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 3 - Jul/Sep - 2017

Original Article Imprimir 

Páginas 16 a 23


Adolescent pregnancy and abortion: Implications of absence of family support

Embarazo en la adolescencia y aborto: Implicaciones de la ausencia de apoyo familiar

Gravidez na adolescência e aborto: Implicações da ausência de apoio familiar

Autores: Eleomar Vilela de Moraes1; Olegário Rosa de Toledo2; Flávia Lúcia David3; Mariza Martins Avelino4; Rodolfo Nunes Campos5

1. Doctoral student, Health Sciences Graduate Studies Program, Medical School, Goiás Federal University (UFG). Goiânia, Goiás State, Brazil
2. PhD in General and Applied Biology, Júlio de Mesquita Filho Paulista State University (UNESP). Botucatu, São Paulo State,Brazil. Adjunct Professor, Pharmacy Course, Biological and Health Sciences Institute (ICBS), Araguaia University Campus, Mato Grosso Federal University (UFMT). Barra do Garças, Mato Grosso State, Brazil
3. PhD in Pharmacology, São Paulo University (USP). São Paulo, São Paulo State, Brazil. Associate Professor, Pharmacy Course, Biological and Health Sciences Institute (ICBS), Araguaia University Campus, Mato Grosso Federal University (UFMT). Barra do Garças, Mato Grosso State, Brazil
4. PhD in Biological Sciences, Brasília University (UnB). Brasília, Federal District, Brazil. Associate Professor, Pediatrics and Childcare Department,, Medical School, Goiás Federal University (UFG). Goiânia, Goiâs State, Brazil
5. PhD in Medicine, São Paulo University (USP). São Paulo, São Paulo State,Brazil. Auxiliary Professor, Mental Health and Forensic Medicine Department,, Medical School, Goiás Federal University(UFG). Goiânia, Goiâs State, Brazil

Eleomar Vilela de Moraes
Av. Getúlio Vargas 663, Setor Aeroporto
Aragarças, GO, Brasil. CEP: 76240-000
veleomar@gmail.com

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How to cite this article

Keywords: Maternal-Fetal Relations, street drugs, alcohol drinking.
Palabra Clave: Relaciones materno-fetales, drogas ilícitas, consumo de bebidas alcohólicas.
Descritores: Relações materno-fetais, drogas ilícitas, consumo de bebidas alcoólicas.

Abstract:
OBJECTIVE: Investigate the socio-cultural characteristics and risk factors related to abortion among pregnant adolescents with 10-19 years-old, assisted by the Unique Health System from Medium Araguaia.
METHODS: This is a cross seccional, descriptive and non probabilistic epidemiological study. We investigated 101 pregnant adolescents assisted by the Medium Araguaia Unified Health System. The data were analyzed using the chi-square test and the occurrence of the events calculated by odds ratio.
RESULTS: The median age was 17 years and 11% from the interviewees had up to 14 years and approximately half of them studied until the eighth grade. Abortion incidence increased significantly according to the rejection of pregnancy by the family (OR = 23.33), having more than two partners (OR = 10.22), illicit drug use (OR = 9.77) and smoking during pregnancy (OR = 6.69).
CONCLUSIONS: The lack of support, the absence of bonding with the partner, the low self-esteem and detachment to the child in formation, seem destabilize deeply the adolescent, who now consider abortion as a viable alternative.

Resumen:
OBJETIVO: Investigar las características socioculturales y las posibilidades de ocurrencia de aborto entre adolescentes embarazadas de 10 a 19 años.
MÉTODOS: se trata de un estudio epidemiológico transversal, descriptivo y no probabilístico. Fueron investigadas 101 adolescentes embarazadas atendidas por el Sistema Único de Salud del Meio Araguaia. Los datos fueron analizados por medio del test Chi-Cuadrado y la ocurrencia de los eventos calculada por la Razón de Prevalencia.
RESULTADOS: El promedio de edad fue 17 años y 11% de las entrevistadas tenían hasta 14 años, y aproximadamente la mitad estudió hasta la octava serie. La ocurrencia de aborto aumentó significativamente conforme el rechazo del embarazo por la familia (RP=17,30), tener más de dos compañeros (RP=8,52), usar drogas ilícitas (RP=5,39) y fumar durante el embarazo (RP=4,62).
CONCLUSIONES: La falta de apoyo de la familia, la ausencia de vínculo con el compañero, la baja autoestima y el desapego al niño en formación parecen desestabilizar profundamente a la adolescente que pasa a considerar el aborto como una alternativa viable.

