INTRODUCTION

Globally, about 830 women die every day worldwide due to complications related to pregnancy or childbirth. In 2015, it was estimated that 303,000 women died during pregnancy, childbirth and the postpartum period.¹

The vast majority of deaths occur in low-income countries such as Peru. In view of this alarming situation, MINSA indicates the importance of family planning to reduce maternal mortality by avoiding unwanted pregnancies and their complications. In addition, neonatal deaths and sexually transmitted diseases are avoided.²

Who in 2019 reported that there were 1.9 billion women of childbearing age in the world, of whom only 1112 million obtained family planning.³

Due to the lack of adherence to the contraceptive method, multiple studies began to be conducted worldwide to explain the reasons for this situation. Among them, the study in Mexico by Sámano r, et al,⁴which conducted a study on adolescents in the second half of pregnancy and 4 months postpartum, since it is public knowledge that adolescence is a risk factor for obstetric complications; in which they were able to determine that being under 15 years of age, having a low level of education and educational backwardness are associated with a higher risk of non-adherence to the contraceptive method.

At the national level, in Peru, studies were also carried out, among which we can mention that of Gutiérrez c, et al,⁵where they were able to determine other factors at the national level such as the quality of user care, the distance from the health service to the home, religion and economic resources.

According to the ENDES, a national database, reported that in 2021, 78.1% of women of childbearing age "use a contraceptive method". Among the reasons for non-adherence, the most important factor is the change to a more effective method, making the pill the most discontinued method⁶

As we have seen from what has already been described in each study, there are different results with respect to the factors associated with no adherence to contraceptive methods; Therefore, this study seeks to determine the factors associated with no adherence to contraceptive methods in Peru.

METHODS

RESULTS

The univariate analysis (table 1) showed a prevalence of 48.6% for women who did not adhere to the contraceptive method. In addition, most of the women belong to urban areas (83.8%), have a high school education (47.7%), are between 30 and 49 years old (53.2%), their marital status is that of cohabitant (35.6%), their dialect is Spanish (97.8%), and they have a high wealth index (42.5%).

In the bivariate analysistable 2 we observed that the variables marital status separated (RPc 1.1, CI 1.1 - 1.2), marital status widowed (RPc 1.2, CI 1.0 - 1.3), marital status cohabiting (RPc 1.2, CI 1.2 - 1.3), marital status poor (RPc 1.2, CI 1.2 - 1, 3) and wealth index(RPc 1.0 , CI 1.00 - 1.07) poor are statistically significant with a p value < 0.05 and a crude RP confidence interval in all variables not exceeding unity. While the variables secondary education level (RPc 0.7 , CI 0.7 - 0.8), primary education level (RPc 0.8 , CI 0.8 - 0.8) , no education level(RPc 0.8 , CI 0.6 - 0.9), age between 30 and 49 years (RPc 0.9 , CI 0.9 - 0.9), marital status divorced (RPc 0.6 , CI 0.4 - 0.8 ), marital status single (RPc 0.7 , CI 0.6 -0.7), other dialect than spanish (RPc 0.8 , CI 0.7 - 0.9), average wealth index (RPc 0.9 , CI 0.9 - 1.0) are statistically non-significant.

In the multivariate analysis (table 3) We observed that the variables rural area of residence (rpa 1.0 , ci 1.0 - 1.1), , marital status separated ( rpa 1.1 , ci 1.0 - 1.1), marital status widowed ( rpa 1.3 , ci 1, 1 - 1.5), marital status cohabiting ( rpa 1.1 , ci 1.1 -1.2) are statistically significant with a p value < 0.05 and a crude rp confidence interval in all variables not exceeding unity. While the variables secondary education level ( rpa 0.7 ,ci 0.7 - 0.7), primary education level ( rpa 0.7 , ci 07 - 0.7) , no education ( rpa 0.7 , ci 0.6 - 0.8) , age between 30 and 49 years ( rpa 0.7 ,ci 0.6 - 0.7), marital status divorced ( rpa 0.5 , ci 0.3 - 0.7), marital status single ( rpa 0.5 ,ci 0.5 - 0.5), dialect other than spanish ( rpa 0.8 , ci 0.7 - 0.9), average wealth index ( rpa 0.9 , ci 0.9 - 0.9), poor wealth index ( rpa 1.0 ,ci 0.9 - 1.0) are statistically non-significant..

