Health equity in Somalia? An evaluation of the progress made from 2006 to 2019 in reducing inequities in maternal and newborn health.

BACKGROUND: Every human being has the right to affordable, high-quality health services. However, mothers and children in wealthier households worldwide have better access to healthcare and lower mortality rates than those in lower-income ones. Despite Somalia's fragile health system and the under-5 mortality rate being among the highest worldwide, it has made progress in increasing reproductive, maternal, and child health care coverage. However, evidence suggests that not all groups have benefited equally. We analysed secondary 2006 and 2018-19 data to monitor disparities in reproductive, maternal, and child health care in Somalia. METHODS: The study's variables of interest are the percentage of contraceptive prevalence through modern methods, adolescent fertility rate, prenatal care, the rate of births attended by midwives, the rate of births in a health care facility, the rate of early initiation of breastfeeding, stunting and wasting prevalence and care-seeking for children under-five. As the outcome variable, we analysed the under-five mortality rate. Using reliable data from secondary sources, we calculated the difference and ratio of the best and worst-performing groups for 2006 and 2018-19 in Somalia and measured the changes between the two. RESULTS: Between 2006 and 2018-19, An increase in the difference between women with high and low incomes was noticed in terms of attended labours. Little change was noted regarding socioeconomic inequities in breastfeeding. The difference in the stunting prevalence between the highest and lowest income children decreased by 20.5 points, and the difference in the wasting prevalence of the highest and the lowest income children decreased by 9% points. Care-seeking increased by 31.1% points. Finally, although under-five mortality rates have decreased in the study period, a marked income slope remains. CONCLUSIONS: The study's findings indicate that Somalia achieved significant progress in reducing malnutrition inequalities in children, a positive development that may have also contributed to the decrease in under-five mortality rate inequities also reported in this study. However, an increase in inequalities related to access to contraception and healthcare for mothers is shown, as well as for care-seeking for sick children under the age of five. To ensure that all mothers and children have equal access to healthcare, it is crucial to enhance efforts in providing essential quality healthcare services and distributing them fairly and equitably across Somalia.

Mapping socio-geographical disparities in the occurrence of teenage maternity in Colombia using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

BACKGROUND: The prevalence of teenage pregnancy in Colombia is higher than the worldwide average. The identification of socio-geographical disparities might help to prioritize public health interventions. AIM: To describe variation in the probability of teenage maternity across geopolitical departments and socio-geographical intersectional strata in Colombia. METHODS: A cross-sectional study based on live birth certificates in Colombia. Teenage maternity was defined as a woman giving birth aged 19 or younger. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied using multilevel Poisson and logistic regression. Two different approaches were used: (1) intersectional: using strata defined by the combination of health insurance, region, area of residency, and ethnicity as the second level (2) geographical: using geopolitical departments as the second level. Null, partial, and full models were obtained. General contextual effect (GCE) based on the variance partition coefficient (VPC) was considered as the measure of disparity. Proportional change in variance (PCV) was used to identify the contribution of each variable to the between-strata variation and to identify whether this variation, if any, was due to additive or interaction effects. Residuals were used to identify strata with potential higher-order interactions. RESULTS: The prevalence of teenage mothers in Colombia was 18.30% (95% CI 18.20-18.40). The highest prevalence was observed in Vichada, 25.65% (95% CI: 23.71-27.78), and in the stratum containing mothers with Subsidized/Unaffiliated healthcare insurance, Mestizo, Rural area in the Caribbean region, 29.08% (95% CI 28.55-29.61). The VPC from the null model was 1.70% and 9.16% using the geographical and socio-geographical intersectional approaches, respectively. The higher PCV for the intersectional model was attributed to health insurance. Positive and negative interactions of effects were observed. CONCLUSION: Disparities were observed between intersectional socio-geographical strata but not between geo-political departments. Our results indicate that if resources for prevention are limited, using an intersectional socio-geographical approach would be more effective than focusing on geopolitical departments especially when focusing resources on those groups which show the highest prevalence. MAIHDA could potentially be applied to many other health outcomes where resource decisions must be made.

