Women's socioeconomic factors associated to the choice of contraceptive method in Spain
Factores socioeconómicos de las mujeres asociados a la elección del método anticonceptivo en España
Dolores Ruiz-Muñoza,b,c and Gloria Péreza,b,c,d
aCIBER in Epidemiology and Public Health (CIBERESP), Spain
bHealth Information Systems Service, Barcelona Public Health Agency, Barcelona, Spain
cInstitute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
dFaculty of Health and Life Sciences, Pompeu Fabra University, Barcelona, Spain
This article forms part of the doctoral dissertation of D. Ruiz Muñoz at the Pompeu Fabra University (UPF) of Barcelona (Spain).
ABSTRACT
Objective: To describe the influence of socioeconomic characteristics on the choice of the contraceptive method used among women in Spain in 2006.
Methods: This is a cross-sectional study of women aged 15-49 who reported the contraceptive method used during the first sexual intercourse (n = 3352) and during the 4 weeks prior to the interview (n = 2672). Data were analyzed taking into account women's socioeconomic characteristics.
Results: The mostly used method during the first sexual intercourse was the condom. Women from developing countries more frequently used the pill than native-born Spanish women. The condom was also the most commonly used method in the 4 weeks prior to the interview. The use of other contraceptive methods increased with age. Being older and having children were both associated with an increased use of permanent methods.
Conclusions: The choice of a specific contraceptive method seems to be more strongly influenced by women's stage of life than by socioeconomic characteristics.
RESUMEN
Objetivos: Describir la influencia de las características socioeconómicas en la elección del método anticonceptivo utilizado por las mujeres en España en 2006.
Métodos: Estudio transversal de las mujeres de 15-49 años de edad que declararon el método anticonceptivo utilizado en la primera relación sexual (n = 3352) y durante las cuatro últimas semanas (n = 2672), teniendo en cuenta sus características socioeconómicas.
Resultados: El preservativo fue el método más utilizado durante la primera relación sexual. Las mujeres de países en vías de desarrollo usaron más frecuentemente la píldora que las autóctonas. El preservativo fue también el método más utilizado durante las cuatro últimas semanas. El uso del resto de los métodos aumenta con la edad. Tener una edad más alta e hijos se asoció con un mayor uso de métodos permanentes.
Conclusiones: La elección de un método anticonceptivo concreto parece estar más influenciada por el ciclo vital de la mujer que por sus características socioeconómicas.
Palabras clave: Anticoncepción. Conducta reproductiva. Conducta anticonceptiva. Factores socioeconómicos. España.
Introduction
Several studies have highlighted the factors that influence women's use of contraception. Women of lower socioeconomic positions use contraception less and use less effective contraceptive methods, having the highest risk of unintended pregnancy.1,2 It has been observed that different countries in Europe not only have differences in the prevalence of the use of contraception but also in the forms of contraception used.1-3A recent study showed that 70% of sexually active women in Spain aged 15-49 years used contraception during their first intercourse and 78% used it during the four weeks prior to the interview.4 This same study showed that women's characteristics such as age, level of education, country of origin, religiousness and age at first intercourse influence the use of contraception at first intercourse, and that in the case of the use of contraception during the last four weeks characteristics such as living with a partner, having children and having used contraception at first intercourse appear to be more relevant.
]]> The condom, followed by the pill, were the methods used most, both in their first intercourse and during their most recent sexual intercourse, in Spain,4,5 but it is not known if women's socioeconomic characteristics have an influence on their decision to use a specific contraceptive method.In this context, the aim of the present study was to describe the influence of women's socioeconomic characteristics on the choice of the contraceptive method used among women in Spain in 2006.
Methods
This is a population-based cross-sectional study of non-institutionalised women aged 15-49 years in Spain in 2006.
