“For me, being a father is a good thing, it’s a different emotion, it’s a new life that we learn to lead, but… I’m feeling like this… with a much greater burden of responsibility…” Caio, 18 years old, son is 1 year old.

“Oh, she’s beautiful! She’s everything to me. She’s my life. Now, I think I’ve aged like this… mentally… about ten years…” Fernanda, mother at 17 years old.

In everyday language, the terms motherhood and fatherhood mean, respectively, the quality or condition of being a mother and a father. The word responsible , on the other hand, means someone who is responsible for their own actions or those of others, or who is legally or morally responsible for someone’s life, well-being, etc.

The condition of being a mother or father, and not just a parent, implies that the conception of a child is inscribed in the desire, that this becomes a reality in a pregnancy or adoption, whose product is recognized as a child and, from then on, is the object of love and care forever.

Thus, if we are going to talk about responsible motherhood and fatherhood in adolescence, a question immediately comes to mind: will the adolescent be able to assume the identity of father or mother while experiencing a stage of the life cycle in which their experiences are focused on their own growth and development, when the search for independence and autonomy is an important task in the construction of their personal identity in metamorphosis and when pleasure and the social prohibition of sex are experienced as two sides of the same coin, which is sexuality? And breaking down the question:

1. How to face the double crisis of the transformation of boy/girl into man/woman and at the same time of son or daughter into father or mother?

2. How to behave in the context of an immediate and consumerist society, guided by a double message whose eroticization of everyday life creates fascination with sex, but does not warn of the embarrassment that early sexual activity can cause? And where do the guidelines for coexistence between the male and female genders translate into a double standard in which there are privileges for one and expectations of submission for the other, respectively?

To answer these questions, we may be able to draw on some reflections on teenage pregnancy , since it is through this event that adolescent mothers and, in most cases, fathers are born.

Teenage pregnancy has been considered a public health problem in the last three decades, both in scientific literature and in the lay press, especially in the United States and in so-called developing countries, such as Brazil, given its increasingly high incidence.

Brazilian census data have shown that, while the fertility rate among the adult population worldwide has been decreasing, it is increasing among our adolescents. For some authors, however, these demographic data produce a misleading idea , since it is the large growth, in relative and absolute terms, of the adolescent cohort in the population and the sharp decrease in fertility among the adult female population that give greater visibility to the number of pregnancies in adolescence.

Recent data from the Epidemiological Profile of Children and Adolescents , prepared by the Recife Health Department (November 2004), reveal that, in the period from 2000 to 2003, of the total births that occurred in Recife, 22.72% of the live births occurred to adolescent mothers between the ages of 10 and 19, of which 4.3% were to adolescents between the ages of 10 and 14 and 95.7% were between the ages of 15 and 19. However, it was observed that there was a 15.21% increase in the proportion of live births to teenage mothers aged 10 to 14 when comparing the year 2003 with that of 2000.

On the other hand, according to Medrado and Lyra (7), “teenage pregnancy has also been considered, almost always and a priori , a social problem , marked by a generally alarmist discourse , associated with negative aspects that can occur with the teenager and her baby (dropping out of school, difficulty in finding a job, low birth weight of babies, etc.) and pejorative adjectives associated with pregnancy as unplanned, unwanted, early and/or premature “. For them, “it is essential to reexamine the concepts implicit in conventional approaches to preventing teenage pregnancy and to reevaluate the process of increasing motherhood/fatherhood among teenagers without preconceptions that these are always and inexorably the result of the irresponsibility of young people”.

It is important to consider, however, that for some girls, pregnancy is part of their life plan and even seems to be desired. Even if at first it causes some discomfort in the family environment because it occurs outside of marriage, with the prospect of the baby’s arrival and its strong power of seduction, the family’s acceptance is inevitable and they begin to support the mother/child binomial.

According to Scott (11), “for some teenagers it seems that having a child was neither as thoughtless nor as out of the ordinary as all the accusations suggest. The symbolic value of a child is enormous, and the idea of ​​having one was often a planned accident . Being irresponsible was precisely to gain responsibility and anticipate her entry into a full life as an adult woman.”

