title: Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries.
abstract: OBJECTIVE
  To identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico).
  
  
  METHODS
  We analyzed baseline data of 7049 women of childbearing age (15-49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013).
  
  
  RESULTS
  Women in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59-0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58-0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39-0.64). Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility (OR 1.64, CI: 1.13-2.36).
  
  
  CONCLUSIONS
  Our study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities. Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use.
  
  
  CONCLUSIONS
  We show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need.
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama. Electronic address: diegori@iadb.org.
authors.forename: Diego
authors.initials: D
authors.lastname: Rios-Zertuche
authors.affiliation: Department of Economics, Universidad de Costa Rica. Electronic address: mina1001@hotmail.com.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Blanco
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama. Electronic address: mpzuniga@iadb.org.
authors.forename: Paola
authors.initials: P
authors.lastname: Zúñiga-Brenes
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. Electronic address: palmie@uw.edu.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Palmisano
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. Electronic address: dvc2@uw.edu.
authors.forename: Danny V
authors.initials: DV
authors.lastname: Colombara
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama. Electronic address: emmai@iadb.org.
authors.forename: Emma
authors.initials: E
authors.lastname: Iriarte
mesh_terms: D000293:Adolescent; D000328:Adult; D002489:Central America; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000193:education / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008800:Mexico; D008875:Middle Aged; D011204:Poverty Areas
keywords: Contraceptive knowledge; Family planning; Health inequalities; Poverty; Salud Mesoamerica; Unmet need