Policies for expanding family planning coverage: lessons from five successful countries.

Background: Enhancing the design of family planning interventions is crucial for promoting gender equality and improving maternal and child health outcomes. We identified, critically appraised, and synthesized policies and strategies from five selected countries that successfully increased family planning coverage. Methods: We conducted a policy analysis through a scoping review and document search, focusing on documents published from 1950 to 2023 that examined or assessed policies aimed at enhancing family planning coverage in Brazil, Ecuador, Egypt, Ethiopia, and Rwanda. A search was conducted through PubMed, SCOPUS, and Web of Science. Government documents and conference proceedings were also critically analyzed. National health surveys were analyzed to estimate time trends in demand for family planning satisfied by modern methods (mDFPS) at the national level and by wealth. Changes in the method mix were also assessed. The findings of the studies were presented in a narrative synthesis. Findings: We selected 231 studies, in which 196 policies were identified. All countries started to endorse family planning in the 1960s, with the number of identified policies ranging between 21 in Ecuador and 52 in Ethiopia. Most of the policies exclusively targeted women and were related to supplying contraceptives and enhancing the quality of the services. Little focus was found on monitoring and evaluation of the policies implemented. Conclusion: Among the five selected countries, a multitude of actions were happening simultaneously, each with its own vigor and enthusiasm. Our findings highlight that these five countries were successful in increasing family planning coverage by implementing broader multi-sectoral policies and considering the diverse needs of the population, as well as the specific contextual factors at play. Successful policies require a nuanced consideration of how these policies align with each culture's framework, recognizing that both sociocultural norms and the impact of past public policies shape the current state of family planning.

The role of gender inequality and health expenditure on the coverage of demand for family planning satisfied by modern contraceptives: a multilevel analysis of cross-sectional studies in 14 LAC countries.

Background: Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. Methods: Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. Findings: DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman's education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. Interpretation: Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. Funding: Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO).

A Violência Mora ao Lado? Violência Familiar e Comunitária entre Adolescentes / Does the Violence Live Next Door? Family and Community Violence Amongst Adolescents

Resumo Para descrever a ocorrência de situações de violência contra adolescentes na família e na comunidade, foi conduzido estudo transversal em escolas públicas de municípios do Brasil. O Questionário da Juventude Brasileira Versão Fase II foi utilizado. Participaram 2.860 adolescentes, sendo 58,5% do sexo feminino. Cerca de um terço dos participantes sofreram violência física na família. Na comunidade, 32,7% dos adolescentes reportaram ter sofrido situações de violência psicológica. Situações de violência física ocorreram mais entre meninos, em participantes de 15 a 19 anos e nos que experimentaram álcool ou drogas ilícitas. Considera-se como importante que ações preventivas contra violência de naturezas distintas sejam contínuas e abrangentes, incluam diferentes subgrupos e garantam o suporte necessário.

Abstract Describing the occurrence of violence situations against adolescents, in the family and community, was conducted a cross-sectional study in public schools of municipalities in Brazil. Brazilian Youth Questionnaire Phase II Version was used. Participated 2860 adolescents, being 58.5% female. About a third have already suffered some form of physical violence in the family. In the community, 32.7% of the adolescents reported have already suffered some form of psychological violence. Situations of physical violence were more common amongst boys, 15 to 19 years old participants, and who have already tried alcohol or illegal drugs. It is important that preventive actions against violence of different natures are continuous and comprehensive, including different subgroups and providing the necessary support.

Psychological violence against women practiced by intimate partners: a cross-sectional study in a rural area of Rio Grande do Sul, Brazil, 2017. / Violência psicológica contra a mulher praticada por parceiro íntimo: estudo transversal em uma área rural do Rio Grande do Sul, 2017.

