ORIGINAL RESEARCH

 

What is and how can be explained pregnancy in adolescence

 

 

Kallyne Rubyan Oliveira Queiroga^I; Maria do Carmo Andrade Duarte de Farias^{II, VI}; Geofabio Sucupira Casimiro^III; Aissa Romina Silva do Nascimento^IV; Paula Christianne Gomes Gouveia Souto Maia^V; Kennia Sibelly Marques de Abrantes^{IV, VI}; Vitor Engrácia Valenti^VI; Luiz Carlos de Abreu^VI

^IEnfermeira pela Universidade Federal de Campina Grande, Centro de Formação de Professores, Cajazeiras, PB
^IIProfessor Associado. Universidade Federal de Campina Grande, PB. Pesquisadora em nível de Pós-doutorado
^IIIBioquímico, professor da Universidade Federal de Campina Grande, Centro de Formação de Professores, Cajazeiras, PB
^IVMédica. Especialista em Saúde da Família e do Trabalhador. Professora da Universidade Federal de Campina Grande/CFP, Cajazeiras, PB
^VBioquímico, professor da Universidade Federal de Campina Grande, Centro de Formação de Professores, Cajazeiras, PB, professora da Universidade Federal de Campina Grande, Centro de Formação de Professores, Cajazeiras, PB
^VILaboratório de Delineamento de Estudos e Escrita Científica. Departamento de Saúde da Coletividade. Faculdade de Medicina do ABC

 

 

---

ABSTRACT

INTRODUCTION: The inconsequential exercise of sexuality may generate innumerous conflicts and interfere wityh each adolescent's plans for the future, resulting in early pregnancy, for example.
OBJECTIVE: Describe the ideas associated to the subject pregnancy in adolescence.
METHODS: This is a systematic revision with scientific production about pregnancy in adolescence disseminated in health science journals, in the period of 2006 to 2010. It has a quantitative and qualitative approach to the data. The total analyzed samples were 20 articles. The data collection instrument was a structured script containing objective and subjective questions. The quantitative data was presented in tables, the subjective, in charts, reflected through thematic analysis (Bardin).
RESULTS: The findings revealed negative feelings, among others, associated to the pregnancy during adolescence and its occurrence to psychological and socio-economic factors.
DISCUSSIONS: The pregnancy in adolescence can be seen as a period of search for identity, occurring due to rebelliousness, many times experienced in relation to their families and to the historical and social context. However, its explanation is multifactorial.
CONCLUSION: This phenomenon may be something that is experienced positively or negatively, in a desired or undesired form, with or without family support. Therefore, it is necessary a holistic view of the fact. Hopefully this study may clarify questions regarding pregnancy in adolescence and may cooperate to establish preventive and educational actions.

Key words: pregnancy in adolescence. scientific research. systematic revision.

---

 

 

INTRODUCTION

The term adolescence derives from Adolecere, a Latin Word which means grow, develop, become a Young adult. It consists in an evolutionary stage of human development. Therefore, being the transition between childhood and adult age, definite for the formation of the individual's personality This is an experience permeated by psychic spaces, of external and internal limits.

In order to better understand this transition state one must analyze it in its totality, taking into consideration the biological, economical, psychological, social or cultural factors, because it is exactly this set of aspects which unifies the phenomenon of adolescence².

The World Health Organization (WHO), in accordance with the Health Ministry (HM), defines as an adolescent the people who correspond to the 10 to 19 age group, and may be divided in two stages: 10 to 14 years of age and 15 to 19 years of age. The statute of the child and the adolescent, through the Law number 8.069/90, defines that the adolescence corresponds to the period of life which ranges from 12 to 18 years of age³.

The world's population of adolescents corresponds to more than a billion. So that 60 of each 1000 girls from 10 to 19 years of age become mothers, the equivalent to the birth of 17 million new born, on average, each year. According to the IBGE (Brazilian Institute for Geography and Statistics), in Brazil, in 2010, the female population corresponding to the 10 to 19 age group was approximately of 17 million⁴. The outlined data implies in the development of economical, social, educational, cultural, work, justice, sport, entertainment actions, among others; aiming to meet the needs of this age group.