The source of information was the 2006 fecundity interview developed by the Centro de Investigaciones Sociológicas. From an initial sample of 9737 interviewees, we selected women aged 15-49 years who reported the contraceptive method used during their first sexual intercourse (n = 3352) and during the four weeks prior to the interview (n = 2672). Full details of the survey have been reported elsewhere.4
Two dependent variables were analyzed, the contraceptive method used during first sexual intercourse and during sex in the four weeks prior to the interview. After having reported using contraception, women were asked if they used any of the following methods: condom, pill, withdrawal, injection, intrauterine device (IUD), emergency contraception, periodic abstinence, male sterilization, female sterilization, cream/foam spermicides or sponge, diaphragm, any other method. We selected women who had used a single method and compared these methods both individually and in groups of methods: condom/pill; condom/pill/IUD; ineffective (withdrawal, periodic abstinence and cream/foam spermicides or sponge)/effective (all the other methods of the previous list except the category "any other method", as we do not know the effectiveness of the methods included in that category); permanent (male and female sterilization)/reversible (methods defined previously as effective).
Details of the selection of independent variables and explanation about categories have been reported previously.4 The variables used in the analysis of first sexual intercourse were: level of education, country of origin, religiousness and age at first intercourse; and during the four weeks prior to the interview: all the variables mentioned above, living with partner, number of children and use of contraception at first intercourse. All analyses were stratified by age.
We performed a descriptive analysis using the Chi-squared test. Bivariate, multivariate and multinomial logistic regression models were fitted, and crude and adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated for each group of age. Final adjusted models include all independent variables.
All statistical analyses were performed using STATA, version 10.1. Missing values were excluded from the analysis.
]]>Results
Table 1 shows the prevalence of the most common contraceptive methods used during the first sexual intercourse stratified by variables of interest. Male condom was the method most commonly used in all ages (92.6% in 15-19, 86.7% in 20-24, 85.6% in 25-34 and 68% in 35-49). Women who did not use condom mostly used the pill, and the rest of methods are practically not used. The only variable associated with the choice of a contraceptive method was country of origin (data not shown). Women from developing countries aged 15-19 (aOR = 0.11; 95%CI: 0.02-0.58) and 25-34 (aOR = 0.35; 95%CI: 0.19-0.66) used the pill more than the condom, compared to women of the same age from developed countries.
Table 2 shows the prevalence of the contraceptive methods used most commonly during the four weeks prior to the interview stratified by variables of interest. The contraceptive method used varies depending on age. Condom is the most common method in all ages (68.2% in women aged 15-19, 53.3% in 20-24, 48.1% in 25-34 and 34.1% in 35-49). In women aged 15-24 the majority of those who did not use the condom used the pill, and no socioeconomic variable was associated with the choice between them (data not shown). Among women aged 25-49, the pill is also the second most commonly used method, and the use of IUD and specially permanent methods increases. Women aged 25 to 49 showed no differences in the choice of a reversible method, using mainly condom, pill or IUD, but there were differences in the use of a reversible method compared to a permanent one. Older women (aOR = 2.28; 95%CI: 1.39-3.75 for women aged 35-49 compared to those aged 25-34) and those with children (aOR = 3.95; 95%CI: 1.12-13.9 for women with one children compared to women without children) are the ones who used permanent methods more after adjusting for all independent variables (data not shown).
It has to be remarked that no variable was found associated with the choice of ineffective methods in the adjusted regression models in either of the two moments.
Discussion
During first sexual intercourse women mostly used condom at all ages, as has been previously reported in Spain and other European countries.3,4 Only being from a developing country influences prioritising the pill over the condom, as has been shown previously among women from Latin America.6
Condom is also the method most used in the four weeks prior to the interview, although an increase with age was found in the use of other contraceptive options.4,5 Condom use is higher in Spain than other European countries,1-3 possibly as a result of "safe sex" campaigns implemented to prevent sexually transmitted infections, specially among younger women.1,5 Only being older and having children are associated with choosing a method in recent intercourse, preferring a permanent method to a reversible one.
