Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 102 a 112


Use of contraceptive methods among high school adolescents

Uso de métodos anticonceptivos entre adolescentes de enseñanza media

Uso de métodos anticoncepcionais entre adolescentes de ensino médio

Autores: Angela Ferreira da Silva1; Maria Helena Baena de Moraes Lopes2

1. Nurse. Doctor Student in Health Sciences by the Campinas State University (UNICAMP) at the Nursing College (FENF). Campinas, SP, Brazil
2. Nurse. Doctor in Genetics and Molecular Biology and Head Professor of the Campinas State University (UNICAMP) at the Nursing College (FENF). Campinas, SP, Brazil

Angela Ferreira da Silva
Rua Afonso Celso de Souza Matthes, nº100, Residencial Green Ville
Poços de Caldas, MG, Brasil. CEP: 37.704-800
(angelafesi@yahoo.com.br)

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How to cite this article

Keywords: Adolescent, sexuality, contraception.
Palabra Clave: Adolescente, sexualidad, anticoncepción.
Descritores: Adolescente, sexualidade, anticoncepção.

Abstract:
OBJECTIVE: Describe the frequency, characteristics of contraceptive use (MAC) and sexual activity among high school adolescents.
METHODS: A descriptive and cross-sectional study was carried out with the use of a questionnaire applied to 1,193 adolescents.
RESULTS: It was verified that 41.1% of adolescents started sexual activities between 13 and 15 years old. Most used contraception at the first intercourse (91.1% of women and 82% of men). The most commonly used method was the male condom. Adolescents seek information for choosing MAC through family or companion suggestions and information given by their doctor and other health care professionals.
CONCLUSION: Although most adolescents started their sexual lives, most use condoms as a contraceptive method, used separately or in combination with the pill. The adolescents were mainly influenced by their families.

Resumen:
OBJETIVO: Describir la frecuencia y características del uso de métodos anticonceptivos (MAC) y la actividad sexual entre adolescentes de enseñanza media.
MÉTODOS: Fue realizado un estudio descriptivo y transversal con la utilización de un cuestionario, aplicado a 1.193 adolescentes.
RESULTADOS: Se verificó que el 41,1% de los adolescentes iniciaron las actividades sexuales entre 13 y 15 años de edad. La mayoría usó algún método anticonceptivo en la primera relación sexual (91,1% de las mujeres y el 82% de los hombres). El método más utilizado fue el preservativo masculino. Los adolescentes buscaron información para la elección del MAC a través de sugerencias de la familia, o del compañero (a) y de informaciones dadas por el médico y otros profesionales de la salud.
CONCLUSIÓN: Aunque gran parte de los adolescentes han iniciado la vida sexual, la mayoría usó el condón como método anticonceptivo, por separado o en combinación con la píldora. Los adolescentes fueron influenciados en su elección principalmente por la familia.

Resumo:
OBJETIVO: Descrever a frequência e características do uso de métodos anticoncepcionais (MAC) e atividade sexual entre adolescentes do ensino médio.
MÉTODOS: Foi realizado um estudo descritivo e transversal com a utilização de um questionário, aplicado a 1.193 adolescentes.
RESULTADOS: Verificou-se que 41,1% dos adolescentes iniciaram as atividades sexuais entre 13 e 15 anos de idade. A maioria usou algum método anticoncepcional na primeira relação sexual (91,1% das mulheres e 82% dos homens). O método mais utilizado foi o preservativo masculino. Os adolescentes buscaram informações para a escolha do MAC através de sugestões da família, ou do (a) companheiro (a) e de informações dadas pelo médico e outros profissionais da saúde.
CONCLUSÃO: Embora grande parte dos adolescentes tenha iniciado a vida sexual, a maioria usou o preservativo como método anticoncepcional, separadamente ou em combinação com a pílula. Os adolescentes foram influenciados em sua escolha principalmente pela família.

INTRODUCTION

The World Health Organization (WHO) proposes a strategic change in the performance of the health professional in relation to the adolescent, within the approach of health promotion and effective youth participation, pointing out the need to reflect on the issue of contraception. It is therefore fundamental that health services at the primary level of care should be structured according to the logic of health promotion and harm prevention principles1.

