FHI - July 1998

Research Project Examines Adolescent Pregnancy, Sterilization in Brazil -- July 1998

RESEARCH TRIANGLE PARK, NC, USA -- Adolescent pregnancy has been increasing in Brazil in the past two decades, and the state of Ceará is no exception. According to the recent Demographic and Health Survey, nearly one-quarter of 15-to-19-year-old women have had at least one child or are currently pregnant.

The consequences of adolescent pregnancy and childbirth are well known from studies around the world: Young mothers and their children are at increased risk for sickness and death. In addition to potential health problems, there are social and economic risks. Teen mothers are more likely than young women who do not become pregnant to quit school early, thus limiting their job skills and reducing future income-earning potential. Young women who seek unsafe abortions also face risks, including hemorrhage, permanent infertility and death.

A study in Ceará interviewed more than 500 young women, aged 18 and under, to determine their perceptions of the impact of pregnancy on their lives. Researchers at the Maternidade Escola Assis Chateaubriand (MEAC) interviewed 367 adolescents who gave birth, plus 196 teens seeking emergency care for spontaneous or induced abortions, to determine how the pregnancy affected their psychological well-being, schooling and employment, and relationships with family and partners. Prenatal teens were interviewed at the time of their first visit to the MEAC prenatal clinic, at the thirty-fifth week of pregnancy, at 45 days postpartum and at one year postpartum. Young women in the abortion group were interviewed prior to discharge for emergency treatment, at 45 days postpartum and one-year postabortion. (The results from the final round of interviews have not yet been analyzed.)

The study was conducted as part of the Women's Studies Project (WSP) at Family Health International (FHI.) Brazil was one of 10 countries to participate in this international research effort to explore women's perceptions of the impact of family planning on their lives. The WSP was funded by the U.S. Agency for International Development.

Among the findings from the interviews conducted 45 days postpartum or postabortion:

For many adolescents, an unplanned pregnancy is not necessarily an unwanted pregnancy. Forty-six percent of the young mothers said they wanted to have a baby when they became pregnant, compared with only 13 percent of the aborting teens. However, when asked if they would have preferred to delay pregnancy, 61 percent and 91 percent said yes, respectively.
Self-esteem increased among both groups of young women after birth or after abortion. However, teens in the prenatal group had the highest levels of self-esteem.
There was a decline in school enrollment among study participants, from 50 percent to 30 percent. Among new mothers, school enrollment fell by half, to 20 percent. Sixty-three percent of the abortion group remained in school.
Young women who gave birth had more support from family and friends than did those who had abortions. About one-fourth of the aborting teens said their mothers did not know about the pregnancy, and an additional 25 percent said their mothers were unhappy about the pregnancy.
Among new mothers, many initially expected the pregnancy to improve their relationships with partners. However, regardless of whether the pregnancy was planned, partner relationships deteriorated. Among the abortion group, girls had lower expectations about how the pregnancy would affect their relationships; at 45 days postabortion, relationships had worsened.
Prenatal teens reported that their relationship with their mothers improved while adolescents in the abortion group reported no change.
Although abortion is illegal in Brazil, more than half the prenatal group said (during the first interview) that someone had suggested they terminate their pregnancy, and 23 percent actually attempted abortion. Cytotec, a prescription drug used to treat digestive disorders, was obtained from the black market, and 80 percent of the aborting teens chose this method. Young women also used herbal teas to induce abortion.

In a separate study, also conducted as part of the Women's Studies Project, researchers interviewed women who had undergone tubal ligation (sterilization) with a comparable group of women who were not sterilized. In Brazil, sterilization is widely used: 40 percent of women ages 15 to 19, who are married or in union, rely on this contraceptive method. Brazilian women typically use oral contraceptives until they attain their desired family size, then undergo tubal ligation. Fifty-seven percent of sterilized women undergo the procedure before their thirtieth birthday.

Researchers from the Centro de Pesquisas das Doenças Materno-Infantis in Campinas interviewed women, ages 30 to 49, to determine the impact of sterilization on their lives. Of the 472 women participating in the survey, half had undergone tubal ligation and the other half had not been sterilized.

Surprisingly, there were few differences between the two groups of women. Ninety-two percent of the women who had been sterilized were happy with their choice, while 79 percent of the comparison group were satisfied. Sterilized women said they were satisfied with their method because they had reached their desired family size, the method was effective, and it was safe. Regret and dissatisfaction for sterilization were highest among women who were very young when they underwent the procedure. Eighteen percent of women sterilized before age 25 regretted their choice compared with 7 percent ages 25 to 29.

Researchers concluded that sterilized women had married earlier, started childbearing earlier, and had given birth to more children than women who were not sterilized. This information could be useful to health care providers as they counsel women to help them make contraceptive decisions that are best for them throughout their reproductive lives.

For more information about these studies, contact Barbara Barnett, Senior Science Writer/Editor, Family Health International, at 1-919-544-7040, Ext. 482. Or fax 1-919-544-7261 or e-mail: bbarnett@fhi.org.

See Also:

Research Project Examines Adolescent Pregnancy, Sterilization in Brazil -- July 1998