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Bried report

  1. 1. Journal of Adolescence 32 (2009) 715e721 Brief report: A socio-demographic profile of multiparous teenage mothers Maria de Fatima Rato Padin a,*, Rebeca de Souza e Silva b, Elisa Chalem a, ´ Sandro Sendin Mitsuhiro a, Marina Moraes Barros c, Ruth Guinsburg c, Ronaldo Laranjeira a a Department of Psychiatry, Federal University of S~o Paulo, S~o Paulo, Brazil a a b Department of Preventive Medicine, Federal University of S~o Paulo, S~o Paulo, Brazil a a c Department of Pediatrics, Federal University of S~o Paulo, S~o Paulo, Brazil a aAbstractObjective: Delineate a socio-demographic profile of multiparous teenage mothers at a public hospital inBrazil.Method: This is a cross-sectional study consisting of 915 interviews with teenage girls, including 170multiparous subjects whose babies were born alive.Results: The multiparous teenage mothers had the following average characteristics: 17.8 years old; firstpregnancy at 16 years; beginning of sexual life at 14.2 years; dropped out of school at 13.6 years; attendedschool for 6 years with only 10% still attending school when they were interviewed; 87.4% had prenatalexams; monthly income was reported to be 0.3% less than the national minimum salary.Conclusion: Teenage mothers are in need of better social, educational, and health care in order to have a greaterchance of a positive motherhood experience, thereby creating a better, healthier environment for their children.Ó 2009 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rightsreserved.Keywords: Adolescence; Adolescent pregnancy; Repeat pregnancy; Multiparity; Multiparous; Teenager * Corresponding author at: Av. Ibirapuera, 2907, cj 614, S~o Paulo, SP, Brasil. Tel.: þ55 (11) 5542 6389; fax: þ55 (11) a5579 5643. ´ E-mail address: (M. de Fatima Rato Padin).0140-1971/$30.00 Ó 2009 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.doi:10.1016/j.adolescence.2009.01.008
  2. 2. 716 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721Introduction Motherhood during the teenage years (age 10e19 years) is a complex issue because of theadded challenges of adolescence, according to the criterion used by the WHO (Barrell, 2003). There are studies showing negative outcomes of motherhood during adolescence, such as riskof pre-term birth, low birth weight, and high mortality related to pregnancy and birth (Fraser,Brockert, & Ward, 1995; Klein, 2005). There are also studies showing positive outcomes: higheducational achievement, personal satisfaction, and continuity in the pursuit of autonomy amongadolescent mothers (Amini et al., 1996; Seamark & Lings, 2004; Stevens-Simon, Kelly, & Singer,1996; Zeck et al., 2007). The variety inherent in these outcomes may be related to socio-economic factors. The differencein background among teenage mothers is a strong determinant of positive or negative outcomes.The literature suggests that a low socio-economic level generally leads to negative outcomes inearly pregnancy (Brand~o & Heilborn, 2006; Cunnington, 2001; Elfenbein & Felice, 2003; aMcLeod, 2001). Although multiparity is an increasingly common phenomenon (Elster, 1984), there are nostudies describing these adolescents. The objective of this study is to fill this gap by delineating thesocio-demographic profile of these multiparous teenage mothers.Methods This study used a sequential sample of 915 pregnant teenage girls who were admitted to the ´Childbirth School of the Obstetric Center of the Dr Mario de Moraes Altenfelder Silva MaternityHospital between July 2001 and November 2002. This hospital, which is located in the northern region of S~o Paulo in the neighborhood of aCachoeirinha, approximately 8 km from the city, is considered to be a level III care centerproviding for high risk pregnancies. The neighborhood has one of the highest rates of juvenilevulnerability, meaning this population presents with low family income, high rates of populationgrowth, a high proportion of adolescents in relation to the general population, and high rates ofschool dropouts, of violence and of teenage pregnancy. This region has a population of 147 649inhabitants, among whom 10.21% (15 075) are adolescents, with a demographic density of 352.9/km2 and a monthly family income of R$874.21. Among the 915 adolescents studied, 170 are multiparous, ranging in age between 11 and 19;63% were