Adolescence, according to WHO, corresponds to the second phase of life and is between 10 and 19 years old, and this period can be divided into two stages: 10 to 14 years and 15 to 19 years1.

The discussion of the topic of contraception with adolescents is extremely important for the promotion of their health and prevention of diseases, being a public health problem that brings complications not only to the adolescents, but also to the child, the family and the whole society.

Studies that evaluate the use of contraceptives among adolescents in public high schools in the South of Minas Gerais have not been identified. Such studies could subsidize intervention strategies at the moment when the sexual life can begin, helping adolescents to make decisions in a conscious and informed way. To do so, it is necessary to know which methods are most used and how they seek information on the subject, which may differ between populations due to their profile.

The present study aimed to describe the frequency and characteristics of the use of contraceptive methods and sexual activity among high school adolescents in public schools in Poços de Caldas, Minas Gerais.


METHOD

A descriptive and transversal study was carried out, with a quantitative approach. The research was carried out between May and July 2011, in Poços de Caldas, a city in the interior of Minas Gerais, located in the southwest region of the state. According to IBGE, Poços de Caldas has an estimated population of 166,085 inhabitants4.

The study population was composed of adolescents enrolled in public high schools. There were 3034 adolescents enrolled, of whom 747 didn´t meet the inclusion criteria and there was a refusal to participate in the Municipal School survey (n=464), 1823 received the TCLE, 620 didn´t return the signed TCLE and 1203 returned the TCLE and received the questionnaire, of which 10 didn´t return the questionnaire and 1193 answered and returned the questionnaire, of which the latter composed the survey sample.

We included students of both sexes, aged 14 to 19 years and studying in the daytime period. Students who refused to participate in the study were excluded, were not present on the days when data collection was authorized, and those who didn´t return the Informed Consent Form (TCLE) or the questionnaire were excluded.

In order to facilitate the calculation, a population of 3,000 subjects was considered, representing the high school adolescents of public schools, the level of statistical significance of 5% and a sampling error of 6%, in order to determine the sample size. a sample stratified by sex, with the same proportion, resulting in 384 adolescents by sex5. The proportion of 50% was assumed to generate the largest sample required, so the sample would not be underestimated.

The authorization of the Municipal Department of Education and Regional Superintendence of Education for the collection of data within the schools and the directors of each public high school was requested to carry out the research. The research was submitted to the Research Ethics Committee (CEP) of the Faculty of Medical Sciences of the State University of Campinas (UNICAMP), and duly approved by CEP Opinion No. 1195/2010, CAAE: 6521.0.000.146-10. It is worth mentioning that, at the time the project was approved, the signing of the Term of Assent was not required and the process was not carried out by the Brazil Platform.

The questionnaire "Locus of control, knowledge, attitude and practice of pill and condom use among university adolescents" was used, after author's authorization, which provides, among others, data referring to sociodemographic characteristics (age, sex, color or race, (age of onset of sexual activity, use of MAC at first sexual intercourse, age of onset of MAC use, current use of MAC) , number of pregnancies and influences in the choice of method)(6).

To ensure the confidentiality of the respondents, each school was identified by an alphabetic code (for example: A, B, C, D and so on). The researcher kept to her control the listing containing the codes of the respective schools.

An initial contact with the class was made for the presentation of the project and delivery of the TCLE to the adolescents, so that the parents signed the authorization in the case of minors. The date of return of the term for data collection was also combined in that first contact for two days after the initial contact. At this point, the participant would receive information about the research, as well as the option of not participating or withdrawing at any time.

The adolescents were approached in their respective classrooms, after authorization of the teacher, under the supervision of the researcher. The self-explanatory questionnaire was delivered to the students, and at the end of the filling, the students placed the questionnaire in a single envelope identified only by the alphabetical code corresponding to the school.

A database was created in Microsoft Corporation® Excel, 2007, 6.0 for statistical analysis. The sociodemographic characteristics of the sample and the answers regarding the contraceptive method were analyzed descriptively, by calculating the absolute (n) and relative (%) frequencies of the variables.


