SciELO - Scientific Electronic Library Online

 
vol.22 número2Perfil microbiológico de microorganismos aislados de pacientes en unidades de cuidados intensivos de un Hospital de Lambayeque, Perú, 2019-2020Perfil clínico y epidemiológico en pacientes Covid-19 atendidos en un Hospital de la Selva Peruana, 2020 índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados

Revista

Articulo

Indicadores

  • No hay articulos citadosCitado por SciELO

Links relacionados

  • No hay articulos similaresSimilares en SciELO

Compartir


Revista de la Facultad de Medicina Humana

versión impresa ISSN 1814-5469versión On-line ISSN 2308-0531

Rev. Fac. Med. Hum. vol.22 no.2 Lima abr./jun 2022  Epub 16-Mar-2022

http://dx.doi.org/10.25176/rfmh.v22i2.4789 

Original article

Factors associated with the lack of use of contraceptive methods in female adolescent in Peru. Endes 2018-2020

Yolanda Beatriz Dulanto-Ramos1 

Consuelo Luna-Muñoz2  3  , Médico cirujana, Médico Pediatra, Doctora en salud Pública

Luis Roldan2  4 

1Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Perú.

2Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú.

3Servicio de Emergencia Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.

4Escuela de Postgrado en Gestión Pública, Universidad Tecnológica del Perú, Lima, Perú.

ABSTRACT

Introduction:

In Peru, adolescents tend to use contraceptive methods (CM) less frequently, constituting a subgroup at risk of unwanted pregnancies and sexually transmitted diseases.

Methods:

Quantitative, observational, analytical-cross-sectional study corresponding to a secondary analysis of data from women aged 15 to 19 from the ENDES 2018-2020. To quantify the association, Poisson regression was used for robust variances, calculating the Prevalence Ratio (PR) in its crude (PRc) and adjusted (PRa) forms, with a 95% con􀃶dence interval.

Results:

28.4% did not use MC, there was a signi􀃶cant association for the variables without a partner (Rpa: 2.49 CI: 1.99-3.11) and zero children (Rpa: 2.73 CI: 2.22-3 .35).

Conclusions:

The factors associated with the lack of CM in female adolescents were without a partner and zero children, with a higher prevalence of the lack of CM.

Keywords: Adolescent; Contraceptive methods; Domestic violence. (Source : MeSH - NLM).

INTRODUCTION

In 2020, the WHO estimated that every year 21 million adolescents aged 15 to 19 living in developing countries become pregnant. Some teens plan and want to get pregnant, but in many cases they don't; approximately ten million pregnancies of adolescents in this age range living in developing countries are unwanted1.

The promotion of the use of CM has been shown to be effective in reducing early and unwanted pregnancies, maternal and neonatal morbidity and mortality, and cases of unsafe abortions. In addition, male and female condoms offer double protection against unwanted pregnancy and sexually transmitted diseases2.

Regarding women, who are considered a vulnerable group to infection of sexually transmitted diseases, there are different studies that report the prevalence of frequency of CM use, as is the case of the study carried out in the Congo in 2020 by Casey et al.3who reports a prevalence of 51.7% in the age group of 15 to 19 years, compared with 20 to 24 years of 36.5%.

In Uganda in 2020, Otim4carried out a study in the Central, East, Northeast and West regions of the country, in which it reports that there are high percentages in these regions of non-use of CM in women who do not have children compared to those who do (73.9; 79.9%; 91.0% and 86.7% respectively); it also observed that in the Northeast region, adolescents who had no education had a higher percentage (65.8%) of not using CM.

In the case of Latin America, Gómez et al.5in 2019 reported low prevalences in Haiti (31.3%) and Bolivia (34.6%) in contrast to countries such as Brazil, Colombia, Costa Rica, Cuba, and Paraguay with more than 70% of CM usage. In Colombia in 2018, Angarita et al.6found that women who have not been victims of intimate partner violence (OR 0.75, 95%CI 0.69-0.82), physical (OR 0.87, 95%CI 0.80-0.94) and psychological (or 0.75, 95% CI 0.69-0.82) are more likely to use some CM than women who were. In Peru, a study based on the demographic and family health survey (ENDES) 2017 reports a prevalence of 52.3% for non-use of CM, and women living in rural areas have a prevalence ratio of 1.8 (95%CI: 1.5-2.1) for non-use of CM, compared to those living in urban areas7; However, it does not specify the types of CM or how the dependent variable was defined.