not attending school, 72% lived near the hospital and 93% belonged to the C (middle)and D (lower) economic classes (Chalem et al., 2007) according to the Brazil Economic Classi-fication Criterion 1997, defined by the Research Companies National Association in partnershipwith the Brazilian Advertising Association and in agreement with the Market Research InstitutesBrazilian Association. The Cachoeirinha Maternity and the Federal University of S~o Paulo (UNIFESP) Ethics aCommittees approved the study. A random quality check was carried out in 10% of the interviewsin order to increase the data reliability. The interviewers, who were not related to the hospital or to the present study, were specificallytrained for this task. Whenever the interviewers found it appropriate, social assistance and mental
  3. 3. M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721 717health resources were provided by the maternity center or by external resources, especially insituations of violence and mental disorders. The participants were included in the study according to the principles described above andupon their free and documented consent in the Obstetric Center after anesthetic recovery, withina period that ranged between 4 and 48 h after delivery. Without any previous contact, the womenwere approached in a collective ward since public wards in Brazil are collective Table 1. The participants were interviewed using a questionnaire based on the Perinatal NeedsAssessment (PNA), an instrument used in a study carried out in California that included 1147pregnant women, and was aimed at analyzing to what extent their social network affects the livesof such women. The questionnaire was translated and adapted to the Brazilian culture and to thepeculiarities of our population (Zahnd, Klein, & Needell, 1997). The following variables weretaken into account: identification data (age and address), socio-economic data (educational level,occupational situation, family income, and home conditions), pregnancy data (planning,contraceptive methods and prenatal exams), data on other children and on sexual activity(beginning of sexual activity, use of condoms and use of contraceptive methods). Student’s t-test was used to detect any differences in mean ages, beginning of sexual activity,and other independent variables concerning multiparous and primiparous girls. Pearson’s chi-square test was utilized to detect possible differential behavior between both groups of pregnantmothers regarding categorical variables, such as marital status, etc. A level of at least 5% wasconsidered significant in all tests performed.Results On average, multiparous teenage mothers were one year older than the primiparous ones.However, the former had their first pregnancy, on average, at the age of 16 years whereas thelatter at the age of 16.7 years. Regarding sexual life, the multiparous teenage mothers had their first experience 6 monthsearlier (14.2 years old) than the primiparous ones (14.7 years old), with both groups becomingpregnant 2 years later approximately. With respect to pre-natal exams, 97.4% of the primiparousgirls and 87.4% of the multiparous girls had done so. On the other hand, only 36.5% of themultiparous girls and 20.4% of the primiparous girls used contraceptive methods. The relationship between reproductive life and educational level was found to be differentregarding multiparous and primiparous teenage mothers. On average, the former had quit schoolearlier (13.6 years old) and initiated their sexual life at 14 years old approximately. In other words,school drop-out occurs almost concomitantly with the beginning of sexual life. They becamepregnant at 16 years old, on average, thus suggesting that the great majority of them were alreadyout of school; during the interviews only 10% said they were still going to school. Regarding the primiparous teenage mothers, however, they had quitschool at the age of15.9 years old, which coincides with the beginning of pregnancy (around 16.7 years old). Theprimiparous girls had higher educational level than the multiparous ones (8 versus 6 years ofelementary education, respectively), and 36.4% reported that they still go to school. Additionally, important differences exist regarding their life conditions, since the multiparousteenage mothers have a monthly income significantly inferior to the national minimum salary.