RESULTS

The sociodemographic characteristics of the studied group are presented in Table 1. Of the 1193 adolescents, 62.8% were female and 37.2% were male. Age ranged from 14 to 19 years, with the highest frequency being 16 years (36.5% of women and 33.9% of men). Most of the interviewees were female (62.8%), white (54.6% of women and 51.2% of men), of Catholic religion (58% and 53.7%, women and men , respectively), didn´t work (72.7% of the women and 56.4% of the men) and lived with the family (96.4% of the women and 96.6% of the men). Among the 494 adolescents who had started sexual activity, 41.4% were female and 49.2% were male.




Regarding sexual characteristics, 41.3% of adolescents and 28.5% of adolescents reported having no partner at the time of the research and 63.7% of the women and 50.8% of the men reported that they had not yet started sexual activity according to shown in Table 2.




Regarding the use of MAC in the first sexual intercourse, considering only the 487 adolescents who responded to this question, a total of 388 (91.1% of the women and 82% of the men) made use of some MAC. Age at onset of MAC varied from 9 to 19 years and the predominant age group was 13 to 15 years (58.5% and 62%, among female and male adolescents). The majority of adolescents made current use of some MAC (81.4%, female and 82%, male).

The frequency of sexual intercourse was two to four times a week (84.5% for them and 87.7% for them). Nine cases of pregnancy were reported, occurring more frequently at the age of 14 years (37.5%), with the youngest being 11 years and the highest, at 17 years. Three pregnancies evolved into (spontaneous) abortion, three evolved for normal deliveries, and three for cesarean delivery.

Table 3 shows the methods used in the first sexual intercourse. The predominant method was the male condom (66.6%), followed by the combination of the male condom and the contraceptive pill (8%). The methods most used by the adolescents at the time of the study were also the male condom (59.9%), the contraceptive pill (14%) and the male condom and contraceptive pill combination (10.3%).




The questionnaire presented several options for answering the question regarding the reason for not using MAC, namely: I don´t like it; my partner doesn´t like me; I don´t know how to get a method; it's expensive; I think the methods are bad for health; I don´t know how to use any method to avoid pregnancy; I'm afraid someone in my family will find out; I didn´t think of the time; I want to get pregnant / I want my partner to get pregnant; she didn´t think she was in danger of getting pregnant; this is the responsibility of my (my) partner and, finally, "other", and in this case, I must state the reason (s). The reason most cited by adolescents for not using MAC at the first intercourse was "didn´t think about it" (59.4%). As for the reason for not using any MAC currently, 29% answered "other" as justification, but didn´t say what the reason, or "I don´t like" (23.2%).

Table 4 shows that, of the 379 adolescents who used MAC at the time of the study, 292 (77.0%) said they had been influenced in choosing the current method. It was noted the importance of the family suggestion (38.3% of the women and 52.3% of the men) as well as the companion (32.1% and 19.2%, respectively) and the information given by the physician / professionals of health (25.9% and 22.3%).




Table 5 shows the distribution of adolescents according to age at onset of sexual activity and age at onset of MAC use. Among the 494 adolescents who started sexual activities, only 63.8% (173/271) of the female adolescents and 65.3% (141/216) of the male sex were between 13 and 15 years old, when they started sex. In the same age group, 58.4% (90/154) of the female adolescents and 62% (72/116) of the male initiated MAC, and 45.3% (224/494) of the adolescents didn´t respond to this last question.




DISCUSSION

In the group studied, 41.1% of the adolescents had started sexual activities, and had the first sexual intercourse in the age group of 13 to 15 years, for both sexes. A study with adolescents conducted in Piauí found similar results: adolescents started sexual activities with the mean age of 15 years7, which corroborates the study with adolescents in Cuiabá8. Another study also carried out in Piauí with adolescents nursing students, the coitarche was approximately 17 years9. The study of Cardiovascular Risks in Adolescents (ERICA),10 which is a cross-national, school-based study, indicated that in 32 geographic strata of the country, 28.1% of adolescents had started sexual activities, with a higher prevalence at 17 (56.4%), these data corroborate with the study carried out with nursing graduates mentioned above.

