避孕药具使用对妇女健康和社会经济地位的影响：证据简报

Evidence brief Key messages Contraception empowers women and positivelyimpacts their overall health and wellbeing byreducing health risks, contributing to a healthierlife and conferring greater agency. Specifically,contraceptive use does the following: reduces health risks associated with high-risk pregnancies, such as pre-eclampsia andendometrial, ovarian and cervical cancers; contributes to a healthier life by improvinganaemia and menstrual health, reducingthe size of leiomyoma and dysfunctionalbleeding and lowering pain associated withendometriosis; decreases depressive symptoms amongwomen with pre-existing mental disordersand has a protective effect against anxiety inwomen; and empowers women by contributing to theirsocioeconomic status and wellbeing. Introduction With an estimated 874 million women ofreproductive age (15–49 years) using a modernmethod of contraception in 2022,(1) contraceptionuse has become a norm in much of the world.Evidence has accumulated over the years regardingthe multitude of medical and non-medical benefitsof contraception provision, including its criticalrole in improving women’s health by reducingunintended and high-risk pregnancies and therebythe number of women exposed to the risk ofmaternal death or morbidity. Contraception canpotentially enhance maternal, newborn and childhealth by enabling women to practice the healthytiming and spacing of pregnancies and births andthus helping women to focus on their health and oncaring for their newborns, infants and children. Inaddition to the maternal and child health benefits,the use of contraceptive methods can improvewomen’s socioeconomic status by enabling girlsand young women to continue their studies,helping them to achieve a higher education andto participate in employment that increases theirearning power and contributes to their householdincome. As witnessed in the countries of FarEast Asia and Southeast Asia, contraceptiveprovision also contributes to a nation’s economicdevelopment by reducing fertility. This yieldsa demographic dividend due to the high, andincreasing, ratio of working-age people compared to dependents.(2) In 2007, readers of the BritishMedical Journal (BMJ) rated oral contraceptive pillsas one of the 15 biggest milestones in medicinesince 1840.(3) The United States Centers forDisease Control (CDC) has included contraceptionamong the 10 great public health achievements ofthe 20th century.(4) Despite this broad consensuson the benefits of family planning, some viewthe evidence as unconvincing primarily due to itsheavy reliance on cross-sectional observationaldata that show associations rather thancausal links or because of the varied coverage,methodologies and quality of the studies. Inaddition, contraception has been questioned for itsdemographic rationale, health rationale, quality ofcare and concerns for human rights.(5) Therefore,World Health Organization (WHO) commissionedsystematic reviews of the magnitude and thequality of the evidence regarding the strength ofthe relationship(s) between contraceptive useandwomen’s health outcomes as well as theirsocioeconomic status (SES). The overarchingquestion for the set of six commissionedsystematic reviews was to assess whether theuse of contraceptives leads to improvements inwomen’s health and their SES through the number,timing and spacing of pregnancies and to otherdirect health and non-health benefits. This Briefhighlights the key findings and their implications. Methods Results Use of contraception andwomen’s empowerment Systematic reviews proceeded with thedevelopment of protocols and their registrationon the International Prospective Register ofSystematic Reviews (PROSPERO). The protocolsfollowed the 2020 Preferred Reporting Items forSystematic Reviews and Meta-Analysis (PRISMA)reporting checklist.(6) Relevant databases wereidentified, and the search strategy was guided bythe Population, Intervention, Comparator, Outcomeand Study Design (PICOS). Search results wereexported into EndNote or Mendeley, de-duplicatedand uploaded into Covidence,(7) a web-basedsystematic review software, for screening. Titlesand abstracts were reviewed, and discrepancieswere resolved before the review of the final setof selected publications. Data for key variableswere extracted, including publication details, studycharacteristics, population, interventions, controlsand outcomes, in a standardized data collectionform. The methodological quality of studies wasassessed using the updated Cochrane risks of biastool 2(8), for randomized clinical trials[RCT]s /cluster RCTs and the ROBINS-I(9) fornon-randomized studies of interventions, exceptfor the reviews entitled “Does family planning useempower women? A systematic review” that usedthe Newcastle–Ottawa Scale and “A meta-analysisinto the mediatory effects of family planningutilization on complications of pregnancy in womenof reproductive age” that applied the Downs andBlack scale to assess the quality. Two systematic