Women today make up more than half of the Brazilian population and are the main users of the public health system. Despite this, they do not always get the support they need to take care of their own health. Pregnant teenagers are part of this contingent that is normally left out of public health care, due to the fact that pregnancy occurs early, often without planning, and also because they are not part of the economically active population in the country, which can create a burden on the system. . But uA work aimed at this public is offered with excellence at Unicamp and has generated actions to overcome this situation and help develop the potential of these adolescents.
The Women's Hospital - Caism provides specialized care to these pregnant women at the Adolescent Pre-Natal Outpatient Clinic (PNA), in a pioneering initiative in the country, and a group of PNA professionals, in providing this care, have been involved in activities that include the creation of an open group to guide these girls about human and reproductive rights, as well as research to support knowledge about this audience.
Professor at the Faculty of Medical Sciences (FCM) Fernanda Surita says that this action to care for pregnant and postpartum teenagers (women who have just had their children) is an arm of the Reproductive Health and Healthy Habits (Sarhas) research group, which she coordinates. According to the professor, Sarhas was born thinking about taking care of women's health and looking at it beyond the health-disease binomial. With teenagers, it aims to address prevention of another pregnancy, discuss family relationships, mental health, nutrition, exercise, as well as issues specific to the period.
Pregnant teenagers being monitored at Caism are aged between 10 and 18 years old, coming from the Metropolitan Region of Campinas or its coverage area. These young women are being drained by the public health network, being endorsed and scheduled for care at the Pre-Natal Center for Adolescents.
The open group is doing unprecedented social work in public service in this age group. Pregnant teenagers, as soon as they arrive at the outpatient clinic for consultation, have closer contact with health professionals. They do not need to spend the entire time waiting for care in the waiting room. Today, they and their companions are invited to participate in this group, which has the majority of Caism professionals and postgraduate students, who work voluntarily in the group's activities.
The teenagers participate in conversation circles, exposing their dilemmas and needs, and receive guidance. The advantage is that these moments do not interfere with the scheduled appointment. “If the doctor calls them for a consultation or if the sonographer calls them for an exam, the teenagers come and go on their own. The meeting continues and lasts about an hour”, reports the teacher. “Sometimes, they last longer, especially during the intervention of the physical educator with exercises and relaxation”.
In this group, there is always a doctor or nurse to take care of the physiological or pathological aspects of the pregnancy. It also includes the participation of psychologists, social workers, physical educators and nutritionists. There, issues such as labor pain, psychological factors, rights at school and work, presence of a companion at birth, sexuality, physical activity and equality, among other aspects, are discussed.
“Teenagers have doubts about how to deal with some obstacles at school, with their partner, with negative experiences in their family”, reports the teacher. “The most conflicting situations are noted, and the person can be referred for individual care with professionals in the fields of Psychology, Social Work or Psychiatry.”
Pregnant teenagers undergo Caism more frequently during prenatal care, however, during the postpartum period (postpartum period), consultations decrease, with return visits only 40 days after birth. That's why it's necessary to keep them well-prepared for new situations. This is the concept of Pre-Natal Education (Antenatal Education), states Fernanda Surita.
“Notions of baby care, breastfeeding and contraception are also presented there. We emphasize the importance of returning to their studies and life plans, even if they have had negative experiences”, recalls Fernanda. “Professionals reinforce the value of establishing bonds of friendship and reciprocity between adolescents, companions and health professionals.”
The companions also end up getting closer to the Caism team, which is very productive, because, being closer, this is a way of bringing these teenagers closer to them, influencing them and supporting them. “This is, therefore, health education work, which is something bigger. We have to invest in the new generations, in the future and in the potential of these girls”, he highlights.
The expectation is that this open group, with educational activities in the prenatal and postpartum period, will strengthen with the arrival of new professionals. “We hope that, with our help, these girls will be empowered regarding their rights, life expectancy and future. It is a construction work in which we try to somehow guide teenagers who have already been dealing with the problems of sometimes unplanned pregnancies. We hope that they follow their paths, develop their potential and the best life options”, points out Fernanda.