As mentioned, all these factors can influence a lower use of CM, and being adolescents a risk group of unwanted pregnancies with unattended contraceptive needs2the objective of this study was to identify the factors associated with the non-use of CM in adolescent women of the ENDES 2018-2020.

METHODS

Study Design

An observational, analytical and cross-sectional study was carried out using the ENDES 2018-2020 database in Peru8. The study had a two-stage, probabilistic sampling of balanced, stratified and independent type, at the departmental level and by urban and rural area.

Population and sample

The study population consisted of 117 476 women and the sample after applying the inclusion criteria (participants aged 15 to 19 years with complete data for the dependent variable) was 1 706 adolescents aged 15 to 19 years, which was collected based on the sample design of the ENDES 2018-2020.

Variables

The variables were dichotomized and evaluated using the ENDES 2018-20208which we did not modify. They were dichotomized in order to better represent the state of the participant and facilitate the interpretation of the coefficients of the statistical model9.

The dependent variable was no use of CM (question V313), dichotomized as use of CM (folkloric method, traditional method and modern method) and no use of CM (no method). The covariates were categorized into sociodemographic, reproductive and violence. Among the sociodemographic factors were considered age10(question V012), average adolescence (14 to 17 years) and late adolescence (18 to 21 years); were considered; area of residence7, (question V025), rural and urban; wealth index11(question V190), poor (very poor, poor) and non-poor (medium, rich and very rich); - Higher education (910) (question V149), poor (very poor, poor) and non-poor (medium, rich and very rich); higher education12(question V149), higher (non-university higher, university higher and postgraduate) and non-higher (initial/pre-school, primary and secondary); and the couple13(question V501), having a partner (cohabiting and married) and not having a partner (single).

For reproductive factors, the number of children4(question V201), not having children and having one to more children (if you have live children); age at first sexual intercourse4(question V5125), early adolescence (11 to 13 years) and middle adolescence (4 to 17 years); and sexual partners14(question V836), one sexual partner (if you have had one sexual partner in your life) and two more sexual partners (if you have had several sexual partners in your life) were taken into account.

Finally, the violence factor considered domestic, economic, psychological, physical and sexual violence15-17(questions D101F and D103D, D101A-E and D103 A-B, D105A-G and D105H-I of the ENDES 2018-2020 respectively).

Data analysis

For this study we used a secondary data source from the ENDES 2018-2020. Statistical processing and analysis were performed using Stata software15. The univariate analysis was performed from the calculation of frequency and percentage.

In the bivariate analysis, prevalence ratios were calculated, crude (ORc) and adjusted (ORa) as a measure of association, both accompanied by their respective 95% confidence intervals. A value of p < 0.05 was considered. The ORc and ORa were calculated using a Poisson regression model with robust variances. All estimates were made considering the expansion factor of the sample design. A power of 99% was obtained for risk factors identified as significant, with the overall mean power of all factors being 56%.

Ethical aspects

Approval was obtained from the ethics committee of the Institute of Biomedical Sciences of the Faculty of Human Medicine of Ricardo Palma University; however, this was a study based on secondary sources.

RESULTS

Of the 1,706 women aged 15 to 19 years, 28.4% did not use CM. It was observed that the adolescents were mostly in late adolescence (72.5%), lived in urban areas (53.1%), were poor (77.8%), had no higher education (93.7%), had a partner (88.0%), had one or more children (82.9%), had their first sexual relationship in late adolescence (84.1%), had a sexual partner (69.2%), More than half reported domestic violence (54.4%) and psychological violence (50.1%), while the majority did not report economic, physical or sexual violence 85.4%, 80.7% and 96.9% respectively.Table 1

In the bivariate analysis, the variables not having a partner and not having children were significant (p value= < 0.001).Table 2

In the multivariate analysis, it was found that not having a partner had a prevalence ratio of 2.49 (95%CI: 1.99-3.11) of not using CM with respect to having a partner; and not having children had an ORa of 2.73 (95%CI: 2.22-3.35) of not using CM with respect to having one or more children.Table 3

Table 1.  Características generales de las mujeres adolescentes de 15 a 19 años según la ENDES 2018-2020. 