Despite the several controversies related to the delimitation of the start and end of adolescence, puberty allows the identification of its beginning. This, in turn, is marked by the growth and development of the secondary sexual characteristics, sexuality awareness, structuring of the personality and the body image⁵.

In this period becomes evident the transformation in the intellectual and affective Field, demonstrated by an alleged rebellious attitude, a certain isolation, attachment and exaggerated influence from a determined social group which they take part, adoption of new ways of dressing, speaking and relating to others, in addition to episodes of depression, sadness and euphoria. Currently, the health and relational social life are constantly approached in the different forms of media. These, in turn, dictate many forms of how to live their own bodies, how the relationships with others must be, and the sexuality, among other aspects⁶.

The interaction of the biological, psychological, social, economical, political, cultural, ethical, legal, historical, religious and spiritual factors influenced the sexual practices of each social group⁷.

The sexuality is unavoidable, inexorable and irremovable in the human being from birth, and in the adolescence it starts to be experienced with more intensity⁸. It may be defined by the desire of contact, warmth, affection or love; manifested by the look, kiss, self-pleasure and production of mutual orgasm. It is also perceived by the thoughts, fantasies, desires, opinions, attitudes, values, behaviors, practices and in the relationships⁹.

Men and women have initiated their sexual life increasingly earlier. If we analyze the studies carried out among Brazilians we may observe a tendency of anticipation of the start of the sexual life, mainly among women, who are experiencing their first sexual intercourse increasingly younger.

The Health Ministry carried out a study, in which was observed that, in 1984, the average age for the initiation of sexual life was at 16, among women of 16 to 19 years of age. While in 1998, the verified mean age decreased to 15 years old. Furthermore, the number of adolescents of the male gender who had their first sexual intercourse up to the age of 14 was 35,2%, in 1984, while in 1998, this percentage rose to 46,7%. Regarding the estimate of women who had their first sexual intercourse before the age of 14, it practically doubled between 1984 and 1998 (13,6% and 32,3% respectively)¹⁰

It is common to notice behavioral alterations in the adolescents' exercise of sexuality, in a way that this fact has been the object of study and intervention of public policies. The exercise of sexuality in an inconsequential form may generate several conflicts and interfere in the plans for the futures of each adolescent, resulting in early pregnancy, abortion, sexually transmitted infections/ acquired immunodeficiency syndrome (DST/AIDS), early school leaving , marginality , etc.

The phenomenon of pregnancy in adolescence has called the attention of the authorities of underdeveloped and developed countries. In Brazil, the research carried out by the National Demographic and Health Survey demonstrates a rise in the fecundity among women aged 15-19, in opposition to the significant drop in women of the age group between 20-24. This tendency is accentuated in the eighties and nineties. The average fecundity age, in Brazil, declined from 28,9 years of age to 26,3 years of age^11,12. The fact has been alerting several health professionals, such as: Social workers, psychologists, doctors, nurses, besides the educational professionals and the family.

Pregnancy in the adolescence proceeds, many times, from the non or inadequate use of contraceptive methods. In this way, the preventive actions should not simply include the offer of female and male preservatives or the other contraceptive methods, but also, should guarantee the exchange of experience, account of their lives and the reception of information which favors the adoption of healthy habits¹³.

Among the various arguments used to explain the occurrence of these facts, stand out the demographic, educational, sexual and contraceptive behavior variables, psychosocial factors related to the adolescent and their families. Besides the factors of biological and socio-cultural nature, such as the immaturity of the reproductive system, inadequate weight gain during the pregnancy, early initiation of sexual life, greater frequency of sexual intercourse, poverty, and social marginality, combined to the lifestyle adopted by the adolescent, the lack of ante-natal care, low levels of instruction and a lower expectation of professional performance for the future^11,14.

Pregnancy in the adolescence may cause a greater risk of low-birth weight (LBW) and prematurity, which are pointed out as being the main responsible for the greater morbidity and mortality rates in the newborn's first year of life. It is pointed out as a consequence of the early gestation the exposure to abortions, affective troubles, regarding the woman and the newborn, propensity to low self esteem and depression, emotional consequences resulting from unstable conjugal relations¹¹.