Resumo:
OBJETIVO: Investigar as características socioculturais e as chances de ocorrência de aborto entre adolescentes grávidas de 10 a 19 anos.
MÉTODOS: Trata-se de um estudo epidemiológico transversal, descritivo e não probabilístico. Foram investigadas 101 adolescentes grávidas atendidas pelo Sistema Único de Saúde do Médio Araguaia. Os dados foram analisados por meio do teste de qui-quadrado e a ocorrência dos eventos calculada pela Razão de Prevalência.
RESULTADOS: A mediana da idade foi 17 anos e 11% das entrevistadas tinham até 14 anos e aproximadamente metade estudou até a oitava série. A ocorrência de aborto aumentou significativamente conforme a rejeição da gravidez pela família (RP=17,30), ter mais de dois parceiros (RP=8,52), usar drogas ilícitas (RP=5,39) e fumar durante a gravidez (RP=4,62).
CONCLUSÕES: A falta de apoio da família, a ausência de vínculo com o companheiro, a baixa autoestima e o desapego à criança em formação, parecem desestabilizar profundamente a adolescente que passa a considerar o aborto como uma alternativa viável.

INTRODUCTION

There are many different circumstances leading to unplanned pregnancy during adolescence, including factors such as poor schooling, family income, early menarche, poverty, individual traits, limited use of contraceptives, lack of knowledge about contraceptive practices, absent or inadequate sex education and becoming sexually active at an early age, together with psychological and emotional problems, fostering the appearance of unplanned pregnancies1. Together with other social elements, these variables may not be viewed as stand-alone events, but rather as facts that interact among themselves, shifting by region and social group. Studying this phenomenon from a wide variety of standpoints is an important tool for preventing teen pregnancy and consequently abortion2.

Despite the legal implications that still swirl around the issue of deliberate abortion, it has been ascertained that it continues to rise in Brazil, although forbidden, even among the under-15 segment of the population3. Family status, education levels and government support all influence the health and well-being of the population, especially adolescents3. Regardless of social status, family support was identified as the main factor for minimizing negative emotional repercussions during teen pregnancy4. Girls supported by their partners and families were clearly better balanced, managing to form an appropriate mother-child relationship5. However, the main problems found among pregnant girls result from a lack of tolerance and respect from their families, triggering emotional instability that in many cases leads to abortion6.

In order to prevent teen pregnancy, it is necessary to reassess the efficacy of women´s health protection programs, stressing aspects related to contraceptives and sexual preferences. Consequently, Family Health Units must be properly prepared to assist this segment of the population, seeking support from educators, social workers and psychologists in the community7.

From this standpoint, it is important to obtain epidemiological data identifying aspects related to this specific segment for the population, consequently encouraging studies focused on extending knowledge of the problem at the regional and national levels8. Data obtained through epidemiological studies are vital for deploying government actions designed to help these girls take crucial decisions8.

In view of the importance of exploring the specific characteristics of teen motherhood, this study intends to explore social and cultural characteristics and the occurrence of events related to previous abortions by pregnant girls receiving care through Brazil's Unified National Health System (SUS)


METHODS

This is a descriptive, non-probabilistic, cross-sectional epidemiological study seeking information on the social and behavioral profiles of pregnant teens. The respondents were recruited at Basic Health Units in the Médio Araguaia region, at the Dr. Kleide Coelho de Lima Municipal Hospital and the Barra do Garças Reference Center in Mato Grosso State, in the Legal Amazonia region, Brazil. The studied population consisted of pregnant girls between 10 and 19 years of age, who agreed to participate in this research project, presenting Deeds of Informed Consent signed by their parents or guardians.

The information was collected through individual interviews, based on a questionnaire with closed questions that was tested previously, allowing possible errors, ambiguities, distortions and difficulties in understanding to be detected. Requirements on data confidentiality and secrecy were complied with, pursuant to rules set forth in CNS Resolution Nº 466/12 issued by the Ministry of Health on research projects involving human beings. This project was approved under Nº 975.413/CEP/UFMT/2015.

For the sample calculation, number of pregnant girls in a similar population was taken at 2.4%, with a type I error of 5% and estimated minimum size (n = 84). In view of missing data, the number of girls invited to respond was increased by 20% (n = 101). The data were assessed through the EPI-INFO software®, version 3.5.3, followed by a statistical analysis with percentage values. Associations between the variables were established through the chi-square, Mantel-Haenszel and Fisher's Exact tests, together with the occurrence of events calculated by the Prevalence Ratio, with a 95% Confidence Interval (CI 95%) and a with statistically significant difference considered as the associated p-value at 0.05 or less.

