Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Original Article Imprimir 

Páginas 55 a 64


Adolescent pregnancy: study on the regional health secretaries of Paraná state, Brazil

Embarazo en la adolescencia: estudio en las regionales de salud del estado de Paraná, Brasil

Gravidez na adolescência: estudo nas regionais de saúde do estado do Paraná, Brasil

Autores: Mirian Cozer1; Gilmar Ribeiro de Mello2; Fernanda Mendes Bezerra Baço3; Lirane Elize Defante Ferreto de Almeida4; Marco Kasmin Correa5

1. Final Year Master's Degree Student, Graduate Studies Program in Regional Development and Management, West Paraná University (UNIOESTE). Francisco Beltrão, Paraná State, Brazil. Lecturer, Paranaense University(UNIPAR). Umuarama, Paraná State, Brazil
2. PhD in Accounting, Management and Accounting School, São Paulo University (FEA/USP). São Paulo, São Paulo State,. Lecturer, Master's Degree Program in Regional Development and Management, West Paraná University (UNIOESTE). Francisco Beltrão, Paraná State, Brazil
3. PhD in Economics, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil. Lecturer, Graduate Studies Program in Regional Development and Management and Economics Course, West Paraná University (UNIOESTE). Francisco Beltrão, Paraná State, Brazil
4. PhD in Public Health, Campinas State University (UNICAMP). Campinas, São Paulo State,. Lecturer, Graduate Studies Program in Regional Development and Management and Medicine Course, West Paraná University (UNIOESTE). Francisco Beltrão, Paraná State, Brazil
5. Master's Degree in Regional Development and Management, West Paraná University (UNIOESTE). Francisco Beltrão, Paraná State, Brazil. Bachelor's Degree in Economics, Maringá State University (UEM). Maringá, Paraná State, Brazil

Mirian Cozer
Rua: Apucarana, 62. Apt. 101, Industrial
Francisco Beltrão, PR, Brasil. CEP: 85601-730
miriancozer@yahoo.com.br

PDF Portuguese      


Scielo

Medline


How to cite this article

Keywords: Fecundity rate, adolescent, economic indicators, social indicators.
Palabra Clave: Tasa de fecundidad, adolescente, indicadores económicos, indicadores sociales.
Descritores: Taxa de fecundidade, adolescente, indicadores econômicos, indicadores sociais.

Abstract:
OBJECTIVE: Verify the relation of adolescent pregnancy incidence with the economic and social development in Paraná State during the year of 2010.
METHODS: We perform an ecological and exploratory study with data collected from the Born Alive Information System, FIRJAN index for municipal development (IFDM), IPARDES index for municipal development (IPDM), Municipal Human Development Index (IDHM) and from the GINI Coefficient. The data was analyzed through descriptive statistics and Pearson's linear correlation test.
RESULTS: Of the 152.048 babies born alive in Paraná State on the year of 2010, 27.762 (Proportion of born alive - PFA = 18,26%) were born from adolescent mothers with 15 to 19 years mothers years. The specific fertility rates (TEF's) presented an average of 3,07% for the State and in the statistical test was identified a significant correlation between TEF and PFA (r =0,841; p = 0,000); TEF and IFDM (r = -0,505; p = 0,017); TEF and IPDM (r = -0,433; p = 0,044).
CONCLUSION: We believe that these correlations occur from methodological differences used in the estimate for each indicator, given that the TEF measures the intensity of fertility to which women in each age group from the reproductive period, whereas the PFA estimates the participation from the age group in the total of live births in all age groups. Thus, it is deductible that only the IFDM and IPDM indicators have correlation with gestation in this age period, with no association with the remaining economic and social indicators analyzed in this study, as the indicator for municipal development and the GINI coefficient.

