From unplanned pregnancy to contraception: contributions to the debate.

Correspondence E. R. Brandão Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro. Av. Horácio Macedo s/n, Rio de Janeiro, RJ 21941-598, Brasil. [email protected] Results of the Born in Brazil study (Pesquisa Nascer no Brasil; CSP 2014; v. 30 sup. 1) recently published in the Brazilian press 1,2 emphasize the need for wider social debate on contraception and unplanned pregnancy. The survey, conducted in 2011-2012, emphasizes the high unplanned pregnancy rate in the country, reaching 55.4% of the women interviewed. The data further show that 25.5% of Brazilian women preferred to postpone having a child and that 29.9% simply never wanted to become pregnant, either at present or in the future. The results corroborate those of previously published studies 3. The issue cuts across several other serious publish health problems and calls for urgent theoretical and political analysis. For example, teenage pregnancy is approached from different theoretical and methodological perspectives that do not always elucidate the cultural factors that condition it. The Zika virus epidemic has raised new and urgent challenges for reproductive planning and for guaranteeing the right to abortion for pregnant women infected with the virus. Attention is also needed to the sequelae, complications, duress, and suffering caused by the experience of illegal abortion in the country, as proven by various studies 4,5,6,7,8,9 and the recently published results of the Brazilian National Survey on Abortion in 2016 10. In fact, these three events – teenage pregnancy, pregnancy in the context of the Zika virus epidemic, and widespread illegal abortion in Brazil – lead us to reflect along two lines: the unswerving defense of abortion as a reproductive right of women at any age and in any social circumstances, addressed in recent articles on the issue motivated by the Zika virus epidemic 11,12,13, and a critical analysis of the many difficulties involved in women’s learning and practicing contraception. Here, we choose this second line of reasoning, which we feel has received less attention in Brazil, shifting our focus to the moment prior to pregnancy in order to identify possible reasons for so many unplanned pregnancies in the country. Contraception is usually approached in public health from the perspective of knowledge and use of contraceptive methods and access to them, that is, as a technical and individual rather than cultural issue. One even hears surprised and skeptical comments on the fact that Brazil still has such a high unplanned pregnancy rate when the country now has a “wide supply” of modern contraceptive methods. What explains this apparent paradox? To argue about the types of methods and their availability and distribution, to recommend or even prescribe them, does not mean that they are becoming part of many women’s daily routine. PERSPECTIVAS PERSPECTIVES