INTRODUCTION
Over the past nine years, governments, civil society, multilateral organizations, donors, the private sector, and the research community have come together around an ambitious goal: to enable 120 million more women and girls to use modern contraceptives by 20201. FP2020 initiative that now plans to maintain efforts for FP2030. This shows us the grandeur of the importance of exposing, discussing, and acting on the issue.
Unwanted pregnancy is a public health problem across Europe, although there is no common definition and no standard way of measuring it. It is estimated that 34% (in Western Europe) to 54% (in Eastern Europe) of pregnancies are intentional. To determine the unwanted pregnancies, it can be used the length of the reproductive period and exposure to the risk of conception, the desired number of children and contraceptive use and effectiveness. Use of effective contraceptives is high in most of Europe, but there is scope, through better provision of sexual health services, better formal sex education and better training of providers, to increase uptake of the most effective contraceptives and improve use of all methods2.
Worldwide, an estimated 44% (90% uncertainty range [IU] 42–48) of pregnancies were unintended from 2010 to 2014. The unintended pregnancy rate decreased by 30% (90% [IU] 21–39) in developed regions but remains substantially higher in developing regions. Sexual and reproductive health services are needed to help women avoid unwanted pregnancy and to ensure healthy outcomes for those experiencing such pregnancies3.
Data from the 2016 National Abortion Survey showed that 13% of the women interviewed had an abortion caused by not wanting the pregnancy4. In Brazil, for example, maternal mortality from abortion complications is the fifth leading cause of death in the country5. Children of unplanned pregnancies often have poorer mental and physical health, take poor cognitive tests and are more likely to end up living in families where marital relationships have broken down2
Reproductive planning (PRp), when adequately and fully offered to women of all races and social classes, including people with a uterus who are disproportionately affected, is one of the most successful interventions in public health6. From the perspective of public management, data published by the United Nations Population Fund - UNFPA report that in countries with an economic situation like Brazil’s, such as Ecuador, for every dollar invested in sexual and reproductive health, the Ecuadorian government saves up to 17 dollars.
Brazil urgently needs to identify an adequate and quick solution to reduce the high rate of unplanned pregnancies in the country and its consequences in terms of maternal morbidity and mortality, as well as the high rate of unsafe abortions. Bahamondes and collaborators in 2017 already identified unmet needs.