215Impact of Brazilian Family Health Strategy on Reproductive Health: Analysis at Individual and Population Levels

Abstract

Background Family Health Strategy (FHS) is the largest community-based health program in Brazil. There is limited evidence about its effectiveness, especially about adolescents. We aimed to access its effects on adolescents’ reproductive health. Methods We estimate its effects on contraception at individual level using data from a national health survey carried out in 2013 and applying propensity score matching combined with complex survey weights. We employed a differences-in-differences approach for evaluate its effects on adolescent maternity rate at municipal level between 1996 and 2016. Results FHS has positive effects on the probability of using contraceptives. The highest effect was over the concomitant use of pills and male condom (increase of 12 percentage points). For households with female adolescents, it was even higher (26 percentage points). We found a monotonous decrease on adolescent maternity rate following exposure time to FHS, especially in the poorest regions. Conclusions Even not being focused on reproductive health, FHS has positive effects on it. We interpret the negative impact on adolescent maternity rates to be linked to an increased use of contraceptive methods. Key messages Programs such as FHS can be extremely important in promoting knowledge about family planning, especially for adolescents living in social vulnerability. We believe our findings to be important inputs for the discussion in countries where early childbearing is more prevalent, and inequalities are particularly striking..

Policies for expanding family planning coverage: lessons from five successful countries

“…The program was subsequently expanded and renamed to Family Health Strategy (ESF, Estratégia Saúde da Família ) ( 50 ), now present across Brazil. Although ESF’s focus is broader, evidence suggests it positively impacted contraceptive use, attributed to enhanced primary healthcare unit coverage ( 51 ).…”

“…Notwithstanding, there is still progress to be made, especially in achieving a more balanced distribution of contraceptive methods. Currently, long-acting reversible methods have limited participation, with cultural rejection, inadequate medical training, and constraints on healthcare personnel from insertion and counseling contributing to this situation ( 51 ). Ecuador’s progress in family planning during the examined period, particularly between 1994 and 2018, places it as a successful case in family planning.…”