In view of the exposed, the pregnancy in adolescence has concerned many specialists and researchers. This fact is detected by the publication of large numbers of research on this issue, in books, chapter of books, journals, newspapers, sites etc.. by a wide range of professionals. Local, regional, national and international events of a wide range of professional categories are also occasions where research on this theme is disseminated. Besides the oral presentations or in panels, the abstracts of these works are published in the annals of these events.

Thus, the aim is to describe the ideas associated to the theme pregnancy in adolescence.

 

METHODS

This is a systematic revision¹⁵, which used as a data source the dissemination of research approaching the subject pregnancy in adolescence, published in the healthcare field journals, which include investigations in the nursing area.

Having chosen the theme and the delimitation of the problem to be investigated, a bibliographical survey of the publications about pregnancy in adolescence was carried out, in the libraries and on the Internet. Catalogues, books, manuals, abstracts, specialized journals, databases, newspapers etc.. Were consulted, and MEDLINE, PubMed and SciELO were highlighted , on which a dynamic reading was performed , allowing an overview of the topic in question and the specific delimitation of the problem. When the bibliographical survey was concluded, the works that theoretically base this study were selected, the ones which appear in the bibliographic citations of this research.

The journals were selected between September and October 2011, by research on the Internet in the sites www.bireme.br and www.scielo.br (Scientific Electronic Library Online) , to select the national and international journals, with indexation in the ISSN; contained in the Qualis list, preferably A1and A2, with national and international circulation , which were representative to nursing (considering that the aim of this research was the end of course paper for the Graduation Course in Nursing with the title: The analysis of scientific production about pregnancy in adolescence (Graduate Nursing Program) - Federal University of Campina Grande, 2011) Apart from these sites, the specific sites for each journal selected in this research were consulted.

The Scientific Electronic Library Online - SciELO is an electronic library which contains a selected collection of Brazilian scientific journals. The SciELO is a result of a research project of the Research Support Foundation of the State of São Paulo (FAPESP), in partnership with the Latin American and Caribbean Center on Health Sciences Information (BIREME). As from 2002, the Project is supported by the National Council for Scientific and Technological Development (CNPq), and has an aim the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific production in electronic format¹⁶.

The process of selection of the journals was thorough and detailed. In the consults carried out , a total of 06 journals were separated , with Qualis A₁ and A₂, published during the period from 2006 to 2010, i.e. : Latin American Nursing Journal, Acta Paulista de Enfermagem Journal, USP Nursing School Journal, Text and Context Nursing Journal, Public Health Journal and Public Health Publication.

The delimited period of time of 05 years is justified as it is considered satisfactory to carry out the proposed analysis, once that, in this time many changes may occur in the social, economic and in the health policies, in Brazil, which, without doubt, may influence in the results of the research projects developed in such areas.

After the separation of the journals published in the delimited time, the abstracts of all the fascicles were read, while the article that focused on the object of this study: Pregnancy in adolescence , was highlighted. Were identified 23 articles that had in their titles or in their keywords the expressions pregnancy, gestation or fecundity in adolescence. From these 23 articles 3 were excluded, since these were not original articles.

As a data collection instrument a structured script was used, formulated contemplating items which allowed learning from the analyzed articles: the descriptors, qualifications and professional activity of the main author, idea associated to the topic and explanation about pregnancy in adolescence.

The instrument was tested with a single article¹⁷ about pregnancy in adolescence, published in a period previous to the proposed one for the collection of this research. This test permitted to identify the adequacy of the script for the definite collection of data.

With the script for the collection at hand, the findings were collected through the thorough and careful reading of all the selected articles. As each article was read, notes were made contemplating the constant items in the referred script. The collection was carried out in the month of October 2011.

The analysis of the data was based on a quantitative and qualitative approach. In quantitative terms, the following variables were investigated: the journal's title; the year of publication; qualifications and professional activity of the authors, which were represented in tables.

The qualitative data were reflected by means of content analysis, in its modality of thematic analysis¹⁸, which concerns the attachment of the common aspects, joined to the majority of the participants, associated to each theme.