Resumen:
OBJETIVO: Verificar la relación de incidencia de gestantes adolescentes con el desarrollo económico y social en el Estado de Paraná durante el año 2010.
MÉTODOS: Fue realizado un estudio ecológico y exploratorio desde datos recolectados en el Sistema de Información sobre Nacidos Vivos, Índice FIRJAN de desarrollo municipal (IFDM), Índice IPARDES de desarrollo municipal (IPDM), Índice desarrollo humano municipal (IDHM) y Coeficiente GINI. Los datos fueron analizados a través de estadística descriptiva y test de correlación lineal de Pearson.
RESULTADOS: De los 152.048 bebés nacidos vivos en el Estado de Paraná en el año de 2010, 27.762 (Proporción de nacidos vivos - PFA=18,26%) nacieron de madres adolescentes con 15 a 19 años de edad. Las tasas específicas de fecundidad (TEF´s) presentaron media del 3,07% para el Estado y en el test estadístico se identificó correlación significativa entre TEF y PFA (r = 0,841; p = 0,000); TEF y IFDM (r = .-0,505; p = 0,017); TEF y IPDM (r = .-0,433; p = 0,044).
CONCLUSIÓN: se cree que esas correlaciones derivan de las diferencias metodológicas utilizadas en la estimación de cada indicador, visto que la TEF mide la intensidad de fecundidad de cada mujer en cada grupo etario del período reproductivo, mientras que la PFA estima la participación del grupo etario, en el total de nacidos vivos, en todas las franjas etarias. De esa forma, se deduce que apenas los indicadores IFDM e IPDM poseen correlación con la gestación en ese período etario, no habiendo asociación con los demás indicadores económicos y sociales analizados en este estudio, como el indicador de desarrollo municipal y el coeficiente GINI.

Resumo:
OBJETIVO: Verificar a relação da incidência de gestantes adolescentes com o desenvolvimento econômico e social no Estado do Paraná durante o ano de 2010.
MÉTODOS: Foi realizado um estudo ecológico e exploratório a partir de dados coletados no Sistema de Informação sobre Nascidos Vivos, Índice FIRJAN de desenvolvimento municipal (IFDM), Índice IPARDES de desenvolvimento municipal (IPDM), Índice desenvolvimento humano municipal (IDHM) e Coeficiente GINI. Os dados foram analisados através de estatística descritiva e teste de correlação linear de Pearson.
RESULTADOS: Dos152.048 bebês nascidos vivos no Estado do Paraná no ano de 2010, 27.762 (Proporção de nascidos vivos - PFA=18,26%) nasceram de mães adolescentes com 15 a 19 anos de idade. As taxas específicas de fecundidade (TEF's) apresentaram média de 3,07% para o Estado e no teste estatístico identificou-se -se correlação significativa entre TEF e PFA (r = 0,841; p = 0,000); TEF e IFDM (r = .-0,505; p = 0,017); TEF e IPDM (r = .-0,433; p = 0,044).
CONCLUSÃO: Acredita-se que essas correlações decorram das diferenças metodológicas utilizadas na estimativa de cada indicador, visto que a TEF mede a intensidade de fecundidade de cada mulher em cada grupo etário do período reprodutivo, enquanto que a PFA estima a participação do grupo etário, no total de nascidos vivos em todas as faixas etárias. Dessa forma, deduz-se que apenas os indicadores IFDM e IPDM possuem correlação com a gestação nesse período etário, não havendo associação com os demais indicadores econômicos e sociais analisados neste estudo, como o indicador de desenvolvimento municipal e o coeficiente GINI.

INTRODUCTION

The World Health Organization (WHO) describes adolescence as the phase between 10 and 19 years of age1, while Brazil's Children's and Adolescents' Statute (ECA) promulgated on July 13, 1990 (Law Nº 8,069) establishes this stage as the age bracket between 12 and 18 years of age2. This period is characterized by sweeping changes, particularly rapid growth, the appearance of secondary sexual characteristics, dawning awareness of sexuality, structuring of the personality, environmental adaptation and social integration3. This is also the time of life when youngsters begin to define their own identities and establish ethical and moral value systems, being particularly vulnerable to issues faced by vast majority of modern societies4.

Sexual initiation occurs frequently during this period. Reports released by the Ministry of Health (MS)5 addressing the sex life of adolescents suggest that the number of sexually active youngsters is on the rise. Aligned with this information, in 2012, the National School Health Survey (PeNSE) indicated that adolescent boys become sexually active at younger ages than girls: only 18.3% of girls between 13 and 15 years old had engaged in intercourse, rising to 40% for boys of the same age6.

It is worthwhile stressing that early sexual initiation is found in a wide variety of social strata, and may be viewed as a widespread trend that is prompting concern, due to the possibility of unwanted pregnancies and the dissemination of sexually transmitted diseases7.

