Ana Luiza Vilela Borges

Monitoring contraceptive discontinuation is crucial to reduce unmet needs and unintended pregnancies while supporting person‐centered counseling. The objective is to summarize discontinuation rates by method type (long‐acting reversible contraceptive [LARC] or short‐acting reversible contraceptive [SARC]), type (abandonment or switching), and to describe reasons for discontinuation. This systematic review and meta‐analysis searched for studies published between 2010 and 2020, with data collected before the COVID‐19 pandemic,among women of reproductive age. Random‐effects models were used to pool 12‐month discontinuation rates and estimate the likelihood of switching versus abandoning methods. Fifty‐four studies were included. The 12‐month discontinuation rate (unit of analysis: women) was 16.2 percent for LARC users ( n = 867,658) and 57.9 percent for SARC users ( n = 18,882). SARC users had lower odds of switching than abandoning their method (odds ratio: 0.17; 95 percent confidence interval: 0.06–0.54), whereas no significant difference was observed among LARC users. By episode use, 12‐month discontinuation was 53.7 percent ( n = 13,445) for SARC and 16.0 percent for LARC ( n = 2,277), lower in postpartum women (8.5 percent) and higher among married women (22.5 percent). Pregnancy desire was the main reason for discontinuation among women not in need of contraception, whereas side effects predominated among those still in need. Monitoring contraceptive discontinuation is essential to guide public health policies and meet sexual and reproductive rights.

Introdução: A oferta do cuidado pré-concepcional às mulheres em Unidades Básicas de Saúde constitui uma estratégia essencial para a promoção da saúde materno-infantil. Objetivo: Descrever a oferta de ações de cuidado pré-concepcional a mulheres em idade fértil atendidas em Unidades Básicas de Saúde da zona leste de São Paulo. Métodos: Estudo transversal, descritivo, com 464 mulheres de 18 a 49 anos atendidas em oito UBS do distrito do Itaim Paulista. Os dados foram coletados por entrevistas presenciais, abordando características sociodemográficas, história reprodutiva e ações de cuidado pré-concepcional, como avaliação da intenção reprodutiva, orientações e prescrição de ácido fólico. Resultados: Predominou perfil socioeconômico vulnerável, com baixa escolaridade e inserção formal no trabalho. A maioria já havia engravidado (média de 2,3 gestações). Apenas cerca de 20% relataram ter sido questionadas sobre intenção de engravidar. Poucas receberam orientações ou prescrição de ácido fólico antes da concepção. Embora o uso de ácido fólico durante a gestação tenha sido alto, no período pré-concepcional foi raro. Conclusão: Observou-se baixa oferta de cuidado pré-concepcional nas UBS, com lacunas na avaliação da intenção reprodutiva e na prevenção antes da gravidez. O fortalecimento dessas ações na Atenção Primária é essencial para reduzir iniquidades e melhorar desfechos maternos e perinatais.

RESUMO Objetivos: avaliar a inserção do dispositivo intrauterino de cobre no pós-parto imediato, considerando efeitos colaterais, intensidade da dor, informações recebidas, participação do acompanhante, satisfação, taxa de expulsão e continuidade do uso. Métodos: estudo longitudinal-prospectivo com 117 mulheres que inseriram o dispositivo intrauterino de cobre no pós-parto imediato em uma maternidade pública de São Paulo, Brasil. Os dados foram coletados no alojamento conjunto por questionário online. Resultados: uma parcela significativa das mulheres não recebeu informações sobre vantagens (31,8%) e efeitos colaterais (42,4%). Após seis meses, 37,5% haviam interrompido o uso, por expulsão (9,4%) ou remoção (28,1%). Efeitos colaterais foram relatados por 60% das mulheres. Apesar da satisfação elevada (85,3% na inserção e 75,0% aos seis meses), a maioria das mulheres (60%) desejava outro método contraceptivo. Conclusões: a falta de aconselhamento reprodutivo adequado pode impactar a continuidade do uso do dispositivo intrauterino e influenciar a escolha contraceptiva no pós-parto.

Objectives: to evaluate the insertion of the copper Intrauterine Device in the immediate postpartum period, considering side effects, pain intensity, information received, partner involvement, satisfaction, expulsion rate, and continued use. Methods: a prospective longitudinal study involving 117 women who had a copper Intrauterine Device inserted in the immediate postpartum period at a public maternity hospital in São Paulo, Brazil. Data were collected in the rooming-in unit through an online questionnaire. Results: a significant portion of the women did not receive information about advantages (31.8%) or side effects (42.4%). After six months, 37.5% had discontinued use due to expulsion (9.4%) or removal (28.1%). Side effects were reported by 60% of the women. Despite high satisfaction rates (85.3% at insertion and 75.0% at six months), the majority (60%) expressed a desire for a different contraceptive method. Conclusions: inadequate reproductive counseling may affect the continued use of intrauterine devices and influence contraceptive choices in the postpartum period.

