The number of pregnancies in children and adolescents, aged 10-19, is steadily declining in Rio Grande do Norte. In 2021, 5,749 cases were reported, a decrease of 41.92% compared to a decade earlier (9,899 cases in 2011). However, the indicators still worry health professionals due to the risks they pose to young women and their children. Data are from the state Ministry of Public Health (CISAPP). Alice, not her real name, is 17 years old and was about to give birth to her son at Januario Seco Maternity School when she spoke to a reporter. The young woman did not plan to become pregnant and left school.
At 37 weeks pregnant, Alice was accompanied by her mother and said her delivery was scheduled for the next day. The young woman’s pregnancy was not planned and she did not even believe that she could have children. “It was a surprise, I have a uterine cyst and the doctor I saw at the time said I can’t get pregnant anymore. I live with my husband and we don’t use anything to avoid it.”
In October of last year, Alice started feeling nauseous and decided to take a drug test. Not believing the positive result, he confirmed the result with a blood test. “As soon as I found out, I told my mother and my husband and they were happy. My pregnancy was fine and thank God the pressure was very high. I was in so much pain and didn’t know my body well but was very eager to see my son’s face. The father is in Rio Grande do Sul, he got a job there and we’ll move.”
The teen has been sexually active since the age of 15. Natalens, he moved with his partner to Bregueno, an hour from the capital, with which he had already established a stable union. Alice attended until the ninth year of elementary school II and has no plans to return to her studies. Even before pregnancy, she had already left school. “I was studying, but after all this, I found the right person who said he would help me with everything and went to the country,” he says.
His mother, Maria, also a fictitious name, had Alice when she was seventeen. That is why he said that he gave his daughter all the support. “When she told me, I was waiting for a big surprise, but the family is now happy with the arrival of my grandson. Everyone helped. We had to deal with people judging her for being young and not studying, but we ignore these criticisms,” she comments.
In 1994, Velma Barros got pregnant at the age of fifteen and went through a complicated experience, even being evicted from her parents’ home. During her pregnancy, she had to drop out of school to take care of her daughter while her then-boyfriend, now her husband, worked in a bakery to support the young family. 23 years after the birth of Erica, she was able to complete her high school. Velma has also finished his higher education and is currently doing postgraduate studies.
“I’ve been dating since I was 14 and got pregnant unexpectedly at 15. I lived in Guarapes and didn’t know any way to avoid it, that’s the truth. I wasn’t aware of this. My parents kicked me out of the house and I went to live with my in-laws who didn’t accept the pregnancy. Also. It was so hard, I suffered so much. It was two horrible years of my life, I practically had to mature,” she says.
With the birth of a daughter, the family began to accept the situation. Velma devoted three years exclusively to taking care of her daughter. Later, I had to choose to study or work, I did not have a teenager. I started working at a hotel like ASG and stayed there for ten years, because of the schedule I couldn’t juggle with school, but I really wanted to go back to school,” he says.
Velma, 42, says she is proud of her father, who refused to speak to her during her pregnancy. “When I go to the country, he says to everyone ‘My daughter is a graduate.’ I’ve been this time without studying so I don’t miss anything for my children. I have three: Erica, 27, Deborah, 23, and Gabriel, 11. I talk to them about everything, they are my friends and I Even a grandmother. The eldest had a 23-year-old girl and she followed the whole process.”
Experts warn of the risks
Of the 4,459 deliveries performed in 2021 at the Januario Seco Maternity School (MEJC), 548 were to mothers under or equal to 19 years of age. This number represents a decrease of 6.48% compared to the previous year (586 cases). In 2018 and 2019, there were 580 and 508 births in this age group, respectively.
For Luciana Araújo, obstetrician-gynecologist, the main risks of these conditions are premature birth, low birth weight, intrauterine growth restriction, anemia and nutrient deficiencies, as well as risks of pre-eclampsia, high blood pressure during pregnancy, urinary tract infection, and early rupture. suitcase.