OBJECTIVE: To estimate prevalence and factors associated with intimate partner psychological violence against women in a rural area in the state of Rio Grande do Sul, in 2017. METHODS: This was a cross-sectional population-based study with women aged 18-49 years old and who had had an intimate partner in their lifetime. Questions from the World Health Organization Violence Against Women Study were administered. Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: 971 women participated. Prevalence of lifetime psychological violence was 17.2% (95%CI 14.9;19.7). Those diagnosed with depression (PR=2.23 - 95%CI 1.70;2.91) and who had consumed alcohol in the last week were more likely to refer lifetime psychological violence (PR=1.53 - 95%CI 1.07;2.17). Single women were more likely to experience psychological violence than married women (PR=1.86 - 95%CI 1.32;2.63). CONCLUSION: Psychological violence against woman in rural areas was related to mental health and alcohol use.

Prevalence and inequalities in contraceptive use among adolescents and young women: data from a birth cohort in Brazil.

Monitoring trends of contraceptive use and identifying the groups with less coverage are needed to guide public policies and make them more efficient. But, in Brazil, recent data about these aspects are limited. This study aimed to investigate the prevalence of contraceptive use and its inequalities during adolescence and early adulthood. Data from the 1993 Pelotas birth cohort, Rio Grande do Sul State, Brazil, were used. At 15, 18 and 22 years, respectively, 335, 1,458 and 1,711 women reported having started their sexual lives and were included in analysis. Prevalence and 95% confidence intervals were obtained to describe the most used contraceptive methods. Inequalities in modern contraceptive use were evaluated according to wealth index, scholastic backwardness and ethnicity. In all follow-ups, more than 80% of women used at least one modern method. The use of barrier methods decreased with age; at 22 this prevalence was 36.3%. Such use concomitant with other modern methods was lower than 50% in all follow-ups. We observed inequalities in the use of modern contraceptive methods, mainly in barrier methods used with other modern methods. These findings may contribute and improve the public policies in family planning.

Corrigendum: Trends and Inequalities in Unplanned Pregnancy in Three Population-Based Birth Cohorts in Pelotas, Brazil.

[This corrects the article DOI: 10.1007/s00038-020-01505-0.].

Prevalence and inequalities in contraceptive use among adolescents and young women: data from a birth cohort in Brazil / Prevalência e desigualdades no uso de métodos contraceptivos entre adolescentes e mulheres jovens: dados de uma coorte de nascimentos no Brasil / Prevalencia y desigualdades en el uso de métodos contraceptivos entre adolescentes y mujeres jóvenes: datos de una cohorte de nacimientos en Brasil

Monitoring trends of contraceptive use and identifying the groups with less coverage are needed to guide public policies and make them more efficient. But, in Brazil, recent data about these aspects are limited. This study aimed to investigate the prevalence of contraceptive use and its inequalities during adolescence and early adulthood. Data from the 1993 Pelotas birth cohort, Rio Grande do Sul State, Brazil, were used. At 15, 18 and 22 years, respectively, 335, 1,458 and 1,711 women reported having started their sexual lives and were included in analysis. Prevalence and 95% confidence intervals were obtained to describe the most used contraceptive methods. Inequalities in modern contraceptive use were evaluated according to wealth index, scholastic backwardness and ethnicity. In all follow-ups, more than 80% of women used at least one modern method. The use of barrier methods decreased with age; at 22 this prevalence was 36.3%. Such use concomitant with other modern methods was lower than 50% in all follow-ups. We observed inequalities in the use of modern contraceptive methods, mainly in barrier methods used with other modern methods. These findings may contribute and improve the public policies in family planning.