In Brazil, teen pregnancy and its complications are major causes of mortality among young mothers between 10 and 19 years of age8. From the medical standpoint, both mother and child are subject to risk factors, with age being an aggravating factor that may also trigger psychological and social disorders.

Based on epidemiological data, healthcare practitioners are being encouraged to conduct studies in order to quantify the scope of this problem, thus providing input for heightening awareness among other healthcare practitioners and in other fields - such as education and social work, for example - in addition to the population in general, paving the way for the implementation of preventive measures. These research projects may well help improve this situation, which is where studies in this field must be encouraged to an even greater extent.

As a result, an answer is sought here to whether this high teen pregnancy rate is linked to economic and social development levels. On this basis, this study intends to explore the link between teen pregnancy and social and economic development in Paraná State in 2010. Selecting 2010 as the year for this analysis is justified by the fact that all the variables are endowed with different frequencies, with 2010 being the most recent year in which they are all available.


METHODS

This study may be described as exploratory and ecological. The study sample consisted of young women between 15 and 19 years old, whose children were born live during 2010, living within areas covered by one of 22 Regional Health Bureaus (RS) in Paraná State, whose information taken from the Live Birth Declaration (DN) is included in the Live Births Information System (SINASC)`database for this State. The municipality in which the mother resided was used for distribution purposes among these Regional Health Bureaus.

In order to identify the fertility intensity to which women are subject in each age bracket during the reproductive period, 9 a Specific Fertility Rate (SFR) was calculated for the 15 to 19 year old age bracket by dividing the number of children born live to women between these ages by the total number of women in this age bracket, then multiplying by 1000.

The proportion of Offspring of Teen Mothers (OTM) was calculated in order to estimate the size of this group in the total number of live births. This involves the ratio between the number of children born live to teen mothers between 15 and 19 years old by the total number of live births to mothers of all ages, multiplied by 100.

In order to measure the education levels of mothers between 15 and 19 years old, the functional illiteracy concept was used as established by the United Nations Educational, Scientific and Cultural Organization (UNESCO): inability to read, write or handle basic calculations in everyday activities requiring such life skills 10.

The proportion of teen mothers with less than four years of education was calculated, in relation to the total number of mothers between 15 and 19 years of age.

For each Regional Health Bureau in this State, individual measurements were used, synthesized in the following aggregate measurements: proportion (%) of offspring of teen mothers; specific fertility rate (%); and proportion (%) of teen mothers who are functionally illiterate. The data were taken from the Live Births Information System (SINASC).

In order to describe the economic and social development of each Regional Health Bureau in Paraná State, a weighted mean was prepared for the following indexes: Rio de Janeiro Federation of Industries (FIRJAN); Municipal Performance - Paraná State Institute for Social and Economic Development (IPARDES); Municipal Human Development Index (MHDI) and GINI. Both the FIRJAN and IPARDES Indexes used the following rates as analysis factors: employment, income, education and health, adding agricultural output for the IPARDES Index, specifically for Paraná State. The MHDI was based on assessing factors related to criteria corresponding to long lifespan, health, access to knowledge (education) and living standards. The GINI Index measures social inequalities and income distribution, constituting a powerful economic indicator used in studies.

The mean average of these Indexes was calculated, in order to classify the regions by economic and social development, seeking associations with data on teen pregnancy (OTM and SFR), specifically: whether or not there are any associations between one or more Economic and Social Development Indexes and the number of pregnancies and / or live births for the age bracket addressed by this study.

The weighted mean was calculated through data taken from each of the Indexes, available in their on-line databases. The data were collected for all municipalities in Paraná State and grouped as shown in the Regional Health Bureaus allocation, weighted by the population serviced by each of these Bureaus, as shown in the following formula:



Where: IND is the weighted Development Index for the Regional Health Bureau

INDm is the Index for the municipality m

Popm
is the municipal population for the municipality m

PopRs
is the population of the Regional Health Bureau; and

M is the number of municipalities encompassed by the Regional Health Bureaus.


The data were tabulated in Excel® worksheets version 2010 and subsequently exported to the Statistical Package for Social Science (SPSS®), version 18. An analysis was conducted of associations and correlations among the measured variables through Pearson´s linear correlation test, as their distribution was normal. The Kolmogorov-Smirvov and Shapiro-Wilk normality tests were applied11, with a significance level of 5%.