Young women arrive at the Islamic Jihad Center and are referred by health departments through the organizational system. “We do prenatal and multidisciplinary consultations, accompanied by a nurse, social worker and psychologist. Most of them need this support, even for the family to accept the pregnancy in a better way. In high-risk prenatal care, we have cases of pregnant women up to 15 years of age. From ages 15 to 19, they are managed by basic health units,” explains Luciana, who is also on duty and responsible for high-risk prenatal care.
In addition, during the consultations, emphasis is placed on contraceptive methods in the postpartum period, breastfeeding and back to studies. “We noticed that most of them stopped studying to devote themselves to the child only because sometimes they have no one to leave them with. This greatly affects the psychological development of mothers, which is still being formed. They start puberty early.”
Factors contributing to pregnant adolescents are poor access to or adherence to contraceptives, early sexual initiation, alcohol, drug and smoking abuse, as well as a lack of information. Luciana also commented on the high recidivism rates at the maternity hospital. It has been observed that among adolescent girls who do not undergo follow-up after childbirth, 20 to 30% end up getting pregnant again within one year, 50% in the second and 61% five years after the first birth.
The context of each individual’s life can lead to this recidivism. We observed that unfavorable socioeconomic conditions, early initiation of sexual activity, low contraceptive adherence, dropout from studies and early formation of a stable union are factors influencing these attitudes. We offer IUDs, pills, condoms, and patches, among other contraceptive methods. Most of them accept that, but we have exceptions,” the doctor points out.
According to Mariana Carvalho, a psychologist at MEJC Hospital, teenage pregnancy is a public health problem, understood as a complex social phenomenon that involves social, cultural, historical, and psychological factors. “Many people assume that teenage pregnancy is something unplanned or desirable, but this is not always the case. It is a complex phenomenon that also needs a complex and interdisciplinary view.”
According to Mariana, in some cases coming from the countryside, for example, it is possible to realize that adolescence itself is already a limiting thing. I think there are two very strong factors that influence the occurrence of these situations, such as the lack of other life projects, whether it be career, educational or financial plans. Many pregnant women do not have this projection and replace it with the maternity project. Additionally, family history recurrence, which is a transgenerational issue where females have a history of teenage pregnancy.”
Sesap and SMS strive to reduce pregnancies
According to the Ministry of Health, through the DATASUS system, the live birth rate for mothers aged 10-19 in the RN corresponds to 9,899 cases in 2011. According to the Coordination of Health Surveillance (CVS / Sesap), this number decreased to 8,230 cases in 2017. Last year, there were 5,749 cases, 1,754 of which were on the Great Christmas. The health districts of São José de Mebebo track 885 births, 711 in Mossoro, 478 in Pau dos Veros, and 399, 366 and 315 in Caiko, Santa Cruz and Aso, in that order.
To contribute to the reduction of these rates, the State Department of Public Health (Sesap) supports and monitors the implementation of the measures promoted by the municipalities, in particular with the Saúde na Escola Program and in Primary Health Care in Basic Units (UBS). Luciana Olinto, a nurse and technician with the Comprehensive Adolescent Health Care Program, comments that due to the difficulty of adolescents seeking primary care, it is essential to take advantage of the school space where they are admitted.
Data show a gradual decrease in the incidence of teenage pregnancy over the past few years in Rio Grande do Norte. It is a complex issue involving life projects. We need to invest through public policies so that these young people envision a change in the scenario,” he explains.
The School Health Program, a partnership between the Ministries of Health and Education, aims to contribute to the integrated formation of students through promotion, prevention and health care measures. Membership is optional for each school. According to the State Department of Education (SEEC), 2,448 educational institutions, both state and municipal, have joined the program at RN.
In Natal, the Municipal Education Department (SME) reports that out of 146 units, only 27 have the programme, 25 of which are primary schools and two municipal centers for early childhood education (CMEI). Working with the concept of regionalism, it is necessary for the school to be close to UBS to stick. Upon contact, the Municipal Health Department (SMS) informs that its Adolescent Health Center is preparing a program with the School Health Center that will promote lectures on sex education and combating sexual abuse and exploitation. There is no official date for the start of activities.