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 30 a 37


Social representation of unplanned and unwanted pregnancies in young women from Guadalajara's Metropolitan Zone, Jalisco, Mexico

Representaciones sociales del embarazo no planeado y no deseado en mujeres jóvenes del Área Metropolitana de Guadalajara, Jalisco, México

Representações sociais da gravidez não planejada e não desejada em mulheres jovens da Área Metropolitana de Guadalajara, Jalisco, México

Autores: Alejandra Sierra-Macías1; María de los Ángeles Covarrubias-Bermúdez2; Marco Antonio Zavala-González3; Gloria Patricia Velázquez-Mota4

1. Nursing Degree. Fellow, National Science and Technology Council, Mexico. Public Health Sciences PhD Program, Guadalajara University, Health Sciences University Center. Guadalajara, Jalisco, Mexico
2. Psychology Degree. Fellow, National Science and Technology Council, Mexico. Public Health Sciences PhD Program, Guadalajara University, Health Sciences University Center. Guadalajara, Jalisco, Mexico
3. Master's Degree in Education. Fellow, National Science and Technology Council, Mexico. Public Health Sciences PhD Program, Guadalajara University, Health Sciences University Center. Guadalajara, Jalisco, Mexico
4. Master's Degree in Public Health. Fellow, National Science and Technology Council, Mexico. Public Health Sciences PhD Program, Guadalajara University, Health Sciences University Center. Guadalajara, Jalisco, Mexico

María de los Ángeles Covarrubias-Bermúdez
Universidad de Guadalajara
Endereço, Sierra Mojada 950, Puerta 1, Edificio "N", Planta Alta, Colonia Lomas de Independencia
Guadalajara, Jalisco, México. CEP: 44240
angelescovarrubias@hotmail.com

PDF Portuguese      


Scielo

Medline


How to cite this article

Keywords: Women's health, unplanned pregnancy, unwanted pregnancy, qualitative research, Mexico.
Palabra Clave: Salud de la mujer, embarazo no planeado, embarazo no deseado, pesquisa cualitativa, México.
Descritores: Saúde da mulher, gravidez não planejada, gravidez não desejada, pesquisa qualitativa, México.

Abstract:
OBJECTIVE: Identify the social representations of unplanned and unwanted pregnancies in young women from Guadalajara's Metropolitan Zone, Jalisco, Mexico.
METHODS: This qualitative research was performed with 79 women between 18 and 21 years-old undergraduate level's students in the area of health sciences, to whom we applied free lists for to indicate closeness or distance relating to studied key phrases. We obtained social representations applying Abric's theory, and we expressed by graphics.
RESULTS: The social representation of unplanned pregnancy was "fear, problem and family conflict", while for unwanted pregnancy was "sex without protection, unwanted and irresponsibility".
CONCLUSION: The social representations of unplanned and unwanted pregnancies can be linked Mexican stereotype of pregnancy adolescent, characterized for lack of awareness of the implications of the sexual life's onset, and the responsibility involved in the pregnancy. The key phrase "unwanted child" it's associated to events as child abuse and problems for the birth and development of children, and lower employment and educational opportunities for parents.

Resumen:
OBJETIVO: Identificar las representaciones sociales del embarazo no planeado y no deseado en mujeres jóvenes del Área Metropolitana de Guadalajara, Jalisco, México.
MÉTODOS: Fue realizado un estudio cualitativo con 79 mujeres entre 18 y 21 años de edad, estudiantes de nivel de graduación en el área de ciencias de la salud, a quienes fueron aplicadas listas libres para indicar la proximidad o distancia con relación a las fases de estudios. Las representaciones sociales fueron obtenidas aplicando la teoría de la Abric y expresada a través de diagramas.
RESULTADOS: La representación social del embarazo no planeado era "miedo, problemas y conflictos familiares", mientras que el embarazo no deseado era "sexo desamparado, no planeado e irresponsabilidad".
CONCLUSIÓN: Las representaciones sociales de embarazo no planeado y no deseado pueden ser asociadas al estereotipo mexicano de adolescentes embarazadas, caracterizado por la falta de conciencia de las implicaciones del inicio de la vida sexual y falta de responsabilidad con el embarazo. El término "hijo no deseado" está asociado a situaciones como abuso infantil y problemas para el nacimiento y desarrollo de los niños, así como para disminuir lo empleo y oportunidades educacionales para los padres.

