El rol del pediatra en la prevención de la fecundidad adolescente

La fecundidad adolescente en Cuba es elevada y muestra resistencia a su reducción en los últimos años a pesar de las acciones realizadas. Para promover una sexualidad responsable en los adolescentes, se requiere de un diferente y particular accionar de los pediatras. El objetivo de esta colaboración es aportar elementos que sensibilicen e involucren a los pediatras cubanos para que ofrezcan orientación a los adolescentes sobre el ejercicio de una sexualidad plena, libre y responsable, que contribuya a la reducción de la fecundidad y al cuidado integral de la salud sexual y reproductiva. El método utilizado fue la revisión de las legislaciones vigentes y las recomendaciones de varias sociedades internacionales de pediatría, respecto a la función e importancia de la especialidad en la prevención del embarazo adolescente. Se destacan las ventajas del pediatra para la prevención de la fecundidad adolescente, se explican las habilidades que deben adquirir para informar y orientar a los adolescentes, se analizan las barreras que debe favorecer el acceso del adolescente a la prevención de la fecundidad y se exponen las recomendaciones específicas para su actuación Se concluye que los pediatras cubanos pueden contribuir a la reducción de la fecundidad y mejorar el cuidado integral de la salud sexual y reproductiva de los adolescentes.

Adolescent fertility in Cuba is high and shows resistance to its reduction in recent years despite the actions taken. To promote responsible sexuality in adolescents, a different and particular action of pediatricians is required. The objective of this collaboration is to provide elements that sensitize and involve Cuban pediatricians to offer guidance to adolescents on the exercise of a full, free and responsible sexuality, which contributes to the reduction of fertility and comprehensive care of sexual and reproductive health. The method used was the review of current legislation and the recommendations of several international pediatric societies, regarding the role and importance of the specialty in the prevention of adolescent pregnancy. The advantages of the pediatrician for the prevention of adolescent fertility are highlighted, the skills they must acquire to inform and guide adolescents are explained, the barriers that the pediatrician must face to favor the access of adolescents to prevent fertility are analyzed, and the specific recommendations for the action of the pediatrician in the prevention of adolescent fertility are exposed. It is concluded that Cuban pediatricians can contribute to the reduction of fertility and improve the comprehensive care of sexual and reproductive health of adolescents.

La fecundidad en Argentina a inicios del siglo XXI: ¿el fin de la meseta? El papel de la educación en los cambios / Fecundidade na Argentina no início do século 21: o fim do plateau? Efeitos da educação nas mudanças / Fertility in Argentina at the beginning of the 21st century: the end of the plateau? Effects of education on changes

Resumen El presente trabajo ofrece un análisis del comportamiento de la fecundidad desagregado por nivel de instrucción de la madre en Argentina en el siglo XXI y presta especial atención a la evolución de la fecundidad adolescente en el mismo período. A diferencia de lo acontecido en otros países de la región en las últimas dos décadas, donde el descenso de la fecundidad fue casi ininterrumpida, en la Argentina la fecundidad tuvo un comportamiento estable, similar a una meseta, desde comienzos del siglo XXI hasta 2014, a partir de cuando comenzó un descenso sostenido análogo al de sus países vecinos. Para este análisis se usan datos de las estadísticas vitales y de las estimaciones y proyecciones de población del INDEC, y para el análisis por nivel de instrucción, datos de las encuestas permanentes de hogares del INDEC y del Censo Nacional de Población y Vivienda de 2010. En el análisis se puede observar una importante brecha en los niveles de fecundidad entre las mujeres más y menos instruidas, principalmente en la fecundidad adolescente. Esta brecha es un reflejo de inequidad, dado que la alta fecundidad afecta sobre todo a las mujeres de los estratos sociales más vulnerables.

Resumo Este documento faz uma análise do comportamento da fecundidade na Argentina no século 21, desagregado por nível de escolaridade da mãe, com especial atenção à evolução da fecundidade na adolescência nesse período. Ao contrário do que aconteceu em outros países da região nas últimas duas décadas, onde a fecundidade diminuiu quase continuamente, na Argentina a fecundidade teve um comportamento estável, semelhante a um plateau, desde o início do século 21 até 2014, quando começou um declínio sustentado semelhante ao observado nos países vizinhos. Utilizamos dados de estatísticas vitais, estimativas e projeções da população do INDEC e, para a análise por nível de educação, dados das Pesquisas Domésticas do INDEC e do Censo Nacional da População e Habitação 2010. A análise mostra uma lacuna significativa nos níveis de fecundidade entre as mulheres mais e menos instruídas, principalmente na fecundidade adolescente. Esta lacuna é reflexo da desigualdade, uma vez que a alta fecundidade afeta principalmente as mulheres dos estratos sociais mais vulneráveis.

