INTRODUCTION

Adolescence refers to the period of the life cycle between 11 and 20 years of age in which a person makes the transition to adulthood, with important biological, social and psychological changes that influence the construction of personality, in order to reach biological and sexual maturity, in addition to emotional and social maturity ¹ . 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 early pregnancy or sexually transmitted infections, given the high tendency for non-systematic, incorrect use or absence of contraceptive methods (MCM) by adolescents, despite having knowledge about sexuality and prevention ² .

Some individual factors that are related to teenage pregnancy refer to an unsafe marital situation, low educational level, maternal history of pregnancy in adolescence or search for independence. These factors are associated with the cultural context, since while in many developing countries the social status of women is determined by marriage and motherhood, in developed countries high standards of social and economic fulfillment have been established. Furthermore, the lack of or deficient education regarding sexual and reproductive life since the early years of school, or even family and community, has generated little information on the issues of reproduction and sexuality among adolescents. -Conducts regarding 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 exacerbates sexual impulses and associates the early exercise of sexuality with social prestige and power . ³

Regarding early pregnancy, the World Health Organization (WHO) ⁴ states that it profoundly affects the health trajectory of adolescents, creating obstacles to their psychosocial development, and is associated with a higher risk of maternal morbidity and mortality, in addition to poor outcomes in terms of well-being, since when there is a younger maternal age, there is a risk of having a lower gestational age, low weight or poor nutritional status in the child ^3,4 . It is reported that for 2018, Latin America and the Caribbean (LAC) had the second highest adolescent fertility rate in the world, at 66.5 births per 1,000 adolescents (2010-2015), compared to a global rate of 46 births per 1,000 adolescents ⁴ .

And although rates are decreasing worldwide, the reduction is extraordinarily slow in LAC compared to other regions, because even with local and national responses to address this problem, no significant progress has been made ⁴ . There are many reasons for the slow response to the issue, including: lack of systematic monitoring and evaluation of interventions and programs, analysis of the success and failures of initiatives and why these initiatives did not achieve better results; and low Latin American scientific production on this topic ⁵ .

Thus, the objective of this study was to analyze the measures cited in the scientific literature to prevent early pregnancy in the population of Latin America and the Caribbean over the last two decades; to visualize the trends in studies, as well as the systematization of the information acquired; to describe and analyze the findings that are common, different, and new 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 developed on the topic of early pregnancy in the population of Latin America and the Caribbean ⁶ .

The search began by conducting the search in the Scopus, EBSCOhost, SciELO and Science Direct databases, chosen because they are the largest and most recognized bibliographic reference databases of scientific literature worldwide. The keywords “teenage pregnancy” and “prevention” were used, in Spanish, English and Portuguese. The results were examined in publications published between 1998 and 2018, of open access scientific articles.

The search and analysis carried out between March and May 2018 corresponded to 59 records, of which the articles that revealed pregnancy prevention actions in the adolescent population were included, with samples belonging to the countries that make up the region of Latin America and the Caribbean. However, documents such as books, abstracts, conference or symposium summaries, letters to the editor, news, information notes, meeting minutes or undergraduate papers were omitted from the search, as were studies that reported prevention actions in populations other than Latin American populations, or on the prevention of problems during pregnancy or new teenage pregnancy. These exclusion criteria were used to generate uniformity in the search and analysis of results. Finally, after filtering with the previously established inclusion and exclusion criteria, 34 articles were selected for analysis (Figure 1).

The selected articles were systematized using a document registration matrix based on the PRISMA-P protocol recommended for the development of systematic, bibliographical reviews and meta-analysis ⁷ . This matrix recorded 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.

Once the document registration matrix was completed, the data from all articles were analyzed and the SPSS 22.0 program was used to perform the descriptive statistics analysis.