RESULTS AND DISCUSSIONS

With 399 municipalities distributed among 22 Regional Health Bureaus, Paraná State had a population of 10,444,526 inhabitants according to the 2010 Demographic Census12, ranked as the sixth most heavily-populated State in Brazil, with 5.47% of the Brazilian population. Over a ten-year period (2000 - 2010) this State posted population growth of 9.27%. Its economy ranks fifth in Brazil, currently accounting for 5.98% of the Brazilian Gross National Product (GDP), with a per capita income of R$ 22,700 (2011 data) and a GDP of R$ 239,366,007 million 13.

A teen pregnancy rate of 6.03% was found among women in this State. In 201014, the profile of these teen mothers was: white (98.81% self-declared white); unmarried (82.53%); at least seven pre-natal appointments (72.18%); pregnancy lasting between 37 to 41 weeks (91.76); vaginal birth (58.25%); birthweights between 3.00 and 3.99 kg (61.40%); and under 1% of the babies with anomalies.

Based on the analyzed data (IBGE and SINASC/PR), out of the total number of 152,048 live births in Paraná State, an OTM of 18.26% was noted for mothers between 15 and 19 years of age. In 2010, the geographical distribution of this age bracket with the highest figures at the Regional Health Bureaus was as follows: Guarapuava and its municipalities (22.48%), for the V Regional Health Bureau, followed by the XXI Regional Health Bureau (Telêmaco Borba) with 22.47%; and the VII Regional Health Bureau (Pato Branco) with an OTM of 22.38%. The Regional Health Bureaus with the lowest proportions of babies born to teen mothers was found at the XV Regional Health Bureau (Maringá) with 14.08%, as shown in Table 1, with a mean OTM of 19.45% for the 399 municipalities (Table 2) and a standard deviation of (±) 2.27. The highest OTM rates for the study conducted by Martins (2014) in the Healthcare micro-regions of Mato Grosso do Sul State was 25.8% with the lowest OTM at 19.5%, close to the mean value found in Paraná State.






The SFR for Paraná State in 2010 reached <0.06177 (6.17%) for each 1,000 women between 15 and 19 years of age. Knowing that the mean calculated on the basis of the descriptive analysis of the 399 municipalities reached 3.07% with a standard deviation of (±) <0.4539 (Table 2), indicated a discrepancy in these data. This discrepancy may be justified by the calculation methodology used to determine this rate, as the SFR at 6.17% is determined by the IBGE methodology, while the figure found as the statistical mean was based on the weighted mean of the municipalities encompassed by the respective Regional Health Bureaus, with a SFR defined for each Regional Health Bureau in Paraná State.

The highest SFR found were at the following Regional Health Bureau: XXI (Telêmaco Borba), followed by IV (Irati) and V (Guarapuava), with SFRs of 3.813%, 3765% and 3.68%, respectively (Figure 1). The lowest Specific Fertility Rate was found at the XV Regional Health Bureau, represented by the Maringá and region municipalities (Table 1).


Figure 1. Spatial distribution for the Specific Fertility Rate for 22 Regional Health Bureaus in Paraná State.



In his paper, Alves15 stressed that the SFR fell in all age brackets between 1991 and 2000, except adolescents (15 - 19 years of age), indicating an upsurge in teen pregnancy in Brazil during the 1990s, with an SFR of 74.8 births for each 1,000 adolescents in 1991. Nevertheless, according to the 2010 Census (IBGE), the fertility rate is declining compared to 2000 Census data, with an SFR of 89.5% in 2000 and 67.2 % in 2010. However, Alves15 stated that the rates in Brazil are high when compared to those of other countries: only 2.3% in South Korea; 7% in France; 8.4% in China; 11.6% in Saudi Arabia; 29.5% in Iran; 34% in the USA and 59% in South Africa. It is important to stress that the drop in the SFR also resulted in a smaller proportion of children and young people, with a steadily aging population. It is also stressed that the SFR in individual municipalities and / or States does not adequately represent the SFR of an entire country.

