A prevenção dA grAvidez nA AdolescênciA nA visão de AdolescenTes

The objective of the research is to understand the vision of adolescents on the prevention of adolescent pregnancy in a school in the municipality of Divinópolis, Minas Gerais. This is a descriptive study, exploratory, with a qualitative approach, with 14 adolescents. Semistructured interviews. Data were analyzed and interpreted by discourse analysis. The analysis of the reports of the subjects interviewed originated four empirical categories: perception about the importance of preventing teenage pregnancy, knowledge about the use of contraception methods, use of contraceptives methods, barriers to access to health services for the prevention of pregnancy. It is concluded that the adolescents consider the prevention of teenage pregnancy as something positive, express their Knowledge about contraceptive methods demonstrate that practicing, safe sex and unsafe and point out flaws in the quality of health care. Efforts of public power are required for the realization of the public policies in health care of adolescents. descripTors: Adolescent. Contraception. Pregnancy in adolescence. Prevention and control. prevención del eMBArAzo en lA AdolescenciA en lA visión de AdolescenTes resUMen: El objetivo de esta investigación fue comprender la visión de los adolescentes con relación a la prevención del embarazo de adolescentes en una escuela en el municipio de Divinópolis, en Minas Gerais. Investigación descriptiva, de tipo exploratorio, con enfoque cualitativo, realizado con 14 adolescentes, por medio de entrevistas semiestructuradas. Los datos fueron analizados e interpretados por análisis del discurso. El análisis de los informes de las personas entrevistadas originó cuatro categorías empíricas: percepción acerca de la importancia de la prevención de los embarazos en la adolescencia, el conocimiento sobre el uso de métodos anticonceptivos, el uso de métodos anticonceptivos, las barreras para el acceso a los servicios de salud para la prevención del embarazo. Se concluye que los adolescentes consideran la prevención del embarazo en la adolescencia como algo positivo, expresan sus conocimientos acerca de los métodos anticonceptivos, demuestran que practican el sexo seguro e inseguro y señalan defectos en la calidad de la atención de la salud. Los esfuerzos de los poderes públicos son necesarios para la realización de políticas públicas en materia de atención de la salud de los adolescentes. descripTores: Adolescente. Anticoncepción. Embarazo en adolescencia. Prevención y control. 30 http://dx.doi.org/10.1590/0104-07072015000130014


INtRODUCtION
This study is included in the context of research on teenage pregnancy prevention -the stage of life between 10 and 20 years of age, according to the World Health Organization (WHO) and the Brazilian Ministry of Health (MH). 1 Adolescence is a complex period of life which is characterized by social, psychological, anatomic and hormonal changes that, along with new experiences, shape the personality of an adult-to-be and contribute to define the behavioral pattern and personal values that will set up throughout their lives.Since this is a period of constant psychological and social contradictions, expressed by a position of confrontation and opposition to values, traditions, society rules, as a means of shaping their identity and autonomy over adults, these individuals may be vulnerable to unhealthy behavior and thus more subject to health damages.At this point in their life cycle, adolescents do not often abide by the rules of society and guide their lives under their own rules, which may result in the use of drugs, alcohol abuse, and unsafe sex. 2 In a context in which the violation of social rules prevails, and considering that an individual's first sexual experience occurs in the adolescence, pregnancy is common and is a phenomenon of great importance and social relevance.Indeed, the ratio of births in Brazil whose mothers were aged between 10 and 19 was 21.1% in 2007. 3In addition, childbirth among adolescents may be the first reason for hospitalization of women aged between 10 and 19 in Brazil in 2012, which certainly results in high public expenses. 46] Feelings of loss, sadness, loneliness, isolation, concern, as well as unemployment or entering an unskilled labor market may occur as a consequence of teenage pregnancy. 7t is worth noting that many teenagers wish to become pregnant as a way of escaping or solving their problems within their social and family contexts.In this case, motherhood appears as an occupation that gives meaning to life and brings recognition within their living environment. 8For this reason, and in order to prevent teenage pregnancy, actions focused on the health of adolescents and families must be implemented. 8 the management of adolescent health promotion, it is the role of primary care to implement the monitoring of growth and development, which includes a permanent and full approach to reproductive health care, involving health education, group activities and individual care. 9However, it is possible to see that these actions are limited, and only the distribution of contraceptive methods has been done. 9][12] However, there is a lack of studies in the literature that explore the view of pregnant adolescents about pregnancy prevention.In this sense, such investigations are relevant as they can bring about elements that enable to define care actions that minimize this issue.
Considering the implications of teenage pregnancy and the need for subsidies to develop and plan health actions that have a positive effect on this reality, it is essential to study teenage pregnancy prevention from the adolescents' point of view, so as to bring about reflections on the topic and to identify indicators for preventive purposes.In this sense, the objective of this study was to understand the view of adolescents on teenage pregnancy prevention in a school in the municipality of Divinópolis, Minas Gerais.

