Elia Chamorro-Vázquez,1 Silvia Padilla-Loredo,2 María del Pilar Gómez-Luján,3 María Luisa Quintero-Soto2
1Centro Universitario Valle de Chalco, Universidad Autónoma del Estado de México, Valle de Chalco; 2Unidad Académica Profesional Nezahualcóyotl, Universidad Autónoma del Estado de México. Estado de México, México; 3Facultad de Enfermería, Universidad Nacional de Trujillo, Trujillo, Perú
Correspondence: Elia Chamorro Vázquez
Email: firstname.lastname@example.org; email@example.com
Date received: December 17th, 2014
Date judged: May 29th, 2015
Date accepted: July 24th, 2015
Introduction: Adolescent pregnancy is an issue of concern for the implications on the health of the mother and son and their integral and social development. Objective: To determine the influence of sexual behavior and reproductive health status of pregnant adolescents in a community in the State of Mexico.
Methodology: Descriptive study in a random sample of 200 cases of 1001 pregnant adolescents 13 to 19 years registered in health centers. Data were collected with a survey and analyzed using SPSS version 15.
Results: 0.7 correlations exist between sexual and reproductive lives, 90% of girls become pregnant in their first sexual intercourse at a range of three years at the onset of menarche. The social, economic and health status of pregnant adolescents, impact is characterized as an economic capital under, with basic or less education, insufficient capital for integral development, belonging to a disadvantaged group of poverty and inequality; during pregnancy may have symptoms of preeclampsia, low weight, urinary tract infections, malnutrition and few prenatal visits.
Conclusions: Pregnancy and health problems in adolescents are associated with disadvantages in economic, social. The implications are multidimensional, in which they can influence through programs of sexual and reproductive health for adolescents, a process perspective and respect for the principles of universality of rights, health and education.
Keywords: Pregnancy in adolescence; Pregnancy complications; Sexual behavior
The increase in rates of teen pregnancy is a reality, the report on maternity in childhood1 mentions that 20,000 girls give birth every day, 70,000 deaths occur each year from complications of pregnancy and childbirth, 3.2 million unsafe abortions are performed on teenagers each year, and about 19% of girls in developing countries become pregnant before age 18. Of the 7.3 million births to adolescents under 18 that occur each year in developing countries, 2 million are births in girls under 15 years.
It is common in Latin America and the Caribbean for the population between 10 and 24 years old to have unprotected sex, which means a potential risk of unwanted pregnancies, abortions, and sexually transmitted infections (STIs), including HIV, which is why teenage pregnancy is common and it is known that the age of first intercourse is significantly lower in men than in women.2,3
Information in Mexico about behaviors, attitudes, and sexual practices in adolescents and youth is available in the Encuesta sobre Comportamiento Reproductivo de los Adolescentes y Jóvenes del Área Metropolitana de la Ciudad de México (ECRAMM) from 1988. At that time, 41.9% of men and 22.9% of women reported having sex at an average age of 17 and 16 years, respectively. The Mexfam (1999) survey of young people between 13-19 years of age stated that 22.3% of men and 10.3% of women had already had sex, and that the average age of first intercourse was 15 years. According to the Encuesta Nacional de la Juventud (ENJ-2000), the proportion of sexually active young people aged 15 to 29 years amounted to 55.3%; of whom 67.7% said that the age of initiation was between 15 and 19 years of age.4
In 2006, Mexico had 22,190,481 adolescents, representing 20.63% of the total population. It is estimated that by 2020 and 2050 the young population will decline to 19.2 and 14.1 million people, respectively. The average age for initiating sexual life in adolescents is similar to that reported in the ENJ-2000 and the Encuesta Nacional de Salud y Nutrición (ENSANUT-2006).
The prevalence of contraceptive use in women aged 15 to 19 years who have initiated sexual life increased from 36.4% in 1992 to 39.4% in 2006 (Encuesta Nacional de Dinámica Demográfica, 1992, 2006). The use of a contraceptive method at first intercourse is higher in men with 71.5% than in women with 44.2% (ENSANUT).