The question on the mother´s education was marked as unknown by 54 teen mothers, while 72 stated that they had "no" education, out of 786 mothers in all age brackets (< 14 years, 15 to 19, 20 to 34, > 35 years of age). When addressing the percentage of functional illiteracy among teen mothers between 15 and 19 years old, Paraná State presented a mean figure of 4.3% mothers classified as functionally illiterate. Based on the descriptive analysis of the data, a mean figure of 3.5% was obtained for functional illiteracy, with a standard deviation of (±) 3.53 (Table 2). Particularly noteworthy were municipalities encompassed by the XVIII Regional Health Bureau (Cornélio Procópio) with an extremely high illiteracy rate of 9.01%, meaning that out of each 100 teen mothers who had children in 2010, around nine were functionally illiterate, followed by 6.44% for this rate at the V Regional Health Bureau (Guarapuava). While the other Regional Health Bureaus hovered between 1.04% to 5.46%, the XV Regional Health Bureau (Maringá) was particularly noteworthy with the lowest functional illiteracy rate of 1.04% (Table 1). In the study conducted by Martins, 8 the lowest functional illiteracy percentage found was 19% for teen mothers who had children in 2008 in the Ponta Porã micro-region of Mato Grosso do Sul State. It is worthwhile stressing that the Regional Health Bureaus with illiteracy rates prompting concern were located in geographical regions with the lowest social and economic development rates, as shown in the analysis presented in Table 1.

According to the National Household Sampling Survey (PNAD) published in 2014 by the IBGE16, illiteracy is shrinking in Brazil, although still affecting 13 million Brazilians over 15 years old and accounting for 8.3% of the population. What causes the most concern is that illiteracy may be found nationwide, underscoring the urgent need to implement public policies designed to eradicate it.

In order to characterize one of the Municipal Indexes, an attempt was made to define the FIRJAN Municipal Development Index (IFDM) through the weighted mean of the municipalities listed below that constitute each of the 22 Regional Health Bureaus, thus obtaining a classification for this Index. Based on the IFDM weighted mean, all the Regional Health Bureaus were rated as Moderate, meaning that they posted rates between 0.6 and <0.8, with this information corroborated by a statistical mean with a value of <0.71 for the FIRJAN (IFDM) Index, as shown in Table 1.

Based on the guidelines issued by the Paraná State Institute for Social and Economic Development (IPARDES) and as explained in the methodology, a weighted mean was calculated for the IPDM constituting each Regional Health Bureau. This mean resulted in an IPDM of 0.7 and, through a descriptive analysis of the data for 399 municipalities constituting Paraná State, a mean of <0.72 was obtained for this Index, with a standard deviation of (±) <0.041, falling within the mean level in the IPARDES classification, like all the Regional Health Bureaus. The data are presented in detail in Table 1.

Vasconcelos17 mentioned some other indicators for measuring the living conditions of the population, with the Human Development Index (HDI) being particularly noteworthy, monitored by the United Nations Development Program (UNDP). Consequently, since 1993, the UNDP has used the HDI in its Annual Report as a standardized yardstick for assessing and measuring the wellbeing of a population 16.

The UNDP data for 2010 was used, which underpinned the preparation of the Human Development Atlas for Brazil16 from which the MHDI was extracted for the municipalities constituting each of the 22 Regional Health Bureaus in Paraná State, described in Table 1. It is stressed that the MHDI for Paraná State during the year under analysis (2010) reached <0.75, through the weighted mean and, based on the descriptive analysis of the data, the MHDI mean reached <0.72, classified as high, based on the specifications for this indicator.

In order to measure social inequalities, the GINI Index or Coefficient was used, where Paraná State has a GINI Coefficient for 2010 of <0.54, very close to the weighted mean found for the municipalities constituting the III Regional Health Bureau (<0.54), while the statistical mean was <0.49, with a standard deviation of <0.034 (±) (Table 2).

When correlating the SFR and OTM variables with the IFDM, IPDM, MHDI and GINI Indexes, which reflect economic and social development, an association was noted at a 5% significance level, between the SFR and IFDM, as well as the SFR and IPDM. The OTM presented no correlation with any economic or social indicator for the municipalities under analysis (Table 3), only with the SFR (r = 0.84 p = 0.00), which is aligned with the study conducted by Martins8 in Mato Grosso State, which obtained statistically significant correlations between the SFR and OTM (r=<0.6163; p=<0.043).