Effects of Community-Wide Teen Pregnancy Prevention Initiatives on Local Teen Birth Rates in the United States: A Synthetic Control Approach.

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = .001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = .03), 10.7 fewer births among Hispanic teens (p = .03), and 4.2 fewer births (p = .10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.

Association Between Pain During Pregnancy and Postpartum Depressive Symptoms in Adolescent and Adult Women.

ISSUE: Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations. BACKGROUND: Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic. AIM: We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women. METHODS: This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann-Whitney and Kruskal-Wallis tests compared depressive symptoms in relation to pain status. FINDINGS: Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to "deep pain with intercourse" (p = .09), "burning vaginal pain after sex" (p = .01), "pelvic pain lasting hours or days after intercourse" (p = .06), and "pain with urination" (p = .09). When stratified by age group, significant associations were found only for the adolescents. DISCUSSION: Our results suggest that women reporting pain in different daily situations have higher EPDS scores. CONCLUSION: Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.

The Association of Teen Pregnancy and Violence: A Multilevel Study in Colombia.

Background: Colombia has a high teen pregnancy (TP) rate. In 2018, one in five pregnancies was from teen mothers between 10 and 19 years of age. While TP rates are declining globally, Colombia's TP rate decline has been particularly low, despite sexual education and contraception campaigns. Other factors must be studied to prevent TP. Colombia has a long history of violence. We aim to assess whether there is a relationship between TP and exposure to violence in Colombia. Methods: Data from the Colombian Demographic and Health Survey 2015 and the Colombian National Department of Statistics were analyzed for association between TP and sexual violence, physical violence, physical punishment as a child, and community violence. Univariate, bivariate, multivariate, and multilevel binary logistic regression models were calculated using SPSS v.25 and HLM v.7. Results: Fifteen percent of teens were pregnant. Emotional violence was reported by 47%, sexual harassment by 27%, physical violence by 17%, physical punishment as a child by 7%, and unwanted sex by 2%. Unwanted sex (odds ratio [OR]: 3.18, 95% confidence interval [95% CI]: 1.96-5.16), sexual harassment (OR: 2.43, 95% CI: 1.89-3.14), and physical punishment (OR: 20.30, 95% CI: 7.96-22.81) were associated with adolescent pregnancy. In unadjusted models, emotional violence was associated (OR: 1.22, 95% CI 1.06-1.40) and community violence showed a tendency (OR: 1.24, 95% CI: 0.99-1.55). Physical violence was not associated. Conclusions: Violence exposure and particularly physical punishment, unwanted sex and sexual harassment were associated with TP incidence and should be considered risk factors for TP.

Attempted suicide by hanging in a pregnant adolescent with psychiatric illness: A case report.

Cases of mental illnesses and suicide attempts while pregnant are of grave concern because they negatively affect both the mother and her fetus. Here we report a case of an 18-year-old woman, who was found at 35 weeks into her pregnancy. She was unconscious when her sister-in-law rescued her. Upon arrival, she was agitated and had respiratory distress. She went into spontaneous labor the next day and delivered a premature infant who succumbed within 24 h. She had a history of mental illness in the past and previous suicide attempts. The reason for her suicide stemmed from conflicts within her family and disagreement with her husband. Various psychosocial elements play a role in suicide risk, such as young age, having a history of mental health issues, experiencing trauma facing domestic violence, and dealing with financial stress. This underlines the need for mental health screening in the course of antenatal visits for a complete risk assessment.

Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study.

Background/objectives: The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. Design: We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. Setting: One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Participants: Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). Interventions: The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Main outcome measures: Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Data sources: Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Results: Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Limitations: Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. Conclusions: This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future work: Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. Study registration: The study is registered as NIHR CRN Portfolio (42900). Funding: This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