The first step for the organization of the material was the separation of the articles by journal and year, for the construction of a planning table, to facilitate the checking, after the reading of each article. In this separation, the articles of the study were categorized with the initials of the journal, year and sequential order of reading and analysis.

After this, the qualitative analysis of the articles followed these steps:

• Initial reading and re-reading of the articles- each article was read to gain a panoramic insight of the author's rationale;
• Identification of the units of significance which emerged from the publication- it was attempted to ask a series of questions to the text to understand the content of the author's message;
• Discovery of the thematic / categories;
• Interpretation and discussion of the found thematic and categories - it was attempted to take our own position regarding the listed ideas
• From the reading, collection and analysis of the data emerged 02 topics:
• Ideas associated to pregnancy in adolescence;
• Explanations about the occurrence of pregnancy in adolescence

In the reading and comprehension of each topic various categories were listed. After this classification and aggregation, the categories referring to each topic were presented in tables and analyzed based on the literature.

 

RESULTS

CARACTERIZATION OF THE INVESTIGATED JOURNALS

Table 01 gives us the graphic visualization of the scientific production about pregnancy in adolescence in the period from 2006 to 2010

The table 2 presents the list of the main authors of the analyzed articles, according to their academic title and or academic qualifications.

ANALYSIS OF THE CONCEPTIONS EXPRESSED BY THE AUTHORS IN THE INVESTIGATED ARTICLES ABOUT PREGNANCY IN ADOLESCENCE

In order to facilitate the analysis of the information obtained from the investigated scientific articles, 2 topics were identified and grouped into categories expressed in charts. Which are: Ideas associated to pregnancy in adolescence (Chart 1) and explanations for the occurrence of pregnancy in adolescence (Chart 2).

 

DISCUSSION

ABOUT THE INVESTIGATED JOURNALS

According to the table 01 is display the graphic visualization of scientific production about pregnancy in adolescence in period from 2006 to 2010. 3752 studies were produced and published in these journals, excluding only those of bibliographical revision. In this period 20 articles had in their descriptors the words "pregnancy in adolescence", becoming target of our study. Thus, were published about the topic, 10 articles in the Public Health Publication, 4 in the Public Health Journal, 3 in the Acta Paulista de Enfermagem Journal. The journals: Latin American Nursing Journal, USP Nursing School Journal and the Text and Context Journal published 1 article, each.

As already mentioned, the choice of the journals was carried out based on their Qualis . In this manner, the Latin American Nursing Journal and the Text and Context Journal , as they have national and international circulation, affiliated to the Brazilian Association of Scientific Editors - ABEC and appear in the most important national and international indexing bases. We chose the USP Nursing School Journal, the Acta Paulista de Enfermagem Journal, Public Health Journal and the Public Healthy Publication as they are national reference in the Nursing area and Health area, and they have Qualis A₁ - A₂ , and they all appear in the Scientific Electronic Library¹⁶.

The table 02 disposes of the qualifications and academic titles of the main author of the analyzed articles, and is composed of 10 professors with doctorate degrees, 2 professors with master's degrees, 3 Post doctorate, 3 specialists and 2 Assistentialists.

Not all the articles contained the information about the qualifications / academic titles of the main author, so that it would contemplate the objective of our study. Therefore, a search for this data was carried out accessing the curriculum lattes of each main author, in the CNPq lattes platform¹⁹.

Table 2's findings point to the fact that the development of the research is closely linked to the academic world. This tendency has been observed since 1970 and has been extending for more than 20 years, in a way that not only the development of research, but also its infrastructure is essentially tributary to the expansion of the post graduation program, all of this propitiated by the hegemonic models of the universities, where the people are to develop the scientific works and there is the necessary financial support for research²⁰. It is worth emphasizing that this structural model was analyzed and what is expected is a growing and gradual inversion of the relation research and teaching. In this respect, teaching shall seek research to develop itself.

CONCEPTIONS EXPRESSED BY THE AUTHORS OF THE INVESTIGATED ARTICLES IN RELATION TO THE PREGNANCY IN ADOLESCENCE

The table 01 expresses the ideas of the authors in relation to the pregnancy in adolescence, so that 15 demonstrated negative feelings, 6 positive feelings, 15 associated it with a public health problem and/or a social problem, 2 made reference to this period as a transition time, search for identity and 1o used words such as early, challenge and phenomenon so as to define the topic.