It is believed that these correlations derive from methodological differences in estimating each indicator, as the SFR measures the intensity of fertility to which women are subject in each age bracket during the reproductive period, between 15 and 49 years of age, while the OTM estimates the share held by the age bracket between 15 and 19 years old in the total number of live births for all age brackets18.

In the study conducted by Martinez19 of municipalities in São Paulo State, teen pregnancy presented associations with social and economic characteristics in municipalities with smaller populations and higher poverty levels, indicating larger percentages of people in situations of social vulnerability, with this study demonstrating close links between teen pregnancy and economic and social indicators.

It is important to note the correlation between the SFR and illiteracy variables at r = 0.41, with a significance rate of <0.05. This prompts us to reflect on the dynamic of the association between these two variables. Functional illiteracy reflects the association between a lack of education and unplanned pregnancies. In his study, Martins8 stated that the fertility rate among teen mothers was higher in healthcare micro-regions with higher functional illiteracy rates and lower social and economic development indicators. This study also found a significant positive correlation between the prevalence of mothers with low education levels and the prevalence of teen mothers, with these findings similar to those reported by Friche et al.20 in their study conducted in Minas Gerais State on mother-child health indicators and SINASC data.

According to the IBGE Census12, between 2000 and 2010 the number of youngsters not in school for the age bracket under analysis (15 to 19 years of age) dropped at both the national and State levels, while the reduction in the number of functionally illiterate adolescents reached around 74% 12.

This study attempts to understand and analyze the contexts of the indicators related to teen pregnancy in Paraná State in 2010, finding associations between only the Specific Fertility Rate and the IFDM and IPDM social and economic development indicators, which was foreseeable, as these indicators measure the same nuances. The other indexes did not present significance levels of 5%.

It is suggested that other studies on the same topic be conducted extending the sample universe in order to analyze fertility rates and illiteracy percentages, seeking an association between them.

It is worthwhile stressing that the correlation merely tests whether two numerical variables are directly or inversely proportional, which does not establish any links of interference between the variables in purely mathematical terms.

It is suggested that when analyzing the SFR with data from only municipalities, rather than regions, municipalities should be clustered together under Regional Health Bureaus or should be added to these Bureaus in other States, thus expanding the study universe, and consequently obtaining a larger number of observations, in the belief that the stipulated index would present a 5% significance, as this datum was only slightly higher than that stipulated as significant in the study.


CONCLUSION

This research project attempted to measure the impact of teen pregnancy on social and economic results in Paraná State. A statistically significant correlation was found between the Specific Fertility Rates (SFR) and the IFDM, the SFR and the IPDM. The OTM presented no correlation with any economic or social indicator in the municipalities under analysis.

This research project is aligned with other investigations indicating that teen pregnancy is a public health problem with direct repercussions on the lives of these girls, including low education levels and difficulties in entering the job market, due to the need to care for their babies and the absence of skills and qualifications. Promotion and prevention actions must target this age bracket, through projects focused on social insertion, sex education, family planning, specialized pre-natal care, and multidisciplinary teams, meaning activities that focus on the reproductive health of these adolescents.


REFERENCES

1. WHO - World Health Organization. Physical status: the use and interpretation of anthropometry. Geneva; 1995. Technical Report Series n. 854. [accessed on: April 25, 2015]. Available at: <http://www.who.int/childgrowth/publications/physical_status/en/index.html>.

2. Brasil. Lei nº 8.069. Estatuto da Criança e do Adolescente. Brasília, DF, 1990. [accessed on: August 1, 2015]. Available at: <http://www.planalto.gov.br/ccivil_03/leis/l8069compilado.htm>.

3. Yazlle MEHD. Gravidez na adolescência. RevBras de Ginecologia e Obstetrícia2006; v. 28, n. 8.

4. Brasil. Ministério da Saúde. Secretaria de Assistência à saúde - SAS. Departamento de Assistência e promoção à saúde-DAPS. Coordenação materno-infantil - COMIN. Serviços de assistência á saúde do adolescente - SASAD. Normas de atenção à saúde integral de Adolescente. Brasília, Ministério da Saúde, 1993. 28p.