This also seems to be true for some male adolescents, as Sarti(9) comments in his work The Family as a Moral Universe that, with the possibility of a boy becoming a family man, the image of a respectable man begins to take shape, with nuances and shades . In fact, paternity has historically contributed to reinforcing masculinity, and the condition of being a father inserts a man into the cultural context with the prerogative of being responsible. However, boys are not always allowed to demonstrate such a capacity for responsibility, and even controlling pregnancy is often demanded as a feminine issue, considering the male role in sexual relations to be only the task of taking care not to contract sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS). Therefore, the word “be careful” has different meanings when said to a boy or a girl. The adolescent father is absent from the process of pregnancy and paternity due to fear, pressure or exclusion. The adolescent runs away or simply distances himself from the problem and from responsibility in the face of contradictory and punitive attitudes, especially on the part of the family of the pregnant adolescent, with threats of physical and moral aggression. Other times, the family starts to take on the care of the pregnant woman alone and excludes the father. On the other hand, research on parenthood (fatherhood and motherhood) in adolescence often omits the fathers from the sample and information about the father is obtained indirectly, through reports from the child’s mother. Therefore, there seems to be a perverse relationship between adult society and the condition of fatherhood in adolescence, which ends up making it difficult for the adolescent to think about, prevent or assume his condition as a father(6). Strategies for finding adolescent fathers have suggested that, even when a boy wants to take on an active role as a father to his child, social institutions seem to hinder or deny him this right. Services have been created to care for pregnant adolescents, but few of them are concerned with adolescent fathers.

According to Sarmento(8), in 1996, at the Center for Comprehensive Attention to Women’s Health at the State University of Campinas (CAISM/UNICAMP), 40% of the partners of pregnant adolescents were under 19 years old, and 13% were between 14 and 16 years old. According to this author, there is a need to develop strategies to welcome and monitor these young men, since paternity is rarely studied and welcomed. The expectation of becoming a father generates feelings, concerns and joys that configure a special emotional state, seemingly constituting a state of evolutionary transition, which includes a process of identity change and new configurations of emotional bonds. It seems that men have some difficulties in assuming the paternal role, which are also common to adolescents:

1. uncertainty about the veracity of paternity and envy of women for their ability to gestate, in addition to fear of responsibility, since their experiences are still focused on their own growth;

2. fantasies that the child may pose a threat to his current life;

3. fantasies with deep roots, resulting from childhood jealousy and archaic desires to make the little brothers who come to dethrone him disappear;

4. the woman’s need to name him father and allow him to get closer to the child.

Still according to Sarmento(8), in childhood, boys sometimes show an interest in playing with dolls and feeding them, but this is generally forbidden by adults. However, identification with a loving father, and not with a tyrannical rival, will contribute especially to a positive masculine identity later on.

For the aforementioned author, based on the monitoring of adolescent fathers in her service, it is worth highlighting some aspects that seem constructive for the adolescent father:

• prospect of becoming an adult with the arrival of a child;
• possibility of organizing resources for a positive and different meaning of life, which, in adolescence, reveals itself to be so contradictory and full of dangers;
• apparently, the process of individuation and separation of the adolescent, accelerated by reproductive life, brings with it a sense of reparation for their parents, as the loss of the son who quickly became an adult is replaced by the gain of the grandson;
• pregnancy can be used as a means of defense against self-destructive impulses such as drugs, crime, other risky situations such as promiscuity, gambling, STD/AIDS, etc.;
• The partner’s pregnancy harbors a deep desire for creation, embodied in the birth of the child. This desire, however, could be represented in other creative acts, such as studies, artistic achievement, competitive and successful practice of sports, community participation, etc.

Despite the above opinions, for health and education professionals, the vast majority of cases of teenage pregnancy are unplanned events, with the flavor of an unpleasant surprise and characteristics of a traumatic process involving three generations: the adolescent, the baby and the family(ies). Several risk factors can be outlined in the lives of adolescents and their families that predispose to this situation, as well as embarrassing consequences involving, above all, the adolescent and her child.

