Inequalities in contraceptive use in Latin America and the Caribbean
Authors: Jorge E Machado-Alba
Journal: The Lancet Global Health (2019)

Latin America and the Caribbean are undergoing a unique process of demographic transition in which the population is progressively ageing but pregnancy rates remain high among women younger than 20 years, and large differences in the number of children per family exist between poor and rich people.1Neal S Harvey C Chandra-Mouli V Caffe S Camacho AV Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveys.Reprod Health. 2018; 15: 146Crossref PubMed Scopus (26) Google Scholar Additionally, Latin America and the Caribbean have recently been threatened by infectious diseases such as Zika, which caused an epidemic of children born with microcephaly2dos Santos GRB Aragão FBA Lobão WJM et al.Relationship between microcephaly and Zika virus during pregnancy: a review.Rev Assoc Med Bras (1992). 2018; 64: 635-642Crossref PubMed Scopus (6) Google Scholar that could have been avoided had there been more advanced policies in place to promote the use of and access to hormonal contraceptives.3Machado-Alba JE Machado-Duque ME Gaviria-Mendoza A Orozco-Giraldo VA Hormonal contraceptive prescriptions in Colombia and Zika virus.Lancet. 2016; 387: 1993Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar In The Lancet Global Health, Rodolfo Gomez Ponce de Leon and colleagues4Gomez Ponce de Leon R Ewerling F Jacob S et al.Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.Lancet Glob Health. 2019; 7: e227-e235Summary Full Text Full Text PDF PubMed Scopus (71) Google Scholar state that national health programmes in Latin America and the Caribbean are failing to adopt long-acting reversible contraceptives such as intrauterine devices or hormonal implants, and most women in the region (particularly those in lower wealth quintiles, young women, indigenous women and those living in rural areas) are unable to benefit from these methods. Their analysis shows that in 17 of the 23 countries considered, use of long-acting reversible contraceptives was below 10%. In fact, in most countries short-acting reversible contraceptives are still most commonly used. Long-acting methods are highly effective, safe, convenient, and guarantee adherence.4Gomez Ponce de Leon R Ewerling F Jacob S et al.Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.Lancet Glob Health. 2019; 7: e227-e235Summary Full Text Full Text PDF PubMed Scopus (71) Google Scholar They also preserve women's rights to decide about their fertility in the future. The authors provided a real picture of contraceptive use in Latin America and the Caribbean by going beyond establishing the prevalence of contraceptive use (defined as the percentage of sexually active women aged 15–49 years who were using a contraceptive method at the time of the survey), to evaluate the demand for family planning satisfied (defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey). Data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries. Demand for family planning satisfied with modern methods was greater than 80% only in ten countries, reflecting the inequalities that exist in the region, in particular the poor access to long-acting reversible contraceptives in lower wealth quintiles.5Ugaz JI Chatterji M Gribble JN Banke K Is household wealth associated with use of long-acting reversible and permanent methods of contraception? A multi-country analysis.Glob Health Sci Pract. 2016; 4: 43-54Crossref PubMed Scopus (19) Google Scholar Additionally, only Cuba, Mexico, Trinidad and Tobago, Colombia, and Ecuador had more than 10% of women adopting long-acting contraceptive methods. The question arises whether contraception is accessible in those countries not included in the study. Venezuela has serious problems regarding access to health care and medicine,6Bello RJ Damas JJ Marco FJ Castro JS Venezuela's health-care crisis.Lancet. 2017; 390: 551Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar whereas information on Chile, one of the most developed countries in Latin America and the Caribbean, was not available. Additionally, women's perceptions of the role of contraceptives in their lives and their difficulties in adopting them are not addressed.7Sedgh G Hussain R Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries.Stud Fam Plann. 2014; 45: 151-169Crossref PubMed Scopus (200) Google Scholar The use of demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys as research strategy provided the authors with a broad range of useful information to compare and understand the reality of reproductive health issues. Other researchers could adopt this research strategy to address other issues of interest, such as access to antiretrovirals, antimalarials, antituberculosis drugs, and oral rehydration salts across different regions of the world.8Desmonde S Tanser F Vreeman R et al.Access to antiretroviral therapy in HIV-infected children aged 0–19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004–2015: a prospective cohort study.PLoS Med. 2018; 15: e1002565Crossref PubMed Scopus (24) Google Scholar, 9Fenner L Ballif M Graber C et al.Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening.PLoS One. 2013; 8: e77697Crossref PubMed Scopus (19) Google Scholar Women have the right to decide how many children to have and when to have them. For this, they must have effective, easy-to-use birth control methods that are available and accessible regardless of socioeconomic status or country of residence. I declare no competing interests Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countriesLong-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis. Full-Text PDF Open Access