Abstract This paper presents an analysis of Argentina's fertility behavior disaggregated by level of education of the mother in the 21st century, and focuses on the evolution of adolescent fertility during the same period. Unlike what other countries from the region have experienced in the last two decades, where fertility decline occurred almost uninterruptedly, Argentina's fertility had a stable behavior, similar to a plateau, from the beginning of the 21st century until 2014. Since then, it began a sustained decline similar to that evidenced in neighboring countries. Data from vital statistics, INDEC population estimates and projections are used, and data from INDEC Household Surveys and the 2010 National Population and Housing Census are used for the analysis by education level. The analysis shows a significant gap in fertility levels between the most and least educated women, mainly in adolescent fertility. This gap is a reflection of inequity, given that high fertility rates mainly affect women from the most vulnerable social strata.

Subnational inequalities of early marriage and fertility among Chinese females from 1990 to 2010 / 北京大学学报(医学版)

OBJECTIVE@#To analyze the inequality of early marriage and adolescent fertility with respect to local economic development among Chinese females aged 15-19 years from 1990 to 2010.@*METHODS@#Aggregated data were extracted from the Chinese National Census from 1990 to 2010. We calculated the ever-married rate and fertility rate of female adolescents aged 15-19 years. Using gross domestic product (GDP) per capita as an indicator for socio-economic status of a province, we calculated the slope index of inequality (SII) and the concentration index (CI) to analyze the subnational inequalities of early marriage and adolescent fertility. Weighted linear regression models were also established to assess the associations between GDP per capita and the ever-married rate/fertility rate.@*RESULTS@#The ever-married rate for Chinese female adolescents aged 15-19 years decreased from 4.7% in 1990 to 1.2% in 2000, and rebounded to 2.1% in 2010. From 1990 to 2000, the fertility rate decreased from 22.0 per 1 000 to 6.0 per 1 000, and further decreased to 5.9 per 1 000 in 2010. In 1990, the socio-economic inequalities of the ever-married rate and fertility rate for female adolescents aged 15-19 years were not statistically significant (P for SII or CI>0.05). The values of SII revealed that, in 2000 and 2010, female adolescents with the lowest GDP per capita had an ever-married rate 2.4% (95%CI: 0.4-4.4) and 2.3% (95%CI: 0.3-4.2) higher than those with the highest GDP per capita, respectively. In the meantime, in 2000 and 2010, female adolescents with the lowest GDP per capita had a fertility rate 12.9 per 1 000 (95%CI: 5.4-20.5) and 9.3 per 1 000 (95%CI: 4.6-14.0) higher than those with the highest, respectively. In 2000 and 2010, the CIs for marriage were -0.32 (P=0.02) and -0.17 (P=0.03), respectively, and the CIs for childbirth were -0.37 (P<0.01) and -0.26 (P<0.01), respectively. In 2000, the ever-married rate and the fertility rate were estimated to increase by 1.4% (95%CI: 0.1-2.7) and 7.9 per 1 000 (95%CI: 2.9-12.8) with 100% increase in GDP per capita, respectively; in 2010, the numbers were 1.5% (95%CI: 0.1-2.9) and 6.7 per 1 000 (95%CI: 3.2-10.1), respectively.@*CONCLUSION@#Subnational socio-economic inequality of early marriage and adolescent fertility existed in 2000 and 2010. Female adolescents residing in less-developed areas were more likely to engage in early marriage and childbirth. Reducing income inequality and increasing education investment for poverty-stricken areas seem to be effective measures to reduce this inequality.