  4. 4. 718 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721Table 1Distribution of mean values and standard deviation regarding some risk factors for multiparity among teenagers,according to degree of parity and statistical significances (P) for the respective hypothesis tests.Variables Primiparous (n ¼ 745) Multiparous (n ¼ 170) P-valueAge 16795 (1514) 17765 (1178) 0.000Age of first pregnancy 16733 (1744) 15988 (1546) 0.000Beginning of sexual life (n ¼ 660) (n ¼ 160) 0.000Time elapsed until first pregnancy 14,761 (1,507) (n ¼ 660) 14,225 (1,355) (n ¼ 660) 0.118Use of contraceptive methods 2,012 (n ¼ 20.4%) 1,825 36.5% 0.000Pre-natal exams (%) 97.4 87.4 0.000School drop-out age 15953 (1921) 13618 (2634) 0.000Attending school nowadays (%) 36.4 10 0.000Period of time out of school 0.780 (1175) 2371 (2005) 0.000Years of Education 7826 (2198) 6465 (2481) 0.000Monthly income 3021 (1121) 2710 (0940) 0.001 ´Adolescent mothers were from the Dr Mario de Moraes Altenfelder Silva Hospital, 2003.Discussion The data gathered in this research confirmed that early motherhood among low-income youngwomen is an indicator of a more probable multiparity (Blankson et al., 1993; Matsuhashi, Felice,Shragg, & Hollingsworth, 1989). The few studies geared to motherhood and pregnancy of adolescents with a middle/high socio-economic profile have led us to believe that the impact of this event does not bring as muchinconvenience to this population as it does to the low socio-economic level adolescents whoalready live in adverse conditions. The precarious socio-economic and educational levels of much of the population in developingcountries make it much more difficult to obtain positive outcomes in teenage pregnancy andmotherhood (BENFAM, 1996). Even in developed countries, such as the United States, there isa negative outcome for teenage motherhood in cases where there are low educational and incomelevels. The primiparous girls in our study dropped out of school in the beginning of their pregnancies,a finding which is in accord with studies that demonstrated a relationship between pregnancy andschool dropout (Barnet et al., 2004; Sweeney, 1989). However, most multiparous girls in our study had quit school long before becoming pregnant,which indicates that school dropout is not a result of the pregnancy and that the low educationallevel was attained prior to their pregnancies. The family background of these young women was not assessed. Therefore, it was not possibleto conduct a more complex analysis about the repetition of parental models or the influence offamily background factors in the negative outcomes of teenage pregnancy and motherhood. Repeated pregnancy in adolescence makes us consider the possibility that these girls desired tobecome pregnant and carry the pregnancy to full term (Atkin and Alatorre-Rico, 1992). More-over, in lower social classes, the status of motherhood is often related to a more prominent socialstanding. In other words, there is a change in the social status of the young women: they movefrom being viewed as adolescents to attaining the social identification as mothers.
  5. 5. M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721 719 Nowadays, particularly in Brazil, public health measures disregard these young women’spsychosocial needs and invest only in preventive programs for pregnancy, STDs and AIDS(Creatsas and Elsheikh, 2002; Klerman, Baker, & Howard, 2003). Although the present study is not conclusive, it is clear that social programs should go farbeyond the preventive approach and address the true needs of these adolescents. Governmentsshould focus on measures aimed at minimizing the impact that pregnancy, motherhood andmultiparity can bring to the lives of low income girls who already experience a great deal ofdifficulty. There are few studies in the literature about the impact of adolescent multiparity indeveloping countries. Some public health measures that could lead to positive outcomes in teenage pregnancy andmotherhood include: Stimulate and monitor prenatal medical appointments through financial support. Provide training for essential baby care that could facilitate the mother/baby relationship. Promote family planning beyond the contraception, STD’s and AIDS prevention focus, giving support to developing the girls’ knowledge about their own sexuality and reproductive health. Include the adolescent’s parents as a support system for the girls’ sexual guidance and individual growth process. The parents’ approval of the decision to use contraceptives would be important. The parents could also be a key factor in helping to stabilize the adolescent mother’s life. Offer special programs with financial incentives for the adolescents to continue studying (currently there is only a financial incentive for children to continue studying in Brazil). Offer special school programs adapting class schedules and demands so that the young mother can integrate motherhood and her studies. Build nurseries in secondary schools that would admit both the employees’ and the students’ children. If applied, the measures described above would confirm previous studies of adolescentsshowing that support from the family, the health system, and the educational system diminishesthe school dropout rates and obstetric complications, and contributes to the improvement ofmaternal care (Akinbami et al., 2000).Study limitations The interviews were carried out after the anesthetic recovery period to make sure that thewomen would not be discharged before we got a chance to talk to them since the mothers who hadhad a natural labor would leave the hospital 24 hours after delivery. The interviews were carried out in collective wards due to the accommodation in publichospitals in Brazil.Lessons learned The implementation of special programs for both primiparous and multiparous teenage pregnantgirls should be carried out by a multidisciplinary team (psychologists, doctors, social assistants,
