Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic

Autor: Luis Bahamondes, Vinicius Machado Correia, Ilza Monteiro, Maria Helena de Sousa, Bruna F. Bottura, M. Valeria Bahamondes, Arlete Fernandes, Mayara P. Gonçalves, Ximena Espejo-Arce
Rok vydání: 2014
Předmět:
Zdroj: Human Reproduction. 29:2163-2170
ISSN: 1460-2350
0268-1161
1056-1412
DOI: 10.1093/humrep/deu191
Popis: STUDY QUESTION: What is the contribution of the provision at no cost for users of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD] the levonorgestrel-releasing intrauterine system [LNG-IUS] contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. SUMMARY ANSWER: Over the last 10 years of evaluation provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths 315-424 child mortalities 634-853 combined maternal morbidity and mortality and child mortality and 1056-1412 unsafe abortions averted. WHAT IS KNOWN ALREADY: LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time or not more than 10 years. Furthermore information regarding the estimation of the DALY averted is scarce. STUDY DESIGN SIZE AND DURATION: We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. PARTICIPANTS/MATERIALS SETTING METHODS: Women who consulted at the Department of Obstetrics and Gynaecology University of Campinas Brazil were new users and users switching contraceptive including the copper IUD (n = 13 826) the LNG-IUS (n = 1525) implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality child mortality and unsafe abortions averted. MAIN RESULTS AND THE ROLE OF CHANCE: We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (+/- SD) age of the women at first consultation ranged from 25.3 +/- 5.7 (range 12-47) years in the 1980s to 31.9 +/- 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3 74.5 and 64.7% in the 1980s 1990s and 2000s respectively). For an evaluation over 20 years the cumulative pregnancy rates (SEM) were 0.4 (0.2) 2.8 (2.1) 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS the implants copper IUD and DMPA respectively and cumulative continuation rates (SEM) were 15.1 (3.7) 3.9 (1.4) 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS implants copper IUD and DMPA respectively (P < 0.001). Over the last 10 years of evaluation the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853 and 1056-1412 unsafe abortions averted. LIMITATIONS REASONS FOR CAUTION: The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant and the low number of users of implants. In addition the DALY calculation relies on a number of estimates which may vary in different parts of the world. WIDER IMPLICATIONS OF THE FINDINGS: LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality child mortality and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods mainly LARC and DMPA at no cost or at affordable cost for the underprivileged population. STUDY FUNDING/COMPETING INTERESTS: This study received partial financial support from the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) grant # 2012/12810-4 and from the National Research Council (CNPq) grant #573747/2008-3. B.F.B. M.P.G. and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001 all the TCu380A IUD were donated by Injeflex Sao Paulo Brazil and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA) Turku Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study. (c) The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions please email: journals.permissions@oup.com.
Databáze: OpenAIRE
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