MethOD
This is a descriptive, exploratory and qualitative study.Qualitative research enables the researcher to better explain the phenomena under investigation, since they are able to explore the spectrum of opinions and the different representations. 13his study was conducted in a municipal primary school, located in the ninth sanitary sector of the southern area of Divinópolis.This school is within the area covered by the Family Health Program (FHP).
A total of 14 adolescents participated in the study, and the number of interviews was defined based on the criterion of data saturation. 14After the study was explained, legal guardians and adolescents who accepted to participate signed a Free and Informed Consent Form.
Data were collected between April and May 2013, by means of semi-structured and scripted interviews, recorded with the consent of participants, and which contained questions on pregnancy prevention.The interviews were carried out Fiedler MW, Araújo A, Souza MCC individually, in a classroom, during class hours.
After speeches were transcribed in detail and thoroughly read, the material was submitted to the speech analysis technique proposed by Platão and Fiorin. 15This method consists of identifying figures of speech (words or sentences that correspond to something real in the natural world) and themes (elements that organize, categorize and ordinate the reality perceived by senses) and further linking, with the creation of empirical categories (expressions that will be discussed in light of the corresponding scientific literature). 15he study was conducted in compliance with the requirements of Resolution 466/12 of the Health Council of Brazil. 16The research proposal was approved by the Human Research Ethics Committee of UFSJ under protocol number 174.853 of 02/06/2013.
In order to distinguish the subjects and also protect their identities, they were identified by the letter A and a number, which indicated the order in which the interviews were conducted.

ReSULtS
Participants of the study lived in the area covered by Sanitary Sector 9 of Divinópolis, and came from three different neighborhoods and health care units, attended primary school, of which five were boys and nine were girls, aged between 10 and 16 years old.
The analysis of the interviewees' speeches allowed us to reflect on their perceptions regarding teenage pregnancy prevention, which resulted in four empirical categories, presented as follows.

Category 1: Perception of the importance of teenage pregnancy prevention
When questioned about their thoughts on teenage pregnancy prevention, all interviewees considered it important.Regarding the reasons for which they believe it is relevant at this stage of life, adolescents mentioned the possibility of continuing their leisure activities, their freedom and adolescence itself: I think it's important; some friends of mine had children in their adolescence, so prevention is very important.Otherwise you have to stop with your life, your life changes, it becomes completely different...getting pregnant puts an end to adolescence (A13).
I think teenagers who get pregnant stop having fun, as they will dedicate themselves to the child, there is no time left for having fun, that's why it's important to prevent it (A11).
These findings show that teenage pregnancy prevention is a relevant topic for participants, as they reflect on the consequences of pregnancy at this stage of life.
Other adolescents highlighted the importance of preventing pregnancy in order to favor greater opportunities for a better future, a job and continuity in education.
Adolescents stated that preventing a child at this time of life avoids family conflicts and prejudice from society regarding a precocious pregnancy.
Nowadays, pregnant teenagers are subject to a lot of prejudice as well.It is important to prevent it, because if they don't have a child in their adolescence, they will be able to get married without worries; it's more difficult to get married when you have a child, since it's difficult to find a guy who takes you seriously (A5).
[...] the adolescents' parents will argue with them so it's important to prevent it (A12).
It is possible to notice that adolescents can identify the benefits of prevention, although they show particular prejudice regarding adolescent parents, which is something concerning and that requires special attention.
Interviewees described the relevance of teenage pregnancy prevention, emphasizing that the baby would not be cared of properly or would be rejected, without mentioning all the spending: it is necessary to prevent it, because some will say they don't want it, will not accept it, some will tell the person to abort because they don't want it (A14).
she [the teenage mother] won't be able to take care of the baby, it has to be avoided (A6).
if it is prevented, there will be money, they won't spend it with the baby (A5).
Again, prejudice is observed regarding teenage parenthood, which confirms the need for actions on this matter.
The prevention of teenage pregnancy in adolescent's view Participants believe that there are no negative aspects in teenage pregnancy prevention: I think there is no negative aspect, because if the teenager gets pregnant, they will be wasting their life (A10).
no, it has to be prevented because there will only be negative aspects if they get pregnant in their teenage, as they are supposed to be going to parties instead of taking care of a baby (A14).
Therefore, it is possible to observe that adolescents see pregnancy prevention as positive and important, thus being receptive to an educational approach of this topic.