The Family Nurse Partnership is an intensive home visiting service that offers first-time young mothers up to 64 visits with a family nurse from pregnancy to their child's second birthday. The Family Nurse Partnership aims to improve birth outcomes, child health and development and promote economic self-sufficiency among young mothers. Previous research in England found no differences in birthweight, maternal smoking, repeat pregnancies or accident and emergency attendances between mothers who did or did not take part in the Family Nurse Partnership. However, children in the Family Nurse Partnership group had better measures of development at school age. We aimed to add to the evidence from earlier studies, by using electronic records that are routinely collected as part of health, education and social care services, to compare outcomes for around 26,000 mothers enrolled in the Family Nurse Partnership between 2010 and 2019 with similar mothers who were not enrolled. This study showed that around one in four mothers who were eligible for the programme were enrolled in the Family Nurse Partnership, and family nurses gave priority to mothers who were younger, more deprived or who had other markers of vulnerability (e.g. a history of substance misuse violence, self-harm or mental health conditions). We found no evidence of a difference in indicators of child maltreatment between mothers who were enrolled in the Family Nurse Partnership and those who were not enrolled, but we found weak evidence to suggest that children born to mothers enrolled in the Family Nurse Partnership were more likely to achieve a Good Level of Development at school entry (age 5). We also saw that mothers enrolled in the Family Nurse Partnership were less likely than those who were not enrolled to have their next child within 18 months of their first child. More research is needed to understand which elements of intensive home visiting services work best, for whom and when. This will help inform decisions about whether it is better to offer highly intensive services for a small portion of the target population or to extend and enhance existing universal health visiting services to better support all adolescent mothers.

Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study.

BACKGROUND: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. METHODS: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women's and children's hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. RESULTS: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. CONCLUSIONS: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

INTRODUCCIÓN: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. MÉTODOS: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. RESULTADOS: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. CONCLUSIONES: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Prevalence and factors associated with adolescent pregnancy among sexually active adolescent girls in Peru: Evidence from Demographic and Family Health Survey, 2015-2019.

Background: The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem. Methods: A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model. Results: The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4-32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI:1.33-1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48-4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07-1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76-0.86), being currently studying (aPR: 0.43; 95%CI: 0.38-0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85-0.97), third (aPR: 0.81; 95%CI: 0.74-0.89), fourth (aPR: 0.79; 95%CI: 0.69-0.91) and fifth (aPR: 0.59; 95%CI: 0.47-0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69-0.83) or late adolescence (aPR: 0.40; 95%CI: 0.35-0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72-0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77-0.92). Conclusions: Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnancy. To decrease the prevalence of teenage pregnancy in Peru, it is imperative to enhance national policies concerning family planning and provide comprehensive sex education targeted at adolescents.

Variables predictoras del uso de los métodos anticonceptivos en jóvenes: una revisión sistemática / Predictor variables of contraceptive method use in young people: A systematic review

Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las bases de datos PubMed, CINAHL, Scopus, Cuiden Plus, LILACS e IME. Selección de estudios: Se realizó una evaluación de la calidad de los estudios que fue revisada por dos investigadores en paralelo. Como resultado, se seleccionaron un total de cinco investigaciones primarias. Extracción de datos: Se extrajo información sobre la población seleccionada en el estudio, método anticonceptivo estudiado y las variables predictoras identificadas. Resultados: Se identificaron siete variables predictoras que explican específicamente el uso del preservativo masculino, píldora anticonceptiva o píldora anticonceptiva de emergencia. Las variables más relevantes fueron el nivel de conocimiento y las actitudes hacia el empleo de los métodos anticonceptivos, de manera que un mayor conocimiento y unas actitudes positivas incrementan la probabilidad de uso de métodos anticonceptivos. Otro resultado destacado fue la presencia de un sesgo formativo con un mayor conocimiento de las mujeres sobre las opciones anticonceptivas hormonales y actitudes más positivas. Conclusión: Los futuros programas formativos deben orientarse hacia la evaluación de cambios en el comportamiento, mediante el desarrollo de actitudes positivas hacia el uso de los métodos anticonceptivos a través de la adquisición de un conocimiento de calidad sobre las opciones contraceptivas.(AU)

Objective: To analyse predictor variables of contraceptive method use in young people. Design: Systematic review. Data sources: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. Study selection: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. Data extraction: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. Results: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with womenhaving higher knowledge of hormonal contraceptive options and more positive attitudes. Conclusion: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.(AU)