Variables n Coeficiente de variación
Uso de métodos anticonceptivos    
No usa métodos anticonceptivos 484 6,30%
Usa métodos anticonceptivos 1222 3,37%
Edad    
Adolescencia media 469 6,70%
Adolescencia tardía 1237 2,61%
Área de residencia    
Rural 800 3,83%
Urbano 906 2,70%
Índice de riqueza    
Pobre 1327 3,14%
No Pobre 379 7,13%
Educación superior    
No superior 1599 1,35%
Superior 107 16,01%
Pareja    
No tener pareja 204 13,45%
Tener pareja 1502 1,97%
Cantidad de hijos    
No tener hijos 291 6,20%
Tener uno a más hijos 1415 3,85%
Edad en la primera relación sexual    
Adolescencia temprana 271 8,90%
Adolescencia media 1435 1,37%
Parejas sexuales    
Una Pareja sexual 1181 3,22%
Dos a más parejas sexuales 525 6,35%
Violencia doméstica    
No 777 4,72%
Si 929 3,72%
Violencia psicológica    
No 852 4,47%
Si 854 3,98%
Violencia económica    
No 1457 1,54%
Si 249 10,16%
Violencia física    
No 1376 2,16%
Si 330 9,91%
Violencia sexual    
No 1653 0,55%
Si 53 18,38%

a/:p valor obtenido a través de la prueba F para muestras complejas Fuente :INEI ENDES 2018,2019,2020

En el análisis bivariado, las variables sin pareja y cero hijos fueron significativas (valor de p= < 0,001). Tabla 2

Tabla 2.  Análisis bivariado de los factores asociados al no uso de métodos anticonceptivos en mujeres adolescentes de 15 a 19 años según la ENDES 2018-2020. 

Factores Uso de método anticonceptivo Valor de p
NO SI
n(%) n(%)
Factores sociodemográficos      
Edad      
Adolescencia media 141(29,1) 328(26,8) 0,339
Adolescencia tardía 343(70,9) 894(73,2)  
Área de residencia      
Rural 229(47,3) 571(46,7) 0,827
Urbano 255(52,7) 651(53,3)  
Índice de riqueza      
No pobre 94(19,4) 285(23,3) 0,081
Pobre 390(80,6) 937(76,7)  
Educación superior      
No superior 446(92,1) 1153(94,4) 0,090
Superior 38(7,9) 69(5,6)  
Pareja      
No tener pareja 125(25,8) 79(6,5) <0,001
Tener pareja 359(74,2) 1143(93,5)  
Factores reproductivos      
Cantidad de hijos      
No tener hijos 165(34,1) 126(10,3) <0,001
Tener uno a más hijos 319(65,9) 1096(89,7)  
Edad en primera relación sexual      
Adolescencia temprana 71(14,7) 200(16,4) 0,387
Adolescencia media 413(85,3) 1022(83,6)  
Parejas sexuales      
Una pareja sexual 330(68,2) 851(69,6) 0,556
Dos a más parejas sexuales 154(31,8) 371(30,4)  
Factores de violencia      
Violencia doméstica      
Si 268(55,4) 661(54,1) 0,632
No 216(44,6) 561(45,9)  
Violencia psicológica      
Si 249(51,4) 605(49,5) 0,471
No 235(48,6) 617(50,5)  
Violencia económica      
Si 75(15,5) 174(14,2) 0,507
No 409(84,5) 1048(85,8)  
Violencia física      
Si 100(20,7) 230(18,8) 0,386
No 384(79,3) 992(81,2)  
Violencia sexual      
Si 17(3,5) 36(2,9) 0,543
No 467(96,5) 1186(97,1)  

Tabla 3.  Análisis multivariado de los factores sociodemográficos asociados al no uso de métodos anticonceptivos en mujeres adolescentes de 15 a 19 años según la ENDES 2018-2020. 

Factores Rp crudo IC95% Valor de p Rp ajustado IC95% Valor de p
Pareja            
No tener pareja 1,48 1,32-1,66 <0,00 2,49 1,99-3,11 <0,00
Tener pareja            
Cantidad de hijos            
No tener hijos 1,43 1,3-1,57 <0,00 2,73 2,22-3,35 <0,00
Tener uno a más hijos            

DISCUSSION

The research found that 28.4% of adolescents aged 15 to 19 years did not use CM, a similar result is observed in the study of Guerrero18where adolescents of the same age did not use contraceptives in 22.6%; However, Mejía19in his study in four universities in Latin America reports that only 7% do not use any CM.

It was also found that 71.6% of adolescents used CM; However, Casey et al.3report that only half of adolescents aged 15 to 19 years use CM (51.7%). Gomez et al.5found that the use of reversible long-acting contraceptives among adolescent women aged 15 to 17 years is 1.1% and in women aged 18 to 19 years 2.0%.