According to the 2005 ENSANUT, among adolescents between 12 and 19 years of age, the pregnancy rate was 79 per 1000. Stratifying the groups, for the 12 to 15 group it was 6 per 1000, with notable differences in the 16 to 17 and 18 to 19 groups, with rates of 101 and 225 pregnancies per thousand women, respectively. The total number of adolescents served by the health system in 2006 was 201,475 for childbirth, and 19,291 for abortions (Sistema Automatizado de Egresos Hospitalarios, DGIS / SSA).5
The Programa Nacional de Salud in Mexico (PNS 2007-2012) reported a higher prevalence of pregnancy and an increased risk of dying from maternity-related problems than women 20 to 35 years old. 13% of maternal deaths reported in 2005 occurred in adolescents.6
Teen pregnancy is a major issue because it involves two important aspects of the life of any human being- a biological process that is pregnancy and a life stage that is youth- in both biological and social terms it is the stage of the life that can engender hope, enthusiasm, achievement, and, why not, social change. Procreation is the individual's ability to multiply the species, and the best time to do it is when the person has reached biological, physical, and economic maturity; therefore, pregnancy at an early age brings adverse consequences, such as the high rate of maternal and infant mortality, the risk of preeclampsia, and low birthweight of the child, especially if it occurs in a context of social inequality marked by poverty.7
The risk to the biological and emotional health of the adolescent mother commits her to transforming and limiting the emotional sequence of the life stage, to assume a maternal role for which she has not acquired the emotional maturity, economic independence, or autonomy, as well as her future, disrupting human development, her life project, continuing school, and socializing with her peers. The desire or eagerness begin sexual life is different from the desire to begin reproductive life.
In this context, some questions arise: Why there is a close relationship between the onset of sexual life and the onset of reproductive life (pregnancy) for teen women? Has the girl taken care of her health? Has she paid enough attention to health programs to improve her educational opportunities, recreation, and quality of life? Are health staff prepared to give attention to this age group? In particular, has nursing staff focused on the care of adolescents in general and specifically of the pregnant teenager?
Care goes beyond helping and assisting, it is not only procedures. According to Colliere,8 care is primarily an act of life, representing an infinite variety of activities to maintain and preserve life, to allow it to continue and reproduce. In other words, the author asks us to reflect on the need for society in general and teenagers in particular to have nursing professionals conscious of this action, so that care for people is a responsibility and an affective and effective commitment to one another, an essential caring that is a fundamental part of our being.9
The purpose in this study was to identify and describe the perception of health and sexual and reproductive behavior of pregnant teenagers. Somehow, having a better understanding that teenage pregnancy is not accidental nor strictly biological, is a complex problem with serious consequences for health and development of the adolescent and family.
A descriptive study was conducted in a random sample of 200 cases of 1001 pregnant adolescents 13 to 19 years enrolled in health centers. The data were collected by the Encuesta sobre Embarazo en Adolescentes (EEA), its design took as reference the Questionnaire for the study of sexual and reproductive health of adolescent boys and young men in Latin America (Lundgren, R. Washington OPS 2000)11 and the survey on reproductive health of middle and high school students (Menkes Bancet Catherine, Centro Nacional de Investigaciones Multidisciplinarias. UNAM. Mexico 2003).12
The EAA was structured with a total of 78 reagents, the answers were designed for the participant to choose one or more options; for quantitative variables, the response options were closed, the other responses were on the Likert scale with options ranging from very good to very bad. It consisted of six sections: I) General data and situation, II) Characteristics of the family of origin, III) Knowledge and use of contraceptive methods, IV) Sexual and reproductive life, V) Prenatal care, health status, and emotional state, VI) Relationship and life plan.
SPSS version 15 was used for data analysis. Percentages and averages were obtained. Informed consent was obtained in writing guaranteeing anonymity and confidentiality, when the teenager was under 18, consent was given by a legal adult companion.
The average age was 17 years, 73% were between 17 and 19 years old; a little more than half (53%) had basic schooling of 6 to 9 years of school; marital status was married with 72%, although a lesser proportion also cohabitate with their civil partner, so it can be inferred that the births occurred within marriage or life with a partner. 50% of adolescents were going to school before pregnancy and stopped during pregnancy to work in the home; 61% of the mothers of the teen girls had their first child before they were 19 years old.
95% of teenagers started sexual life before 17 years of age and their first sexual intercourse was at age 15, with the person they call their "partner" or "boyfriend"; on this topic some authors claim that in the most deprived social groups, the onset of sexual life corresponds more to patterns of early marriage, so both events often occur simultaneously between the onset of menarche and first sexual intercourse.
The first pregnancy in these teens occurred between 16 and 18 years of age in 89% of cases, indicating a correlation of 0.7 between the onset of sexual and reproductive lives, because pregnancy occurred within six months after their first sexual intercourse. 31% of pregnant adolescents used contraception at first intercourse and 41% used some method before becoming pregnant. The reported proportion of contraceptive use at first intercourse and before pregnancy can be interpreted based on the gender and power relationship between men and women regarding contraceptive use as a measure of protection for sexually transmitted diseases and prevention from unwanted pregnancy (Table I).
|Table I. Sexual and reproductive behavior of pregnant adolescents|
(n = 200)
|Menarche (12-14, x = 11 years)||142||71|
|First sexual intercourse before age 17 (media = 15)||190||95|
|First pregnancy before age 18 (media = 16.5)||178||89|
|Adolescent aged under 17 at birth of her first child (media = 16.3)||156||78|
|Contraceptive use at first intercourse||Frequency
(n = 92)
|Contraceptive use before first pregnancy|
Among the reasons mentioned by teens for not using contraception it is relevant to point out that the partner did not want to use any method (17%), she did not dare to ask her partner to use it (12%), and fear of being hurt (12%).