In chart 01 to contemplate various ideas associated to pregnancy in adolescence initially were grouped all of those which corresponded to negative feelings, and in 15 articles, being these feelings: "something bad, unpleasant surprise, something not planned, complication, threat to the future, obscure moment, difficult situation, conflicted situation, painful situation, doubtful moment, moment of desire, moment of contestation, serious situation and critical period".

The pregnancy in adolescence becomes a complicated period, a threat to the future, an obscure moment, a doubtful moment, contes-tation and desire, due to the need of restructuring and readjustment, mainly, regarding the psychological variable , the biochemical variable and the socio-economic sphere, generating physical, emotional and social risks for the young people involved²¹.

As for the authors who made reference to the awakening of positive feelings (6 articles) regarding the pregnancy in adolescence, they expressed ideas, such as: "it is not always something unforeseen; it contributes to the adolescent and family's development, satisfactory period". However, this phenomenon does not always happen in an unexpected or is an unpleasant thing. It may be associated to the accomplishment of a project for the adolescent, a kind of permission to enter the adult`s world, involving complex dimensions and which are bound to status change and reaffirming of social ascension projects^22:780

Furthermore, many times, young people experience very difficult situations, lack of educational and professional opportunities, and lack of access to a quality service, among other things, so that all of this may contribute so that the occurrence of pregnancy in the adolescence period may be experienced as a hope of building a better future, satisfactory period²³. There also are authors who believe that this period may contribute to the adolescents and their family's development, due to the fact that both experience a mix of feelings, impregnated by various meanings and experiences²⁴.

We found in 15 articles the idea that pregnancy in adolescence is associated to a public health / social problem. For some authors, the pregnancy in adolescence becomes a public health problem, due to the increase of this phenomenon's occurrence, being proven in various researches both in Brazil and in several other places in the world, generating biological, social and psychological consequences ²⁵. Others, however, claim that the pregnancy in adolescence becomes a social problem, since the fact may go against all the projects which society prescribes to the individual²³.

The pregnancy in adolescence was also associated to a period of transition/search for identity (2 articles). In this sense, the pregnancy in adolescence may be interpreted as being a phenomenon, due to the fact that a passage from the situation of daughter to become a mother occurs, originating a difficult situation, distressful. It may, also, be seen as a period of searching for identity, happening due to rebelliousness, many times experienced by the adolescents, regarding their families and the historical and social context where they are inserted²¹.

A grouping of concepts was also carried out, such as: "something premature, challenge and phenomenon" (10 articles). For some authors, this period is a great challenge which needs to be faced²³; for others, the fact that the pregnancy happened in adolescence makes it premature¹⁴.

The chart 02 addresses the explanation for the occurrence of pregnancy in adolescence, according to the authors. 12 claim that the premature menarche and the premature initiation of sexual activity are explanatory factors for the event, 10 attributed its occurrence to the non following of family guidance, or the lack of knowledge or non use of contraceptive methods, or still the difficulty to have access to health services; 8 attributed the occurrence to psychosocial, economical and cultural conditions; 3 to the low level of education. 2 to satisfy the spouse and to the short lasting relationships, 2 believed it was due to the fact that the young people, because of this, gain freedom from their parents home and start being seen as adults.

About the premature menarche (point by 0 authors as being the explanation), it is a fact that the average age presents nowadays a tendency to decrease, as it is observable that there is a decline of about four months, for four decades, corresponding to the age group of 11 to 12 years of age. National works have reported that, in the 1930's, it happened around the age of 13,6, 13,4 years of age in the 1940's; 12,8 years of age in the 1960''s and 12,6 years of age in the 1980's²⁶.

On the other hand, the premature menarche has been associated to the early start of the sexual relationships²⁶. The occurrence of pregnancy in adolescence happens because of the initiation, many times premature, of sexual activity; [...] they get pregnant because they surrender to their sexual impulses, stimulated by the promiscuous atmosphere of their homes and the involving society^27:1486.