 
RESULTS

The social and demographic profiles of these adolescents reflect the personal characteristic of this age bracket, within the Médio Araguaia region population. Table 1 presents 101 pregnant girls in the sample. Around 11% of them were between 10 to 14 years of age, with most between 15 and 17 years old, married or in stable relationships, and not working outside the home. Most reported family incomes of up to three minimum wages, with less than half (43.6%) having completed eighth grade.




The resulting document helped identify several causes for attempted abortions among these young respondents (Table 2). Family rejection of their pregnancies was the main trigger for the event, which was 17.30 times more likely to occur. Similarly, having more than two partners increased the likelihood of attempted abortion by 8.52 times. Other important variables leading to attempted abortions were losing their virginity on a casual date and changing partner recently.




Table 3 presents factors related to assorted substances causing chemical dependence. Alcoholic beverages had the greatest impact on attempted abortions, at 5.61 times more likely to occur. Smoking during pregnancy is related to an almost fivefold increase in the odds of attempted abortion (PR = 4.62). Except for data related to the use of illegal drugs, all the figures shown in the Table presented statistical significance.




DISCUSSION

Unwanted pregnancy has consequences at the biological, psychological and social levels, particularly interruption of education and vocational training. It may be stated that although the care provided by government health service is provided by well-qualified and dedicated practitioners, it is not easy to remedy the specific psychological and social consequences for each patient seeking care9. While pregnancy may be a normal occurrence for some of these girls, for others, particularly when unmarried, it can be difficult and embarrassing. In these cases, family backing with dialogue and assistance lessens depression. As unplanned pregnancies are generally also unwanted, they can crush a girl´s life plans and dreams. Consequently, the choices open to a lonely and rejected pregnant girl are to find a boyfriend or common-law husband, cope with a difficult pregnancy alone, put the child up for adoption, or opt for abortion.

The effects of pregnancy on teen health or even the concept may be less important than psychological and social aspects. Joblessness, low income, child abandonment and dropping out of school may cause ripple effects that will be hard to correct. In a study conducted by Yazlle 10, 15% of adolescents were reported as not having paid jobs. On the other hand, this author reveals that 68.3% of them were unemployed. This disparity is possibly due to regional characteristics, little industry, widespread farming or ranching, and low-income families where most of these youngsters were neither employed nor in school at the time of the interviews.

Despite limited employment in the region, the mean monthly family income of up to three minimum wages found in the Médio Araguaia region is aligned with consulted literature, where most families do not usually earn more than four minimum wages, showing that low incomes are consolidated as almost a model for teen pregnancy. In a study conducted in the city of Goiânia, half of the pregnant women came from families with family incomes of less than two minimum wages, with 36.9% of them mentioning less than one minimum wage11.

Pregnant teenagers from low-income families will probably not continue in school, as the need to find paid work to support their families outweighs their interest in studying. As youth is also related to low-grade or non-existent skills, their prospects of finding a job are even poorer. This situation worsens for younger girls who become sexually mature before achieving economic, psychological and social independence. This study found a median age of 17 years old, with 48.5% of them between 15 and 17 years of age. The same occurred in healthcare units in Minas Gerais State12, where the mean age was 17 years old. The similar age bracket found in the Médio Araguaia region shows that pregnancy among the very young is a widespread problem, leading to the conclusion that the vast majority of these mothers are sacrificing a decisive phase in their development. Consequently, the lack of planning steps up the challenges of pregnancy, made even worse by inexperience and youth.

In many cases, girls follow their sexual impulses, apparently not believing in the possibility of becoming pregnant, with early sexual initiation on random dates without contraception. This ramps up the number of pregnancies that, in parallel to the lack of prospects for the future and the inability to cope with the resulting conflicts, result in problems such as child abandonment, leaving the family, dropping out of school or illegal abortions. On this point, unmarried girls are more likely to opt for abortions, at almost tenfold the number of married teens13.

In this study, about half the respondents remained in school only up to the eighth grade. However, a better education does not always protect girls against unplanned pregnancies, especially when under sexual coercion, as low incomes and poor schooling may also contribute to teen pregnancies14. There is much discussion over whether dropping out of school is a trigger factor for pregnancy, or a result. Data indicate that most dropouts occur after pregnancy is confirmed15, hampering entry onto the job market and heightening dependence on parents, especially at the financial level6.