A statistically significant association was found for the partner variable (p = <0.001). Not having a partner had 2.49 times higher prevalence of not using CM than having a partner; while having a partner had a higher percentage of use of CM (76.1%), however, Valladares et al.13report association between marital status and non-use of CM, where those who never married had 63.2% non-use of CM.

These findings may be explained by the fact that adolescents without a partner may not consider the use of CM necessary, since they would not have sex; or some of them, when they have a formal partner with an apparent stability of the relationship, abandon the use of CM, putting their sexual health and the possibility of having an unwanted pregnancy at risk.

In this investigation, a significant association was found between the variable number of children and not using CM. Not having children had a prevalence of 2.73 times of not using CM compared to having one or more children; but having one or more children had the highest percentage of CM use (77.5%),Tabla 2; In the study by Otim4in the Northeast region of Uganda, similar results to ours are reported since adolescents with zero children have a higher percentage of non-use of CM (91%) with a significant association.

The variables age, area of residence, wealth index, higher education, age at first sexual intercourse, sexual partners, violence (domestic, psychological, economic, physical and sexual) showed no statistical significance20.

In other studies found significant association for these variables for example Dunn et al.10reports significance for the age variable, and adolescents aged 15 to 17 years have a higher percentage of non-use of CM (21.3%);Salazar7found significant for the variable number sexual partners, and also observed that adolescents with four or more sexual parthers had a higher frequency of not using CM, such as condom (43.5%) finally Quispe et al.15found an association between women who do not use CM and domestic violence (16.4%).

Within the limitations, the frequency of use of each CM and the evaluation of its correct use were not determined; and others specific to analytical cross-sectional studies, such as the fact that causality cannot be established; only association between the variables studied.

CONCLUSION

An association was found between non-use of CM and the reproductive factor not having children (ORa: 2.73 CI: 2.22-3.35) and the sociodemographic factor not having a partner (ORa: 2.49 CI: 1.99-3.11). No association was found with the violence factor.

REFERENCES

1. Adolescent pregnancy [Internet]. [citado 31 de agosto de 2021]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancyLinks ]

2. OMS | Recomendaciones de la OMS sobre salud y derechos sexuales y reproductivos de los adolescentes [Internet]. WHO. World Health Organization; [citado 7 de agosto de 2021]. Disponible en: http://www.who.int/reproductivehealth/publications/adolescent-srhr-who-recommendations/es/Links ]

3. Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu J-B, Rafanoharana RV, et al. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLOS Medicine. 31 de marzo de 2020;17(3):e1003086.DOI: https://doi.org/10.1371/journal.pmed.1003086 [ Links ]

4. Otim J. Contraceptive nonuse among women in Uganda: a comparative assessment of predictors across regions. BMC Women's Health. 17 de diciembre de 2020;20(1):275. DOI: https://doi.org/10.1186/s12905-020-01148-6 [ Links ]

5. Gomez, Ponce de Leon RGP de, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, et al. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. The Lancet Global Health. 1 de febrero de 2019;7(2):e227-35. DOI:https://doi.org/10.1016/S2214-109X(18)30481-9 [ Links ]

6. Angarita Mejía DZ, Cucaita Muñoz DM. Relación entre violencia de pareja y uso de anticonceptivos en mujeres colombianas [Internet]. 2018. Disponible en: https://repository.urosario.edu.co/handle/10336/18302Links ]

7. Salazar,Landauro FA, Chanduví Puicon W. FACTORES ASOCIADOS AL NO USO DE METODOS ANTICONCEPTIVOS EN MUJERES EN EDAD FÉRTIL DE 15 A 49 AÑOS. ENDES 2017. Disponible en: http://repositorio.urp.edu.pe/bitstream/handle/URP/3006/FSALAZAR.pdf?sequence=1&isAllowed=yLinks ]

8. PERU Instituto Nacional de Estadística e Informática INEI [Internet]. [citado 15 de febrero de 2022]. Disponible en: https://www.inei.gob.pe/bases-de-datos/Links ]

9. Cumsille F, Bangdiwala SI. Categorización de variables en el análisis estadístico de datos: consecuencias sobre la interpretación de resultados. Rev Panam Salud Publica. noviembre de 2000;8:348-54. DOI: http://dx.doi.org/10.1590/s1020-49892000001000005 [ Links ]

