Journal of Medical and Clinical Nursing Studies

Teenage Pregnancy

Tricia Bogossian

Specialist in Adult Intensive Care Nursing and Neonatal Nursing by UERJ and Occupational Nursing (UFRJ), Santa Ursula University in Rio de Janeiro-RJ, Brazil

*Corresponding author
Tricia Bogossian, Specialist in Adult Intensive Care Nursing and Neonatal Nursing by UERJ and Occupational Nursing (UFRJ), Santa Ursula University in Rio de Janeiro-RJ, Brazil.

ABSTRACT
This work seeks throughout its topics to present one of the major social problems in the world, teenage pregnancy, highlighting the vision of renowned authors, as well as establishing an understanding of the measures adopted by governments in order to minimize the growth of adolescents who become become mothers. The general objective of the work is to highlight the aspects involved in teenage pregnancy, as for the specific objectives, they are: describe the social view on teenage pregnancy; present the measures or precautions established by the government as a way to minimize pregnancy among teenagers; highlight the relevance of prenatal care for pregnant women. In the process of developing the work, a literary review was carried out, based on works published in the last 11 years, to highlight some of the main concepts and evaluations of authors from both the social and medical fields.

Keywords: Adolescents, Pregnancy, Society

Introduction
Teenage pregnancy occurs in all societies, but the level of teenage pregnancy and pregnancy varies from country to country. Low maternal age has been found to increase the risk of a range of pregnancy complications, premature birth, low birth weight and elevated risk of prenatal and infant mortality. Adolescents and their children represent a population at increased risk for medical and educational problems and psychosocial problems [1].

Women who begin having children in their teens face a variety of problems during pregnancy and later life. They have higher rates of midwifery and neonatal outcome deficiencies, lower educational attainment, higher rates of poverty and welfare dependency.

The general objective of this work is to highlight the aspects involved in teenage pregnancy. As for the specific objectives, they are: to describe the social view on teenage pregnancy; present the measures or precautions established by the government as a way to minimize pregnancy among teenagers; highlight the relevance of prenatal care for pregnant women.

In the process of developing the work, a bibliographical review was carried out, based on works published in the last 11 years, including books and articles, consolidating the vision of renowned authors, as well as the authors’ concepts and assessments on how teenage pregnancy can impact both in the social environment and in the medicinal field. Substantiating the content presented throughout the work.

Theoretical Reference
The Teenage Years
Adolescence is the phase of human beings where important physical and psychological changes occur and, in turn, a marked transformation of social interactions and relationships. It is currently estimated that one in every five people is a teenager.

Adolescence is characterized by establishing itself as a phase of life in which the individual needs to acquire reproductive maturity where the psychological factors of childhood are intertwined with those of adult life and which, in turn, leads to their socioeconomic independence [2].

According to the ECA (Child and Adolescent Statute), the age range of adolescence begins at 12 and goes up to 18 years old. For the World Health Organization (WHO), this phase corresponds to ages 10 to 19, where it is used to refer to the transition stage between childhood and adulthood [3] .

Adolescence is a period of transition between childhood and adulthood. Its definition is not easy, as its characterization depends on a series of variables: ecological location (referring to the natural environment), socioeconomic stratum, ethnic origin and period of adolescence, among others.

Adolescence is the crucial period of the life cycle in which individuals take a new direction in their development, reach sexual maturity, rely on the psychological and social resources they obtained in their previous growth and assume for themselves the functions that allow them. identity and consider your own life project [4].

The teenager is an individual who acts freely and spontaneously in his environment within society, without measuring the consequences or responsibilities of his actions. At puberty, you are physiologically an adult, but society restricts you to the role and status of a child, established by the parents on whom you depend. Apparently, it is up to society to define adolescents as immature and incapable beings. 

According to Cruz; lime adolescence is characterized by biological, cognitive, emotional and social changes, constituting an important moment for the adoption of new practices, behaviors and gain of autonomy [5]. At this stage, young people become more vulnerable to behaviors that can weaken their health, such as inadequate diet, physical inactivity, smoking, alcohol and drug consumption and unprotected sex. This need for autonomy leads adolescents to reject the protection of adults and face risky situations and behaviors, which can lead to serious accidents, contamination by sexually transmitted diseases (STDs), unplanned and/or unwanted pregnancies and even death.

Adolescents and Sexual Health
Adolescents are increasingly forming romantic relationships and initiating sexual activity at an early age [6].