É necessário monitorar as tendências no uso de métodos contraceptivos e identificar os grupos com menor cobertura, a fim de orientar as políticas públicas e torná-las mais eficientes. Entretanto, no Brasil, são limitados os dados recentes sobre a cobertura dos métodos contraceptivos. O estudo buscou investigar a prevalência do uso de métodos contraceptivos e as desigualdades no uso durante a adolescência e início da vida adulta. Foram usados dados da coorte de nascimentos de Pelotas de 1993, Rio Grande do Sul, Brasil. Aos 15, 18 e 22 anos, respectivamente, 335, 1.458 e 1.711 mulheres informaram já terem iniciado a vida sexual e foram incluídas na análise. Foram obtidas as prevalências e intervalos de 95% de confiança para descrever os métodos contraceptivos mais utilizados. As desigualdades no uso de métodos contraceptivos modernos foram avaliadas de acordo com o índice de riqueza, atraso escolar e cor da pele. Em todos os seguimentos, mais de 80% das mulheres informavam usar pelo menos um método moderno. O uso de métodos de barreira diminuiu com a idade (prevalência de 36,3% aos 22 anos). Esse uso junto com outro método moderno era menos de 50% em todos os seguimentos. Foram observadas desigualdades no uso de métodos contraceptivos modernos, principalmente no uso de método de barreira junto com outro método moderno. Os achados podem contribuir para melhorar as políticas públicas em planejamento familiar.

Es necesario monitorizar las tendencias en el uso de métodos contraceptivos e identificar los grupos con menor cobertura, a fin de orientar las políticas públicas y hacerlas más eficientes. Sin embargo, en Brasil, son limitados los datos recientes sobre la cobertura de los métodos contraceptivos. El estudio buscó investigar la prevalencia del uso de métodos contraceptivos y las desigualdades en su uso, durante la adolescencia e inicio de la vida adulta. Se usaron datos de la cohorte de nacimientos de 1993 en Pelotas, Río Grande do Sul, Brasil. A los 15, 18 y 22 años, respectivamente, 335, 1.458 y 1.711 mujeres informaron ya haber iniciado la vida sexual y fueron incluidas en el análisis. Se obtuvieron las prevalencias e intervalos de 95% de confianza para describir los métodos contraceptivos más utilizados. Las desigualdades en el uso de métodos contraceptivos modernos fueron evaluadas de acuerdo con el índice de riqueza, atraso escolar y color de piel. En todos los seguimientos, más de un 80% de las mujeres informaban usar por lo menos un método moderno. El uso de métodos de barrera disminuía con la edad (prevalencia de 36,3% a los 22 años). Ese uso junto con otro método moderno era menos de un 50% en todos los seguimientos. Se observaron desigualdades en el uso de métodos contraceptivos modernos, principalmente en el uso del método de barrera junto a otro método moderno. Los hallazgos pueden contribuir a mejorar las políticas públicas en la planificación familiar.

Violência psicológica contra a mulher praticada por parceiro íntimo: estudo transversal em uma área rural do Rio Grande do Sul, 2017 / Violencia psicológica contra la mujer por parte de una pareja íntima: un estudio transversal en una zona rural de Rio Grande do Sul, Brasil, 2017 / Psychological violence against women practiced by intimate partners: a cross-sectional study in a rural area of Rio Grande do Sul, Brazil, 2017

Objetivo: Estimar a prevalência e fatores associados à violência psicológica praticada por parceiro íntimo contra a mulher residente em zona rural do Rio Grande do Sul, Brasil, 2017. Métodos: Estudo transversal de base populacional, com mulheres de 18-49 anos que tiveram parceiro íntimo na vida. Foram aplicadas questões do World Health Organization Violence Against Women Study. Utilizou-se regressão de Poisson para estimar razões de prevalências (RP) e intervalos de confiança de 95% (IC95%). Resultados: Participaram 971 mulheres, com prevalência de violência psicológica de 17,2% (IC95% 14,9;19,7) na vida. Aquelas com diagnóstico de depressão (RP=2,23 - IC95% 1,70;2,91) e que consumiram álcool na última semana (RP=1,53 - IC95% 1,07;2,17) tiveram maior probabilidade de referir violência psicológica na vida; as solteiras apresentaram maior probabilidade dessa natureza de violência, comparadas às casadas (RP=1,86 - IC95% 1,32;2,63). Conclusão: Violência psicológica contra a mulher na zona rural relacionou-se com agravos na saúde mental e com uso de álcool.

