INTRODUCTION

Several circumstances are determining factors for unplanned pregnancy during adolescence. Among them, factors such as education, family income, early menarche, poverty, individual characteristics, reduced use and lack of knowledge about contraceptive practices, lack of or unsatisfactory sexual education, low education, premature onset of sexual activity and psycho-emotional problems favor the emergence of an unplanned pregnancy ¹ . These variables, as well as other social elements, cannot be understood as an isolated event, but as a fact that can interact with each other and change according to regions and social groups. Their study, developed from different perspectives, constitutes an important tool in the prevention of early pregnancy, as well as abortion ² .

Even with the legal implications involving the issue of induced abortion, it is observed that in Brazil, despite the prohibition, this practice continues to occur, even when considering the population under 15 years of age ³ . Family status, level of education and support from the government influence the health and well-being of the population, especially adolescents ³ . Family support, regardless of social status, was identified as the main factor that minimized negative emotional repercussions during teenage pregnancy ⁴ . Adolescents who received support from their partners and family demonstrated greater balance and were able to establish an adequate mother-child relationship ⁵ . However, the greatest problems identified among pregnant adolescents are due to a lack of tolerance and respect on the part of the family, which facilitates the emergence of emotional instability, which in many cases favors the practice of abortion ⁶ .

In order to prevent teenage pregnancy, it is necessary to reevaluate the effectiveness of women’s health support programs, emphasizing aspects related to contraception and sexual orientation. Therefore, Family Health Units must be prepared to serve this population, seeking support from education, social service and psychology professionals present in the community ⁷ .

In this regard, it is important to obtain epidemiological data that identify aspects related to this specific population and, therefore, studies should be encouraged to expand knowledge of the problem, both regionally and nationally ⁸ . Data obtained in epidemiological studies are essential for the development of public actions that aim to assist these adolescents in their decision-making ⁸ .

Considering the importance of revealing the singularities of teenage motherhood, this study aims to understand the sociocultural characteristics and occurrence of events related to induced abortion committed in previous pregnancies by pregnant adolescents treated by the Unified Health System.

METHODS

This is a cross-sectional, descriptive, non-probabilistic epidemiological study that sought information on the social and behavioral profile of pregnant adolescents. Participants were recruited from Basic Health Units in Médio Araguaia, at the Dr. Kleide Coelho de Lima Municipal Hospital and at the Barra do Garças Reference Center – MT, located in the Legal Amazon region of Brazil. The study population consisted of pregnant adolescents aged 10 to 19 years, who agreed to participate in the research and presented the “free and informed consent form” signed by their parents or guardians.

Information was collected through individualized interviews. The questionnaire used, containing closed questions, was previously tested, allowing the detection of possible errors, ambiguities, difficulties in understanding and biases. The requirements regarding confidentiality and secrecy of information were respected, in accordance with the determinations of Resolution CNS 466/12 of the Ministry of Health for research involving human beings. The research was approved under No. 975.413/CEP/UFMT/2015.

For the sample calculation, the prevalence of pregnant adolescents in a similar population of 2.4%, type I error of 5% and estimated minimum size (n=84) were considered. Considering the existence of missing data, the number of adolescents surveyed was increased by 20% (n=101). The data were evaluated with the aid of the EPI-INFO ^® program version 3.5.3. A statistical analysis was performed with percentage values. The associations between the variables were made using the Chi-Square, Mantel-Haenszel, and Fisher’s Exact tests, and the occurrence of events was calculated using the Prevalence Ratio, with 95% confidence intervals (95% CI). A p-value less than or equal to 0.05 was considered statistically significant.

RESULTS

The sociodemographic profile of the adolescents represents the personal characteristics of this age group, within the dynamics of the population of the Middle Araguaia. Table 1 presents the particularities of the 101 pregnant young women who made up the sample. Approximately 11% of the adolescents were between 10 and 14 years old, while the majority were between 15 and 17 years old, were married or in a stable union, and did not work. Most of them had a family income of up to three minimum wages, and less than half (43.6%) had studied up to the eighth grade.

The document produced allowed us to identify several causes for attempted abortion among the pregnant teenagers interviewed (Table 2). Family rejection of the pregnancy was the main trigger for the event, with 17.30 times more chances of occurrence. Similarly, having more than two partners increased the number of attempted abortions by 8.52 times. Other important variables that led to attempted abortion were losing one’s virginity in a casual encounter and having recently changed partners.

Table 3 shows the factors related to the various substances that cause chemical dependency. The use of alcoholic beverages had the greatest impact on the increase in attempted abortion, with a 5.61 times greater chance of occurrence. Smoking during pregnancy is related to an almost five-fold increase in the chances of attempting an abortion (PR=4.62). With the exception of the data related to the use of illicit drugs, all values ​​shown in the table were statistically significant.

DISCUSSION

Unwanted pregnancy has consequences at the biological and psychosocial levels. Among these, the most prominent is the interruption of schooling and professional training. It is possible to state that although the public health service is provided by serious and committed professionals, it is not easy to repair the psychosocial consequences specific to each patient who seeks care ⁹ . While for some, pregnancy may be a normal occurrence, for others, especially single women, it can be difficult and embarrassing. In these cases, family support through dialogue and assistance reduces depression. Since unplanned pregnancy is usually synonymous with unwanted pregnancy, the adolescent has her dreams and life plans compromised. Thus, the choices of the pregnant, rejected and lonely adolescent are to find a partner, face the difficult pregnancy alone, offer the child for adoption or have an abortion.