In order to provide an associative tone to the aspects and preventive possibilities for responsible parenthood in adolescence, some predisposing factors for teenage pregnancy are summarized below, without in-depth considerations, only to stimulate reflection on them.

PREDISPOSING FACTORS

• Explosion of sexuality now centered on genitality. It seems that the enormous hormonal avalanche, in the initial and middle phases of adolescence, leads adolescents to experience sex narcissistically without concerns or responsibilities towards the other, as they still lack the feeling of object love. In their eagerness to experience sexual pleasure, they become pregnant.
• Early sexual initiation.
• Impulsiveness, immediacy, sense of omnipotence and indestructibility, typical of adolescents.
• Previous early pregnancy in the family.
• Previous early pregnancy in the adolescent herself.
• Unfavorable socioeconomic status. Although teenage pregnancy occurs in all segments of the population, it is up to seven times more frequent among poor adolescents.
• Low level of education, school dropout and unemployment. Pregnancy is much more frequent among adolescents who are out of school or, often, they are forced to drop out of school because of pregnancy, thus perpetuating the cycle of unpreparedness to face an increasingly restricted and competitive job market.
• Unconscious desire to get pregnant and pressure from friends to start having sex.
• Ignorance of the physiology of the reproductive organs.
• Incorrect use (or non-use) of contraceptive methods. Despite the wide range of information and even the existence of family planning programs and guidance on contraception in various health services, adolescents seem to opt more for the “naturally nothing” method, as Takiuti says(14).
• Conflicting family relationships. In this context, the adolescent may find himself without reference points and may start to idealize the construction of his own family, more balanced, through pregnancy, or use it to confront parental figures.
• Chronic illness, death or separation of parents, leading to mourning that, by all indications, will only be repaired with a new object of love, in this case, a child.

CONSEQUENCES

The consequences of teenage pregnancy are more concentrated in the psychosocial sphere for both sexes, especially for the adolescent: stopping school (or staying out of school), moving away from friends and activities appropriate for their age, having to assume motherhood/fatherhood without being prepared and limiting their financial independence from their family, as well as their vocational and work opportunities, thus perpetuating the cycle of poverty. The possibility of pregnancy recurring in adolescence should also be taken into account.

From a biological point of view, the consequences for pregnant adolescents appear in the form of a higher incidence of hypertensive disease specific to pregnancy (GVHD), anemia, hemorrhages and other complications of childbirth and the puerperium, which determines an increase in maternal mortality. All of these consequences are questioned and attributed, by several authors, to the primiparity and low income of the majority of pregnant adolescents, as well as their late arrival at prenatal care, which is not always provided. Furthermore, the younger the pregnant adolescent, the more vulnerable she will be to risks.

With regard to the concept, pregnancy in adolescence is associated with higher rates of prematurity and low birth weight, increased perinatal mortality and a greater risk of birth defects, shorter breastfeeding duration and signs of child abuse and neglect. All of these consequences are minimized with good prenatal care and good monitoring of the adolescent and her child after birth.

It should also be considered that, once the pregnancy has occurred, three options are presented to the adolescent: 1) continue the pregnancy and take responsibility for the child as a single parent, bearing the consequences already mentioned, or enter into a marriage, usually of convenience, with the risk of separation in the short term; 2) have the child and give it up for adoption; 3) terminate the pregnancy through abortion.

The practice of abortion as a solution for an unplanned pregnancy seems to be greater in wealthier regions and among adolescents from more privileged socioeconomic classes. In the United States, half of all teenagers who become pregnant decide to have an abortion. In Brazil, where the vast majority of abortions are clandestine, in 1989 the annual number of abortions among teenagers was estimated at 130,000, which corresponded to one abortion for every four live births.

Performed on low-income teenagers, by curiousor by self-manipulation, and in precarious aseptic conditions, such abortions lead to complications such as hemorrhages and infections, constituting one of the main causes of death among adolescents in Latin American countries(2). The disastrous moral effects left by abortion must also be considered, such as difficulty in readapting to the group, guilt complex, in addition to the possibility of a new pregnancy.