According to the chart 02 , 10 authors suggest that the explanation for pregnancy in this age group is multifactorial , being the factors interlinked, being highlighted the lack of information, difficulty of access to contraceptive methods, poverty and situations of social marginality²⁸.

We understand that the psychosocial, economical, cultural conditions (referred to by 8 authors) and the low educational levels (referred to by 3 authors) are intimately related factors, once that the access to education and information is directly related to the occurrence of gestation, so that the higher the educational levels lower the rates of gestation in adolescence²⁹.

On the other hand, the occurrence of gestation in adolescence may be explained by the difficulty of access to health services, as, sometimes, the offer of health assistance sometimes does not offer time schedules compatible to the adolescents time, nor professionals prepared to assist them; and lack of care. All of these factors are linked to the young person's life condition, housing, time, purchasing power, habits and customs³⁰.

The pregnancy in the majority of adolescents is not planned, due to short term relationships, with a fragile bond, in which there not always is the control of conception, reflecting in the loss of contact with this partner during pregnancy and the care is assigned only to the woman³¹. This associated was referred to by one article.

The desire to "free themselves from their parents" was pointed out in 2 analyzed articles. Many adolescents become pregnant because they desire or believe that is their boyfriend`s desire, because they wish to be set free from their parents home, they want to be seen as adults, apart from receiving influence from cultural factors²¹.

We live in the midst of a society which remains in constant change, where each ay the values, thoughts and concepts are altered, in such a way that they may accompany the dynamics o time. In this respect, several controversies are observed regarding the delimitation of the beginning and end of adolescence and what really in fact sexuality is and what it involves. The sexual freedom, which is currently preached, leads young people to live their relationships many times in an inconsequent way, which leads to the non use of contraceptives and the exposure to STI.

In this context, is inserted the pregnancy in adolescence, frequently approached nowadays, as it presents a significant number in various studies, in Brazil and in the world. Within the various denominations and ideas which the authors use so as to define it, we prefer the denomination phenomenon.

Sometimes this phenomenon is something that may be experienced positively or negatively, in a desired or undesired way, with or without the family's support. Therefore, it is necessary to have a holistic vision of the fact, so that this young woman may be seen from the biological, social, cultural, psychological and economical aspect.

The explanations given by the authors for the occurrence of gestation in the adolescence are always associated to the relationships, be they family relationships, in which is expected that the family supplies them with the values and necessary guidance so that they may experience sexual activity in a safe way; be they a love relationship, in which the pursuit of the partner's satisfaction is above their will. It is also highlighted the accessibility to the health services to take away their doubts, shares their expectations, which many times does not happen.

With effect, it is observed that the factors pointed out as being explanatory for the pregnancy is adolescence are the same which many time appear as a consequence of the phenomenon in consideration. On the other hand, this cooperates for the maintenance of a cycle of poverty, educational deficit, and disqualification for their entry into the work market, generating a rise in cheap labor and informal work. Another important fact is the instability of the conjugal relationships and the emergence of new partnerships in a non consensual form. For many, the solution ends up being the choice of abortion, explained by the lack of support by the family and the partner.

In this circumstance, when describing the findings related to pregnancy in adolescence^{32, 33}, it is realized the need for improvement of the health assistance provided to this population, pointing out that the actions must implement the models proposed by the programs developed by the health ministry or be applied according to the need of each situation.

 

REFERENCES

1. Becker D. O que é a adolescência? 13ª ed. São Paulo, 2004.         [ Links ]

2. Oliveira TC, Carvalho LP, Silva MA. O enfermeiro na atenção à saúde sexual e reprodutiva dos adolescentes. Rev Bras Enfermagem. 2008 mai/jun; 61(3):306-11. DOI: 10.1590/S0034-71672007000500001        [ Links ]

3. Ministério da Educação (BR). Estatuto da Criança e do Adolescente. 3ª ed. Brasília: Câmara dos Deputados, 2001.         [ Links ]

4. Instituto Brasileiro de Geografia e Estatística. Sinopse dos Resultados do Censo 2010. Distribuição da população por sexo, segundo os grupos de idade. Disponível em: <http://www.censo2010.ibge.gov.br/sinopse/webservice/> Acesso em: 16 de agosto de 2012.         [ Links ]

5. Farias MCAD. Assistência de enfermagem à adolescente grávida à luz da teoria geral de enfermagem de Orem. 2003 [Tese de Doutorado em Enfermagem]. Fortaleza(CE): Departamento de Enfermagem, Universidade Federal do Ceará         [ Links ].