Category 2: Knowledge of the use of contraceptive methods
Adolescents expressed their knowledge of contraceptive methods and indicated those they were more familiar with, such as the condom and hormonal contraception.
[...] the condom, and there is also a pill, I forgot the name.It's a pill pack, I think it contains 10 pills (A13).
In spite of identifying contraceptive methods, we noticed that adolescents do not know how to use them properly, as presented in the theme sentences and excerpts of speech: the adolescent identifies the injectable contraceptive as a method, but does not know how to use it (A2), (A3) and (A7); The adolescent identifies the calendar-based method, but does not know how it works (A10).
For the condom, you open it and unroll it over the penis, taking care not to tear or pierce it.I don't know anything about the pill (A5).
I have a friend here at school who uses it, but I don't know how to use it (A12).
According to the adolescents' speeches, most of them mentioned the condom as a contraceptive method, but could not explain in detail how to use it.These findings show that educational actions are not taking place in the adolescent environment.
Look, I cannot tell you exactly.When they explained it to us at school, they told us that we have to grab the condom, put it on the penis, and if there is a tip left at the end, we must roll it so the air won't penetrate and the condom won't pop (A11).

Category 3: Use of contraceptive methods
When participants reported their sexual experiences, they showed that they have both safe and unsafe sex: it was all new to me, different, weird, but done carefully.I didn't know, I was unexperienced, but I think he already knew how it was, so it was all done carefully.We used a condom and kept using it (A5).
the first time we did it using a condom, but since then we haven't used it anymore, and I regret that.We just used it two or three times.I always said we had to use it, but he always said it was better without it and so.We were always scared, but anyway we kept doing it (A8).
It should be mentioned that adolescents always reaffirm the characteristics of that age group, in which there is greater vulnerability and limited autonomy.
Adolescents mentioned that even though they haven't started their sexual lives, they intend to use a condom at their first experience: [...] I think about using a condom, which is the method I know, but later on, if I get to know other methods, maybe I'll try (A12).

Category 4: Barriers to access health services in pregnancy prevention
In the adolescents' speeches, it was evident that they face different barriers to access health services for pregnancy prevention and addressing sexuality.The reported barriers refer mainly to the quality of the service provided and to the embarrassment they experience as a result of this kind of health service.The service is considered poor and professionals not very friendly.Interviewees also highlighted a lack of confidence in condoms provided by health units.Besides, many of them consider the information on pregnancy prevention obtained with relatives as sufficient, thus finding it unnecessary to search for information in primary health care units.

First, because I wasn't interested, I hadn't thought about this, and second, because I don't like it there, I don't like their service. Women are very strange (A13). Oh, I don't know, it's embarrassing to go to a health unit and talk about this (A8).
Because my mother talks a lot about this with me, my aunts, so I never needed to go there to get this kind of information (A5).
Oh, I think it's not a good unit.It takes too long to be assisted (A2).