Objetivo: Estimar la prevalencia y factores asociados a la violencia psicológica practicada por pareja contra mujeres residentes en una zona rural del estado de Rio Grande do Sul, en 2017. Métodos: Estudio poblacional transversal realizado con mujeres de 18-49 años que tuvieron pareja íntima en la vida. Se aplicaron preguntas del World Health Organization Violence Against Women Study. La regresión de Poisson ha sido usada para estimar razones de prevalencia (RP) e intervalos de confianza del 95% (IC95%). Resultados: Participaron 971 mujeres con prevalencia de 17,2% (IC95% 14,9;19,7) de violencia psicológica en la vida. Aquellas con depresión (RP=2,23 - IC95% 1,70;2,91) y que habían consumido alcohol en la última semana tenían más probabilidades de referir violencia psicológica en la vida (RP=1,53 - IC95% 1,07;2,17). Mujeres solteras tenían más probabilidades de violencia psicológica en sus vidas que las casadas (RP=1,86 - IC95% 1,32;2,63). Conclusión: La violencia psicológica contra la mujer en las zonas rurales, tuvo relación con la salud mental y el consumo de alcohol.

Objective: To estimate prevalence and factors associated with intimate partner psychological violence against women in a rural area in the state of Rio Grande do Sul, in 2017. Methods: This was a cross-sectional population-based study with women aged 18-49 years old and who had had an intimate partner in their lifetime. Questions from the World Health Organization Violence Against Women Study were administered. Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: 971 women participated. Prevalence of lifetime psychological violence was 17.2% (95%CI 14.9;19.7). Those diagnosed with depression (PR=2.23 - 95%CI 1.70;2.91) and who had consumed alcohol in the last week were more likely to refer lifetime psychological violence (PR=1.53 - 95%CI 1.07;2.17). Single women were more likely to experience psychological violence than married women (PR=1.86 - 95%CI 1.32;2.63). Conclusion: Psychological violence against woman in rural areas was related to mental health and alcohol use.

Access to Primary Health Care by older adults from rural areas in Southern Brazil.

OBJECTIVE: To characterize the access and use of health services considered reference among the older rural population from a municipality in southern Brazil, whose rural area has full coverage of the Family Health Strategy (FHS), investigating factors associated with the choice of the Basic Family Health Unit (BFHU) as reference. METHODS: This is a cross-sectional study conducted in 2017 with systematic sampling of rural households in the municipality of Rio Grande (RS) using a standardized in-house questionnaire. We performed descriptive analyses of sociodemographic profile, type of reference service chosen, and reasons for choosing/using the prime-choice service and the nearest BFHU. Poisson regression was used to investigate factors associated with the type of reference service chosen. RESULTS: Among the 1,030 older adults who participated in the study, 61.4% considered the BFHU a prime choice/reference service mostly due to its proximity (82.6%); the others sought other places due to a greater ease (34.6%) and resoluteness (52.6%). Almost ⅔ of the respondents sought care at the BFHU during the last year, and the reasons differed among those who considered the unit as reference (chronic disease) and those who sought another place (procedures). We also found that the lower the age, income, education, and household-unit distance, the greater the likelihood of the older adult considering the nearest BFHU as reference service. CONCLUSIONS: The FHS has reached the vulnerable older rural population, approaching an equitable public health system. However, further evaluations are necessary to verify the quality and adequacy of care, given that social structure, enabling factors (such as economic condition), and possible beliefs regarding health still establish the standards for choosing a service.

Trends and inequalities in unplanned pregnancy in three population-based birth cohorts in Pelotas, Brazil.