  6. 6. 720 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721neonatal nurses, and educators) so that these mothers’ specific needs can be addressed. Moreover,these programs should enable teenage mothers to pursue their autonomy and personal growth.Acknowledgements Financial support was kindly provided by Fundac~o de Amparo a Pesquisa de S~o Paulo- ¸a ` aFAPESP Grant number: 00/ 10293-5ReferencesAkinbami, L. J., Schoendorf, K. C., Kiely, J. L. (2000). Risk of preterm birth in multiparous teenagers. Archives of Pediatrics Adolescent Medicine, 154, 1101e1107.Amini, S. B., Catalano, P. M., Dierker, L. J., Mann, L. I. (1996). Births to teenagers: trends and obstetric outcomes. Obstetrics and Gynecology, 87, 668e674.Atkin, L. C., Alatorre-Rico, J. (1992). Pregnant again? Psychosocial predictors of short-interval repeat pregnancy among adolescent mothers in Mexico City. Journal of Adolescent Health, 13, 700e706.Barnet, B., Arroyo, C., Devoe, M., Duggan, A. K. (2004). Reduced school dropout rates among adolescent mothers receiving school-based prenatal care. Archives of Pediatrics Adolescent Medicine, 158, 262e268.Barrell, M. (2003). Adolescent motherhood in an inner city area in the UK: experiences and needs of a group of adolescent mothers. Journal of Practicing Midwife, 6, 21e24.BENFAM. (1996). The National Research about demography and health. Family Welfare Civil Society in Brazil.Blankson, M. L., Cliver, S. P., Goldenberg, R. L., Hickey, C. A., Jin, J., Dubard, M. B. (1993). Health behavior and outcomes in sequential pregnancies of black and white adolescents. Journal of the American Medical Association, 269, 1401e1403.Brand~o, E. R., Heilborn, M. L. (2006). Middle-class teenage sexuality and pregnancy in Rio de Janeiro, Brazil. a ´ Sexualidade e gravidez na adolescencia entre jovens de camadas medias do Rio de Janeiro, Brasil. Cadernos de Sau´de ˆ Pu´blica, 22, 1421e1430.Chalem, E., Mitsuhiro, S. S., Ferri, C. P., Barros, M. C., Guinsburg, R., Laranjeira, R. (2007). Teenage pregnancy: behavioral and socio-demographic profile of an urban Brazilian population. Gravidez na adolescencia: perfil socio- ˆ ´ demografico e comportamental de uma populac~o da periferia de S~o Paulo, Brasil. Cadernos de Sau Pu´blica, 23, ´ ¸a a ´de 177e186.Creatsas, G., Elsheikh, A. (2002). Adolescent pregnancy and its consequences. European Journal of Contraception Reproductive Health Care, 7, 167e172.Cunnington, A. J. (2001). What’s so bad about teenage pregnancy? Journal of Family Planning and Reproductive Health Care, 27, 36e41.Elfenbein, D. S., Felice, M. E. (2003). Adolescent pregnancy. Pediatric Clinics of North America, 50, 781e800.Elster, A. B. (1984). The effect of maternal age, parity, and prenatal care on perinatal outcome in adolescent mothers. American Journal of Obstetrics and Gynecology, 149, 845e847.Fraser, A. M., Brockert, J. E., Ward, R. H. (1995). Association of young maternal age with adverse reproductive outcomes. New England Journal of Medicine, 332, 1113e1117.Klein, J. D. (2005). Adolescent pregnancy: current trends and issues. Pediatrics, 116, 281e286.Klerman, L. V., Baker, B. A., Howard, G. (2003). Second births among teenage mothers: program results and statistical methods. Journal of Adolescent Health, 32, 452e455.Matsuhashi, Y., Felice, M. E., Shragg, P., Hollingsworth, D. R. (1989). Is repeat pregnancy in adolescents a planned affair? Journal of Adolescent Health Care, 10, 409e412.McLeod, A. (2001). Changing patterns of teenage pregnancy: population based study of small areas. British Medical Journal, 323, 199e203.
  7. 7. M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721 721Seamark, C. J., Lings, P. (2004). Positive experiences of teenage motherhood: a qualitative study. British Journal of General Practice, 54, 813e818.Stevens-Simon, C., Kelly, L., Singer, D. (1996). Absence of negative attitudes toward childbearing among pregnant teenagers. A risk factor for a rapid repeat pregnancy? Archives of Pediatrics Adolescent Medicine, 150, 1037e1043.Sweeney, P. J. (1989). A comparison of low birth weight, perinatal mortality, and infant mortality between first and second births to women 17 years old and younger. American Journal of Obstetrics and Gynecology, 160, 1361e1367.Zahnd, E., Klein, D., Needell, B. (1997). Substance use and issues of violence among low-income, pregnant women: The California Perinatal Needs Assessment. Journal of Drugs Issues, 27, 563e584.Zeck, W., Bjelic-Radisic, V., Haas, J., Greimel, E. (2007). Impact of adolescent pregnancy on the future life of young mothers in terms of social, familial, and educational changes. Journal of Adolescent Health, 41(4), 380e388.