Condoms given by health units are cheap. I'd rather buy them (A3).
These findings reveal the precarious health services provided in primary health care units Fiedler MW, Araújo A, Souza MCC across the country, both in terms of human resources and infrastructure.In contrast, adolescents who have not had their first sexual experience showed their intention to look for these services as soon as they begin their sexual lives: the adolescent intends to look for a health care service only when they begin their sexual experiences (A1), (A6), (A7), (A9), (A10), (A11), (A12)

DISCUSSION
The results of the present study allowed us to reflect on the adolescents' approach to teenage pregnancy prevention.The topics that were brought up include the positive aspects of teenage pregnancy prevention, knowledge and use of contraceptive methods and barriers to access health services for addressing pregnancy prevention at this stage of life.
The phenomenon of teenage pregnancy is not recent, but new ways of understanding and accepting it have appeared, in the context of modern society.At present, it is understood as a process that interrupts adolescents' growth and coming-of-age, resulting in waste of opportunities [5][6][7] , as agreed by participants of our study, who mentioned the full experience of adolescence as a positive aspect of pregnancy prevention.
It is worth highlighting that pregnancy at this point results in a change in the stage of life, in which the adolescent enters the adult world, as they are faced with many new responsibilities.They have some limitations and a series of important aspects and events that contribute to their development are hampered, such as school, leisure, professional planning and building a career.In that sense, the subjects of our study claim that teenage pregnancy prevention is a valuable instrument to offer better living conditions in adulthood.
Still regarding the implications of teenage pregnancy, some investigations have shown that it can cause harm to the baby's health, often as a result of mistreatment and rejection by adolescents, as well as of family conflicts. 5,7For this reason, it is important to take actions that foster pregnancy prevention, as pointed out by this study.
Our investigation showed that adolescents consider pregnancy prevention important, since one of its negative effects is the impossibility of having leisure activities.A study carried out with pregnant adolescents from southern Brazil found that many interviewees reported difficulties and feelings of regret for having a child.A reason for dissatisfaction that was often mentioned was the reduced number of nights out. 7dolescents from the present study reported the negative aspects of pregnancy; however they consider pregnancy prevention important at this stage of life, and said unanimously that there are no negative aspects in pregnancy prevention.A study carried out in Porto Alegre is in line with our study, as it showed that adolescents want to prevent pregnancy in order to avoid possible regrets. 179][20] In our investigation, the male condom was mentioned very often by interviewees.9][20] For instance, campaigns promoted by the Ministry of Health have encouraged the use of male condoms.However, these campaigns are criticized, because although they draw attention to the matter, they do not manage to provide new knowledge and promote changes in behavior of adolescents with a low socioeconomic level. 3,19dolescents are only superficially familiar with contraceptive methods, since they provided incorrect or incomplete information about their use.1 Therefore, it is essential to consider the impact of precocious sexual initiation, which is exacerbated by the lack of knowledge, reflection and awareness of adolescents' behavior regarding sex. 19A study conducted with adolescents from Rio de Janeiro revealed that many young people begin their sexual practices without any information about contraception and they deny the use of any contraceptive method at their first sexual intercourse. 22e reinforce the need for making information available to adolescents, noting that schools must also play a role in it, which should not be limited to primary health care units. 17egarding the use of contraceptive methods by sexual active adolescents, another study found similar results to those found here, with about 70% of adolescents making use of a contraceptive The prevention of teenage pregnancy in adolescent's view method. 19,21Nonetheless, reports of individuals from our study showed that not all of them make use of contraceptive methods continuously, as found in other investigations, which results in greater risks of pregnancy and sexually transmitted diseases. 19,23nother important finding in our study was the barriers to access health services for addressing sexuality, which were related to service quality and condoms made available, as reported by adolescents.According to the Ministry of Health, actions aimed at adolescents must propose effective care to sexual and reproductive health. 1 However, it is clear that health professionals are not always sufficiently skilled or trained to meet the needs of this population, thus resulting in a gap between professionals and patients. 21ndeed, programs aimed at adolescents, both in the fields of health and education, have not managed to reach this population before they have an unsafe sexual intercourse. 24There is a lack of bonding between health care units and adolescents, and these individuals seldom seek these units for assistance regarding sexual health. 25In the present study, many adolescents reported they intended to search for information at a health care unit only when they began their sexual activities, but this thought does not correspond to the need for previous preparation for sexual intercourse, as adolescents must be informed continuously and accurately, before an unexpected pregnancy occurs.
