Teenage pregnancy and domestic violence in the context of primary health care

Abstract

Introduction: Teenage pregnancy still have a high incidence in Brazil, even after a great reduction in the last decades, and may be related to situations of social vulnerability and domestic violence. The Family Health Strategy (FHS) is fundamental in adolescent health care, although it has been little active in confronting violence against adolescents. Objective: This study aimed to describe the socioeconomic profile, identify maternal-fetal characteristics and situations of social vulnerability of young women with a history of teenage pregnancy and possible associations with the occurrence of domestic violence. Methodology: This is a cross-sectional study, with an interview of 100 adolescents between 13 and 19 years old with a history of pregnancy in 2018 in a poor neighborhood in Fortaleza - CE. A questionnaire with 57 questions was applied and the variables analyzed were related to socioeconomic profile, prenatal follow-up, childbirth and exposure to domestic violence during pregnancy. Chi-square test (χ2) and Odds Ratio (OR) were done in the analysis. Results: The average age of the interviewees was 17.5 years (sd = 1.65). The average family income was 1.18 minimum wage (sd = 0.83), 91% were black or brown, 57% were in a consensual union and 18% had a job. Regarding education, 71% stopped their studies, 46.5% of them did it before their first pregnancy and 35.2% stopped studying after becoming pregnant. In the prenatal follow-up, 96.3% had at least one medical appointment, 62.1% started in the first trimester and 69.1% had 6 or more medical appointments. Among the children, 7.6% and 6.4% were born premature and with underweight, respectively. The percentage of domestic violence was 26% and the main aggressor was the partner. Suffering domestic violence had a statistically significant association with low education (OR 4.06; 95% CI 1.27-12.97), lower maternal age (OR 4.2; 95% CI 1.43-12.32) and “history of newborn hospitalization” (OR 3.83; 95% CI 1.34-10.95). Conclusion: Adolescent mothers were in a context of social vulnerability and a part of them was a victim of violence during pregnancy, a situation associated with low schooling and a younger age of the adolescent. The negative consequences for the newborn’s health tend to be more frequent in situations of violence. It was noted that adolescents had good prenatal attendance and that could have a positive influence on obstetric and neonatal outcomes. Pregnancy is often the young woman’s first contact with the health service and access to prenatal care in the FHS for adolescents can reduce maternal and child complications and improve identification of domestic violence.