In general, use of any contraceptive depends on three factors: the decision of the partner, wanting to become pregnant, and lack of information. Other reasons include lack of knowledge about its use, ignorance and indecision, because they believe that methods fail, because they did not think they would get pregnant, because they only had sex once, or because they did not plan to have sex. When studying teen pregnancy from a gender perspective, it is mentioned that teenage girls do not have the bargaining power or emotional capacity to decide if they really want to have sex or whether to use contraception. It is mentioned that young women lack real power in relationships with men.13
It was identified that 76% of the teens were on their first pregnancy and 24% were on their second, third, or fourth pregnancy. One of the factors directly related to adolescents’ likelihood of getting pregnant is the socioeconomic condition they are in, 67% did not plan the pregnancy and 72% say they would have liked to have their first child between 20 and 29 years old.
The average number of prenatal visits during pregnancy was three in 54% of adolescent girls, the first medical consultation was during the first two months of pregnancy, less than recommended by the NOM-007-SSA2-1993,10 which reports on the care of women during pregnancy, childbirth, postpartum, and the newborn. The health risks of pregnant adolescents are related to the lack of prenatal care. Medical visits or home visits by nursing staff ensure frequent monitoring of the health of the expecting mother.
In this regard, 40% of teens reported the presence of pathophysiological and emotional symptoms during pregnancy, some of the warning signs were vaginal bleeding, headache, and signs related to hypertension and urinary tract infection (Figure 1); there were also reports that they sometimes feel sadness, nervousness, anxiety, difficulty sleeping, and lack of desire to communicate and carry out daily activities (Figure 2).
Figure 1. Pathophysiological symptoms reported by pregnant adolescents (n = 200). Source: Results of EEA, 2013.
Figure 2. Figure 2. Emotional symptoms reported by pregnant adolescents (n = 200). Source: Results of EEA, 2013.
As for the perceived health status of adolescents during pregnancy, 58% of them considered it between excellent and good. The perception of one’s own health status influences the approach to medical services and self-care practices (Figure 3).
Figure 3. Figure 3. Health status perceived by adolescents during pregnancy (n = 92). Source: Results of EEA, 2013.
The World Health Organization Health11 mentions that during pregnancy, adolescents are more likely than adults to present emotional stress, eat a poor quality diet, and receive inadequate and late prenatal care, a situation confirmed by the adolescents in this study than on average had three doctors’ visits during the period of pregnancy, although the organization recommends at least five to six prenatal visits.
Some common complications during pregnancy in adolescents that affect maternal or child health are premature birth, low birthweight, and urinary and vaginal tract infection; these changes coincide with those reported by the teens in terms of urinary tract infection and symptoms related to hypertension and preeclampsia.
Furthermore, pregnancy in adolescents is associated with conditions of great social disadvantage, that is, it is more common in poor socioeconomic levels with predominantly low educational levels, unskilled occupations, and low compensation that results in a high proportion single mothers, most often without family support and poor access to health services. These characteristics were identified in the teens in the study, with the maximum schooling having finished secondary school, working unpaid at home, and most not enrolled in any health institution.12
On the other hand according to Langer,13,15 this research agrees that in adolescents living in marginal urban areas and rural poverty where social groups have similar salary, education, and living conditions, pregnancy can be a health problem for both the pregnant woman and the baby. In turn, Barrera Tapia14 pointed out that there is a higher incidence of teenage pregnancy in the most populous municipalities of Estado de Mexico territory such as Nezahualcoyotl, Ecatepec, Chalco, and Ixtapaluca, and much of the eastern part of Estado de Mexico.
Advancing the understanding of the reasons why teens become pregnant is the challenge we must face; further research will contribute to the study of sexual and reproductive behavior of this social group, with the aim of not only a cultural explanation, because this runs the risk of causing complacency and self-justification. The problem must be addressed institutionally, with intervention from all sectors involved.
Because of conditions in which the teenage women live, they are limited to participating in school and at work, and instead of gestating a new life, they could be caring for their own life, their life project. However, adolescents are involved in a crisis, and as experts in health and care we have to reflect on the following questions: Can they resist and make the change? Or should they resign themselves to being doomed to play a passive role? Is there any alternative between the ideal of expected behavior and freedom of action?