Improving breastfeeding among adolescent mothers: a prospective cohort

ABSTRACT BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

Atenção à saúde dos parceiros sexuais de adolescentes com sífilis gestacional e seus filhos: uma revisão integrativa / Health care of sexual partners of adolescents with gestational syphilis and their children: an integrative review

Resumo A sífilis gestacional (SG) em adolescentes é um desafio para a saúde pública brasileira, com elevadas taxas de incidência. A testagem, diagnóstico e tratamento dos parceiros sexuais é indispensável para interromper a cadeia de transmissão, mas desde 2017 deixou de ser critério para o tratamento adequado da gestante. Buscamos analisar e sintetizar o conhecimento produzido sobre a atenção à saúde de parceiros sexuais de adolescentes com SG no Brasil. Realizamos uma revisão integrativa nas bases de dados BVS, SciELO e PubMed, selecionando artigos que abordavam SG e/ou sífilis congênita (SC) em adolescentes de 15 a 19 anos e que incluíam informações sobre os parceiros sexuais. Quarenta e um artigos foram analisados compreensivamente com auxílio do software WebQDA e classificados em duas categorias: (a) Abordagem dos parceiros sexuais no pré-natal, e (b) Papel dos parceiros sexuais no ciclo de transmissão da SG e da SC. Os estudos evidenciam que a abordagem do parceiro é deficitária, com ausência de dados sobre o perfil sociodemográfico e informações sobre testagem e tratamento. No âmbito da atenção primária à saúde não se encontram estudos que abordem fatores inerentes ao contexto de vulnerabilidade dos parceiros sexuais em relação ao enfrentamento da sífilis.

Abstract Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner's approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis.

Socioeconomic factors increase the risk of teenage pregnancy: spatial and temporal analysis in a Brazilian municipality / Fatores socioeconômicos aumentam o risco de gravidez na adolescência: análise espacial e temporal em um município brasileiro

ABSTRACT Objective: To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability. Methods: An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata. Results: We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study. Conclusion: Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

RESUMO Objetivo: Avaliar a distribuição da proporção de mães adolescentes (PMA) no tempo e espaço e sua relação com indicadores socioeconômicos e vulnerabilidade social. Métodos: Realizou-se estudo ecológico com mães adolescentes residentes em 322 setores censitários de Foz do Iguaçu (PR) entre 2013 e 2019. Aglomerados espaciais de mães adolescentes foram identificados por varredura espacial e agrupados em estratos com diferentes prevalências. Avaliou-se a associação entre esses estratos e a vulnerabilidade social individual das mães pelo teste qui-quadrado de Pearson. Ajustaram-se modelos de regressão linear para avaliar associação entre a PMA e fatores socioeconômicos por setor censitário e tendência temporal da PMA nos diferentes estratos. Resultados: Identificaram-se cinco aglomerados de alta prevalência nas regiões periféricas e seis de baixa na região central do município. Proporcionalmente houve mais mães adolescentes com pior índice de vulnerabilidade no estrato de alta prevalência do que no de baixa. Locais com piores condições socioeconômicas apresentaram maior PMA, perfil que não mudou ao longo do tempo. Para o aumento de uma unidade do Índice Brasileiro de Privação e da proporção de mulheres responsáveis por domicílio, a PMA aumentou respectivamente 3,8 (IC95% 3,1-4,4) e 0,086% (IC95% 0,03-0,14). Houve uma redução na PMA global em parte do período, que ocorreu mais tardiamente nos estratos de maior prevalência, mas as proporções voltaram a ficar estáveis nos últimos anos de estudo. Conclusão: A gravidez na adolescência se concentra em regiões de pior condição socioeconômica e com maior vulnerabilidade materna e seu comportamento no tempo ocorreu, nessas áreas, de modo distinto.