It is worth emphasizing again that for some adolescents, pregnancy can represent the concretization of their love object, the possibility of definitively acquiring adult status and enjoying some privileges, even if temporary, as well as demonstrating their capacity to assume responsibilities, as previously mentioned.

PATHS FOR PREVENTION

The problems of youth do not occur in isolation: they are reflections of the existence of risk factors in the family and in the society in which young people are inserted and that lead them to adopt risky lifestyles. Therefore, the prevention of teenage pregnancy and the path to responsible motherhood and fatherhood must adopt less coercive intervention lines, legitimately supported by frank, enlightening and loving dialogue about the exercise of sexuality and focused mainly on promoting the health of adolescents within an ethical stance of respect for them and encouraging harmonious coexistence between genders. Primary prevention

must ensure, for both sexes, the presence of protective factors such as those exemplified below.

• Access to school and decent work: It has been proven that the early onset of sexual relations, as well as the number of children a woman has, decreases as her level of education increases. On the other hand, it is said that education acts as a medicine against fatalism. However, it is essential that schools act not only by increasing the chances of social advancement through the cognitive baggage that they provide to the individual, but also by educating, together with the family, in knowledge of life and gender relations, to strengthen citizenship and experience happiness. Depending on the age of the adolescent, decent work improves their self-esteem, increases the chances of social integration and the possibilities of material resources for self-care. Specific work programs for young people reduce the negative impact of situations of poverty, unemployment and underemployment on the health and psychosocial development of adolescents.
• Appropriate and pleasurable use of free time : involvement in sports, artistic and other socially responsible and supportive activities within the community channels the adolescent’s interests, pleasure and sexual energy into areas other than just the genitals, with the possibility of even postponing sexual initiation.
• Stability and good family dynamics: it is urgent to increase the channels of communication between parents and children. Parents must understand that their children’s needs today are different from theirs when they were young. Adolescents must have healthy role models and be able to benefit from adults’ experiences, while respecting them. Limits, a structuring factor of personality, must mediate the relationships between parents and their children. Authority in the family must be based on mutual respect to build autonomous morality in adolescents(9,13).
• Opportunity to develop well: self-knowledge, self-image, self-esteem, self-control, decision-making and responsibility are all important in achieving self-care. More than anything, the opportunity to develop your life project is important.
• Possibility of developing a scale of personal values: the teenager has the freedom and autonomy to make informed choices about starting their sexual activity without feeling constrained and pressured by the values ​​of their family, society or group of friends.
• Non-involvement with legal or illegal drugs: it is known that psychoactive drugs, especially alcohol, have been used on a large scale at increasingly younger ages and that their use is a factor in allowing early and unprotected sexual activity.
• Adequate and timely information on the physiology of the body and reproductive organs, sexuality, gender relations, STDs/AIDS, pregnancy and use of contraceptives: remember that information only informs, it does not educate. It is the first stage of education, but in isolation it does not lead to the changes in attitudes that are so necessary for significant changes in habits and risk behaviors.

Schoolchildren and adolescents should be informed and guided to understand not only the biological aspects of reproduction and sexual relationships, but also the human and emotional relationships involved in sexuality and the choice and use of contraceptive methods through an educational process that uses an interactive and participatory group dynamic. In this context, the possibilities and advantages of postponing sexual initiation should be discussed and, if it is not possible to wait, adolescents should engage in affectionate, responsible and safe sexual practices. Emphasis should be placed on the degenitalization of sex and the entire body should be perceived as a possible source of pleasure.

Educational action is the responsibility of any adult who is part of the adolescent’s life environment. Theoretically, there is no one better suited than parents to play this role of educator with positive attitudes towards sex from childhood. It is known, however, that our society uses erotic language but avoids talking about sexuality. Sex is often joked about but little is said about it. There are real barriers between parents and children when it comes to talking about sex(15).

In practice, the responsibility for guiding young people has fallen to health professionals, teachers or religious leaders. Currently, community agents and groups of adolescent educators are also involved in carrying out this educational action.