Sexual health is a general state of physical, mental and social well-being, and not the mere absence of disease or illness, in all aspects related to the reproductive system and its functions and processes. As a result, reproductive health includes the ability to have a satisfying and safe sex life and to have children, and the freedom to decide when and how often to do so or not [7] .

In particular, the early onset of sexual relations constitutes a health problem due to its multiple consequences for young people themselves, their families and society [6].

This sexual activity begins to occur, in many cases, soon after the beginning of romantic relationships, which can also be considered premature. Unfortunately, the study of these typical events in the psychosocial development of young people has not received due attention from researchers and the world health organization [7] .

Achieving a healthy sense of sexuality during adolescence also entails new ways of exploring and participating in sexual activity. To better understand this issue, we must clarify that sexual activity is considered to include all erotic expressions that occur between people. Although on some occasions these expressions are part of the sexual game that precedes sexual intercourse, for adolescents, as for other people, they can constitute ends in themselves, depending on the situation and the moment in which they occur [8] .

One of the characteristics of sexual activity is that a marked progression can be recognized in it, ranging from lower degrees of intimacy and stimulation to degrees of intense relationship and maximum stimulation [9].

The lower levels of this progression are probably interpreted as part of conventional affectionate treatment (holding hands) and the higher level corresponds to penetration. This progression can occur in many different ways with regards to its chance of occurring throughout adolescence. Thus, for example, some authors point out that while some adolescents begin their penetrative sexual activity very early, others manage to postpone it until they reach a relatively stable romantic relationship [7] .

They argue that men and women attach different meaning to genital sexual activity, which not only influences their behavior but also plays an important role in their sexual and reproductive health. In fact, while men recognize that for them their first sexual relationship constituted an episode of little consequence, a test that allowed them to confirm their “normality”, women report that their first sexual experience was without love for someone who was emotionally important. However, both men and women report that their first sexual experience was spontaneous and unplanned [9].

Taborda et al, suggest that a home alone with little supervision provides the ideal opportunity for adolescents to engage in sexual activities [9].

Regarding the consequences of sexual activity in adolescence, the literature suggests that these can be physical, psychological and social. Physical, such as unwanted pregnancy and sexually transmitted diseases, and social, such as social sanction or recognition and approval by the partner, peer group or family [8].

Among the psychological consequences are the feelings that maintain behavior such as satisfaction, pride, tranquility and a sense of accomplishment; and negative feelings such as guilt, sadness, regret, shame and worry. In one study, it was found that almost 40% of adolescents who claim to have initiated sexual activity experience a large number of positive feelings and that females report more negative feelings associated with sexual activity than males [9].

With regard to adolescents and reproductive health, it can be understood that, in today’s society, having romantic and sexual relationships from an early age is common among young people. There are also those who manage to postpone it until they find a stable partner or reach adulthood [7] .

Achieving reproductive health in adolescents is beneficial because comprehensive psychological, physical and social health is achieved, but having sexual intercourse at an early age brings consequences such as: unwanted pregnancies and in this way a teenager cannot develop psychologically and socially accordingly. with his age, as he has to assume responsibilities and duties that he should not yet fulfill [8] .

Sex Education
Sexual activity during adolescence can pose a risk to young women’s quality of life, as well as their health. This practice can result in early pregnancy, abortion, AIDS and other sexually transmitted diseases. The need for sexual education to identify and prevent risk factors for unwanted teenage pregnancy is becoming increasingly clear. To fulfill this purpose, all segments of society must be convened [10] .

If the objective is to educate, inform or, better yet, train, then the school stands out among other reference groups because this is its essential role. Some basic principles must be established for the success of educators’ actions. Perhaps the most important thing is not to base sexual education solely on the use of condoms and contraceptive methods, but rather on rescuing the individual as a result of their own actions. This favors the development of a sense of citizenship, respect, commitment, self-care and care for others [11] .

According to the WHO, “Sexuality is a physical demonstration of affection or affection, a human search for direct contact with the person we like”. This definition, despite all its weaknesses, limitations and unclear contours, is certainly one of the most publicized of all definitions of sexuality. In 2002, the WHO carried out a broad consultation with several experts in order to obtain definitions for sex, sexuality, sexual health and sexual rights. The results were then reviewed by a group of experts from different parts of the world. In the case of the concept of sexuality, the definition developed is much more comprehensive, however, the WHO does not recognize it as representing its official perspective [9].