Temporal analysis of maternal, care and newborns characteristics in the city of Guarapuava-PR from 2010 to 2019 / Análise temporal de características maternas, assistenciais e de nascidos vivos do município de Guarapuava-PR de 2010 a 2019

Abstract Objectives: to analyze the temporal trend in maternal, care and newborns characteristics, in the city of Guarapuava, Paraná, Brazil in the period of 2010 to 2019. Methods: ecological temporal tendency study is based on Sistema de Informações sobre Nascidos Vivos (Live Birth Information System). To verify changes on the topics, the Prais-Winsten generalized linear regression was applied. Results: data from 28,919 live births were analyzed in 2019, 15.9% of the pregnancies were adolescents, 49.8% were cesarean deliveries and 9.2% were premature childbirths. A reduction in teenage pregnancy was observed, with annual percentage variation (APV) for mothers aged ten to 14 being -0.14% (p=0.005) and 15 to 19 years old -0.82% (p=0.004); there was an increase in mothers' schooling, with an APV of 60.09% (p=0.026) for eight to 11 years of schooling and 11.27% (p<0.001) for 12 or more; there was an increase of 15.33% (p<0.001) for seven or more prenatal consultations and a decrease in the Apgar classifications considering the risk, with scores from zero to two in the 1st minute with an APV=-0.12 (p=0.010) and scores from three to five in the 5th minute with APV=-0.07 (p=0.011). Conclusions: The city of Guarapuava presents important decreased tendencies in early pregnancy and an increase in mothers' schooling, besides the changes regarding the conditions in which their children are born and how they are welcomed.

Resumo Objetivos: analisar a tendência temporal de características maternas, assistenciais e dos recém-nascidos do município de Guarapuava-PR no período de 2010 a 2019. Métodos: estudo ecológico de tendência temporal com dados do Sistema de Informações sobre Nascidos Vivos. Para verificar mudanças nas características avaliadas, utilizou-se regressão linear generalizada de Prais-Winsten. Resultados: analisaram-se dados de 28.919 nascidos vivos; em 2019, 15,9% das gestações foram de adolescentes, 49,8% dos partos cesáreos e 9,2% partos prematuros. Observou-se redução da gravidez na adolescência, com variação percentual anual (VPA) para mães com dez a 14 anos sendo -0,14% (p=0,005) e 15 a 19 anos -0,82% (p=0,004); aumento da escolaridade das mães, com VPA de 60,09% (p=0,026) para oito a 11 anos de estudo e 11,27% (p<0,001) para 12 ou mais; aumento de 15,33% (p<0,001) para sete ou mais consultas de pré-natal realizadas pelas gestantes e queda nas classificações de Apgar consideradas de risco, com notas zero a dois no 1º minuto com VPA=-0,12 (p=0,010) e notas três a cinco no 5º minuto com VPA=-0,07 (p=0,011). Conclusões: Guarapuava apresentou importantes tendências de redução da gravidez precoce e aumento de escolaridade das mães, além de mudanças sobre as condições em que nascem seus filhos e sobre como são acolhidos.

Gravidez na adolescência: aspectos epidemiológicos da maternidade precoce no estado do Pará, Brasil / Adolescent pregnancy: epidemiological aspects of early motherhood in the state of Pará, Brazil

A adolescência é caracterizada por modificações físicas, mentais e comportamentais nesta fase de transição para a vida adulta. Avaliaram-se a taxa de fecundidade de mulheres de 15 a 19 anos residentes nas macrorregiões de saúde do estado do Pará e seus parâmetros sociodemográficos, da gestação e parto, no período de 2010 a 2020. O estudo é descritivo e analítico e utilizou dados do SINASC/DATASUS. Em 2014, a maior taxa de fecundidade (106,5%) foi na Macrorregião de Saúde III. As mães solteiras ou em união consensual, cor/raça parda e entre 8 a 11 anos de estudo foram as predominantes. O pré-natal foi de quatro a seis consultas entre 37 e 41 semanas. A gravidez precoce em adolescentes expõe a riscos sociais e de saúde como abandono escolar, falta de rede de apoio nos cuidados do bebê, prejuízo na colocação no mercado de trabalho e problemas de saúde mental.

Adolescence is the transition phase to adulthood when physical, mental, and behavioral changes occur. The study evaluated the fertility rate of women aged 15 to 19 years living in the health macroregions of the state of Pará and their sociodemographic parameters, pregnancy and childbirth, from 2010 to 2020. The study is descriptive and analytical and uses data from SINASC/DATASUS. In 2014, the highest fertility rate (106.5%) was in Health Macroregion III. Single mothers or mothers in consensual unions, brown color/race, and between 8 and 11 years of study were the predominant ones. They had four to six prenatal care appointments between 37 and 41 weeks. Early pregnancy in adolescents exposes them to social and health risks such as school dropout, lack of support network in baby care, disadvantage in the labor market, and mental health problems.

Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study / Prevalencia del consumo de alcohol, tabaco y drogas ilícitas durante el embarazo en adolescentes: un estudio observacional, prospectivo y transversal

Abstract Background: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. Methods: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women´s and children´s hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. Results: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. Conclusions: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

Resumen Introducción: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. Métodos: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. Resultados: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. Conclusiones: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Sífilis em gestantes adolescentes e repercussões para o concepto / Syphilis in adolescent pregnant women and its impact on the concept / Sífilis en gestantes adolescentes y su repercusión en el concepto

Objetivo: analisar o desfecho da sífilis congênita em filhos de mães adoles- centes Método: Estudo transversal, que analisou as notificações de sífilis gestacional e congênita de 139 gestantes adolescentes entre os anos de 2016 a 2018, em Fortaleza- Ceará, que foram notificadas no Sistema de Informação e Agravos. Utilizou-se para ana- lisar a significância estatística o Teste do qui-quadrado ou Exato de Fisher. Resultados: frequentaram o pré-natal e realizaram o teste não treponêmico, 95% e 92,8% das adoles- centes respectivamente. Foram adequadamente tratadas, 7,9%. Verificou-se associação estatisticamente significativa entre altas titulações do teste não treponêmico da mãe no parto e do exame de sangue periférico do recém-nascido (p=0,002), assim como do trata- mento inadequado ou não tratamento da mãe com a titulação do teste não treponêmico > 1:8 (p=0,001). Conclusão: a alta incidência da sífilis congênita em filhos de adolescentes, demonstra que, caso tivessem sido tratadas adequadamente durante o pré-natal, a infecção poderia ter sido evitada no bebê. Este estudo subsidiará o desenvolvimento de políticas públicas voltadas a melhoria na assistência pré-natal e de controle da sífilis congênita nessa população.

Objective: to analyze the outcome of congenital syphilis in children of teenage mothers. Method: cross-sectional study analyzing the notifications of gestational and congenital syphilis of 139 pregnant adolescents between 2016 and 2018, in Fortaleza, Ceará in the Brazilian Notifiable Diseases Information System. To the analyze statistical significance were used the chi-square or Fisher's Exact tests. Results: the percentage of adolescents attending prenatal care and undergoing the nontreponemal test was 95% and 92.8%, respectively. A total of 7.9% were adequately treated. There was a statistically significant association between high nontreponemal test titers of the mother at delivery and the peripheral blood test of the newborn (p=0.002), as well as between inadequate treatment or no treatment of the mother with nontreponemal test titers > 1:8 (p=0.001). Conclusion: The high incidence of congenital syphilis in children of adolescents shows that the infection could have been prevented in the baby if they had been adequately treated during prenatal care. This study may support the development of public policies aimed at improving prenatal care and control of congenital syphilis in this population.

Objetivo: analizar el desenlace de la sífilis congénita en hijos de madres adolescentes. Material y método: estudio transversal analizando las notificaciones de sífilis gestacional y congénita de 139 adolescentes embarazadas entre 2016 y 2018, en Fortaleza, Ceará en el Sistema Brasileño de Información de Enfermedades de Declaración Obligatoria. Para el análisis de significación estadística se utilizaron las pruebas de chi cuadrado o exacta de Fisher. Resultados: el porcentaje de adolescentes que asistieron al control prenatal y se sometieron a la prueba no treponémica fue de 95% y 92,8%, respectivamente. El 7,9% recibió tratamiento adecuado. Hubo asociación estadísticamente significativa entre títulos elevados de la prueba no treponémica de la madre en el momento del parto y el análisis de sangre periférica del recién nacido (p=0,002), así como entre tratamiento inadecuado o ausencia de tratamiento de la madre con títulos de la prueba no treponémica > 1:8 (p=0,001). Conclusiones: La alta incidencia de sífilis congénita en hijos de adolescentes muestra que la infección podría haberse evitado en el bebé si hubieran recibido un tratamiento adecuado durante el control prenatal. Este estudio puede apoyar el desarrollo de políticas públicas destinadas a mejorar la atención prenatal y el control de la sífilis congénita en esta población.