Resumo:
OBJETIVO: Identificar as representações sociais da gravidez não planejada e não desejada em mulheres jovens da Área Metropolitana de Guadalajara, Jalisco, México.
MÉTODOS: Foi realizado um estudo qualitativo com 79 mulheres entre 18 e 21 anos de idade, estudantes de nível de graduação na área de ciências da saúde, a quem foram aplicadas listas livres para indicara proximidade ou afastamento em relação as fases de estudos. As representações sociais foram obtidas aplicando a teoria da Abric e expressada através de gráficos.
RESULTADOS: A representação social da gravidez não planejada era "medo, problemas e conflitos familiares", enquanto que a gravidez indesejada era "sexo desprotegido, não planejado e irresponsabilidade".
CONCLUSÃO: As representações sociais de gravidez não planejada e não desejada podem ser associadas ao estereótipo mexicano de adolescentes grávidas, caracterizado pela falta de consciência das implicações do início da vida sexual, e cometeu responsabilidade na gravidez. O termo "filho indesejado" está associado a situações como abuso infantil e problemas para o nascimento e desenvolvimento das crianças, e para diminuir o emprego e oportunidades educacionais para os pais.

INTRODUCTION

The World Health Organization defines teen pregnancy as occurring between 10 and 19 years of age1. It is rated as a public health problem, because it steps up the probability of maternal death, dystosic delivery and / or pre-term birth, low birthweight risk and premature death. Furthermore, it also has social consequences, including family dysfunction and difficulties in accessing and continuing education, thus perpetuating the cycle of poverty, discrimination and social segregation for young parents2.

Responding to this problem, the National Teen Pregnancy Prevention Strategy4 was drawn up in Mexico. It encompasses interinstitutional policies and actions at the national, state and municipal levels, focused on: 1) urging youngsters to complete their basic education; 2) helping them take decisions that favor the exercise of sexuality, through communication campaigns promoting sexual rights and equal healthcare facilities, from a gender-based standpoint; 3) offering contraceptive methods and family planning advice; 4) upgrading healthcare facilities through pertinent and ongoing capacity-building for practitioners; and 5) ensuring sex education in private and public schools. Through this approach it is estimated that it will be possible to eradicate pregnancy among the under-fifteens by 2030, with a 50% drop in pregnancies among young women between 15 and 19 years old.

Nevertheless, data from the National Statistics and Geography Institute 2 show that 98.7 % of women between 15 and 49 years of age stated that they knew about at least one contraceptive method in 2014, while 18.3 % of miscarriages / abortions among women of child-bearing age took place among teenagers. 5. Furthermore, the pregnancy rate in this group rose from 70.7/1,000 women in 2009 to 77 / 1,000 in 20142. It is estimated that 60% of these pregnancies occur during the first six months after sexual initiation, taking place at increasingly younger ages, with pregnancies at 12 years of age reported in 20006. These data suggest that teen pregnancy is due not only to a lack of knowledge about contraceptive methods, but also cultural and / or social elements.

Faced by this situation, it is necessary to study the meanings women assign to unplanned and unwanted pregnancies, in order to understand social and cultural influences on fertility patterns, how fecundity motivations and intentions differ among segments of the population, and how they can be construed differently. Some authors describe an unplanned pregnancy as something that is neither scheduled nor desired8, while unwanted is defined as something taking place at an unfavorable moment for someone not wishing to reproduce at that time9. Other authors suggest that the terms unplanned and unwanted pregnancies are social constructs, that is why their definitions must reflect the specific cultural and moral characteristics of the societies to which they belong10, suggesting that current concepts may be ambiguous and of little use for understanding the motivations leading to pregnancy.

Along these line, the objective of this study was to identify the meanings of the terms unplanned and unwanted pregnancies, for young women living in the Guadalajara Metropolitan Area, Jalisco, Mexico, through the structural social representations approach11. The interest in this group of women is due to the fact that Jalisco is one of the States with the largest number of births to mothers between 15 and 19 years of age. (69.9 / 1,000 women)2. On the other hand, social representations are the way in which individuals relate and signify the world, constituting a form of constructed knowledge shared by colectivities12, and also a body of perceptions, beliefs and opinions on a subject that contributes to the confirmation and justification of individual and group practices11. Consequently, social representations are an appropriate option for studying unplanned and unwanted pregnancies, as concepts allowing identification of their meanings, values, knowledge, attitudes and practices related to these phenomena.