Application of P/F Brass ratio method in the context of fast-paced adolescent fertility decline / Aplicación de la técnica P/F de Brass en un contexto de rápida caída de la fecundidad adolescente / Aplicação da técnica P/F de Brass em um contexto de rápida queda da fecundidade adolescente

Abstract Adolescent fertility -fertility rates at ages 15-19- fell substantially (around 30 percent) between 2000 and 2010. It was the first time Brazil experienced such a decline in those ages since 1970, when the census included one question about children born in the past 12 months. This phenomenon has an important implication for the P/F Brass ratio technique: it underestimates the cumulated current fertility up to age group 20-24 (F2), considering this cohort's previous fertility experience. Therefore, the P2/F2 value, used as an adjustment factor for the reported fertility level, is significantly overestimated. This paper discusses this issue and proposes an alternative to correct the reference period error in the 2010 Demographic Census in Brazil. The results of applying the proposed alternative in this specific context were very similar to those obtained using different techniques, thus supporting the strength of our alternative.

Resumo O Brasil experimentou, entre 2000 e 2010, pela primeira vez desde 1970, quando se introduziu o quesito sobre filhos nascidos vivos nos 12 meses anteriores à data de referência do censo, queda significativa (em torno de 30%) das taxas específicas de fecundidade declarada das mulheres entre 15 e 19 anos (f*1). Esse fenômeno tem uma importante consequência para a aplicação da técnica P/F de Brass: gera um erro, por falta, na fecundidade corrente acumulada até o grupo etário de 20 a 24 anos (F2), se tomada como experiência pregressa dessa coorte, levando a um valor de P2/F2, usado para ajustar o nível da fecundidade declarada, significativamente sobrestimado. O presente trabalho discute detalhadamente este problema e, por fim, propõe uma alternativa para se corrigir o erro de período de referência da fecundidade corrente do Censo Demográfico de 2010 do Brasil. A alternativa proposta, neste contexto específico, gerou estimativas de taxa de fecundidade total muito próximas às produzidas por outras técnicas.

Resumen Por la primera vez desde 1970 —cuando se introdujo la pregunta sobre nacidos vivos en los 12 meses anteriores a la fecha de referencia del censo— Brasil experimentó, entre 2000 y 2010, una disminución significativa de aproximadamente 30% de las tasas específicas de fecundidad declarada de mujeres entre 15 y 19 años (f*1). Este fenómeno trae una consecuencia importante para la aplicación de la técnica P/F de Brass: genera un error por falta en la fecundidad actual acumulada para el grupo de edad de 20 a 24 años (F2), lo que concomitantemente provoca una significativa sobrestimación en el valor de P2/F2 —utilizado para corregir el nivel de la fecundidad declarada—. Este trabajo discute este problema y propone finalmente una adaptación de la técnica original de Brass para aplicarla a los datos del censo de 2010. La alternativa propuesta generó, en este contexto específico, estimaciones de la tasa global de fecundidad similares a las producidas por otras técnicas.

Variables intermedias de la fecundidad adolescente en Chile: evolución, desigualdad e implicancias de políticas / Intermediate variables in the adolescent fertility rate in Chile: evolution, inequality and policy implications

Haciendo uso de las escasas y limitadas encuestas poblacionales disponibles en Chile se describe la evolución de la iniciación sexual y del uso de anticonceptivos, tanto en términos de magnitud como de desigualdad social y de género. La iniciación sexual se adelanta, deviene mayoritariamente prenupcial y se reducen las diferencias según género. El uso de anticonceptivos en la primera relación sexual aumenta, aunque sigue siendo inferior al de los países desarrollados 20 años atrás. La desigualdad social en el uso de anticonceptivos en la primera unión es más pronunciada que la de la iniciación sexual. Esto refuerza la prioridad de universalizar el acceso a anticonceptivos desde la primera relación sexual, para que cada adolescente pueda decidir libre, informada y conscientemente sobre su uso, sin restricciones adicionales a las establecidas legalmente.

Making use of the scarce and limited population surveys available in Chile, the evolution of age at first intercourse and the use of contraceptives is described, both in terms of magnitude and social and gender inequality. Age at first intercourse has become younger, primarily premarital, and gender differences have narrowed. The use of contraceptives at first sexual intercourse has increased, although it continues to be lower than in developed countries 20 years ago. Social inequality in the use of contraceptives at first intercourse is more pronounced than inequality in first intercourse itself. This underlines the priority of universalizing access to contraceptives, starting with the first sexual encounter, so that each adolescent can make their decision about contraceptives freely, consciously and well informed, without additional restrictions to those that are legally established.