For this work, creative group dynamics techniques must be used, as well as existing means of communication and educational material, which in a playful way serve as a bridge for dialogue between adults and adolescents on such important issues as sexuality and unexpected pregnancy(5).

• Access to good quality health services: these should offer comprehensive care programs for adolescents, in which sexual and reproductive health is considered not a problem, but a need to be met with guaranteed health actions for all young people, with effective multisectoral action.

Primary prevention consists of the specific use of resources aimed at contraception, which is not always easy, since the vast majority of adolescents do not use them. Characteristics specific to this age group, such as omnipotence and magical thinking, establish precarious notions of causality between the exercise of genitals and pregnancy. Difficulties in accessing contraceptives, due to fear or embarrassment of the adults’ reaction, fear that they may harm their health or not knowing how to use them, as well as the occurrence of sporadic and unexpected sexual relations and the unconscious desire to test their reproductive capacity are factors that make contraception difficult in adolescence(12).

The wide variety of methods should be part of the knowledge base of adolescents about contraception and be available to them. The methods are not specified here because they are the subject of explanation in another text. The choice of a contraceptive method for adolescents should be free and well-informed, and the prescription thereof is guaranteed by law, provided that the physician recognizes the patient’s capacity for understanding and discernment. The dual protection strategy should always be adopted , recommending an efficient method for preventing pregnancy in combination with another that prevents STDs/AIDS(1,4). Secondary prevention

is carried out once the pregnancy has already occurred and is based on prenatal care specific to this age group, humanized assistance during childbirth, the inclusion of the adolescent’s partner in the process, assistance to him in his fatherhood and support for the families. Tertiary prevention is carried out after childbirth with a multidisciplinary team working on postpartum and lactation care, child care and strengthening the mother/child bond, as well as guiding the adolescent to avoid recurrent pregnancy and favoring her (and the child’s father’s) reintegration into school or work(3). CONCLUDING There are ways to prevent teenage pregnancy and, consequently, there are also ways to have responsible motherhood and fatherhood at this stage of life. However, we must be careful when talking about preventing teenage pregnancy so as not to view it as a pathology. Far from being a purely medical and public health problem, it constitutes a challenge to society, where, alongside the countless technological advances that have occurred, a whole cascade of changes in human behavioral patterns has been taking place at a very rapid pace, especially in the last four decades.

To illustrate the speed of these changes, we need only analyze some aspects of individual and family behavior over the years. In 1960, when people thought about contraception, they used the pill; in 1970, the intrauterine device (IUD); in 1980, injectable and subcutaneous contraceptives; and in 2000, the morning-after pill , now simply called emergency contraception. When analyzing the marital status of couples , in 1960, those married in church predominated; in 1970, those divorced; in 1980, those in relationships ; and in 2000, gay marriages began to be admitted . As for the way of having sex , in 1960 it was only after marriage ; in 1970, sex, drugs and rock n’ roll ; in 1980, only with condoms , and in the year 2000, sex for pleasure . If we consider the type of dating , in 1960 it was behaved ; in 1970, in the car ; in 1980, in the motel , and in the year 2000, over the internet . The family structure in 1960 was composed of a father, mother and many children; in 1970, a father, mother and a few children; in 1980, a mosaic family ( mine, yours and our children ), and in the year 2000, the existence of gay parents was legalized .

It is in this changing society, in which we all include ourselves, that we need to offer models so that the adolescent can live happily and healthily, building his or her identity and autonomy and learning to take care of himself or herself and others, especially if that other person is a child. But where are the models for such an endeavor? Are we, as adults, acting convincingly, serving as a reference for adolescents regarding ethics, harmony and respect in our interpersonal relationships within the family? We need to reflect on this, because it is urgent that adolescents be allowed to build a life project in which sexuality is experienced responsibly, not out of fear of the specter of AIDS, but through the pleasurable exercise of gender relations amalgamated with respect and love. And if in this life project motherhood and/or fatherhood figure in the adolescent’s immediate plans, these roles should be exercised responsibly!