METHODS

A theoretical qualitative survey of social representations proposed by Abric11 was conducted using anthropology tools13. A sample of women was analyzed, who complied with the following inclusion criteria: 1) Be a Health Sciences teaching student, 2) Live in the Guadalajara Metropolitan Area, Jalisco, Mexico at the time of the study, 3) Be between 18 and 21 years of age, and 4) Agree to participate anonymously in the study completing the requested documents. A sample size of at least seventeen respondents was defined, as proposed by Weller and Romney14, who indicated that this was the smallest possible size able to comply with the sufficiency and saturation criteria for the information needed to properly develop the theoretical assumptions of cognitive anthropology. Women meeting the inclusion criteria were invited personally at the Guadalajara University Health Sciences University Center, in December 2015. Each respondent took no more than fifteen minutes to complete each questionnaire, including clarifying doubts about the respective questionnaire.

The data were collected in two phases, through semi-structured questionnaires. During the first phase, the free listings technique13, was used, allowing free replies on requested terms, as rationalized responses. The motivation behind this method is social acceptance, which consists of offering an induction phrase to respondents, and then requesting them to write down the first five words or phrases that come to mind when reading this phrase, as well as the reasons why they thought about them. The respondents were given two free listings, one headed "unplanned pregnancy" and the other "unwanted pregnancy". Once the data had been obtained from the first tool, the most frequent replies were identified for each induction term, through frequency distribution, using the peer comparison technique 13, whose purpose is to highlight outstanding elements of the sought social representation and indicate links. During this phase, the respondents associated words based on their ideas of the terms "unplanned pregnancy" or "unwanted pregnancy". They were requested to first mark the two words or phrases with the strongest associations, and then the two weakest, after which they were requested to repeat the procedure with the remaining words or phrases.

In order to obtain social representations, the data collected through the peer comparison questionnaire was used, analyzing the intensity of the association between the terms for their similarity or antagonism, assigning a value by the association level established by the respondent, with these values being 2, 1, 0, -1 and -2, as proposed by Abric11. The words and phrases were rated from highest to lowest by these values, after which a graph was drawn up according to the theory described by Doise et al.15 Finally, a thematic analysis of the explanations was conducted, related to the terms recalled in the free listings16, reading, re-reading and coding the replies in order to categorize them by theme, and finally triangulate this information among the researchers, in order to obtain consensus on codification.

This survey was rated as risk-free for the respondents, according to the regulations in the General Health Act for health research matters in Mexico17, due to the data collection methods and the types of surveys, not modifying the psychological variables of the respondents, nor addressing sensitive information. There was thus no need for approval by a Committee of Ethics and their participation did not require signatures of deed of informed consent, other than agreement to take part by completing the questionnaires. Consequently, under Mexican law17, as no sensitive information was gathered no notification of privacy was issued, as this was not viewed as potentially generating social segregation.


RESULTS

This research project encompassed 79 women: 40 in the first phase and 39 in the second, none of whom were pregnant. Five of the respondents in the first phase and six in the second phase stated that they were married when asked about their marital status.

Figures 1 and 2 present the graphs corresponding to the social representations of the terms "unplanned pregnancy" and "unwanted pregnancy" respectively. The dotted lines in these graphs indicate concepts or meanings that constitute the core of each social representation, according to the theory developed by Abric11. They correspond to 'fear, "problem", and "family conflict" for unplanned "pregnancy" (Figure 1), and "unprotected sex", "unplanned" and "irresponsibility" for "unwanted pregnancy" (Figure 2).


Figure 1. Social representation of the term "unplanned pregnancy" for young women Guadalajara Metropolitan Area, Jalisco, Mexico.


Figure 2. Social representation of the term "unwanted pregnancy" for young women in the Guadalajara Metropolitan Area, Jalisco, Mexico.



Tables 1 and 2 show the findings of the thematic analysis conducted with the explanations provided by the respondents on the terms recorded in the free listings for "unplanned pregnancy" and "unwanted pregnancy" respectively. In both cases, they identified three categories: facilitators, consequences and expectations; whose characteristics and frequency distributions are shown in these Tables.






