Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy.

OBJECTIVE: to examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women.

DESIGN AND SETTING: a prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014.

PARTICIPANTS: A total of 264 woman aged 15-44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum.

MEASUREMENTS: At baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status.

FINDINGS: Only 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97].

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Brazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect postpartum contraceptive use. Women with unintended pregnancies present an important opportunity to offer additional family planning counseling.