RESUMO Objetivo: Mapear, na literatura, os indicadores utilizados na avaliação da assistência em contracepção em serviços de Atenção Primária à Saúde. Método: Revisão de escopo baseada no referencial de Arksey e O’Malley e nas recomendações do Joana Briggs Institute, abrangendo estudos publicados entre 1994 e 2023. Foram utilizadas seis bases de dados e dois repositórios de literatura cinzenta. Os dados foram coletados em pares e às cegas. A análise utilizou abordagem dedutiva, sendo os indicadores categorizados nas dimensões estrutura, processo (clínico-assistencial e processo organizacional) e resultado; e subdimensões, conforme o referencial de Donabedian. Resultados: Foram incluídos 37 estudos, majoritariamente transversais, com foco em mulheres em idade reprodutiva. Indicadores relacionados ao processo foram os mais recorrentes, principalmente os vinculados ao componente clínico-assistencial. Na dimensão estrutura, destacou-se a disponibilidade e oferta de métodos contraceptivos. Já na dimensão resultado, o uso de método contraceptivo foi o aspecto avaliado com maior frequência. Conclusão: Há necessidade de indicadores mais específicos que avaliem o conteúdo das informações ofertadas, a satisfação das usuárias e as taxas de descontinuidade contraceptiva. Torna-se importante ampliar o escopo da avaliação, incorporando perspectivas dos profissionais de saúde e abordando questões relacionadas às infecções sexualmente transmissíveis na assistência em contracepção.

Objective: To map, in the literature, the indicators used to evaluate contraceptive care in Primary Health Care services. Method: Scoping review based on the framework proposed by Arksey and O’Malley and on the recommendations of the Joanna Briggs Institute, encompassing studies published between 1994 and 2023. Six databases and two grey literature repositories were searched. Data collection was conducted in pairs and independently. The analysis employed a deductive approach, with indicators categorized into the dimensions of structure, process (clinical-care and organizational process), and outcome, as well as into subdimensions, according to Donabedian’s framework. Results: A total of 37 studies were included, mostly cross-sectional, focusing on women of reproductive age. Process-related indicators were the most frequent, particularly those linked to the clinical-care component. In the structure dimension, the availability and provision of contraceptive methods stood out. In the outcome dimension, contraceptive method use was the most frequently assessed aspect. Conclusion: There is a need for more specific indicators to evaluate the content of information provided, user satisfaction, and contraceptive discontinuation rates. It is important to broaden the scope of evaluation by incorporating the perspectives of health professionals and addressing issues related to sexually transmitted infections within contraceptive care.

This study examines factors associated with anxiety and perceived stress among adolescents living in socioeconomically vulnerable urban areas of São Paulo, Brazil, in the context of the Covid-19 pandemic. Drawing from a cross-sectional analysis of 396 cisgender adolescents aged 13–17, recruited through Family Health Strategy units, data were collected via structured home-based interviews and analyzed using validated psychometric tools (GAD-7 and PSS-10). Findings indicate that 28.5% of participants exhibited moderate to severe anxiety, and 72.5% reported moderate to high levels of perceived stress, especially among girls. Multivariate models identified age, gender, perceived emotional neglect, experiences of verbal hostility within the household, digital sociability, and pandemic-induced academic difficulties as key predictors of adverse outcomes. Conversely, protective associations were observed for adolescents whose parents were in a relationship, who reported affective support at school, or who lived in owned housing. The intersection between gender norms, emotional vulnerability, and structural deprivation emerged as a critical lens for interpreting the psychosocial consequences of the pandemic. These results underscore the need for context-sensitive public health strategies that transcend individualizing frameworks and address the material, relational, and symbolic dimensions of adolescent mental health in unequal urban settings.

The development of valid measures of pregnancy intentions has been an important priority in the reproductive health field. A validated measure, the Desire to Avoid Pregnancy (DAP) scale, was developed in the USA to assess preferences regarding future pregnancy and childbearing, but it has not yet been validated in Brazil. This psychometric study aimed to adapt and evaluate the DAP scale in Brazilian Portuguese using both Item Response Theory and Classical Test Theory methods. Reproductive-aged women who had ever reported sexual activity, had not had a hysterectomy, were not sterilized, and had no partner with a vasectomy (n = 1,596) responded to an online survey with the 14 DAP scale items in March and April 2021. The items were comprehensible, even among women with lower education levels. Internal consistency (Cronbach’s α = 0.958) and test-retest reliability (ICC = 0.95) were both excellent. Exploratory factor analysis confirmed a one-factor model. Based on confirmatory factor analysis and the Item Response Model, items 3 (Thinking about becoming pregnant in the next 3 months makes me feel unhappy) and 5 (Becoming pregnant in the next 3 months would bring me closer to my main partner) did not perform well. However, testing a version without these items did not show substantial improvement in the psychometric parameters. The analysis showed significant differences in DAP scores according to age, educational status, and relationship status. As hypothesized, women with higher DAP scores were more likely to use contraception than those with lower scores [OR=2.12; 95%CI = 1.90–2.35]. The DAP scale, validated in Brazil, should be used in its full 14-item version until future studies are available. The scale has the potential to generate more accurate estimates of prospective pregnancy intention in Brazil and can be used to assess the outcomes of unintended pregnancies in maternal and infant health, providing an improvement over previous approaches.