Revista Panamericana de salud Pública/Pan American Journal of Public Health

Volume 23 (6) | June 30, 2008 | page(s) 410-417
Janine L. Barden-O’Fallon¹ , Ilene S. Speizer² , Justin S. White³
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key words: Contraception; pregnancy, unplanned; pregnancy, unwanted; Guatemala.Anticoncepción, embarazo no planeado, embarazo no deseado, Guatemala.

Suggested Citation: Barden-O’Fallon JL, Speizer IS, White JS. Association between contraceptive discontinuation and pregnancy intentions in Guatemala. Rev Panam Salud Publica. 2008;23(6):410-417

Objectives. To determine whether contraceptive discontinuation is associated with pregnancies that are conceived earlier than desired (mistimed) or are not wanted at the time of conception (unwanted).
Methods. Data were obtained from the 2002 Guatemala National Maternal and Child Health Survey. Pregnancies within the three years prior to and at the time of the survey (April 1999–November 2002) were classified as either “intended,” “mistimed,” or “unwanted.” The key independent variable was whether the woman had used contraception within 12 months of the pregnancy and, for those who had used it, the reason for discontinuation (either to get pregnant or for another reason). A multinomial logistic analysis was used to determine the degree of association of discontinuation with pregnancy intentions.
Results. One of every five mistimed pregnancies and one of every six unwanted pregnancies followed discontinuations that were for reasons other than to become pregnant (e.g., contraceptive failure, side effects, and health concerns). Discontinuations for reasons other than to become pregnant were shown to be positively and significantly associated with a reported mistimed pregnancy (coefficient = 2.15; standard error = 0.27) or unwanted pregnancy (2.68; 0.37) compared to an intended pregnancy. Pregnancies preceded by discontinuations for reasons other than to become pregnant were also more likely to be reported as mistimed or unwanted than pregnancies of women who were not using contraception during the year prior to pregnancy.
Conclusions. There is a need to increase contraceptive continuation. Any program should include an increased effort to reduce contraceptive failure and better address the side effects and the health concerns that women have that can lead to discontinuation. Non-users who want to delay or limit births should also be identified and targeted for outreach in order to reduce unintended pregnancies.

Asociación entre la suspensión en el uso de anticonceptivos y las intenciones de embarazo en Guatemala

Objetivos. Determinar si la suspensión del uso de anticonceptivos (SUA) está asociada con embarazos concebidos antes de lo deseado (inoportunos) o no deseados.
Métodos. Se usaron los datos de la Encuesta Nacional de Salud Materna e Infantil en Guatemala de 2002. Los embarazos registrados entre los tres años previos a la encuesta (desde abril de 1999) y el final de la misma (noviembre de 2002) se clasificaron como deseados, inoportunos o no deseados. La variable independiente principal fue si la mujer había usado algún anticonceptivo en los 12 meses previos al embarazo y, en ese caso, la razón de la SUA (para lograr un embarazo u otra razón). Mediante el análisis logístico polinominal se determinó el grado de asociación entre la SUA y el tipo de embarazo resultante.
Resultados. Uno de cada cinco embarazos inoportunos y uno de cada seis embarazos no deseados sucedieron a la SUA por razones ajenas al deseo de un embarazo (por ejemplo, fallas o efectos secundarios del anticonceptivo, o consideraciones de salud). Se encontró una asociación directa y significativa entre la SUA por razones ajenas al deseo de quedar embarazada y los embarazos clasificados como inoportunos (coeficiente = 2,15; error estándar = 0,27) o no deseados (2,68; 0,37), en contraste con los embarazos deseados. Las mujeres que suspendieron el uso de anticonceptivos por razones ajenas al deseo de un embarazo presentaron una mayor probabilidad de considerar sus embarazos inoportunos o no deseados que las mujeres que no emplearon medios anticonceptivos en el año previo a su embarazo.
Conclusiones. Es necesario promover el uso continuado de los anticonceptivos. Los programas deben hacer un mayor esfuerzo para reducir las fallas de los anticonceptivos, informar mejor sobre los efectos secundarios y aclarar las preocupaciones sanitarias que puedan llevar a la SUE. A fin de reducir el número de embarazos no programados, se deben identificar y captar a las mujeres que no usan anticonceptivos y quieren demorar o evitar un embarazo.

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1. MEASURE Evaluation Project, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. Send correspondence and reprint requests to: Janine Barden-O’Fallon, MEASURE Evaluation Project, 206 W. Franklin St. CB# 8120, Chapel Hill, NC 27516, USA; fax: (919) 966-2391; email: bardenof@email.unc.edu.
2. MEASURE Evaluation Project, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. Department of Maternal and Child Health, University of North Carolina at Chapel Hill, School of Public
3. MEASURE Evaluation Project, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. Health Services and Policy Analysis Program, University of California at Berkeley, Berkeley, California, United States
4. (1)A version of this paper was presented at the 134th Annual Meeting of the American Public Health Association, 4–8 November 2006, Boston, Massachusetts, United States of America.