RESULTS

Regarding the publication period, 2014 was the year with the greatest dissemination, with 17.6% (n=6) of the total articles (figure 2). Regarding the Latin American countries reviewed in this search, the publication of articles in Spanish predominated, with 82.4% (n=28), while in English, 11.8% (n=4). Likewise, the systematic review showed that the disciplines addressing 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 did not explicitly state the area of ​​study.

The publications analyzed have in common the type of population, instruments, contexts and types of study: 73.52% (n=23) present research with a population between 500 and 50 subjects ^8,9 , the instruments applied vary between questionnaires (33.3%), surveys (21.2%) and interviews (12.1%), where the majority (87.8%) were constructed and validated by the authors themselves, however, the psychometric properties of these were not specified, 90.9% of the studies included both men and women in the characterization or preventive intervention ¹⁰ .

It is important to highlight that 78.1% (n=25) of the studies reviewed presented the educational headquarters as the place of intervention or characterization with the greatest representation, followed by medical offices (15.6%, n=5). Similarly, 67.6% (n=23) are characterization studies on knowledge and use of CAM, identifying adolescent perceptions on pregnancy prevention, age at onset of sexual intercourse and onset of CAM use, sources of information on sexual and reproductive health, and appropriate and inappropriate beliefs about the use of CAM ¹¹ . Some innovative characterizations were identified in the population from these studies, such as the cultural practices of a country or region that influence actions to prevent adolescent pregnancy ¹² , as well as the level of knowledge of parents or guardians regarding early pregnancy among adolescents, and the male role in effective prevention ¹³ .

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 CAM, increasing the intention to use condoms or other contraceptive methods ^14,15 , delaying the onset of sexual intercourse, and identifying appropriate sources of information ¹⁶ . However, within these interventions, innovative studies are presented on how to increase self-efficacy and obtain new knowledge about respect for oneself and others, commitment and responsibility in decisions for the responsible exercise of citizenship, in addition to body care, addiction management and adequate nutrition in order to avoid pregnancy and premature birth ¹⁷ .

With reference to innovative results, it was found that 30.3% (n=10) of the studies applied more than one technique in the same group of adolescents with a view to developing the investigation, such as questionnaire, group discussion, socio-drama and psychodrama ¹⁹ ; or interviews, target groups and surveys ²⁰. In addition, some studies characterize or intervene in samples of adolescents with characteristics defined by race or gender. For example, a proposal for formal education on responsible sexuality with indigenous populations is presented, highlighting that the limits on knowledge and perception of real needs regarding sexual and reproductive health in this population are due to racial discrimination ¹⁰ . On the other hand, studies were found with male samples, where knowledge about pregnancy risk, self-efficacy and education in gender equity were identified ¹³ , and with the female population to evaluate the effectiveness of a psychoeducational program in sexual and reproductive education, which obtained 87.5% effectiveness in positively changing knowledge about healthy sexuality ⁹ .

Similarly, prevention actions with replicators were recorded, where 106 teachers were trained, who interacted daily with their students and had an impact on the knowledge, decision-making, gender roles, negotiation and self-efficiency of 11,177 adolescents who were later evaluated by researchers to reinforce and verify the level of knowledge acquisition about the prevention of early pregnancy ¹⁷ . Studies of preventive actions involving parents of adolescents were also identified, which identified little or ineffective communication, as well as lack of knowledge about the use of contraceptive methods and early pregnancy ²¹ . Another population involved is health personnel, who constantly participate in care for adolescents, and require specific skills and systems of actions to be capable and willing to play an active role in promoting the transformation of negative models and practices of sexual health ¹⁸ .

Finally, through this systematic review, a theoretical review was obtained on education for the “new masculinity”, proposing the restructuring of male-female roles and the new concept of femininity and masculinity in the current context in order to prevent pregnancy and premature birth. The need for the development of educational programs that demonstrate in a current and precise manner, with a focus on law, the themes related to gender and sexuality was highlighted, in order to minimize censorship and superstition regarding the subject ²² .

