Search

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families. METHODS AND ANALYSIS: In this case-control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta's anatomopathological exam. Air pollutant exposure is estimated through the participant's residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth's risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Little is known regarding the use of emergency contraception among women from different regions of Brazil. The use of emergency contraception as well as contraceptive methods before and after coitus was analyzed. This cross-sectional study assessed the use of emergency contraception by interviewing 2,051 women aged between 18 and 49 attending 76 basic health units in three capitals: São Paulo-SP, Aracaju-SE and Cuiabá-MT. Aspects associated with the use of emergency contraception were analyzed by means of multiple logistic regression. Over half of the women reported the use of emergency contraception (56.7%). Having a high level of education, being from a more privileged socioeconomic group, having a paid job and having had four or more sexual partners were associated with the use of emergency contraception. Being 35 years of age or older and being in a stable relationship was negatively associated. The last time they used emergency contraception, 53.2% used another method, with the male condom and oral pill being the most frequent. Of those who did not use the method, half adopted the regular method after using it (51.7%). The conclusion drawn is that emergency contraception is widely used and does not appear to affect the use of the regular contraceptive method.

Objective: to analyze the level of knowledge about the intrauterine device, the interest in using it and the relationship between these events among women in reproductive age., Method: cross-sectional study conducted with 1858 women between 18 and 49 years old, attending Primary Health Care Facilities. Data were obtained in face-to-face interviews. The level of knowledge was evaluated by items with answers options "agree", "disagree" and "I don't know". Knowledge was categorized as below/equal and above the median. Chi-square and multiple logistic regression were used in Stata 14.2 (95% confidence level)., Results: intrauterine device current use was not frequent (1.7%; n=32) and the level of knowledge was higher among women between 25 and 34 years old, white, living in Aracaju (Sergipe), who were more educated, and who were currently using or had already used the intrauterine device. Interest in using the intrauterine device (38.0%; n=634) was higher among younger women, single, more educated, had health insurance, no children and with higher level of knowledge about the intrauterine device., Conclusion: the level of knowledge about the intrauterine device was associated with the interest in using it.

Objective: This paper examines the factors related to emergency contraception (EC) use in the context of contraceptive discontinuation among undergraduate women in Brazil., Study Design: This a retrospective cohort study conducted among a probability sample of 1679 undergraduate women in Sao Paulo, Brazil. Data were collected online using a contraceptive calendar. We examined factors related to EC use following contraceptive discontinuation for method-related reasons and contraceptive abandonment. We also analyzed factors related to EC use following inconsistent use of contraception. Analyses were conducted using Pearson's Chi-square tests and logistic regression., Results: More than half (54.6%) of young women reported lifetime EC use and 16.5% had used EC in the 12-months prior to the survey. Last use of EC was mostly related to inconsistent or incorrect use of regular contraception (90.6%). Three quarters of women (76.2%) who discontinued contraception and were at risk of becoming pregnant did not use EC following discontinuation, and only 10.5% used EC after stopping contraception altogether. Women who were younger, who self-identified as Evangelicals, who reported more than four lifetime sexual partners, and who had no pregnancy history had higher odds of using EC following discontinuation for method-related reasons., Conclusion: We conclude that most undergraduate students in São Paulo Brazil do not use EC when needed, such as contraceptive discontinuation, potentially reflecting a lack of pregnancy risk recognition., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in São Paulo, Brazil., Methods: This study was part of a larger project conducted in 2015 among 1679 female students aged 18-24 enrolled at the University of São Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use., Results: Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception., Conclusions: The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.

Objective: To identify organizational barriers to IUD availability in Primary Health Care services from the perspective of women's health coordinators., Method: This is a quantitative study carried out with women's health officials from the municipalities of the southern macro region of Minas Gerais, Brazil, with an on-line completion of a structured instrument and a descriptive data analysis., Results: 79 technicians participated in the study. Among the municipalities, 15.2% do not provide IUDs and 8.3% do not refer women to other services, 53.7% do not provide IUDs at basic health units. Among those who provide the IUD, 68.7% do not have a specific protocol and 10.5% do not adopt pregnancy as a condition that makes it impossible to insert the IUD, and 80.6% adopt unnecessary conditions, such as vaginal infection. As a criterion for IUD access, 86.5% referred to a medical prescription, 71.6% required exams, 44.6% were over 18 years of age and 24.4% participation in groups, none based on scientific evidence. Only the doctor inserted the IUD., Conclusion: Problems in the access to the IUD were identified due to organizational barriers to its availability and insertion, such as the lack of availability of the method or the excess of unnecessary criteria to make it available.