1) The study examined a socio-demographic profile of 170 multiparous teenage mothers in Brazil. 2) On average, the multiparous teenage mothers were 17.8 years old, had their first pregnancy at 16 years old, began sexual activity at 14.2 years old, dropped out of school at 13.6 years old, and only 10% were still attending school. 3) The multiparous teenage mothers had a monthly income that was 0.3% less than Brazil's national minimum salary and faced greater challenges than primiparous teenage mothers due to lower educational and socioeconomic backgrounds.

1. Journal of Adolescence 32 (2009) 715e721
www.elsevier.com/locate/jado
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 a
Abstract
Objective: Delineate a socio-demographic profile of multiparous teenage mothers at a public hospital in
Brazil.
Method: This is a cross-sectional study consisting of 915 interviews with teenage girls, including 170
multiparous subjects whose babies were born alive.
Results: The multiparous teenage mothers had the following average characteristics: 17.8 years old; first
pregnancy at 16 years; beginning of sexual life at 14.2 years; dropped out of school at 13.6 years; attended
school for 6 years with only 10% still attending school when they were interviewed; 87.4% had prenatal
exams; 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 greater
chance 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 rights
reserved.
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)
a
5579 5643.
´
E-mail address: fatimaratopadin@yahoo.com.br (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. 716 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721
Introduction
Motherhood during the teenage years (age 10e19 years) is a complex issue because of the
added 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 risk
of 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: high
educational achievement, personal satisfaction, and continuity in the pursuit of autonomy among
adolescent 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 difference
in 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 in
early pregnancy (Brand~o & Heilborn, 2006; Cunnington, 2001; Elfenbein & Felice, 2003;
a
McLeod, 2001).
Although multiparity is an increasingly common phenomenon (Elster, 1984), there are no
studies describing these adolescents. The objective of this study is to fill this gap by delineating the
socio-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 Maternity
Hospital between July 2001 and November 2002.
This hospital, which is located in the northern region of S~o Paulo in the neighborhood of
a
Cachoeirinha, approximately 8 km from the city, is considered to be a level III care center
providing for high risk pregnancies. The neighborhood has one of the highest rates of juvenile
vulnerability, meaning this population presents with low family income, high rates of population
growth, a high proportion of adolescents in relation to the general population, and high rates of
school dropouts, of violence and of teenage pregnancy. This region has a population of 147 649
inhabitants, 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 partnership
with the Brazilian Advertising Association and in agreement with the Market Research Institutes
Brazilian Association.
The Cachoeirinha Maternity and the Federal University of S~o Paulo (UNIFESP) Ethics
a
Committees approved the study. A random quality check was carried out in 10% of the interviews
in order to increase the data reliability.
The interviewers, who were not related to the hospital or to the present study, were specifically
trained for this task. Whenever the interviewers found it appropriate, social assistance and mental

3. M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721 717
health resources were provided by the maternity center or by external resources, especially in
situations of violence and mental disorders.
The participants were included in the study according to the principles described above and
upon their free and documented consent in the Obstetric Center after anesthetic recovery, within
a period that ranged between 4 and 48 h after delivery. Without any previous contact, the women
were 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 Needs
Assessment (PNA), an instrument used in a study carried out in California that included 1147
pregnant women, and was aimed at analyzing to what extent their social network affects the lives
of such women. The questionnaire was translated and adapted to the Brazilian culture and to the
peculiarities of our population (Zahnd, Klein, & Needell, 1997). The following variables were
taken 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 pregnant
mothers regarding categorical variables, such as marital status, etc. A level of at least 5% was
considered 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 the
latter at the age of 16.7 years.
Regarding sexual life, the multiparous teenage mothers had their first experience 6 months
earlier (14.2 years old) than the primiparous ones (14.7 years old), with both groups becoming
pregnant 2 years later approximately. With respect to pre-natal exams, 97.4% of the primiparous
girls and 87.4% of the multiparous girls had done so. On the other hand, only 36.5% of the
multiparous girls and 20.4% of the primiparous girls used contraceptive methods.
The relationship between reproductive life and educational level was found to be different
regarding multiparous and primiparous teenage mothers. On average, the former had quit school
earlier (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 became
pregnant at 16 years old, on average, thus suggesting that the great majority of them were already
out 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 of
15.9 years old, which coincides with the beginning of pregnancy (around 16.7 years old). The
primiparous girls had higher educational level than the multiparous ones (8 versus 6 years of
elementary education, respectively), and 36.4% reported that they still go to school.
Additionally, important differences exist regarding their life conditions, since the multiparous
teenage mothers have a monthly income significantly inferior to the national minimum salary.

4. 718 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721
Table 1
Distribution 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-value
Age 16795 (1514) 17765 (1178) 0.000
Age of first pregnancy 16733 (1744) 15988 (1546) 0.000
Beginning of sexual life (n ¼ 660) (n ¼ 160) 0.000
Time elapsed until first pregnancy 14,761 (1,507) (n ¼ 660) 14,225 (1,355) (n ¼ 660) 0.118
Use of contraceptive methods 2,012 (n ¼ 20.4%) 1,825 36.5% 0.000
Pre-natal exams (%) 97.4 87.4 0.000
School drop-out age 15953 (1921) 13618 (2634) 0.000
Attending school nowadays (%) 36.4 10 0.000
Period of time out of school 0.780 (1175) 2371 (2005) 0.000
Years of Education 7826 (2198) 6465 (2481) 0.000
Monthly 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 young
women 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 much
inconvenience to this population as it does to the low socio-economic level adolescents who
already live in adverse conditions.
The precarious socio-economic and educational levels of much of the population in developing
countries make it much more difficult to obtain positive outcomes in teenage pregnancy and
motherhood (BENFAM, 1996). Even in developed countries, such as the United States, there is
a negative outcome for teenage motherhood in cases where there are low educational and income
levels.
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 and
school 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 educational
level was attained prior to their pregnancies.
The family background of these young women was not assessed. Therefore, it was not possible
to conduct a more complex analysis about the repetition of parental models or the influence of
family background factors in the negative outcomes of teenage pregnancy and motherhood.
Repeated pregnancy in adolescence makes us consider the possibility that these girls desired to
become 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 social
standing. In other words, there is a change in the social status of the young women: they move
from being viewed as adolescents to attaining the social identification as mothers.

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’s
psychosocial 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 far
beyond the preventive approach and address the true needs of these adolescents. Governments
should focus on measures aimed at minimizing the impact that pregnancy, motherhood and
multiparity can bring to the lives of low income girls who already experience a great deal of
difficulty. There are few studies in the literature about the impact of adolescent multiparity in
developing countries.
Some public health measures that could lead to positive outcomes in teenage pregnancy and
motherhood 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 adolescents
showing that support from the family, the health system, and the educational system diminishes
the school dropout rates and obstetric complications, and contributes to the improvement of
maternal care (Akinbami et al., 2000).
Study limitations
The interviews were carried out after the anesthetic recovery period to make sure that the
women would not be discharged before we got a chance to talk to them since the mothers who had
had a natural labor would leave the hospital 24 hours after delivery.
The interviews were carried out in collective wards due to the accommodation in public
hospitals in Brazil.
Lessons learned
The implementation of special programs for both primiparous and multiparous teenage pregnant
girls should be carried out by a multidisciplinary team (psychologists, doctors, social assistants,

6. 720 M. de Fa´tima Rato Padin et al. / Journal of Adolescence 32 (2009) 715e721
neonatal 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 ` a
FAPESP Grant number: 00/ 10293-5
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