We can observe that the lack of bonding and dialog between professionals and interviewees makes adolescents lose interest in seeking the services and result in feelings such as embarrassment, distrust in methods offered and search for information on sexuality in other places considered as adequate. 26ome adolescents reported they are guided by information provided by relatives.Studies that sought for the source of information about sex among adolescents noted that some of them ask their relatives in order to clarify all doubts. 6,20herefore, it is essential to include families in this process of sexual guidance, and it is necessary to encourage discussions between adolescents and parents, and provide them with knowledge in order to address the matter effectively. 27chools are an adequate environment to provide sexual education on teenage pregnancy prevention to parents, relatives and adolescents themselves.3 Nevertheless, it is important to highlight that without intersectoriality between health and education, the process becomes fragile. 18n that sense, we can highlight the proposal by the Health at School Program (HSP) as an opportunity to establish and keep a link between adolescents and the Family Health Program (FHP).This experience was lived by an FHP team who implemented the program in a public school of Fortaleza, Ceará, in which it was initially presented to the school management and teachers, and all doubts concerning the program were cleared.After this step, the HSP proposal was presented to students, who gave their opinions on the topics to be discussed in subsequent meetings and who were examined by a nurse and a dentist; then the Teenager Health Handbook was handed to them.Once the meetings were held, adolescents took a step closer to the FHP and began to attend health services. 28hus, based on the results and following the guidelines of the national policy of adolescent care, it is recommended that professionals be able to embrace and provide services that are specific to this age group, so as to plan intervention measures within the health unit. 3Actions must result in partnerships with schools and relatives so as to have more possibilities of bonding and qualified hearing, and to foster continuity and effectiveness of action aiming to ensure sexual and reproductive health and to prevent precocious pregnancy.
It is worth mentioning that it is the responsibility of primary health care, more precisely of the FHP, to promote monitoring of adolescents' growth and development, especially vaccination, oral health, the establishment of groups of adolescents, with a multidisciplinary approach and the active search for community health agents. 29ctions must include and value adolescents' knowledge, by being thought-provoking, creative, motivating and innovative, and able to encourage adolescents to take part in the educational process. 3,29These interventions, which must be focused on pregnancy prevention, should not be based only on contraceptive guidelines, but should rather be based on discussing sexuality so as to address flirting and sexual initiation, always focusing on adolescents' needs and not excluding discussions about the consequences of pregnancy Fiedler MW, Araújo A, Souza MCC at this stage of life, as well as projects of life that postpone parenthood. 5,7inally, considering adolescents as subjects with full rights, both in regards to sex and reproduction, is the way to acknowledge adolescents as individuals with duties and responsibilities regarding their attitude. 7his study dealt with non-pregnant adolescents, which is a limitation, since the matter involves other factors such as family, health and school services and professionals.

CONCLUSIONS
The present study revealed that adolescents consider teenage pregnancy prevention as something positive.When speaking about positive aspects, interviewees made clear that the use of contraceptives is necessary, but their knowledge on them is not sufficient for a regular and adequate use.It is worth mentioning the contradiction showed by adolescents when they reported the use of contraceptive methods, since their knowledge is not accurate.Adolescents do not seek assistance in order to obtain information about the topic, and barriers to access information were reported, as well as a lack of bonding.In order to resolve the presented matter, it is essential to raise awareness and promote professional training in order to implement actions that are in line with public policies, in a creative and innovative way so as to establish a link, dialog and qualified hearing; for example, establishing a partnership with schools and families.These partnerships are important due to the fact that adolescents do not seek health units, so it is a way of providing access to essential information on contraception, the meaning and the consequences of teenage pregnancy, and to promote a project of life that includes parenthood at a later stage.The present investigation also points out to the need to strengthen the integration of families, school and health in order to enhance their roles within the educational process of teenage pregnancy prevention.