6. Santos DB, Silva RC. Sexualidade e normas de gênero em revistas para adolescentes brasileiros. Saude Soc. 2008 abr/jun; 17(2):22-34. DOI: 10.1590/S0104-12902008000200004        [ Links ]

7. Freitas KR, Dias SMZ. Percepções de adolescentes sobre sua sexualidade. Texto Contexto Enfermagem. 2010 abr/jun; 19(2):351-7. DOI: 10.1590/S0104-07072006000300001        [ Links ]

8. Silva MS, Silva MR, Alves MFP. Sexualidade e adolescência: é preciso vencer os tabus. Anais do 2º Congresso Brasileiro de Extensão Universitária Belo Horizonte. 2004; 12 a 15 de setembro.         [ Links ]

9. Alves AS, Lopes MHBM. Conhecimento, atitude e prática do uso de pílula e preservativo entre adolescentes universitários. Rev. Bras. Enfermagem. 2007 jan/fev; 61(1):11-7. DOI: 10.1590/S0034-71672007000500001        [ Links ]

10. Borges ALV. Relações de gênero e iniciação sexual de mulheres adolescentes. Rev. Esc. Enfermagem USP. 2007; 41(4):597-604. DOI: 10.1590/S0080-62342013000200001        [ Links ]

11. Gama SGN, Szwarcwald CL, Leal MC, Theme Filha MM. Gravidez na adolescência como fator de risco para baixo peso ao nascer no Município do Rio de Janeiro, 1996 a 1998. Rev. Saúde Pública. 2001; 35(1):74-80. DOI: 10.1590/S0034-89102013000100002        [ Links ]

12. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2000 - taxa de mortalidade infantil e fecundidade, 2002. Disponível em: <http://www.ibge.gov.br/home/presidencia/noticias/08052002fecundidade.shtm>. Acesso em: 2 set 2011.         [ Links ]

13. Gurgel MGI, Alves MDS, Vieira NFC, Pinheiro PNC, Barroso GT. Gravidez na adolescência: tendência na produção científica de enfermagem. Esc Anna Nery Rev Enferm. 2008 dez; 12 (4):799-05. DOI: 10.1590/S1414-81452007000200001        [ Links ]

14. Caputo VG, Bordin IA. Gravidez na adolescência e uso frequente de álcool e drogas no contexto familiar. Rev. Saúde Pública. 2008 jun; 42(3): 402-10. DOI: 10.1590/S0034-89102013000100002        [ Links ]

15. Linde K, Willich SN. How objective are systematic reviews? Differences between reviews on complementary medicine. J R Soc Med. 2003;96:17-22. DOI: 10.1177/0141076813501787        [ Links ]

16. SciELO. A Scientific Electronic Library Online. Disponível em: <http://www.scielo.br>. Acesso em setembro a dezembro de 2011.         [ Links ]

17. Costa MCO, Santos CAT, Sobrinho CL, Freitas JO, Ferreira KASL. Indicadores de saúde materno-infantil na adolescência e juventude: sociodemográficos, pré-natal, parto e condições de nascidos vivos. Jornal de Pediatria. 2001; 7(3):235-242. DOI: 10.1590/S0021-75572001000400001        [ Links ]

18. Bardin L. Análise de conteúdo. 70ª ed. Lisboa,1977.         [ Links ]

19. Ministério da Ciência e Tecnologia (BR). Plataforma lattes. Disponível em: <http://buscatextual.cnpq.br/buscatextual/busca.do?metodo=apresentar> . Acesso em: nov 2011.         [ Links ]

20. Guimarães R. Desafios da pós-graduação em saúde humana no Brasil. Rev. Saúde Pública. 2011; 45(1):1-13. DOI: 10.1590/S0034-89102013000100002        [ Links ]