The onset of early sexual intercourse among young people may result in an unwanted and unplanned pregnancy11, so it is important to use some MAC, not only in the first relationship, but in all. In fact, recent data from the Information System on Live Births (SINASC) of the Ministry of Health, showed a reduction of 17% of pregnancy in adolescence, probably related to greater access to contraceptive methods, among other actions12. In the present study, 91.1% of the women and 82% of the men used some MAC at their first sexual intercourse, frequencies much higher than those found among adolescents pregnant at a Sobradinho II Health Center, in which only 54% MAC13.

A study of 295 college students from a city in the interior of São Paulo showed that 48.8% had started sexual activity, and 91.7% reported having used a contraceptive method (MAC) in the first relationship2. The most used method was the condom and this in combination with the pill. Adolescents were influenced by the doctor or health professional (53.4%) and by the media (30.2%)2.

Another study carried out with adolescents from a public school in São José, SC, revealed, in agreement with the previous study, that the most used methods are the condom and the pill. They received information about the school's MAC, friends and family, but they were insecure and lacked information about which method was safer when they started sexual activities3.

Regarding the current use of some MAC, 81.4% and 82% of the young men and women, respectively, did so, corroborating the research carried out in Patos de Minas in high schools in the public and private schools, where 85 % of young people in the public school system used male condoms and 89% in private schools14 and with ERICA (82.3%)10.

Among the methods most used in the first sexual intercourse, used separately or combined, the male condom, following the contraceptive pill, stood out. These data confirm what has already been reported in other studies8,13-15.

Regarding the justification for not using a MAC, the study with adolescents from public institutions in Santa Maria, RS, showed that 30% of the girls thought they were not pregnant, 28% were afraid that the parents would find out, 28% had been dating for some time and 24% had not thought about using contraceptives16. In the present study, the main reason (59.4%) was that they didn´t think of any method at that time (in the first sexual intercourse).

The high number of adolescents who stopped responding (45.3%) didn´t allow to evaluate if there was a significant difference between the age of sexual onset and the age of onset of MAC use, although it was found that the vast majority practiced safe sex in the first relationship and after.

In the present study, it was found that the adolescents sought information for choosing the MAC through suggestions from the family or companion and from information given by the doctor and other health professionals. In the study of adolescents from public and private schools on contraceptive methods, it was evidenced that most of the public school students sought information on sexuality with their parents (39%), friends (39%), while at private school, (42%) and internet (41%)14. As a result, it was noted that the family is an important source of information, since 54% of public school students speak openly about sexuality with their parents, against 39% of private schools14. Data from the surveys cited above differ from the study conducted in Nigeria with adolescents, where the largest source of information was the internet (91%) and media (89.3%)17. In another study carried out in Teresina, adolescents have as a source of information about family planning the health professionals, family and companion18.

Comparing the data from this study with another that used the same questionnaire among university adolescents2, it was observed that some data are similar, while others differ. As for the similarities, the great majority had MAC in the first intercourse (91.7%); the most used method was also the male condom, at the first intercourse (66%) and at the moment of data collection (38.3%). As for the differences, the main reason for not using MAC currently among college students was that "no sexual relation" (40.0%) and in the present study I was "dislike" the most cited reason (23.3 %). University teens responded that books, magazines, television, the internet and information provided by health professionals had influenced their choice of MAC. In the present study, the family and the companion were the most frequently mentioned. It is possible that the difference in the age range (13 to 15 vs 17 to 19 years) and level of schooling may explain these differences, in addition to the cultural environment, origin and others, and new studies are needed to investigate these variables.

The study contributed to a profile of the study population, which may be useful for future intervention studies. However, it has the limitation of being a cross-sectional study, not allowing more in-depth analyzes. In addition, the fact that the students didn´t answer some questions in a relatively high percentage, didn´t allow other comparisons.


CONCLUSION

Most of the adolescents participating in the study made use of MAC, the male condom being used separately or in combination with the pill and/or other methods, the most commonly used MAC. Although most adolescents started their sexual life, most of them used MAC and were influenced in their choice mainly by family and companion.

In view of the above, it is recommended to carry out sex education in schools, but considering the triad: educators, family members and health professionals. For the family has an important role of not only transmitting information but values; the health professionals, transmit correct and updated information; and educators, offer strategies that allow adolescents to feel welcomed and involved in the learning process.


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