In individuals’ sexual behaviors, practices, relationships and meanings are rooted in the set of experiences that constitute these people as social beings, within the cultural scenarios of sexuality dominant in their respective societies. Several factors contribute to shaping these experiences of sexuality differently according to social groups: religiosity, living conditions, sociability networks, patterns of relationships between the sexes, uses of the body and position in the social structure, in addition to the experiences lived around the world. throughout the life course [11].

In Social Sciences, as in other areas of knowledge, in order to carry out a more correct analysis of sexuality, it is necessary to identify all the elements inserted in the process, such as the articulations and nexuses of social stratifications and their interactions, since sexual activity, for To be fully exercised, it depends on socialization, learning, rules, scripts and cultural scenarios. It is not possible to understand sexual behavior without properly connecting it to the context in which it occurs [12].

Over the years, sexuality has become one of the most talked about subjects within the social context, mainly verifying how society has impacted the development of sexuality and promoted a new view of sex. Within schools, a discipline was created aimed at guiding students, as well as providing adolescents and young people with a new vision about the sexuality present within their routine, as well as the possible problems of carrying out sexual activity without due care [13] .

Every day it becomes more common to find reports talking about women or sexual diversity in our country, in recent years the facts related to them are more linked to violence. Since intolerance towards both is gaining more and more strength and causing more and more victims. Women have been gaining more and more space in the job market, achieving more and more prominence in employment areas, but the number of women victims of aggression has grown significantly in our country [11] .

For many teaching professionals, promoting debates or information within the school environment can be fundamental for students to be able to establish relevant concepts about sexual practice, as well as understanding important precautions that can be a method to avoid sexually transmitted diseases [9] .

Sexuality and HIV education programs do not increase any measure of sexual activity, but some programs with ten common characteristics reduce sexual risk, either by delaying or reducing sexual behavior or increasing condom use. Thus, these programs can be an effective component in a larger initiative to reduce HIV [13].

School-based sex education is the cornerstone of HIV prevention for adolescents who continue to bear a disproportionately high burden of HIV worldwide. We systematically reviewed and meta-analyzed existing evidence for school-based sexuality education interventions in low- and middle-income countries to determine the effectiveness of these interventions in changing HIV-related knowledge and risk behaviors [11] .

The development of sexual education practices in schools began at the beginning of the 20th century, focusing on epidemiological control. At the time, discourses prevailed that were, in general, repressive, anchored in the assumptions of religious morality and reinforced by the hygienic nature of public health strategies [11]. With the advancement of political discussions regarding sexual and reproductive rights, in which the feminist movement had a strong participation, discussions about sexuality expanded beyond its biological nature, enabling it to be understood as a practice combined with physical and mental health.

It can be seen from the concepts presented that valid sexual education in schools promotes rational sexual autonomy, requires students to consider the needs and desires of others and occurs within a moral framework. Identifying the moral framework within which sexuality education is taught is a controversial issue. Once this is recognized, possible approaches to balanced teaching of school sexuality education become easier to identify. It is suggested that teachers adopt a stance that combines elements of affirmative and procedural neutrality [13].

New research can be carried out, expanding the focus of analysis and comparing, for example, national and international sexual education practices, in order to identify strategies used in other countries that can help in the foundation of future national public policies [14] .

It can be said that sexuality, in the Brazilian context, has still been considered a taboo permeated by moral principles and prejudices, in which children and adolescents feel repressed in expressing their doubts and expectations regarding the subject. Perhaps the greatest difficulty families have in dealing with sexuality is linked to the fact that society associates it with obscenity, with something dirty, sinful and forbidden [15]. It is important to consider that sexual education must be carried out in order to build knowledge devoid of any type of idea that combines sexuality with impurity or sinful things.

Use in Methods Contraceptives in Adolescence
Adolescents are no longer children, so they must know contraceptive methods to prevent pregnancy and sexually transmitted diseases, in addition to opting for abstinence.

Contraceptive methods are all those mechanisms used voluntarily, by the man, woman or couple, ideally by mutual agreement, to prevent conception. Contraceptive methods vary according to the moment of use, application, form and effectiveness, mechanism of action, among others.

Contraceptive methods include: temporary and permanent [4] .

The definitive methods are surgical and can be performed on both men (vasectomy) and women (Salpingoclasia or “tubal ligation”) [16] .

Among the temporary methods. Some are classified as natural and others as not, that is, they require the use of mechanical or chemical procedures: barrier and hormonal methods. 