5. Brasil. Ministério da Saúde. Secretaria da Atenção à Saúde. Departamento de Ações Pragmáticas Estratégicas. Marco teórico e referencial: saúde sexual e saúde reprodutiva de adolescentes e jovens. Brasília: MS, 2005

6. IBGE. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde do Escolar - PeNSE. 2012. Rio de Janeiro; 2013. [accessed on: April 13, 2015]. Available at: <http://www.ibge.gov.br/home/estatistica/populacao/pense/2012/>.

7. Yazlle MEHD, Franco RC, Michelazzo D. Gravidez na adolescência: uma proposta para prevenção. Rev Bras de Ginecologia e Obstetrícia 2009; 31(10), 477-9.

8. Martins PCR, Pontes ER, Jardim C, Filho ACP, Ribeiro AA. Gravidez na adolescência: estudo ecológico nas microrregiões de saúde do Estado do Mato Grosso do Sul, Brasil - 2008. RevEpidemiolServ de Saúde 2014; 23(1): 91-100.

9. Medronho RA et al. Epidemiologia. 2 ed. São Paulo: Atheneu, 2009. Falta nº de páginas.

10. Infante I. Alfabetismo funcional ensiete países da América Latina. Santiago/Chile. 2000. [accessed on: August 2, 2015] Available at: <http://unesdoc.unesco.org/images/0012/001214/121483so.pdf>.

11. Fávero PL, Belfiore P, Silva FLda, Chan BL. Análise de dados. Modelagem multivariada para tomada de decisões. 2º. triagem. ELSEVIER Editora, 2009. Falta nº de páginas.

12. IBGE. Instituto Brasileiro de Geografia e Estatística. Estados. 2010. [accessed on: April 29, 2015]. Available at: <http://www.ibge.gov.br/estadosat/perfil.php?sigla=pr>.

13. Lourenço GM, Shibata EK, Suzuki JTJ, Nojima D. Índice IPARDES de desempenho municipal: nota metodológica. Governo do Paraná, Curitiba, 2012.Available at: <http://http://www.ipardes.pr.gov.br/.

14. Brasil. Ministério da Saúde. DATASUS. Informações de Saúde. Demografias e socioeconômicas [Internet]. 2010. [accessed on: April 29, 2015]. Available at:<http://tabnet.datasus.gov.br/cgi/deftohtm.exe?ibge/cnv/poppr.def>

15. Alves JED. A transição da fecundidade, redução da gravidez na adolescência e direitos reprodutivos no Brasil. 2012. Aparte Inclusão Social em Debate do Instituto de Economia da UFRJ. [accessed on: August 8, 2015]. Available at: <http://www.ie.ufrj.br/aparte/pdfs/art_105_a_transicao_da_fecundidade_e_gravidez_na_adolescencia_no_brasil.pdf>.

16. IBGE. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra do Domicílios - PNAD. 2014. Rio de Janeiro. IBGE. [accessed on: August 2, 2015]. Available at: <http://www.ibge.gov.br/home/estatistica/pesquisas/pesquisa_resultados.php?id_pesquisa=40>.

17. Vasconcelos FAG. Avaliação nutricional de coletividades. Florianópolis: UFSC; 2007. Nº de páginas.

18. Novelino MSF. Um estudo sobre as mães adolescentes Brasileiras. Physis2011; v.21.n.1.p.299-318.

19. Martinez EZ, Roza DL, Bava-Caccia MC, Gullaci G,Achcar JA, Fabbro-Dal AL. Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: analise espacial. Cad Saúde Pública, 2011;v. 27, n. 5, p.855-867.

20. Friche AAL, Caiaffa WT, César CC, Goulart LMF, Almeida MCM. Indicadores de saúde materno infantil em Belo Horizonte, Minas Gerais, Brasil, 2001: análise dos diferenciais intra-urbanos. Cad Saúde Pública 2006; v. 22, n. 9, p. 1955-65.

21. Bases on line: FIRJAN available at: http://www.firjan.org.br/ifdm/; IPARDES available at: http://www.ipardes.pr.gov.br/.
adolescencia adolescencia adolescencia
GN1 © 2004-2017 Revista Adolescência e Saúde. Fone: (21) 2868-8456 / 2868-8457
Núcleo de Estudos da Saúde do Adolescente - NESA - UERJ
E-mail: secretaria@adolescenciaesaude.com