Fortunately, pregnancy occurs within stable relationships17 for most adolescents, as also shown in our study. However, getting pregnant on a casual date, having two or more sexual partners or having switched partners just before getting pregnant, proved important factors influencing the option for abortion. It may be said that there is a common aspect to these three themes: the lack of affective commitment established with the partner. The absence of this link frequently leads to abortions. For them, the level of legitimacy of the relationship shapes a context that is desirable for the arrival of a child. A relationship in crisis steps up the likelihood of abortion18.

Teen pregnancy and other high-risk behaviors such as drug use for a young population faced by situations of violence, characterizes this group as extremely vulnerable, requiring specific and urgent approaches in order to reshape this context19.

In most countries, teen motherhood tends to be associated with low social and economic status, as well as high-risk behaviors such as less contraceptive use, drinking alcohol, smoking and using drugs20. It has been proven that smoking is associated with less weight gain among pregnant women, resulting in a greater likelihood of low-weight newborns21 and greater chances of miscarriage21. Among psychoactive substances, the use of illegal drugs was a key factor triggering attempted abortions. The consumption of legal or illegal substances is interrelated, as  both reflect low self-esteem to some extent, or at least, a propensity to act thoughtlessly. Consequently, the use of such substances may disclose a lack of affection for the baby on the way, contributing to the appearance of ideas of seeking an abortion.

Possible constraints on this study were filling out some questionnaires with girls immediately before or after birth, and the predominance of youngsters from low-income families receiving care through Brazil's Unified National Health System (SUS). Another aspect warranting discussion is questions classified as "sensitive", possibly causing embarrassment and omission. We thus tried to build up peaceful relationships of trust with the respondents, strengthened by breastfeeding advice given to all of them before the interviews. Consequently, despite possible under-declaration, the information presented here underpins a profile adequately representing the behavior of these girls.


CONCLUSION

The results of this study lead to the conclusion that the situation of social inequality and poor schooling may have influenced girls to seek abortion during previous pregnancies. As discussed above, more partners and constant partner switches denote a lack of long-lasting links, possibly boosting the chances of considering abortion. Family rejection causes feelings of vulnerability and uncertainty about the future, which may also weigh heavily in favor of abortion. The use of legal or illegal drugs also has a negative influence on these youngsters, perhaps reflecting a lack of confidence that tends towards recklessness or a lack of interest in their babies. In general, these elements seem to undermine adolescents psychologically, to the point of abortion becoming a feasible option. Finally, the results of this study may well underpin the preparation of programs providing support for pregnant teenagers, their relatives and partners, in order to lower the number of abortions.


CONTRIBUTORS

EV Moraes, OR Toledo, FL David, M. M. Avelino and R. N. CAMPOS participated equally in all stages of the study (conceptualization, delineation, data analysis and interpretation).


FINANCIAL SUPPORT

This study was financed by the University Level Staff Further Education Coordination Office (CAPES). There were no conflicts of interests.


REFERENCES

1. Ventura SJ, Brady E H, Mathews TJ. Pregnancy and Childbirth Among Females Aged 10-19 Years - United States, 2007-2010. CDC Morbidity and Mortality Weekly Report, supplement/vol.62, Centers for Disease Control and Prevention, nov. 2013.

2. Mazzini MDLH, Alves ZMMB, Silva MRSD, Sagim MB."Mães adolescentes: a construção de sua identidade materna. Ciência, Cuidado e Saúde 2009; 7(4): 493-502. DOI: 10.4025/cienccuidsaude. v7i4. 6657

3. Correia DS, Cavalcante JC, Egito EST, Maia EMC. Prática do abortamento entre adolescentes: um estudo em dez escolas de Maceió (AL, Brasil). Ciência Saúde Coletiva 2011 Mai; 16 (5): 2469-2476.

4. Taborda JA, Silva FCD, Ulbricht L, Neves EB. Consequências da gravidez na adolescência para as meninas considerando-se as diferenças socioeconômicas entre elas. Cad. Saúde Colet 2014 mar; 22(1).

5. Manfré CC, Queiróz SG, Matthes ACS. Considerações atuais sobre gravidez na adolescência R. bras. Med. Fam. e Comun 2010 dez; 5 (17): 48-54.