Parents are their children’s first and main educators. Sexuality education is an important task that must be shared between the school and the family, for the success of this endeavor both must contribute to the formation of healthy, happy and responsible children, adolescents and young people.

Disruptions early in life are often a consequence of lack of access to information, unprotected or unwanted sex, or the ineffectiveness of contraceptives used [16] .

Young people give more importance to spontaneity and the romantic aspect and feel that planning sexual relations would compromise their ideals. They believe that contraceptives interfere with pleasure.

The most commonly used contraceptives in teenagers are intrauterine devices, pills, and condoms, in that order. However, there is a higher percentage of teenagers who do not use any contraceptive method.

According to the World Health Organization, Intrauterine Devices are not recommended for adolescents and young women because, due to their habitual sexual behaviors, they are at greater risk of contracting sexually transmitted diseases or human immunodeficiency virus infections [4] .

It should be noted that many teenagers know about contraceptive methods, are informed about sexual education, but still do not use them, due to lack of access or shame when purchasing in the case of women, this occurs in cities, cantons where all women know each other, information should also be given about abstinence or postponing the beginning of sexual life at an early age.

Teenage Pregnancy
Pregnancy can be considered one of the main stages in a woman’s life, but over the years it has been observed that certain diseases can arise during the pregnancy process. These diseases are more prominent when it comes to the emotional side of women, something that many doctors consider makes them extremely fragile due to the moment in which they find themselves [14].

They are less responsive to their babies and may be more prone to child abuse. Their children perform worse than children of older mothers on intelligence and vocabulary tests and are more likely to have behavior problems and fail in school. Adequate spacing between children is considered a beneficial factor for the health of both mother and child [10] .
Teenage pregnancy is defined as an underage girl (<19 years) becoming pregnant. Sexual activity in adolescence is generally associated with several risks, including sexually transmitted diseases and pregnancy due to failure or non-use of contraceptives. Particularly for teenagers, who are not emotionally mature, there are additional risks of emotional distress or future poverty. The most common causes of teenage pregnancy are early marriage and lack of contraceptive use, adolescent sexual behavior, sexual abuse and indirect causes such as poverty and low education [14].

The United Nations Children’s Fund (UNICEF) defines teenage pregnancy as being conceived between the ages of 13–19. However, in everyday language, the term teenage pregnancy is often used to describe young women who become pregnant when they have not yet reached the legal age of majority, whose age varies around the world. Additionally, the terms adolescents, young person, and child are often used interchangeably, although each has different definitions [10] .

Teenage pregnancy is therefore often a marker of social and economic disadvantage at a young age and a cause of other disadvantages, physical and emotional health problems [14].

Globally, complications of pregnancy and childbirth are the second leading cause of death among adolescents. Furthermore, although teenage births account for 11% of all births worldwide, they account for 23% of the overall burden of disease in disability-adjusted life years (DALYs) attributed to pregnancy and childbirth. . Maternal mortality is higher among adolescents than women aged 20 to 24 years worldwide [17] .

Several social factors have been associated with an increased risk of teenage pregnancy, and teenage pregnancy itself has also been associated with an increased risk of a number of adverse social outcomes. However, teenage pregnancy rates vary significantly between different countries, and similarly the social factors associated with teenage pregnancy also vary. In many countries with the highest rates of teenage pregnancy, it is associated with child and teenage marriage [10] .

Although becoming a parent can be a positive and enriching experience for some teenagers, teenage pregnancy and, in particular, teenage pregnancy is associated with a range of negative social outcomes. One of the main negative results consists of the schooling, as well as the financial development of teenagers who become a country, these points have a considerable impact on their and their children’s quality of life [17 ] .

Being a young mother can affect a person’s upbringing. Ten mothers are most likely to drop out of high school. Most teenage mothers live in poverty. A quarter of teenage mothers will have a second child within 24 months of their first. Factors that determine the causes of repeated births at shorter intervals include marriage and education: the probability decreases with the level of education of the young woman and her parents and increases if she marries [18].

One of the biggest social problems observed by nurses refers to teenage pregnancy, something very common in our country. Mainly due to the active sexuality of teenagers, something that needs to be guided and often observed by both those responsible and those close to them. Seeking to highlight to them the importance of prevention, existing methods to minimize the risks of pregnancy and description of the main diseases that can be transmitted through sexual intercourse [17] .