OBJECTIVES: To assess time trends in unplanned pregnancy, stratified by sociodemographic status, reproductive history, and inequalities in family income and women's skin color, in Pelotas, Brazil. METHODS: Data from mothers of participants of the 1993 (N = 5264), 2004 (N = 4243), and 2015 (N = 4268) Pelotas birth cohorts were analyzed. Unplanned pregnancy was investigated in the perinatal period, with tests to assess changes over time among different sociodemographic and reproductive history subgroups and inequalities as a function of family income and skin color. RESULTS: The prevalence of unplanned pregnancy was 62.7% (3299/ 5264), 65.9% (2794/ 4243), and 52.2% (2226/ 4268) in the 1993, 2004, and 2015 cohorts, respectively. Black or brown women and women of lower socioeconomic status had a higher prevalence of unplanned pregnancy in all cohorts. The overall rate of unplanned pregnancy decreased over time in most subgroups. Inequality as a function of family income and skin color increased during the time frame of assessment. CONCLUSIONS: The prevalence of unplanned pregnancies decreased in the period analyzed, but it is still unjustifiably high. Efforts aimed at reducing unplanned pregnancy are vital and will require special attention to the most vulnerable groups.

Access to rrimary health care by older adults from rural areas in Southern Brazil / Acesso à atenção primária à saúde por idosos residentes em zona rural no Sul do Brasil

ABSTRACT OBJECTIVE To characterize the access and use of health services considered reference among the older rural population from a municipality in southern Brazil, whose rural area has full coverage of the Family Health Strategy (FHS), investigating factors associated with the choice of the Basic Family Health Unit (BFHU) as reference. METHODS This is a cross-sectional study conducted in 2017 with systematic sampling of rural households in the municipality of Rio Grande (RS) using a standardized in-house questionnaire. We performed descriptive analyses of sociodemographic profile, type of reference service chosen, and reasons for choosing/using the prime-choice service and the nearest BFHU. Poisson regression was used to investigate factors associated with the type of reference service chosen. RESULTS Among the 1,030 older adults who participated in the study, 61.4% considered the BFHU a prime choice/reference service mostly due to its proximity (82.6%); the others sought other places due to a greater ease (34.6%) and resoluteness (52.6%). Almost ⅔ of the respondents sought care at the BFHU during the last year, and the reasons differed among those who considered the unit as reference (chronic disease) and those who sought another place (procedures). We also found that the lower the age, income, education, and household-unit distance, the greater the likelihood of the older adult considering the nearest BFHU as reference service. CONCLUSIONS The FHS has reached the vulnerable older rural population, approaching an equitable public health system. However, further evaluations are necessary to verify the quality and adequacy of care, given that social structure, enabling factors (such as economic condition), and possible beliefs regarding health still establish the standards for choosing a service.

RESUMO OBJETIVO Caracterizar o acesso e utilização de serviços de saúde considerados como referência pela população rural idosa de um município do sul do Brasil, com cobertura de 100% da área rural pela Estratégia Saúde da Família (ESF), investigando os fatores associados à escolha da Unidade Básica de Saúde da Família (UBSF) como serviço de referência. MÉTODOS Estudo transversal com amostragem sistemática dos domicílios da área rural do município de Rio Grande (RS), realizado em 2017, através de questionário padronizado, aplicado em domicílio. Foram realizadas análises descritivas referentes a perfil sociodemográfico; tipo de serviço de referência escolhido; e motivos de escolha/utilização do serviço de primeira opção e da UBSF mais próxima. Realizou-se regressão de Poisson para investigar fatores associados ao tipo de serviço de referência escolhido. RESULTADOS Participaram do estudo 1.030 idosos, dos quais 61,4% indicaram a unidade básica como serviço de primeira opção/referência. Enquanto aqueles que escolheram ser atendidos na UBSF o faziam principalmente em razão da proximidade (82,6%), os demais procuraram outros locais pela percepção de maior facilidade (34,6%) e resolutividade (52,6%). Quase ⅔ dos entrevistados buscaram atendimento na UBSF no último ano, e os motivos foram diferentes entre aqueles que consideravam a unidade como referência (doença crônica) e aqueles que procuravam outro local (procedimentos). Além disso, quanto menor a idade, renda, escolaridade e distância residência-unidade, maior a probabilidade do idoso considerar a UBSF mais próxima como serviço de referência. CONCLUSÃO A ESF tem conseguido atingir a parcela rural idosa em situação de vulnerabilidade, indo ao encontro de um sistema de saúde público equitativo. Todavia, novas avaliações para averiguar adequação e qualidade do atendimento se fazem necessárias, visto que estrutura social, fatores capacitantes (como condição econômica) e possíveis crenças sobre saúde ainda definem o padrão de escolha do serviço.

Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys.

BACKGROUND: Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). METHODS: We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman's age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. RESULTS: On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were "health concerns" and "infrequent sex," but the prevalence of each reason varied substantially across countries. Nonuse due to "opposition from others" was higher among married than unmarried women; in turn, the prevalence of nonuse due to "lack of access" or "lack of knowledge" was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to "lack of access." Pro-rich inequality was detected for reasons "health concerns," "infrequent sex," and "method-related", while the reasons "other opposed," "fatalistic," "lack of access," and "lack of knowledge" were linked to patterns of pro-poor inequality. CONCLUSIONS: Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

Maternal depression symptoms and use of child health-care services at The Pelotas 2004 Birth Cohort.

OBJECTIVE: To investigate the influence of maternal depression on child health-care services utilization. METHODOLOGY: Data from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression. RESULTS: The prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2-29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85-0.95; p = 0.001); 16% higher probability to seek medical consultations (1.16; 1.09-1.25, p = 0.001); and they sought emergency services for their children more often (1.30; 1.17-1.45, p < 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98-1.63; p = 0.072). CONCLUSION: Children from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.

Condom use in last sexual intercourse among undergraduate students: how many are using them and who are they? / Uso de preservativos na última relação sexual entre universitários: quantos usam e quem são?

A cross-sectional study was conducted to measure the prevalence of condom use in the last sexual intercourse and associated factors among university students. Undergraduate students from a public university aged 18 and over of the Rio Grande (RS) campuses were eligible. A systematic single-stage sampling was used, based on class lists and self-administered questionnaire. Descriptive, bivariate and multivariable analyses were employed, with Poisson regression for the latter two. Most of the 1,215 university students included in the analysis were aged 20 to 29 (65.6%) and 69.3% began their sexual life before the age of 18. The prevalence of condom use in the last intercourse was 41.5% (95%CI: 38.7-44.3). Male gender, lower age group, condom use at first sexual intercourse, older age of onset of sexual activity, not having a partner and casual partner in the last sexual intercourse increased the likelihood of condom use.

[Pregnancy and abortion experience among children, adolescents and youths living on the streets]. / Experiência de gravidez e aborto em crianças, adolescentes e jovens em situação de rua.

The aim of this study is to identify the prevalence of pregnancy and abortion experience, along with associated factors among street children, adolescents and youths in Porto Alegre and Rio Grande, RS, Brazil. The sampling method in this cross-sectional study was Respondent-Driven Sampling (RDS), innovative in research about hidden populations. Interviews were conducted with 307 subjects, aged 10 to 21 years. In multivariate analysis, Poisson regression with a robust error variance was used. Most of this sample were males, with no contact with school and family. Almost half of the participants had been on the street for five years or more, spending more than 15 hours per day on the streets. The prevalence of pregnancy experience was 29.3%, independently associated with being a girl, having 10 sexual partners or more in the last year, having a fixed sexual partner in the last year, and being older. The prevalence of abortion experience was 10.4%, independently associated with not living with the family, having more than two pregnancies, and being younger. The high prevalence of pregnancy and abortion experience highlights the need for the development of better sexual and reproductive health policies focused on this population.

Uso de preservativos na última relação sexual entre universitários: quantos usam e quem são? / Condom use in last sexual intercourse among undergraduate students: how many are using them and who are they?

