This study compared two groups of adolescent women: 367 girls who sought prenatal care at the Maternidade Escola Assis Chateaubriand (MEAC) adolescent clinic and 196 young women who sought emergency treatment for incomplete abortion (either spontaneous or induced) to better understand how adolescents perceive pregnancy.

Brazil

In Brazil, fertility rates have declined dramatically during the past 20 years. Conversely, adolescent fertility in the northeastern state of Ceará has shown recent increases. According to a 1996 survey, 24 percent of 15 to 19 year olds in Ceará had at least one child or were pregnant. Understanding how adolescents perceive pregnancy -- whether as a positive or negative event in their lives – can provide valuable insights for those who work with young people and may ultimately help reduce the state's teen pregnancy rate.

Research Findings

This study compared two groups of adolescent women: 367 girls who sought prenatal care at the Maternidade Escola Assis Chateaubriand (MEAC) adolescent clinic and 196 young women who sought emergency treatment for incomplete abortion (either spontaneous or induced).

Researchers interviewed prenatal teens four times: at their first prenatal visit, at about 35 weeks gestation, at 45 days postpartum, and at one-year postpartum. Investigators interviewed abortion patients for the first time prior to discharge but after treatment for an incomplete abortion, at 45 days postabortion, and at one year postabortion. (Reports from the final interviews are not yet available.)

• When interviewed at 45 days postpartum or postabortion, there was an increase in the proportion of teens with high self-esteem in both groups. However, the increase for teens in the prenatal group was larger than it was for the abortion patients. The more education a girl had, the higher her level of self-esteem.

• Prenatal teens described their relationship with their mothers since pregnancy as better while adolescents in the abortion group reported no change. In general, adolescent girls reported better relationships with their mothers than with their fathers, a pattern exhibited at baseline and 45 days postpartum/postabortion. Father-daughter relationships improved only among girls whose pregnancies were planned.

• Overall, there was a decline in school enrollment, from 50 percent to 30 percent at 45 days postpartum/postabortion. The highest percentage of school attendees was in the induced abortion group (63 percent). Among new mothers, the proportion enrolled in school dropped by more than half, to 20 percent. The quality of the girl's relationship with her male partner was also predictive of whether she was enrolled in school at 45 days. Compared with adolescents who reported that their relationship with their partner was "okay," teens who reported that the relationship was not good or nonexistent were three times as likely to be in school.

• Among the new mothers, many initially expected the pregnancy to improve their relationships with their partners. However at 45 days, regardless of whether the pregnancy was planned, partner relationships had deteriorated. Adolescents who terminated their pregnancies had lower expectations of how the pregnancy would affect their relationships with partners, and at 45 days postabortion, relationships had, in fact, worsened.

• Among prenatal and aborting teens, adolescents who miscarried expressed more negative views of the pregnancy's impact, as did teens with unplanned births. Having a good mother-daughter or father-daughter relationship increased the probability of having a positive view of the pregnancy. School enrollment also increased the odds of a positive view by 79 percent.

Recommendations

Adolescent pregnancy cannot be equated with unwanted pregnancy -- 40 percent of the teen mothers in this study said that they wanted to have a baby when they became pregnant. Young mothers reported increased self-esteem and improved relationships with their mothers after their babies were born. Health providers, educators and others who work with teens should be aware that, for many young women, motherhood brings enhanced social status. Messages should be developed to inform young women and men of the physical risks of teen pregnancy, as well as the economic risks when young women drop out of school. Young women should understand that motherhood is only one option for their future, and efforts should be made to encourage them to delay childbearing until after they have completed their education.

Study Details

This study was conducted by the Maternidade Escola Assis Chateaubriand and supported by the Women's Studies Project at Family Health International. The WSP was funded through a cooperative agreement from the U.S. Agency for International Development. This particular study received field support from the U.S.AID Mission in Brasília. Dr. Zenilda Vieira Bruno was the principal investigator and Dr. Patricia Bailey served as technical monitor.