With the acceleration of growth, sexual stimuli, hormones and the lifestyle adopted by girls, menarche is occurring earlier, whereas in the past it happened around 12 years of age or more, nowadays most girls are having it. menarche at 9 years of age, becoming a risk factor for earlier onset of sexual activity, and consequently for teenage pregnancy. About half of all pregnancies in this period of life occur in the first 6 months after the first sexual intercourse [19].

Observing the information presented by the nurse, promoting guidance and presenting possible procedures that may be beneficial in the process of preventing pregnancy becomes fundamental. Mainly highlighting that adolescents do not have the necessary psychological or emotional structure to develop fatherhood or motherhood [17] .

Prenatal Care as an Instrument of Assistance and Guidance for Pregnant Adolescents
The prenatal procedure can be defined as a way found by governments and health representatives to monitor and assist women during the gestational period. Promoting and carrying out clinical procedures in order to observe the clinical condition of both women and children, with emphasis on the use of nurses in this process.

According to Almeida, nurses play a fundamental role in the process of monitoring pregnant women, checking whether they have any problems and checking the child’s development. As well as monthly analyzing whether there is any possibility of risk for both, it appears that nurses play a very important role in this procedure [20].

Lima & Moura emphasize that the main objective of providing health care must be the satisfaction of pregnant patients, meeting their needs and expectations. Thus, the nursing consultation currently leads to prestige and acceptance by the population, due to changes in its design, methodology and insertion in health services [21].

It can be seen that prenatal care is currently one of the main procedures carried out within the hospital environment to provide women with all the specialized support they need during this significant and important period for them. With emphasis on the relevance of professional nurses throughout the procedures carried out in order to provide guidance, supervision and assistance at times.

Throughout the prenatal period there are some procedures considered extremely important for clinical support. The tests carried out throughout the period can be applied in the case of problems already presented or even due to family information. Professional nurses need to be attentive and observing possible relevant information to determine the necessary tests.

According to Gonçalves blood and urine tests can be considered extremely important to verify the existence of some diseases within women’s bodies throughout the gestational period, providing an opportunity to treat them and consolidate the impacts they have. these diseases can have for the baby.

It is worth mentioning that one of the main objectives of prenatal care is to check for possible diseases that could have a considerable impact on the life of the pregnant woman or her child, providing all the necessary methods and processes so that in the event of a serious illness, this can be treated and its possible clinical damage can be minimized.

Lima considers that during the pregnancy period all methods or processes of support and clinical verification must be carried out, something that can be proven when analyzing the tests requested by professional nurses in the monitoring procedure for pregnant women. They seek to confirm that everything is in order, both for pregnant women and their children [22-25].

Conclusion
Given the points presented, it can be concluded that teenage pregnancy is identified as one of the social and educational problems present in many countries around the world. Something that generates concern on the part of governments and health bodies regarding the stability and development of teenagers who become pregnant.

It can be seen from the data presented that some measures were taken by the state seeking to assist or assist adolescents throughout their pregnancy, such as the prenatal program and sexual orientation lectures as a way of preventing or working on the aspects that can motivate pregnancy, in addition to these, access to condoms and pregnancy prevention procedures are becoming increasingly present in society.

In this way, aligning the points between guidance, prevention and support for adolescents can be an important difference so that pregnancy cases are minimized. It is worth highlighting that adolescence is a time of great instability and can have a strong impact on people’s lives if they are not properly guided or provided with important support.