10. Dunn S, Xiong AQ, Nuernberger K, Norman WV. Non-use of Contraception by Canadian Youth Aged 15 to 24: Findings From the 2009-2010 Canadian Community Health Survey. Journal of Obstetrics and Gynaecology Canada. 1 de enero de 2019;41(1):29-37. DOI: https://doi.org/10.1016/j.jogc.2018.05.021 [ Links ]

11. Bishwajit G, Yaya S. Domestic violence: a hidden barrier to contraceptive use among women in Nigeria. Open Access J Contracept. 25 de enero de 2018;9:21-8. DOI: https://doi.org/10.2147/OAJC.S154733 [ Links ]

12. Sánchez Reyes LG. "Factores que impiden el uso de métodos anticonceptivos para la prevención del embarazo en pacientes adolescentes atendidas en el Hospital General docente Ambato durante el período septiembre 2014 enero 2015". 1 de marzo de 2015 [citado 10 de diciembre de 2021]; Disponible en: https://repositorio.uta.edu.ec:8443/jspui/handle/123456789/9262Links ]

13. Valladares Llontop AN, Quispe Quispe SE. Factores asociados al uso de métodos anticonceptivos en adolescentes de 15-19 años: Análisis de la encuesta demográfica y de salud familiar (ENDES) 2018. 20 de abril de 2021 [citado 10 de diciembre de 2021]; Disponible en: https://repositorio.upeu.edu.pe/handle/20.500.12840/4446Links ]

14. Noll M, Noll PRES, Gomes JM, Soares Júnior JM, Silveira EA, Sorpreso ICE. Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE). Reprod Health. diciembre de 2020;17(1):139. https://doi.org/10.1186/s12978-020-00987-8 [ Links ]

15. Quispe Apolinario R, Limo-Alvarez M, Runzer-Colmenares FM, Quispe-Apolinario R, Limo-Alvarez M, Runzer-Colmenares FM. Asociación entre el uso de métodos anticonceptivos y violencia doméstica contra la mujer en edad fértil en Perú. Anales de la Facultad de Medicina. marzo de 2020;81(1):40-6. http://dx.doi.org/10.15381/anales.v81i1.16667 [ Links ]

16. Esquivel ,Cerquin AE. FACTORES ASOCIADOS A VIOLENCIA FÍSICA Y PSICOLÓGICA EN GESTANTES ADOLESCENTES DEL HOSPITAL REGIONAL DOCENTE DE CAJAMARCA. OCTUBRE 2012 A SETIEMBRE DEL 2016. Disponible en: https://repositorio.unc.edu.pe/bitstream/handle/UNC/2226/T016_45156367_T.pdf?sequence=1&isAllowed=yLinks ]

17. Elouard Y, Weiss C, Martin-Hilber A, Merten S. Sexual violence as a risk factor for family planning-related outcomes among young Burundian women. Int J Public Health. enero de 2018;63(1):13-22. DOI: https://doi.org/10.1007/s00038-017-0988-z [ Links ]

18. Guerrero Chiroque,Joanna. FACTORES ASOCIADOS AL USO DE MÉTODOS ANTICONCEPTIVOS EN ADOLESCENTES DEL AA. HH SAN SEBASTIÁN - DISTRITO, VEINTISEÍS DE OCTUBRE PIURA, 2020. :81. Disponible en: http://repositorio.uladech.edu.pe/handle/123456789/18046 [ Links ]

19. Mejia CR, Oporto FM, Taya-C L, Oscco SS, Bustamante FM, Quispe L, et al. Factores socioeducativos asociados al no uso de métodos anticonceptivos en universitarias de cuatro países de Latinoamérica. Revista chilena de obstetricia y ginecología. junio de 2020;85(3):245-54.DOI: http://dx.doi.org/10.4067/S0717-75262020000300245. [ Links ]

20. Significancia estadística y relevancia clínica [Internet]. [citado 22 de febrero de 2022]. Disponible en: https://www.fisterra.com/mbe/investiga/signi_estadi/signi_estadi.aspLinks ]

Funding sources: Self-financed.

Received: February 07, 2022; Accepted: March 07, 2022

Correspondence: Yolanda Beatriz Dulanto-Ramos Address: Instituto de Investigación en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Av. Benavides 5440, Lima-Perú. Telephone number: (01) 7080000 E-mail:yoladr1910@gmail.com

Authorship contributions: The authors, YDR and CLM participated in the genesis of the idea and design of the draft; YDR, CLM and LRA in data interpretation, analysis of results, and preparation of the manuscript of the present research work; plus YDR on data collection.

Conflicts of Interest: There was no conflict of interest between the authors during the process of conducting this research.

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons