Revista Adolescência e Saúde

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

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 1 - Jan/Mar - 2019

Review Article Imprimir 

Páginas 94 a 102


Pregnancy prevention in Latin America and the Caribbean: a systematic review based on scientific literature

Prevención del embarazo en la adolescencia en América Latina y el Caribe: revisión sistemática basada en literatura científica

Prevenção da gravidez na adolescência na América Latina e no Caribe: revisão sistemática baseada em literatura científica

Autores: Alvaro Dario Dorado Martinez1; Luz Helena Cabrera Yela2; Yohana Sthefany Rosero Enriquez3

1. Master Student Psychology - Director of the University Welfare System - University of Nariño. San Juan de Pasto, Colombia
2. Psychologist - Student Researcher of the Free Thinkers Group. University of Nariño. San Juan de Pasto, Colombia
3. Psychologist - University of Nariño. San Juan de Pasto, Colombia

Álvaro Darío Dorado Martínez
Pasto, Nariño, Colombia. Código Postal 520001
alvarodoradomartinez@gmail.com

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Keywords: Primary Prevention; Pregnancy in Adolescence; Latin America; Caribbean Region.
Palabra Clave: Prevención Primaria; Embarazo en la Adolescencia; América Latina; Región del Caribe.
Descritores: Prevenção Primária; Gravidez na Adolescência; América Latina; Região do Caribe.

Abstract:
OBJECTIVE: Analyze the scientific production referred to the prevention of pregnancy in teenagers, particularly in Latin America and Caribbean population.
METHODS: Were analyzed 34 scientific articles obtained from the databases: Scopus, EBSCOhost, SciELO and Science Direct.
RESULTS: The results indicate greater disclosure of the theme in the countries like Cuba, Brazil and Mexico, and those were more descriptive or of characterization studies of the teenager population. 78.1% of the studies were developed in the educational context.
CONCLUSION: There is a lack of scientific production in the Latin American, especially in studies of preventive interventions for early pregnancy. In addition, most publications were based on enhance the knowledge about contraceptive methods and sources of information. These are, no doubt, important matters but, unfortunately aren´t enough for the effectiveness of responsible and healthy behavior of sexuality.

Resumen:
OBJETIVO: Analizar la producción científica referente a la prevención del embarazo en adolescentes, específicamente de las poblaciones latinoamericanas y del Caribe.
MÉTODOS: Fueron analizados treinta y cuatro artículos científicos provenientes de los bancos de datos consultados: Scopus, EBSCOhost, SciELO y Science Direct.
RESULTADOS: Los resultados muestran más divulgación del tema en países como Cuba, Brasil y México, siendo estos en su mayoría estudios descriptivos o de caracterización de la población adolescente. El 78,1% de los estudios fueron desarrollados en el contexto educacional.
CONCLUSIÓN: Hay evidencias de la escasez de producción científica en América Latina, particularmente en estudios sobre intervenciones preventivas para embarazo precoz. Además de eso, la mayor parte de las publicaciones era basada en aumentar el conocimiento frente a los métodos anticoncepcionales e informaciones referentes a éstos. Sin duda son muy importantes, no obstante, lamentablemente no son suficientemente eficaces para influenciar el comportamiento saludable y responsable de la vida sexual de la población joven.

Resumo:
OBJETIVO: Analisar a produção científica referente à prevenção da gravidez em adolescentes, especificamente das populações latino-americanas e do Caribe.
MÉTODOS: Foram analisados trinta e quatro artigos científicos provenientes dos bancos de dados consultados: Scopus, EBSCOhost, SciELO e Science Direct.
RESULTADOS: Os resultados mostram mais divulgação do tema em países como Cuba, Brasil e México, sendo estes na maioria estudos descritivos ou de caracterização da população adolescente. 78,1% dos estudos foram desenvolvidos no contexto educacional.
CONCLUSÃO: Há evidências da escassez de produção científica na América Latina, particularmente em estudos sobre intervenções preventivas para gravidez precoce. Além disso, a maior parte das publicações era baseada em aumentar o conhecimento frente aos métodos anticoncepcionais e informações referentes a estes. Estes sem dúvida são muito importante, porém, lamentavelmente não são suficientemente eficazes para influenciar o comportamento saudável e responsável da vida sexual da população jovem.

INTRODUCTION

Adolescence refers to the period of the life cycle between the ages of 11 and 20 in which the person transitions into adult life, with important biological, social and psychological changes that influence the construction of the personality, to reach biological maturity and sexual, as well as emotional and social maturity1. However, it is a critical phase regarding sexual and reproductive health manifested by negligent behavior in health care. This fact makes this group vulnerable to situations such as precocious pregnancy or sexually transmitted infections, given the high tendency of non-systematic, incorrect or contraceptive use (MAC) among adolescents, despite having knowledge about sexuality and prevention2.

Some individual factors that relate to teenage pregnancy refer to an unstable marital status, low school level, maternal history of gestation in adolescence, or quest for independence. These factors are associated as a cultural context, because while in many developing countries the social condition of women is determined by marriage and motherhood, in developed countries high standards of social and economic fulfillment have been established. In addition, lack or poor education regarding sexual and reproductive life from the earliest years of school, or even family and community, has generated low information on the themes of reproduction and sexuality among adolescents. - Behaviors about reproductive health services and family planning methods are also reinforced by the growing influence of the media and idealized social stereotypes that shape behavior that exacerbate sexual impulses and associate early sexuality exercise with social prestige and power3.

On early aggravation, the World Health Organization (WHO) 4 states that it profoundly affects the trajectory of adolescent health, creating an obstacle to its psychosocial development, is associated with a higher risk of maternal morbidity and mortality, as well as deficient results of well-being, since when there is a lower maternal age, there is a risk of having lower gestational age, low weight or poor nutrition status in the child3,4. It is reported that Latin America and the Caribbean (LAC) presented the second highest rate of adolescent fertility in the world, from 66.5 births per 1000 adolescents (2010-2015), compared to a global rate of 46 births per 1000 adolescents4.

Although rates are decreasing worldwide, the decrease is remarkably slow in LAC compared to other regions, since even with local and national responses to address this problem; no significant progress has been achieved4. There are many reasons for the slow fight against the theme among them: the lack of systematic follow-up and evaluation of interventions and programs, analysis of success and failure of initiatives and why these initiatives have not achieved better results; and low Latin American scientific production on this theme5.

Thus, the objective of the present study was to analyze in the scientific literature the measures cited to avoid early pregnancy in the population of Latin America and the Caribbean in the last two decades; visualize the tendency of the studies, as well as the systematization of the acquired information, to describe and to analyze the findings that are common, different and the innovations in the published studies.


METHOD

This descriptive study presents a systematic review and analysis of documents through an explicit and rigorous process that aimed to identify, organize, summarize and analyze the most relevant studies that have been carried out on the subject of early pregnancy in the population of Latin America and the Caribbean6.

It began by searching the Scopus, EBSCOhost, SciELO and Science Direct databases, chosen for being the largest and most recognized bibliographic reference databases of scientific literature in the world. The keywords "teen pregnancy" and "prevention" were used in Spanish, English and Portuguese. The results were examined in the publications made between 1998 and 2018, of scientific articles of free access.

The search and analysis conducted between March and May 2018 corresponded to 59 records, which included articles that revealed pregnancy prevention actions in the adolescent population, with samples belonging to the countries that make up the Latin American and Caribbean region. However, documents such as books, abstracts, abstracts from congresses or symposia, letters to the editor, news, briefing notes, meeting minutes or degree papers were omitted in the search, as well as studies that reported prevention actions in populations other than Latin prevention of problems during pregnancy or new adolescent pregnancy. These exclusion criteria were used to generate uniformity in the search and analysis of results. Finally, after the filter with the inclusion and exclusion criteria previously established, they resulted in 34 articles of choice for the analysis (Figure 1).


Figure 1. Systematic search scheme (based on Moher et al.7).



The chosen articles were systematized through a document registry matrix based on the PRISMA - P protocol recommended for the development of systematic reviews, bibliographies and meta - analysis7. The authors, article title, year of publication, language, URL or DOI of publication, name of the journal, country, study discipline, objective, number and type of sample, method, instruments used and main results were registered.

Once the documentary record matrix was completed, the data of all articles were analyzed and the SPSS 22.0 program was used to perform the analysis of descriptive statistics.


RESULTS

In relation to the period of publication time, the year 2014 was the one that presented the greatest dissemination with 17.6% (n = 6) of the total articles (figure 2). In reference to the Latin American countries reviewed in this search, articles in the Spanish language predominated, with 82.4% (n = 28) and English (11.8%) (n = 4). Likewise, the systematic review showed that the disciplines of approach in the prevention of adolescent pregnancy are more focused on psychology and nursing, with 26.5% (n = 9), respectively. However, 29.4% (n = 10) of the articles didn´t explain the study area.


Figure 2. Relationship between the years of publication and the total number of scientific papers analyzed in the present study.



The analyzed publications have in common the type of population, instruments, contexts and types of study: 73.52% (n = 23) present researches with a population between 500 and 50 subjects8,9, the instruments applied vary between questionnaires (33, 3%), polls (21.2%) and interviews (12.1%), where the majority (87.8%) were constructed and validated by the authors themselves, but their psychometric properties were not specified, 90, 9% of the studies encompassed both men and women in the characterization or preventive intervention10.

It is important to highlight that 78.1% (n = 25) of the reviewed studies presented the educational headquarters as the place of intervention or characterization with greater representation, followed by medical offices (15.6%, n = 5). Likewise, 67.6% (n = 23) are characterization studies about the knowledge and use of MAC, identifying teenage perceptions in pregnancy prevention, age of onset of sexual intercourse and initiation of MAC, sources of information on sexual and reproductive health and adequate and unsuitable beliefs about the use of MAC11. Some innovative characterizations in the population were identified, such as the cultural practices of a country or region that influence the prevention of adolescent pregnancy12, as well as the level of knowledge of parents or guardians before the adolescent pregnancy, and the male role in effective prevention13 .

On the other hand, it was found that 29.4% (n = 10) of studies are based on the implementation of preventive interventions, which are focused on increasing knowledge about MAC, increasing the intention to use condoms or other contraceptive method14, 15, delay the onset of sexual intercourse and identify appropriate sources of information16. However, within these interventions are presented innovative studies on how to increase self-efficacy and gain new knowledge about self-respect and the other, commitment and responsibility in the decisions for responsible exercise of citizenship, in addition to the care of the body, management of additions and adequate nutrition in order to avoid premature pregnancy17.

With regard to the innovative results, 30.3% (n = 10) of the studies applied more than one technique in the same group of adolescents in order to develop the research, such as questionnaire, group discussion, drama partner and psychodrama19 ; or interviews, target groups and surveys20. In addition, some studies characterize or intervene in samples of adolescents with characteristics defined by race or gender. For example, there is a proposal for a formal education of responsible sexuality with indigenous populations, noting that the limits on the knowledge and perception of real sexual and reproductive health needs in this population are due to racial discrimination10. On the other hand, there were studies with male samples, where knowledge about pregnancy risk, self-efficacy and gender equity education13, and with the female population were identified for the evaluation of the effectiveness of a psychoeducational program in sexual and reproductive education obtains 87.5% of effectiveness in the positive modification of knowledge about healthy sexuality9.

Likewise, prevention actions were carried out with replicators, where 106 teachers were trained, which interacted daily with their students and had an impact on knowledge, decision making, gender roles, negotiation and self-efficacy of 11,177 adolescents who were later evaluated by researchers to reinforce and verify the level of knowledge acquisition on the prevention of early pregnancy17. Preventive action studies involving parents of adolescents have also been identified, which identify little or no effective communication, as well as lack of knowledge about the use of contraceptive methods and early pregnancy21. Another population involved is health personnel, who are constantly engaged in adolescent care, and require their own abilities and systems of action to be able and willing to play an active role in promoting the transformation of negative sexual health models and practices18.

Finally, through this systematic review we obtained a theoretical revision on education for the "new masculinity", proposing the restructuring of the man-woman roles and the new concept of femininity and masculinity in the current context in order to prevent pregnancy premature. The need was demonstrated for the development of educational programs that demonstrate in a current and accurate manner, with a focus on law, themes related to gender and sexuality, in order to minimize censorship and superstition in relation to the subject22.


DISCUSSION AND FINAL CONSIDERATIONS

The greater number of publications on actions to prevent teenage pregnancy in countries such as Cuba, Brazil and Mexico may be related to a greater scientific and investigative development of the subject in these countries. On the other hand, Latin American authors publish to a large extent in the Spanish language, probably because it is the official language of most countries.

In addition, consistent with the common aspects identified in the studies, there is evidence that most of them were designed for use in educational institutions, probably due to the large number of adolescents found. Although this review found a minimum percentage of preventive actions in clinical and community settings, it is important to emphasize that such contexts could include adolescents at high risk, who may have dropped out of school23.

Likewise, there are predominantly the use of techniques such as questionnaires, questionnaires and interviews, considering that most of the studies focus on characterizing the population about MAC knowledge, sources of information, initiation of sexual relations, among others. These diagnoses allow prioritizing and analyzing the psychosocial or health problems that subsequently contribute to the design and execution of strategic and situational action plans that contribute to the improvement of the quality of life of vulnerable populations24.

On the other hand, 90.9% of the studies that work with samples of both sexes stand out, and it is vitally important to continue with the participation of adolescents in pregnancy prevention programs that favor acceptance of responsibilities in the subject of sexuality with fairness of gender, promoting a process of orientation and formation of gender roles. Thus, adolescents will appropriate the theme without affecting their personal identity, promoting equity as the basis of the interpersonal relationship, where decisions are shared and coherent to personal and social development25.

A relevant aspect in the systematization was to find a scarce publication of pregnancy prevention in adolescents belonging to indigenous peoples, populations identified as most vulnerable to the phenomenon, mainly in Latin American countries. Census data indicate that the number of early pregnancies in indigenous adolescents is disproportionately higher in Paraguay, where indigenous mothers are four times as many as non-indigenous mothers and twice as large in Costa Rica and Panama.

Two points are highlighted within the results presented in reference to the number of publications found and the type of prevention study of the phenomenon. The findings indicate that scientific productivity on prevention has been reported in the last 17 years and although there are more publications in 2014, this year it is limited to six scientific articles, a scarce quantity if compared as a number of countries belonging to Latin America and Caribbean. Even more so with the importance and impact that this problem reflects in the Public Health of the region whose current levels of adolescent fertility occupy the second place, surpassed only by sub-Saharan Africa4.

Most publications mainly deal with the characterization of people's knowledge, and prevention efforts since the intervention are reduced. This review showed a scant publication interventions (n = 10) and insufficient theoretical and empirical contribution to the mitigation of the phenomenon compared to other points Spanish-speaking countries such as Spain, for example, which has 21 intervention studies and evaluation of high quality to prevent pregnancy5. Or in comparison with the United States, which have 89 studies focused on the effectiveness of programs preventing pregnancy, HIV and other sexually transmitted infections in the population adolescente26. This panorama shows a critical front tendency to effective actions that allow the reduction of the problem, since they provide information on the subject, although promotes the awareness front to sexual and reproductive health, does not contribute to a significant change in the behavior of adolescentes23.

Therefore, although the characterization studies allow understanding the level of knowledge of the population and help in the dissemination of the importance and necessity of addressing this phenomenon, it is imperative to continue with the preventive intervention line, increasing the development of studies, both validation of instruments of standardized in the identification of inadequate knowledge about MAC and early pregnancy, the design and evaluation of comprehensive intervention programs that take over prevention. Going from interdisciplinary visions that allow adolescents to not only understand the use and need of MAC, but also self-efficacy, respect, life project, self-care body, future responsibilities, sense of competence, peer pressure control, well such as the promotion of protective behaviors in family, community, clinical and school settings.

From the results obtained and considering that the studies allow to strengthen and to contribute theory, empiricism and science to the phenomena, some alternatives or suggestions in the visualization and impact of the indicated publications to the prevention of the pregnancy in premature ages in Latin America could be: a) motivation by the drawing , development and publication of proposals for preventive intervention, b) consider the publication of articles in journals included in the databases of broad dissemination, which would generate greater dissemination of successful experiences that could be replicated, c) develop, validate and expose properties (d) to develop studies in new contexts, with populations of vulnerable or non-educated adolescents, to identify beliefs that make prevention impossible; and (e) to design and develop research that reports results of intervention in urban and rural populations ; f) increase diagnoses in indigenous populations and cultural approaches to this population, with relevant adjustments in interventions that respect ethnic ideologies.

The limitations of the study are related as difficult access in some scientific publications, mainly of the Venezuelan and Argentinean region. As future lines of research it is suggested to broaden the characteristics of the published interventions and contrast them between Spanish-speaking contexts, which allow for modifications and innovative or adjusted proposals for effective prevention of the phenomenon.


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