References

1. Barreto AS, Rocha FG, Beserra JA. Gravidez na adolescência e a atuação de excelência do profissional de enfermagem. Revista Brasileira Interdisciplinar de Saúde. 2019.
2. Jezo RF, da Silva Ribeiro IK, Araújo A, de Assis Rodrigues B. Gravidez na adolescência: perfil das gestantes e mães adolescentes em uma unidade básica de saúde. Revista de enfermagem do centro-oeste mineiro. 2017. 7. 
3. de Araujo JK, De Oliveira JA, De Lima NB, da Silva JM, de Lima Junior AA. Gravidez na adolescência: atuação e desafio do enfermeiro na sua prevenção. Revista Saúde-UNG-Ser. 2018. 11: 22.
4. de Oliveira Lameira NR, dos Santos MP, de Souza Rodrigues L, de Souza TM, Garcez JC, et al. Boas práticas de enfermagem voltadas à gravidez na adolescência: relato de experiência. Revista Eletrônica Acervo Saúde. 2020. 21: e2300.
5. Cruz AQ, Lima C. GRAVIDEZ NA ADOLESCÊNCIA: Um olhar sobre os cuidados do enfermeiro. Faculdade Sant’Ana em Revista. 2021. 5: 52-62.
6. Ferrari E. Puberdade e Adolescência: Aspectos biológicos, clínicos e psicossociais - São Paulo: Roca. 2019.
7. Fiedler Milla Wildemberg, Araújo Alisson, Souza Márcia Christina Caetano de. A prevenção da gravidez na adolescência na visão de adolescentes. Texto & Contexto-Enfermagem. 2018. 24: 30-37.
8. Girondi P. Gravidez entre adolescentes muito jovens. Janeiro. Ed. Femina. 2019.
9. Taborda JA, Silva FC, Ulbricht L, Neves EB. Consequências da gravidez na adolescência para as meninas considerando-se as diferenças socioeconômicas entre elas. Cadernos Saúde Coletiva. 2014. 22: 16-24.
10. Rodrigues Lívia Santos, DA Silva Maria Vanuzia Oliveira, Gomes Maria Amábia Viana. Gravidez na adolescência: suas implicações na adolescência, na família e na escola. 2019.
11. Alves Letícia de Sousa, Aguiar Ricardo Saraiva. Saúde sexual e infecções sexualmente transmissíveis na adolescência: uma revisão integrativa. Nursing (São Paulo). 2020. 23: 3683-3687.
12. Ribeiro WA, de Lima JC, Souza MD, de Azevedo Fassarella BP, da Silva AA, de Oliveira LS, da Silva Santiago KC, da Silva CS. Adolescência x gravidez: as contribuições preventivas do enfermeiro na ótica da educação em saúde. Revista Uniabeu. 2019.12.
13. Louro Guacira Lopes. Gênero e sexualidade: pedagogias contemporâneas. Pro-posições, Campinas. 2018. 19: 17-23.
14. Sousa CR, Gomes KR, Silva KC, Mascarenhas MD, Rodrigues MT, et al. Fatores preditores da evasão escolar entre adolescentes com experiência de gravidez. Cadernos Saúde Coletiva. 2018. 26: 160-169. 
15. Louro Guacira Lopes. A construção escolar das diferenças. Petrópolis: Vozes, 2017.
16. Dos Santos AC, Vador RM, Cunha FV, De Almeida A. Abordagem do enfermeiro na gravidez na adolescência. Brazilian Journal of Health Review. 2020. 3: 17438-17456.
17. Sehnem GD, Crespo BT, Lipinski JM, Ribeiro AC, Wilhelm LA, et al. Saúde sexual e reprodutiva dos adolescentes: percepções dos profissionais em enfermagem. Avances en Enfermería. 2019. 37: 343-352. 
18. Santos JD, Silva CF, Petenão E, Soster FC, Berard MB, et al. Perfil das adolescentes com reincidência de gravidez assistidas no setor público de Indaiatuba (SP). J Health Sci Inst. 2009.
19. Dias Ana Cristina Garcia, Teixeira Marco Antônio Pereira. Gravidez na adolescência: um olhar sobre um fenômeno complexo. Paidéia (Ribeirão Preto). 2020. 20: 123-131.
20. Almeida EP. O Papel Do Enfermeiro Do Programa Saúde Da Família No Atendimento Pré-Natal. Revista de Enfermagem do Centro-Oeste Mineiro. 2014. 4: 1029-1035.
21. Lima YMS, Moura MAV. Revista de Pesquisa: Cuidado é Fundamental, Rio de Janeiro, ano. 2015. 9: 93-99.
22. Lima MN, Coviello DM, Lima TN, Alves ES, Davim RM, et al. Adolescentes, gravidez e atendimento nos serviços de atenção primária à saúde. Rev enferm UFPE on line. 2017. 2017: 2075-2082. 
23. de Oliveira YC, Neta AD, Mendes JR, de Brito Cardoso S, Campelo TP, et al. O papel da assistência da enfermagem na prevenção da gravidez em adolescentes: uma revisão integrativa. Revista Eletrônica Acervo Saúde. 2022. 15: e10126.
24. Rodriguez Yamisel Febles. Gravidez na adolescência. 2019.
25. de Oliveira Santos J, dos Santos Silva CF, Petenão E, Soster FC, Berard MB, et al. Perfil das adolescentes com reincidência de gravidez assistidas no setor público de Indaiatuba (SP)* Profile of adolescents with recurrence of pregnancy assisted in the public sector of Indaiatuba (SP). Rev Inst Ciênc Saúde. 2009. 27: 115-121.