Cargando…

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations

STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access t...

Descripción completa

Detalles Bibliográficos
Autores principales: Bahamondes, Luis, Villarroel, Claudio, Frías Guzmán, Natalia, Oizerovich, Silvia, Velázquez-Ramírez, Norma, Monteiro, Ilza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276683/
https://www.ncbi.nlm.nih.gov/pubmed/30895242
http://dx.doi.org/10.1093/hropen/hox030
_version_ 1783378056048541696
author Bahamondes, Luis
Villarroel, Claudio
Frías Guzmán, Natalia
Oizerovich, Silvia
Velázquez-Ramírez, Norma
Monteiro, Ilza
author_facet Bahamondes, Luis
Villarroel, Claudio
Frías Guzmán, Natalia
Oizerovich, Silvia
Velázquez-Ramírez, Norma
Monteiro, Ilza
author_sort Bahamondes, Luis
collection PubMed
description STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women’s and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN, SIZE, DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS, SETTING, METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS, REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.
format Online
Article
Text
id pubmed-6276683
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-62766832019-03-20 The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations Bahamondes, Luis Villarroel, Claudio Frías Guzmán, Natalia Oizerovich, Silvia Velázquez-Ramírez, Norma Monteiro, Ilza Hum Reprod Open Original Article STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women’s and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN, SIZE, DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS, SETTING, METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS, REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest. Oxford University Press 2018-01-23 /pmc/articles/PMC6276683/ /pubmed/30895242 http://dx.doi.org/10.1093/hropen/hox030 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Bahamondes, Luis
Villarroel, Claudio
Frías Guzmán, Natalia
Oizerovich, Silvia
Velázquez-Ramírez, Norma
Monteiro, Ilza
The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title_full The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title_fullStr The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title_full_unstemmed The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title_short The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations
title_sort use of long-acting reversible contraceptives in latin america and the caribbean: current landscape and recommendations
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276683/
https://www.ncbi.nlm.nih.gov/pubmed/30895242
http://dx.doi.org/10.1093/hropen/hox030
work_keys_str_mv AT bahamondesluis theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT villarroelclaudio theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT friasguzmannatalia theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT oizerovichsilvia theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT velazquezramireznorma theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT monteiroilza theuseoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT bahamondesluis useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT villarroelclaudio useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT friasguzmannatalia useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT oizerovichsilvia useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT velazquezramireznorma useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations
AT monteiroilza useoflongactingreversiblecontraceptivesinlatinamericaandthecaribbeancurrentlandscapeandrecommendations