The effects of pregnancy related to the health of the adolescent or even the conceptus may be less important than the psychosocial effects. Unemployment and low income, child abandonment and school dropouts can have future implications that are difficult to correct. In a study conducted by Yazlle ¹⁰ , 15% of adolescents were classified as not having paid work. On the other hand, this author reveals that 68.3% of adolescents were unemployed. This disparity is possibly due to regional peculiarities characterized by a small number of industries, agricultural vocation and low-income families, where most adolescents were neither studying nor working at the time of the interview.

Despite the small job offer in the region, the average monthly family income of up to three minimum wages found in the Médio Araguaia is in line with the literature consulted, where most families do not usually receive more than four wages, revealing that low income is almost established as a model for the emergence of teenage pregnancy. In a study conducted in the city of Goiânia, half of the pregnant women belonged to families with a family income of less than two minimum wages, where 36.9% of these reported less than one minimum wage ¹¹ .

Pregnant teenagers from low-income families are unlikely to attend school, as the need to find paid work to support their families will override their interest in studying. Since young age is related to lack of professional preparation, the prospects of getting a job are even lower. This fact is aggravated the younger the teenager is, since sexual maturity occurs before economic, psychological and social maturity. This study indicated a median age of 17 years and 48.5% of them were between 15 and 17 years old. The same occurred in health units in Minas Gerais ¹²whose average age was 17 years. The similar age range found in the Middle Araguaia shows that young age at pregnancy is a widespread problem. It can be deduced that the vast majority of these mothers are sacrificing a decisive phase of their development. In this way, the lack of planning increases the challenge of pregnancy, aggravated by the inexperience of young age.

In many cases, adolescents obey their sexual impulses and seem not to admit the possibility of becoming pregnant, which leads to the early initiation of sexual life in random encounters and without the use of contraceptive methods. This leads to an increase in the number of pregnancies that, associated with the lack of perspective for the future and the inability to resolve conflicts, generate problems such as abandonment of the child, the family, the school or the carrying out of illicit abortion. In this sense, single adolescents resort more easily to the practice of induced abortion, in a number almost ten times greater than married adolescents ¹³ .

In the present study, approximately half of the interviewees had studied only up to the eighth grade. Although a higher level of education does not always protect young women from an unplanned pregnancy, especially in cases of sexual coercion, low income and little education can contribute to early pregnancy ¹⁴ . There is much debate about whether dropping out of school is a factor that precipitates pregnancy or whether it is a consequence. Data indicate that most dropouts occur after pregnancy is confirmed ¹⁵ , making it difficult to enter the job market and increasing parental dependence, especially at the financial level ¹⁶ .

Fortunately, for most adolescents, pregnancy occurs within stable relationships ¹⁷ , as also evidenced in our study. Despite this, becoming pregnant during a casual encounter, having more than two sexual partners or having changed partners before becoming pregnant were shown to be significant factors that influenced the need for abortion. It can be said that there is a common aspect to these three themes: the lack of emotional commitment established with the partner. The absence of this bond often implies episodes of abortion. For them, the degree of legitimacy of the relationship frames the desirable scenario for the arrival of a child. An unestablished union or one in crisis increases the chance of abortion ¹⁸ .

The association of early pregnancy with other risk behaviors, such as drug use among young people, in a context of situations of violence, characterizes the group as extremely vulnerable, requiring specific and urgent approaches to change the situation found ¹⁹ .

In countries in general, teenage motherhood tends to be associated with low social and economic status and high-risk behaviors, such as reduced use of contraceptives, drinking, smoking, and drug use ²⁰ . Smoking has been shown to be associated with reduced maternal weight gain, increasing the chances of low-weight newborns ²¹ and greater chances of abortion ²¹ . Among psychoactive substances, the use of illicit drugs was the main trigger for attempted abortions. The use of licit or illicit substances is related to each other, as it somehow represents low self-esteem or, at least, a propensity for reckless acts. Thus, the use of such substances may reveal a detachment from the developing child, contributing to the emergence of abortion ideas.

Possible limitations of this study were the completion of some questionnaires with the young woman in the hospital, immediately before or after birth, and the predominance of adolescents from low-income families served by the SUS. Another aspect that deserves to be discussed refers to the questions that could be classified as “sensitive”, capable of causing embarrassment and omission. Thus, we sought to create a calm and trusting relationship with the participants, facilitated by the guidance on breastfeeding that all of them received before the interviews. Thus, despite possible understatements, the information available here allowed us to compose a representative profile of the behavior of these adolescents.

CONCLUSION

The results obtained allow us to conclude that a situation of social inequality and low education level may have influenced the adolescent to induce an abortion in a previous pregnancy. As discussed above, the greater number of partners, the constant exchanges and casual encounters denote a lack of lasting ties that can increase the chances of abortion ideation. Rejection by family members generates a feeling of helplessness and uncertainty about the future, which seem to weigh heavily on the decision to abort. The use of drugs, legal or illegal, also negatively influences the adolescent, perhaps because it represents insecurity, a tendency to act recklessly or a lack of interest in the conceptus. In general, the elements discussed seem to psychologically destabilize the adolescent, to the point that abortion becomes a viable option. Finally, the results obtained in this study may contribute to the development of support programs for pregnant adolescents, their families and partners, with the aim of reducing the number of cases of induced abortion.

CONTRIBUTORS

EV Moraes, OR Toledo, FL David, MM Avelino and RN CAMPOS participated equally in all stages of the study (conception, design, analysis and interpretation of data).

FINANCIAL SUPPORT

The study was funded by the Coordination for the Improvement of Higher Education Personnel (CAPES). There was no conflict of interest.