Adolescent Pregnancy in Portugal: Relational Context, Contraceptive Behavior, and Decisions about the Course of Pregnancy
ESC Congress Library. Pires R. May 28, 2014; 50625; A-210
Raquel Pires
Raquel Pires
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Introduction: Although much effort is being made worldwide to provide access to counselling and contraception, to promote efficient contraceptive behaviour, and to prevent early pregnancy, adolescent motherhood remains a public health concern. In Portugal, sex education is integrated in primary and secondary curricula in public schools. Family planning centres for adolescents, contraceptive methods, and abortion are provided free of charge by public healthcare centers. However, the Portuguese adolescent motherhood rate remains above the European Union average.
Objectives: Descriptive study of the relational context and the contraceptive behaviors leading to adolescent pregnancy and the decisional process underlying its continuation.
Design & Methods: Participants included a nationally representative group of 462 pregnant adolescents. Data were collected between 2008 and 2013, in 42 public health services.
Results: Regardless of having had one (60%) or multiple sexual partners (40%), the majority of adolescents became unintentionally pregnant (77%) in the context of a romantic relationship (99%). On average, relationships were longer than 12 months and adolescents' partners were older than themselves (>4 years) and no longer in school (75%). About 72% of adolescents used contraception, and 71% knew the contraceptive failure which led to pregnancy. The condom (48%) and the pill (35%) were the mostly used methods. The most frequent causes for contraceptive failure were: \"\"the condom broke\"\" and \"\"I forgot to take the pill\"\". About 54% of adolescents did not contact with healthcare services before the tenth gestational week; thus, they had no legal opportunity to terminate their pregnancies. Among the adolescents who had legal opportunity to terminate the pregnancy, only 15% considered that option: 44% were forced/influenced by others to continue the pregnancy and 56% decided to do so on their own.
Conclusions: The knowledge gained with this study may guide policymakers, educators, and healthcare providers to prevent adolescent motherhood more effectively. Educating adolescents about the availability and action of contraception, contraceptive failure during typical use, and the subsequent risk of pregnancy seems to be particularly important to prevent adolescent pregnancy in Portugal. Partners' characteristics may also help explain the insufficient results observed in several preventive programs provided exclusively at school and/or that focused on peer-aged couples. Early pregnancy diagnosis seems to be necessary to increase adolescents' chances of being involved in legal and supported decisions about pregnancy resolution. Further investigation is needed to clarify the conditions under which decisions about pregnancy continuation are made.

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