Recent hormonal methods and long-acting reversible methods could be a good alternative for some specific groups, but they are not commonly used in Spain, or in other European countries, mainly because of a lack of their being offered by professionals.7-9 The main limitations of the study are related to design of the survey. Full details have been reported elsewhere.4
]]> Contraceptive counselling is one of the most important factors affecting the choice of a contraceptive method.10-14 There is no information about counselling in the survey, and the different Autonomous Communities could be dealing with counselling in very different ways. It would be necessary to explore regional differences in the choice of the contraceptive method, as differences in the use of contraception have been found at this level.15To conclude, this study indicates that although socioeconomic characteristics of women are associated with the use of contraception in Spain,4 the choice of a specific contraceptive method seems to be more influenced by the woman's stage of life.5,13
Authorship contributions
D. Ruiz-Muñoz performed the data analysis, participated in the interpretation of the data and drafted the manuscript. G. Pérez reviewed the analysis, participated in the interpretation of the data and in the drafting of the manuscript. The two authors have read and approved the final version of the manuscript.
Conflict of interest
None.
]]>References
1. Spinelli A, Talamanca IF, Lauria L, et al. Patterns of contraceptive use in 5 European countries. Am J Public Health. 2000; 90:1403-8. [ Links ]
2. Skouby SO. Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries. Eur J Contracept Reprod Health Care. 2004; 9:57-68. [ Links ]
3. Cibula D. Women's contraceptive practices and sexual behaviour in Europe. Eur J Contracept Reprod Health Care. 2008; 13:362-75. [ Links ]
4. Ruiz-Muñoz D, Pérez G, García-Subirats I, et al. Social and economic inequalities in the use of contraception among women in Spain. J Womens Health. 2011; 20:403-11. [ Links ]
]]>5. Lete I, Dueñas JL, Serrano I, et al. Use of contraceptive methods in Spain by age groups: results of four national surveys. Prog Obstet Ginecol. 2007; 50:335-9. [ Links ]
6. Ali MM, Cleland J. Sexual and reproductive behaviour among single women aged 15-24 in eight Latin American countries: a comparative analysis. Soc Sci Med. 2005; 60:1175-85. [ Links ]
7. Wellings K, Zhihong Z, Krentel A, et al. Attitudes towards long-acting reversible methods of contraception in general practice in the UK. Contraception. 2007; 76:208-14. [ Links ]
8. Say R, Mansour D. Contraceptive choice for young people. J Fam Plann Reprod Health Care. 2009; 35:81-5. [ Links ]
9. Kane R, Irving G, Brown S, et al. Long-acting, reversible and permanent methods of contraception: insight into women's choice of method. Qual Prim Care. 2009; 17:107-14. [ Links ]
]]>10. Dehlendorf C, Grumbach K, Vittinghoff E, et al. A study of physician recommendations for reversible contraceptive methods using standardized patients. Perspect Sex Reprod Health. 2011; 43:224-9. [ Links ]
11. De Irala J, Osorio A, Carlos S, et al. Choice of birth control methods among European women and the role of partners and providers. Contraception. 2011; 84:558-64. [ Links ]
12. Gemzell-Danielsson K, Thunell L, Lindeberg M, et al. Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden. Acta Obstet Gynecol Scand. 2011; 90:869-77. [ Links ]
13. Skold A, Larsson M. Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden. Sex Reprod Healthc. 2012; 3:43-7. [ Links ]
14. Harper CC, Brown BA, Foster-Rosales A, et al. Hormonal contraceptive method choice among young, low-income women: how important is the provider?. Patient Educ Couns. 2010; 81:349-54. [ Links ]
]]>15. Ruiz-Muñoz D, Pérez G, Gotsens M, et al. Regional inequalities in the use of contraception in Spain: a multilevel approach. Health Place. 2012; 18:408-14. [ Links ]
Correspondence:
druiz@aspb.cat
(D. Ruiz-Muñoz)
Received 11 April 2012
Accepted 23 May 2012