uterine fibroid	87	2.9	2.3–3.5	2	0.1	0.02–0.3
Cervical cancer	2	0.1	0.02–0.3	1	0.03	0.005–0.2
Breast cancer	8	0.3	0.1–0.5	5	0.2	0.07–0.4
Number of contraindications
1 contraindication	1,08	35.4	33.7–37.1	582	19.1	17.7–20.5
2 contraindications	451	14.8	13.6–16.1	170	5.6	4.8–6.4
3 contraindications	99	3.2	2.7–3.9	27	0.9	0.6–1.3
4 contraindications	38	1.2	0.9–1.7	12	0.4	0.2–0.7
5 contraindications	3	0.1	0.03–0.3	1	0.03	0.005–0.2
7 contraindications	1	0.03	0.005–0.2	-	-	-
Total	1,672	54.7	53.0–56.5	792	25.9	24.4–27.5

Variable	CHC among contraceptive users in general	POC among contraceptive users in general	IUDs among contraceptive users in general

	% (95%CI)	% (95%CI)	% (95%CI)
Evaluated contraindications (n = 3,053)
Smoking aged ≥ 35 years	1.9 (1.5–2.5)	*	*
Liver tumor	0.1 (0.02–0.3)	0.1 (0.02–0.3)	0.0
Acute hepatitis	0.6 (0.3–0.9)	*	*
Previous deep vein thrombosis	0.1 (0.05–0.3)	*	*
Acute venous thrombosis	0.0	0.0	0.0
Stroke	0.0	0.0	*
Heart attack or angina	0.1 (0.03–0.3)	0.4 (0.2–0.7)	0.0
Controlled hypertension	4.0 (3.4–4.8)	*	*
Decompensated hypertension	1.1 (0.8–1.6)	0.6 (0.4–1.0)	*
Diabetes	0.9 (0.6–1.3)	0.2 (0.1–0.4)	*
Migraine headache	17.9 (16.6–19.3)	*	*
Migraine headache with aura	3.2 (2.6–3.9)	3.1 (2.6–3.8)	0.1 (0.02–0.3)
Uterine fibroid	*	*	0.1 (0.02–0.3)
Cervical cancer	*	*	0.03 (0.01–0.2)
Breast cancer	0.1 (0.02–0.3)	0.1 (0.03–0.3)	0.0
Prevalence of contraindicated use	21.7 (20.3–23.2)	4.1 (3.4–4.8)	0.1 (0.05–0.3)
Prevalence of contraindicated use among CHC users (n = 1,275)	52.1 (49.3–54.8)	NA	NA
Prevalence of contraindicated use among POC users (n = 950)	NA	13.1 (11.1–15.4)	NA
Prevalence of contraindicated use among IUD users (n= 171)	NA	NA	2.3 (0.9–6.1)

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[1] Correspondence: Gbènankpon Mathias Houvèssou Rua Marechal Deodoro, 1,160 - 3º piso 96020-220 Pelotas, RS, Brasil E-mail: gbemathg@gmail.com