DISCUSSION AND FINAL CONSIDERATIONS

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

Furthermore, in line with the common aspects identified in the studies, there is evidence that most of them were designed for application in educational institutions, probably due to the large number of adolescents found. Although this review found a minimal percentage of preventive actions in clinical and community settings, it is important to emphasize that such contexts could include high-risk adolescents who may have dropped out of school ²³ .

Likewise, the use of techniques such as questionnaires, surveys and interviews is predominantly found, given that most studies focus on characterizing the population’s knowledge of CAM, sources of information, initiation of sexual relations, among others. These diagnoses allow prioritizing and analyzing psychosocial or health issues that subsequently contribute to the design and implementation of strategic and situational action plans that contribute to improving the quality of life of vulnerable populations ²⁴ .

On the other hand, it is worth noting that 90.9% of the studies work with samples of both sexes, and it is vitally important to continue with the participation of adolescents in pregnancy prevention programs that favor the acceptance of responsibilities in the area of ​​sexuality with gender equity, fostering a process of guidance and formation of gender roles. In this way, adolescents will appropriate the topic without affecting their personal identity, promoting equity as the basis of interpersonal relationships, where decisions are shared and consistent with personal and social development ²⁵ .

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

Two important points stand out in the results presented in reference to the number of publications found and the type of study on prevention of the phenomenon. The findings indicate that scientific productivity on prevention has been reported in the last 17 years and, although there was a greater number of publications in 2014, this year it was limited to six scientific articles, a small number when compared to the number of countries in Latin America and the Caribbean. This is even more so given the importance and impact that this problem has on Public Health in the region, whose current levels of adolescent fertility are second only to sub-Saharan Africa ⁴ .

Most publications mainly address the characterization of the population’s knowledge, and prevention actions from intervention are limited. This review demonstrated a scarce publication of interventions (n=10) and an insufficient theoretical and empirical contribution to mitigating the phenomenon when compared to other Spanish-speaking countries, such as Spain, for example, which has 21 high-quality intervention and evaluation studies to prevent pregnancy ⁵ . Or in comparison with the United States, which presents 89 studies focusing on the effectiveness of programs to prevent pregnancy, HIV and other sexually transmitted infections in the adolescent population ²⁶ . This panorama demonstrates a critical trend towards effective actions that allow the reduction of the problem, since providing information on the subject, although it promotes awareness regarding sexual and reproductive health, does not contribute to a significant change in the behavior of adolescents ²³ .

Therefore, although characterization studies allow us to understand the level of knowledge of the population and help to disseminate the importance and need to address this phenomenon, it is imperative to continue with the line of preventive intervention, increasing the development of studies, both for the validation of measurement instruments that can be approved to identify inadequate knowledge about MAC and early pregnancy, and for the design and evaluation of comprehensive intervention programs that assume prevention. Going from interdisciplinary views that allow adolescents not only to understand the use and need for CAM, but also self-efficacy, respect, life project, body self-care, future responsibilities, sense of competence, control of peer pressure, as well as the promotion of protective behaviors in family, community, clinical and school environments.

Based on the results obtained and considering that the studies allow for strengthening and contributing theory, empiricism and science to the phenomena, some alternatives or suggestions for the visualization and impact of publications indicated for the prevention of pregnancy at premature ages in Latin America could be: a) motivation for the design, development and publication of preventive intervention proposals; b) consideration of the publication of articles in journals included in widely disseminated databases, which would generate greater dissemination of successful experiences that could be replicated; c) development, validation and presentation of psychometric properties of measurement instruments; d) development of studies in new contexts, with populations of vulnerable or uneducated adolescents, which allow for the identification of beliefs that make prevention impossible; e) design and development of research that reports results of intervention processes in urban and rural populations; f) increase diagnostics in indigenous populations and cultural approaches to said population, with pertinent adjustments in interventions that respect ethnic ideologies.

The limitations of the study are related to the difficult access to some scientific publications, mainly from the Venezuelan and Argentine regions. As future lines of research, it is suggested to expand 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.