21. Moreira TMM, Viana DS, Queiroz MVO, Jorge MSB. Conflitos vivenciados pelas adolescentes com a descoberta da gravidez. Rev Esc Enferm USP. 2008; 42(2):312-20. DOI: 10.1590/S0080-62342013000200001        [ Links ]

22. Hoga LAK, Borges ALV, Alvarez RE. Gravidez na adolescência: valores e reações dos membros da família. Acta Paul. Enferm. 2009; 6(22): 779-85. DOI: 10.1590/S0103-21002010000200001        [ Links ]

23. Carvalho GM, Merighi MAB, Jesus MCP. Recorrência da Parentalidade na Adolescência na Perspectiva dos Sujeitos Envolvidos. Texto & Contexto-Enfermagem. 2009 jan/mar; 18(1):17-24. DOI: 10.1590/S0104-07072006000300001        [ Links ]

24. Silva L, Tonete VLP. A gravidez na adolescência sob a perspectiva dos familiares: compartilhando projetos de vida e cuidado. Rev. Latino-Am. Enfermagem. 2006; 14(2):199-206. DOI: 10.1590/S0104-11692013000700019        [ Links ]

25. Belarmino GO, Moura ERF, Oliveira NC, Freitas GL. Risco nutricional entre gestantes adolescentes. Acta Paul Enferm. 2009; 22(2): 169-75. DOI: 10.1590/S0103-2100201 0000200001        [ Links ]

26. Berlofi LM, Alkmin EL, Barbieri M, Guazzelli CAF, Araújo FF. Prevenção da reincidência de gravidez em adolescentes: efeitos de um Programa de Planejamento Familiar. Acta Paul Enferm. 2006; 19(2):196-200. DOI: 10.1590/S0103-21002010000200001        [ Links ]

27. McCallum C, Reis AP. Re-significando a dor e superando a solidão: experiências do parto entre adolescentes de classes populares atendidas em uma maternidade pública de Salvador, Bahia, Brasil. Cad. Saúde Pública. 2006; 22(7):1483-91. DOI: 10.1590/S0102-311X2011000200001        [ Links ]

28. Brandão ER, Heilborn ML. Sexualidade e gravidez na adolescência entre Jovens de camadas médias do Rio de Janeiro, Brasil. Cad. Saúde Pública. 2006 jul; 22(7):1421-30. DOI: 10.1590/S0102-311X2011000200001        [ Links ]

29. Chalem E, Mitsuhiro SS, Ferri CP, Barros MCM, Guinsburg R, laranjeira, R. Gravidez na adolescência: perfil sócio-demográfico e comportamental de uma população da periferia de São Paulo, Brasil. Cad. Saúde Pública, Rio de Janeiro. 2007 jan; 23(1):177-86. DOI: 10.1590/S0102-311X2011000200001        [ Links ]

30. Carvacho IE, Mello MB, Morais SS, Silva JLP. Fatores associados ao acesso anterior à gestação a serviços de saúde por adolescentes gestantes. Rev. Saúde Pública [online]. 2008; 42(5):886-94. DOI 10.1590/S0034-89102013000100002        [ Links ]

31. Gontijo DT, Medeiros M. "Tava morta e revivi": significado de maternidade para adolescentes com experiência de vida nas ruas. Cad. Saúde Pública. 2008; 24(2):469-72. DOI: 10.1590/S0102-311X2011000200001        [ Links ]

32. Oliveira-Monteiro NR et al. Gravidez e maternidade de adolescentes: fatores de risco e de proteção. Rev Bras Cresc e Desenv Hum 2011; 21(2): 198-209.         [ Links ]

33. Suzuki CM, Ceccon MEJ, Falcão MC, Vaz FAC. Análise comparativa da frequência de prematuridade e baixo peso entre filhos de mães adolescentes e adultas. Rev Bras Crescimento Desenvolv Hum. 2007; 17(3): 95-103.         [ Links ]

 

 

Manuscript submitted Aug 01 2013
Accepted for publication Dec 28 2013

 

 

Corresponding author: carmo.andrade@ufcg.edu.br