Resumo Foi conduzida pesquisa transversal para medir a prevalência do uso de preservativo na última relação sexual entre universitários e os fatores associados. Foram elegíveis estudantes de graduação de uma universidade pública federal, com idade igual ou superior a 18 anos, dos campi de Rio Grande/RS. Foi utilizada amostragem sistemática, em um único estágio, com base na listagem de turmas e questionário autoaplicável como instrumento. Foram empregadas análises descritiva, bivariada e multivariável, com regressão de Poisson para as duas últimas. Dos 1215 universitários incluídos na análise, a maioria tinha entre 20 e 29 anos de idade (65,6%) e 69,3% iniciaram a vida sexual antes dos 18 anos de idade. A prevalência do uso de preservativos na última relação foi de 41,5% (IC95%:38,7-44,3). Sexo masculino, menor faixa etária, uso de preservativo na primeira relação sexual, maior idade de início da vida sexual, não ter companheiro e parceiro casual na última relação aumentaram a probabilidade de uso de preservativos.

Abstract A cross-sectional study was conducted to measure the prevalence of condom use in the last sexual intercourse and associated factors among university students. Undergraduate students from a public university aged 18 and over of the Rio Grande (RS) campuses were eligible. A systematic single-stage sampling was used, based on class lists and self-administered questionnaire. Descriptive, bivariate and multivariable analyses were employed, with Poisson regression for the latter two. Most of the 1,215 university students included in the analysis were aged 20 to 29 (65.6%) and 69.3% began their sexual life before the age of 18. The prevalence of condom use in the last intercourse was 41.5% (95%CI: 38.7-44.3). Male gender, lower age group, condom use at first sexual intercourse, older age of onset of sexual activity, not having a partner and casual partner in the last sexual intercourse increased the likelihood of condom use.

Experiência de gravidez e aborto em crianças, adolescentes e jovens em situação de rua / Pregnancy and abortion experience among children, adolescents and youths living on the streets

Resumo O objetivo deste estudo é identificar a prevalência de experiência de gravidez e aborto e os fatores associados em crianças, adolescentes e jovens em situação de rua, das cidades de Porto Alegre e Rio Grande, RS, Brasil. Neste estudo transversal, como método de amostragem, foi utilizado o Respondent-Driven Sampling (RDS), inovador em pesquisas com populações de difícil acesso. Foram entrevistados 307 indivíduos, com idade entre 10 e 21 anos. Na análise multivariada foi utilizada regressão de Poisson, com ajuste robusto da variância. A maioria dos participantes foi do sexo masculino, sem vínculos com escola e com a família. Quase metade estava há cinco anos ou mais na rua, permanecendo mais de 15 horas diárias nela. A prevalência de experiência de gravidez foi de 29,3%, estando independentemente associada com ser do sexo feminino, ter mais de 10 parceiros sexuais no último ano, ter parceiro sexual fixo no último ano e ter mais idade. A prevalência de experiência de aborto foi de 10,4%, estando associado com não morar com a família, ter duas ou mais gravidezes e ter menos idade. A alta prevalência de experiência de gravidez e aborto aponta para a necessidade de melhores políticas de saúde sexual e reprodutiva específicas para esta população.

Abstract The aim of this study is to identify the prevalence of pregnancy and abortion experience, along with associated factors among street children, adolescents and youths in Porto Alegre and Rio Grande, RS, Brazil. The sampling method in this cross-sectional study was Respondent-Driven Sampling (RDS), innovative in research about hidden populations. Interviews were conducted with 307 subjects, aged 10 to 21 years. In multivariate analysis, Poisson regression with a robust error variance was used. Most of this sample were males, with no contact with school and family. Almost half of the participants had been on the street for five years or more, spending more than 15 hours per day on the streets. The prevalence of pregnancy experience was 29.3%, independently associated with being a girl, having 10 sexual partners or more in the last year, having a fixed sexual partner in the last year, and being older. The prevalence of abortion experience was 10.4%, independently associated with not living with the family, having more than two pregnancies, and being younger. The high prevalence of pregnancy and abortion experience highlights the need for the development of better sexual and reproductive health policies focused on this population.