Perinatal outcomes of adolescent and adult mothers: a systematic review / Resultados perinatais de mães adolescentes e adultas: uma revisão sistemática / Resultados perinatales de madres adolescentes y adultas: una revisión sistemática

Objective: To identify and analyze studies published in the literature that researched adverse perinatal outcomes in live births to adolescent and adult mothers. Methods: The electronic databases PubMed and VHL (LILACS and MEDLINE) were consulted, using the MeSH descriptors with Boolean operators were used, which were grouped as follows: ("maternal age") AND ("risk factors") AND ("Pregnancy Complica- tions OR "Adverse Birth Outcomes" OR "Perinatal outcome"). This analysis resulted in eight articles published between 2018 and 2022. Results: Studies presented a strong as- sociation between young maternal age (<20 years) and unfavorable neonatal outcomes, such as low birth weight, premature delivery, need for oxygen therapy and admission to the Neonatal Intensive Care Unit. No significant data were found on adverse outcomes in pregnancies in the optimum age range (20>35 years). Conclusion: The analyzed studies point to a strong association between young maternal age and some clinical-obstetric complications.

Objetivo: Identificar e analisar estudos publicados na literatura que pesquisaram desfechos perinatais adversos em nascidos vivos de mães adolescentes e adultas. Métodos: Foram consultadas as bases de dados eletrônicas PubMed e BVS (LILACS e MEDLINE), utilizando-se os MeSH descritores com operadores booleanos, os quais foram agrupados da seguinte forma: ("maternal age") AND ("risk factors") AND ("Pregnancy Complications OU "Resultados adversos do parto" OU "Resultados perinatais"). Essa análise resultou em oito artigos publicados entre 2018 e 2022. Resultados: Os estudos apresentaram forte associação entre a idade materna jovem (<20 anos) e os desfechos neonatais desfavoráveis, como baixo peso ao nascer, parto prematuro, necessidade de oxigenoterapia e internação na UTI neonatal. Não foram encontrados dados significativos sobre resultados adversos em gestações na faixa etária ideal (20>35 anos). Conclusão: Os estudos analisados apontam para uma forte associação entre idade materna jovem e algumas complicações clínico-obstétricas.

Objetivo: Identificar y analizar estudios publicados en la literatura que investigaran resultados perinatales adversos en nacidos vivos de madres adolescentes y adultas. Métodos: Se realizaron búsquedas en las bases de datos electrónicas PubMed y BVS (LILACS y MEDLINE) utilizando los descriptores MeSH con operadores booleanos, que se agruparon de la siguiente manera: ("edad materna") AND ("factores de riesgo") AND ("complicaciones del embarazo OR "resultados adversos del parto" OR "resultados perinatales"). Este análisis dio como resultado ocho artículos publicados entre 2018 y 2022. Resultados: Los estudios mostraron una fuerte asociación entre la edad materna joven (<20 años) y los resultados neonatales desfavorables, como bajo peso al nacer, parto prematuro, necesidad de oxigenoterapia e ingreso en la UCI neonatal. No se encontraron datos significativos sobre resultados adversos en embarazos en el grupo de edad ideal (20>35 años). Conclusión: Los estudios analizados apuntan a una fuerte asociación entre la edad materna joven y algunas complicaciones clínico-obstétricas.

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents? / Por que os pediatras têm desconforto para prescrever contracepção de emergência para adolescentes?

Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

RESUMO Objetivo: A contracepção de emergência (CE) é um método eficaz e seguro para prevenir gravidez não planejada após relação sexual desprotegida entre adolescentes, mas raramente prescrito por pediatras. Diante da escassez de dados sobre o desconforto com a prescrição de CE entre médicos no Brasil, o objetivo deste estudo foi identificar fatores associados a esse desconforto entre pediatras do estado do Amazonas. Métodos: Uma pesquisa do tipo e-survey coletou dados sociodemográficos, conhecimento, atitudes e desconforto com relação à prescrição de CE. Métodos de regressão logística multivariada e inteligência artificial, como árvore de decisão e random forest, foram usados para identificar fatores associados ao desconforto para a prescrição de CE. Resultados: Entre os 151 médicos que responderam à pesquisa, 53,0% sentiam-se desconfortáveis para prescrever CE e apenas 33,1% já a haviam prescrito. A inexperiência foi associada a esse desconforto (odds ratio — OR 4,47, intervalo de confiança — IC95% 1,71-11,66). A prescrição prévia de CE foi fator de proteção com relação ao desconforto nos três modelos. Conclusões: A CE ainda é pouco prescrita por pediatras. Apesar de sua segurança e eficácia, a inexperiência e conceitos equivocados foram associados ao desconforto para sua prescrição. Investigações sobre o assunto são importantes para subsidiar políticas públicas de saúde para a redução da gravidez não intencional na adolescência.

Fatores relacionados à gravidez na adolescência: perfil reprodutivo de um grupo de gestantes / Factors related to pregnancy in adolescence: reproductive profile of a group of pregnant women / Factores relacionados con el embarazo en la adolescencia: perfil reproductivo de un grupo de mujeres embarazadas

Objetivo: descrever o perfil reprodutivo de mulheres adolescentes participantes de um grupo de gestantes. Método: estudo descritivo, transversal, documental e retrospectivo realizado através da ficha de cadastro de participantes de um grupo de gestante vinculado ao consultório de enfermagem de uma universidade pública federal do rio de janeiro em 2018. Resultados: analisou-se 59 cadastros. houve predominância de mulheres, jovens (71,2%); solteiras (72,3%); multíparas (56%); que tiveram cesárea como via de parto anteriormente (39%); no segundo trimestre de gestação (61%); tipo de pré-natal público (86,4%); desejando a via de parto vaginal (45,8%) e laqueadura pós-parto como método contraceptivo (30,5%), participaram do grupo sem acompanhantes (79,7%) e desejam visita domiciliar pós-parto (78%). Conclusão: identificou-se a necessidade, fatores relacionados e vulnerabilidades em saúde reprodutiva com vistas a implementação de cuidados primários voltados à promoção da saúde, prevenção de agravos e detecção precoce.

Objective: to describe the reproductive profile of adolescent women participating in a group of pregnant women. Method:descriptive, cross-sectional, documentary and retrospective study carried out through the registration form of participants of a group of pregnant women linked to the nursing office of a federal public university in Rio de Janeiro in 2018. Results: 59 records were analyzed. there was a predominance of women, young people (71.2%); single (72.3%); multiparous (56%); who had previously had a cesarean section (39%); in the second trimester of pregnancy (61%); type of public prenatal care (86.4%); desiring vaginal delivery (45.8%) and postpartum tubal ligation as a contraceptive method (30.5%), participated in the group without companions (79.7%) and desired postpartum home visit (78%). Conclusion: the need, related factors and vulnerabilities in reproductive health were identified with a view to implementing primary care aimed at health promotion, disease prevention and early detection.

Objetivo: describir el perfil reproductivo de mujeres adolescentes participantes de un grupo de gestantes. Método: estudio descriptivo, transversal, documental y retrospectivo realizado a través del formulario de registro de participantes de un grupo de gestantes vinculadas al consultorio de enfermería de una universidad pública federal de Río de Janeiro en 2018. Resultados: se analizaron 59 registros. hubo predominio de mujeres, jóvenes (71,2%); soltero (72,3%); multíparas (56%); que previamente había tenido una cesárea (39%); en el segundo trimestre del embarazo (61%); tipo de atención prenatal pública (86,4%); deseando parto vaginal (45,8%) y ligadura de trompas posparto como método anticonceptivo (30,5%), participaron del grupo sin acompañantes (79,7%) y desearon visita domiciliaria posparto (78%). Conclusión: se identificaron la necesidad, los factores relacionados y las vulnerabilidades en salud reproductiva para la implementación de la atención primaria dirigida a la promoción de la salud, la prevención de enfermedades y la detección temprana.