6. Maranhão TA, Vieira TS, Monteiro CFS. Violência contra adolescentes grávidas: uma revisão integrativa. Universitas: Ciências Saúde 2012; 10:41-9

7. Trindade LL, Ferraz L, Zanatta EA, Bordignon M, Mai S, Ferraboli SF. Vulnerabilidade na Adolescência: a Ótica dos Enfermeiros da Saúde da Família. Rev enferm UFPE 2014 mai;8(5):1142-8. DOI: 10.5205/reuol.5863-50531-1-ED.0805201406.

8. Costa R, Carvalho A, Fialho A, Moreira T, Queiroz M, Jorge, M. Cuidado de enfermagem ao adolescente: análise da produção científica de 2001 a 2007. Cienc Cuid Saude 2010 Jul/Set; 9(3):585-592. DOI: 10.4025/cienccuidsaude.v9i3.8380.

9. Moreira TMM, Viana DS, Queiroz MVO, Jorge MSB. Conflitos vivenciados pelas adolescentes com a descoberta da gravidez. Revista da Escola de Enfermagem da USP 2008 jun; 42( 2): 312-320.

10. Yazlle MEHD, Mendes MC, Patta MC, Rocha JSY, Azevedo GD, Marcolin ACA. Adolescente Grávida: Alguns Indicadores Sociais The Pregnant Adolescent: Some Social Indicators. Revista Brasileira de Ginecologia e Obstetrícia 2002 out; 24(9):609-614.

11. Menezes IHCF, Domingues MHMS. Principais mudanças corporais percebidas por gestantes adolescentes assistidas em serviços públicos de saúde de Goiânia. Revista de Nutrição 2004 jun; 17 (2): 185-194. Doi: 10.1590/S1415-52732004000200005.

12. Gradim CVC, Lasma MBR, Ferreira MMJ. O Perfil das Grávidas Adolescentes em uma Unidade de Saúde da Família de Minas Gerais Profile of pregnant adolescents in a Family Health Unit in Minas Gerais. Revista APS 2010 jan/mar; 13(1):55-61.

13. Silva RS, Vieira EM. Frequency and characteristics of induced abortion among married and single women in São Paulo, Brazil. Cad. Saúde. 2009 Jan 25(1): 179-187.

14. Pilecco FB, Knauth DR, Vigo A. Aborto e coerção sexual: o contexto de vulnerabilidade entre mulheres jovens. Cad. Saúde Pública. 2011 Mar, 27(3): 427-439.

15. WHO - WORLD HEALTH ORGANIZATION. Juventude e sexualidade. Brasilia, 2003. UNESCO 2004 Edição publicada pelo Escritório da UNESCO no Brasil Juventude e sexualidade / Miriam Abramovay, Mary Garcia Castro e Lorena Bernadete da Silva. Brasília: UNESCO Brasil, 426p. 2004.

16. Cerqueira-Santos E, Paludo SS, Schirò EDB, Koller SH. Gravidez na adolescência: análise contextual de risco e proteção. Psicol. estud 2010 mar; 15(1):72-85 Doi: 10.1590/S1413-73722010000100009.

17. Ferreira CL, Braga LP, Mata ANS, Lemos CA, Maia EMC. Repetição de gravidez na adolescência: estudos sobre a prática contraceptiva em adolescentes. Estud. pesqui. psicol. 2012 abr; 12(1):188-204.

18. Aquino EML, Heilborn ML, Knauth D, Bozon M, Almeida MC, Araújo J, Menezes G. Adolescência e reprodução no Brasil: a heterogeneidade dos perfis sociais. Caderno de Saúde Pública 2003(19 Suppl 2):377-88.

19. Chalem E, Mitsuhiro SS, Ferri CP, Barros MCM, Guinsburg R, Laranjeira R. Gravidez na adolescência: perfil sóciodemográfico e comportamental de uma população da periferia de São Paulo, Brasil Teenage pregnancy: behavioral and sociodemographic profile of an urban Brazilian population Caderno de Saúde Pública 2007 jan; 23(1):177-186.

20. Zhang XD, Kennedy E, Temmerman M, Li Y, Zhang WH, Luchters S. High rates of abortion and low levels of contraceptive use among adolescent female sex workers in Kunming, China: A cross-sectional analysis. Eur J Contracept Reprod Health Care 2014 Jul 1:1-11.

21. Bailey BA, McCook JG, Hodge A, McGrady L. Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting illicit drug use. Matern Child Health J. 2012 Feb;16(2):414-22. Doi: 10.1007/s10995-011-0776-y.
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