DISCUSSION

We found that 43.7% of women did not adhere to the contraceptive method, similar to Barden, et al⁷where they found a 34.7% abandonment of the contraceptive method, while Gutiérrez, et al⁸in their study found a 60% abandonment rate, which may be due to the difference in the number of the study population, since Barden, et al⁷used a population of 6927, while Gutiérrez, et al⁸used a small population of 170 women.

In the study by Melendez, et al.⁹found that women living in urban areas had 1.04 times the risk of nonadherence to contraceptive methods. Similarly, Silva K, et al¹⁰found that women living in urban areas had 1.04 times the risk of non-adherence to their contraceptive method, and mekonnen b¹¹found that women living in rural areas had 1.36 times the risk of non-adherence to their contraceptive method.

Such results are similar to ours where women living in a rural area of residence have 1.05 times higher risk of nonadherence to the contraceptive method.

Continuing with the next variable, women with separated marital status have 1.1 times the risk of nonadherence to the contraceptive method. This result is related to the study by Melendez J.⁹in which he found that women with cohabiting marital status have 1.06 times the risk of nonadherence to the contraceptive method.

In our study, women with a widowed marital status have a 1.1 times higher risk of nonadherence to their contraceptive method. This data cannot be contrasted with the rest of the studies due to the lack of study by the same studies.

Continuing with the next variable, cohabiting marital status in the study conducted by Silva K¹⁰women with cohabiting marital status have 1.08% higher risk of non-adherence to contraceptive method. Another study by Barden O’Fallon J⁷found that cohabiting marital status has 1.75 times the risk of non-adherence to the contraceptive method.

These results are similar to ours, where women with a cohabiting marital status have a 1.1 times higher risk of nonadherence to the contraceptive method. In a different way, in the studies of Colca et al¹²women with a cohabiting marital status have a 42% protection against non-adherence to their contraceptive method and Mekonnen B¹¹women with a cohabiting marital status have a 26% protection against non-adherence to their contraceptive method.

LIMITATIONS

Since we did not find any studies on women with a widowed marital status, we were unable to contrast this information with our results.

We were not able to study other variables of interest to us, such as the husband's decision and the wife's religion, because having such a small sample of these variables would reduce the sample size when performing the statistical analysis.

The study measures current nonadherence to a contraceptive method, but there is no information on previous nonadherence to a contraceptive method, so since this question does not exist in the ENDES, it is not possible to analyze this data.

The ENDES has not explored all the existing dialects in Peru and by not doing so we cannot analyze whether this age group of women, because of their dialect, have a higher risk of non-adherence to the contraceptive method

CONCLUSIONS

It was found that there are factors associated with non-adherence to contraceptive methods in women of childbearing age in Peru based on the demographic and family health survey of the year 2021.

The area of rural residence is significantly associated with non-adherence to the contraceptive method, the area urban tube increased adherence to contraceptive methods in women of childbearing age between 15 and 49 years.

Separated, widowed and cohabiting marital status is significantly associated with non-adherence to the contraceptive method, single and divorced marital status had greater adherence to contraceptive methods in women of childbearing age between 15 and 49 years.

RECOMENDACIONES

It is recommended to intensify family planning policies in rural areas, where our study shows a pressing need in this area that needs our attention.

It is advisable to provide information on the benefits of using contraceptive methods to separated and widowed women, beyond the fact of avoiding gestation, since not having a partner we could address other issues that may be of interest to them.

It is suggested to refocus our attention on women with a cohabiting marital status.

Where we can raise awareness and emphasize to the population with the information already known that for the proper formation of a home, the planning of the future pregnancy is needed, with the complete willingness to help the couple and all the respective care, benefiting both the health of the mother and the child.