DISCUSSION

These results showcase the views of a group of women of the terms "unplanned pregnancy" and "unwanted pregnancy", in which it is possible to distinguish elements facilitating pregnancy through their descriptions of the processes that they experienced, together with the respective implications on the lives of the mother, the couple, their parents and the child, as well as the expectations of pregnant women about their future.

When comparing these results with the literature on facilitators, high-risk sexual practices and being adolescent, the findings corroborated those of this study by describing adolescence as a period characterized by a lack of awareness of the implications of becoming sexually active, and heavy responsibilities arising from pregnancy, with negligent attitudes commonplace 18.

However, it is noteworthy that these types of pregnancy were considered only in adolescence, not taking other facilitators into account, particularly as there are references to unplanned and unwanted pregnancies among women over forty years old9. Similar to the consequences of sexually violent acts19, marital status, educational and job needs and expectations, spirituality, appreciation of independence 20 and poverty21 were not listed as facilitators for these types of pregnancies. Along these lines, it was thought that there might be a constraint on these results due to the fact that the questionnaire was drawn up in a way that recalls more latent meanings when hearing or reading the proposed terms13, curtailing the possibilities of the respondents for accessing other more particular meanings.

On the other hand, regarding the lack of perception that poor information on contraceptive methods is not a facilitator, this was aligned with the reports issued for the past three decades by the National Statistics and Geography Institute 2 on expanding knowledge and use of these methods among young people, indicating the existence of other elements, such as faulty use of contraceptives among teens.

Other related coincidences were: the view that unplanned and unwanted pregnancies affect the mental health of teenage girls4,9,19,20; that the term "unwanted child" is associated with events such as child abuse and problems in child birth and development 21, 22; that there are fewer education and job opportunities for young parents and that interference in the physical health of the mother was not noted by the respondents22. These risks may be addressed and eliminated through a good diet and adequate prenatal care, with the real danger being the stress generated by life plan changes and the risks of less likely access to an adequate quality of life22.

As constraints on the study, careless attitudes towards contraceptive use could not be explained, probably due to the evocative methodology. However, Winkler23 describes that the non-use of contraceptive methods may be due to beliefs that pregnancy will not occur, that there is no control over sexual desire, or they are too embarrassed to ask for contraception. Oviedo argues that significations associated with pregnancy during the transition from childhood to adulthood are the reason for this negligence, explaining that the consolidation of femininity is grounded on learning and deploying motherhood, which is why this is a discourse that is learnt and absorbed gradually over the years, with carelessness being the outcome of an unconscious impulse to firm up her role as a woman. 22.

With regard to the results, as mentioned by Álvarez-Neto, the reasons for unplanned and unwanted pregnancies remain vague18. Although it is clear that they depend on social and cultural aspects and the socialization of these ideas among women, the elements that the group addressed by this study managed to describe, while also identifying other elements, although subtle, were useful for understanding the differences between the terms unplanned and unwanted pregnancies. This allowed us to glimpse that there is a largely negative value assigned to unwanted pregnancy, in which it is assumed that the child will lack care while an unplanned pregnancy has a more positive value, in the hope that it might help the mother to surmount the obstacles that this represents in some way.

This led to the conclusion that the social representations of unplanned and unwanted pregnancies are focused on teenage schoolgirls who are economically dependent on their parents, demonstrating a clear stereotype for these two terms, which might well trigger stigmatization, hampering the possibilities for intervention and education in this segment of the population. Consequently, further study is recommended of this phenomenon of the subjective views of the girls themselves, also including the standpoint of teenage boys.


REMARKS

Contributions from the authors: All the authors participated equally in the conceptualization of the product, data collection, information analysis, writing the paper and approval of the final version of the manuscript. Conflicts of interest: None. Thanks: The researchers thank the young respondents for making this research project possible, as well as the anonymous reviewers assigned to the manuscript, for their contributions to upgrading its quality.


REFERENCES

1. Desarrollo en la adolescencia. [Internet]. Ginebra: Organização Mundial da Saúde, 2016. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1WldmmP

2. Instituto Nacional de Estadística y Geografía. Encuesta Nacional de la Dinámica Demográfica 2014. [Internet]. Aguascalientes: Instituto Nacional de Estadística y Geografía, 2015. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1JX1Qbm

3. Díaz-Sánchez V. El embarazo de las adolescentes en México. Gac Méd Méx. 2003;139(Supl1):S23-8.

4. Estrategia Nacional para la Prevención del Embarazo en la Adolescencia. [Internet]. México D.F.: Gobierno de los Estados Unidos Mexicanos, 2014. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1m8qtu6

5. Instituto Nacional de Estadística y Geografía. Estadísticas a propósito del Día Internacional de la Juventud. [Internet]. Aguascalientes: Instituto Nacional de Estadística y Geografía, 2015. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1MrLwnB

6. León P, Minassian M, Borgoño R, Bustamante F. Embarazo adolescente. Rev Ped Elec. [Internet]. 2008;5(1):42-51. [acesso em 20 fev 2016]. Disponível em: http://bit.ly/1iagI9C

7. Prietsch SOM, González-Chica DA, César JA, Mendoza-Sassi RA. Gravidez não planejada no extremo Sul do Brasil: prevalência e fatores associados. Cad Saúde Pública. 2011;27(10):1906-16.

8. Christofides NJ, Jewkes RK, Dunkle KL, McCarty F, Shai NJ, Nduna M, et al. Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women. Glob Health Action. [Internet]. 2014;7(2). [acesso em ] Disponível em:: http://1.usa.gov/221Hsyh

9. Langer A, Espinoza H. El embarazo no deseado: impacto sobre la salud y la sociedad en América Latina y el Caribe. Rev Panam Salud Públ. 2002;11(1):192-204.

10. Barrett G, Smith SC, Wellings K. Conceptualization, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health. 2004;58(5):426-33.

11. Abric JC. Prácticas y representaciones sociales. México D.F.: Ediciones Coyoacán, 2001.

12. Jodelet D. La representación social: fenómenos, concepto y teoría. En: Moscovici S. (Coord.). Psicología Social II. Barcelona: Paidós, 1993:469-94.

13. Bernard HR. Métodos de investigación en antropología. Abordajes cualitativos y cuantitativos. 2da edición. California: Altamira Press, 2006:167-79.

14. Weller S, Romney K. Systematic data collection. London: SAGE, 1988.

15. Doise W, Clemence A, Lorenzi-Cioldi F. Representaciones sociales y análisis de los datos. México D.F.: Instituto Mora, 2005.

16. Minayo C. El desafío del conocimiento. Investigación cualitativa en salud. Buenos Aires: Lugar Editorial, 1995.

17. Reglamento de la Ley General de Salud en Materia de Investigación para la Salud. México D.F.: Diario Oficial de la Federación de los Estados Unidos Mexicanos, 1983.

18. Álvarez-Nieto C, Pastor-Moreno G, Linares-Abad M, Serrano-Martos J, Rodríguez-Olalla L. Motivaciones para el embarazo adolescente. GacSanit. 2012;26(6):497-503.

19. International Project Assistance Servicies. Los derechos humanos, elembarazo no deseado y la atención relacionada con el aborto. Información de referencia y casos ilustrativos. [Internet]. North Carolina: IPAS, 2003:18-29. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1QFZ9zS

20. Juárez F, Singh S, Maddow-Zimet I, Wulf D. Embarazo no planeado y aborto inducido en México. Causas y consecuencias. [Internet]. México D.F.: Guttmacher Institute, El Colegio de México, 2013:25-8. [ acesso em 31 jan 2016]. Disponível em: http://bit.ly/1TNvcz4

21. Menkes C, Suárez L. El embarazo de los adolescentes en México: ¿es deseado? Conjetura Demográfica. [Internet]. 2013;4(1):21-8. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1RQRr4L

22. Oviedo M, García MC. El embarazo en situación de adolescencia: una impostura en las ubjetividad femenina. Rev Latinoam Cienc Soc Niñez Juv. [Internet]. 2011;9(2):929-43. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/21kHXBr

23. Winkler MI, Pérez-Salas CP, López L. ¿Embarazo deseado o no deseado? Representaciones sociales del embarazo adolescente, en adolescentes hombres y mujeres habitantes de la Comuna de Talagante, Región Metropolitana. Terapia Psicológica. [Internet]. 2005;23(2):19-31. [acesso em 31 jan 2016]. Disponível em: http://bit.ly/1QPOBN2
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