Deepening
While one arm of the Sarhas research group works on front assistance to adolescents, the research aims to strengthen the foundations for a better understanding of teenage pregnancy, a period of many implications for these young women. In this sense, nutritionist Maira Pinho Pompeu, supervised by professor Fernanda Surita, is researching nutritional assessment (body composition and dietary assessment) during pregnancy and the postpartum period of these adolescents. The first results of the study already indicated a great deficit in calcium intake. The prescription of calcium for all adolescents during prenatal care was then implemented, with an important impact on the care provided to these young women.
Another work by this nutritionist is scaling educational actions so that breastfeeding is maintained. This initiative was a partnership with Professor Erika Tanaka, professor at the Department of Nursing and PNA collaborator. The study is ongoing and compares the group of adolescents who participated in prenatal educational groups and the group who only gave birth at Caism. Preliminary data showed that so far all weaning occurred in adolescents who received prenatal care outside Unicamp. “This is another action that impacts assistance and can serve as a model for other institutions”, says Fernanda. “Each girl who receives adequate information is a potential multiplier in her community.”
Another doctoral project is by nurse Rodrigo de Almeida Bastos, supervised by professor Egberto Ribeiro Turato, from the Psychiatry area at Unicamp, co-supervised by professor Fernanda Surita. Rodrigo evaluates how health professionals feel caring for teenagers, "since it is necessary to 'take care' of caregivers and know the difficulties faced by professionals in this area, to equip the team in the best possible way", highlights Fernanda.
Juliana Vasconcellos Freitas de Jesus, also Fernanda and Egberto's advisor, carried out work in her master's degree with teenage boys, partners of pregnant teenagers. They do not have specialized services at their disposal, and they are also involved in the problem of unexpected pregnancies and the desire to be parents, says the teacher.
These young people who accompany pregnant women are the best partners, according to Fernanda, as many others do not accept the pregnancy or do not accompany the pregnancy. “Despite accompanying them to Caism, for there to be a specific service to care for them, it would be necessary to have a doctor for adolescents working together, a herbiatrist, subespecialty of Pediatrics that takes care of adolescents”, he explains.
Contraception
A study by Caism on contraception in the postpartum period, published with data from the postpartum review of adolescents, showed that the IUD (Intra-Uterine Device) was used by 11% of them, a percentage much higher than that of the Brazilian population (around 2% to 3%). This is because there is still a lot of taboo in the country regarding the use of IUDs and a preference for the use of injectable or oral hormonal contraceptives.
For this reason, in the adolescent clinic there was more intensive work encouraging the use of the IUD, discussing its advantages and the lack of knowledge as the main barrier to choosing it. The usage rate of this device was then measured again and there was an increase of more than three times, reaching 37%.
According to Fernanda, it was a fruitful work and now the idea is to also offer patients other long-lasting contraceptive methods, such as the subdermal implant with progesterone – known as implanon. This will be the next step in the PNA. This is a doctoral project by gynecologist Mariane Barbieri, under the guidance of Fernanda Surita and doctor Cássia Juliato.
The implanon will be distributed free of charge to teenagers in rooming-in immediately after giving birth. It is a kind of “chip” that is implanted in the arm. When the adolescents return, it is assessed whether they are satisfied with the method and, if they continue using it, they will be protected from a new pregnancy for three years.
Those who do not wish to use the implanon will be referred for routine postpartum follow-up. They will be suggested other methods and will be followed up at the outpatient clinic for one year after giving birth. It is expected that those who do not use implanon will later choose to use an IUD, since long-term contraception is the most effective for teenagers, says the doctor.
According to the Ministry of Health, it is reducing the percentage of children born to teenage mothers, especially in the Southeast region. Despite this, Brazil is one of the countries that still has high rates of teenage pregnancy in the North and Northeast of the country. On the other hand, unfortunately there has been an increase in pregnancies in younger adolescents, under 15 years of age. “We receive pregnant girls here aged 12-13, some as a result of sexual violence”, reports the teacher. “In this case, we have a service to combat violence that serves 24 hours a day."
