Timely initiation of antenatal care in adolescent victims of sexual violence: implications for legal abortion in Brazil

Abstract

We investigated the timely initiation of antenatal care among Brazilian adolescents to support the national discussion on the gestational age limit for legal abortion. Using data from the Live Births Information System (SINASC) 2020-2022, we correlated the timely antenatal care (first quarter of pregnancy) with the adolescent’s age, region, ethnicity/skin color, and schooling level; 11,607 annual births result from vulnerable rape. The timely initiation of antenatal care was 70.2% for all adolescents (<20 years), but only 55.6% for those under 13 years old; 14.1% of adolescents started antenatal care at 22 weeks or more of gestation (28.3% among those <13 years old). Timely initiation was lower in the North region, among Indigenous girls, and those with low education. Delays in recognizing the pregnancy and communicating with the family contribute to the late start of antenatal care and the decision to abort. The proposed legal abortion time limit will mainly impact the most vulnerable adolescents in terms of socioeconomic and racial factors.

Key words:
Pregnancy in Adolescence; Rape; Abortion; Live Birth; Antenatal Care

Resumo

Investigamos o início do pré-natal em adolescentes brasileiras para subsidiar a discussão nacional sobre o limite de idade gestacional para o aborto legal. Com dados do Sistema de Informação sobre Nascidos Vivos (SINASC) 2020-2022 correlacionamos o início oportuno do pré-natal (primeiro trimestre da gestação) com a idade da adolescente, região, raça/cor e escolaridade; 11.607 partos anuais resultam de estupro de vulnerável. O início oportuno foi de 70,2% para todas as adolescentes (<20 anos), mas de apenas 55,6% para aquelas abaixo de 13 anos; 14,1% das adolescentes iniciaram o pré-natal com 22 semanas ou mais de gestação (28,3% entre <13 anos). O início oportuno foi menor na região Norte, entre meninas indígenas e com baixa escolaridade. Demoras no reconhecimento da gestação e na comunicação para a família contribuem para o início tardio do pré-natal e para a decisão de abortar. A proposta de limite do prazo para abortos legais irá atingir principalmente as adolescentes mais vulneráveis em termos socioeconômicos e raciais.

Palavras-chave:
Gravidez na Adolescência; Estupro; Aborto; Nascido vivo; Cuidado pré-natal

Resumen

Investigamos el inicio oportuno de la atención prenatal entre las adolescentes brasileñas para apoyar la discusión nacional sobre el límite de edad gestacional para el aborto legal. Con datos del Sistema de Información sobre Nacidos Vivos (SINASC) 2020-2022, correlacionamos el inicio oportuno del cuidado prenatal (primer trimestre del embarazo) con la edad de la adolescente, la región, la etnia/color de piel y el nivel de escolaridad; 11.607 nacimientos anuales resultan de violaciones vulnerables. El inicio oportuno fue del 70,2% para todas las adolescentes (<20 años), pero solo del 55,6% para aquellas menores de 13 años; el 14,1% de las adolescentes comenzaron el cuidado prenatal a las 22 semanas o más de embarazo (28,3% entre las menores de 13 años). El inicio oportuno fue menor en la región Norte, entre las niñas indígenas y las de baja escolaridad. Los retrasos en el reconocimiento del embarazo y en la comunicación con la familia contribuyen al inicio tardío del cuidado prenatal y a la decisión de abortar. La propuesta de límite de tiempo para los abortos legales afectará principalmente a las adolescentes más vulnerables en términos socioeconómicos y raciales.

Palabras clave:
Embarazo en la adolescencia; Violación; Aborto; Nacido vivo; Atención prenatal

Introduction

Adequate antenatal care is essential to ensure the pregnant woman’s health and the child’s healthy development, as it enables the implementation of support, prevention, screening, diagnosis, and care actions throughout a critical period¹. The World Health Organization and the Brazilian Ministry of Health recommend that antenatal care be initiated in the first quarter of pregnancy, up to the 12^th week, as it enables effective screening of pregnancy conditions and allows interventions and guidance to reduce health risks and promote a healthier pregnancy¹. The timely start of monitoring has been used as one of antenatal care’s adequacy and quality indicators¹.

During adolescence, pregnancy requires special care due to the particularities of this age group, as the risks of adverse health events are high, besides the complex social and economic conditions that can limit, for example, the young pregnant woman’s access to education^2,3. Data from a national survey conducted in 2011 showed that pregnancies among adolescents aged 12-16 have a higher risk of spontaneous prematurity than adolescents aged 17-19 (OR=1.49) and young adults aged 20-34 (OR=2.38)⁴. Another study that used data from the Live Birth Information System (SINASC) from 2011 to 2021 showed that live births to Brazilian adolescents aged 10-14 had higher percentages of prematurity (18.9%) and low birth weight (14.5%) than in any other age group⁵.

Although Brazil has made progress in creating health policies aimed at adolescents and protecting their rights, many young women still face difficulties and stigmas in accessing health services for timely diagnosis of pregnancy and legal abortion^6,7. These barriers are related to demographic, social, and economic contexts, resulting in variations between different groups by region of residence and socioeconomic conditions of the adolescents and their families⁸. Studies show that most adolescent mothers are Black and brown, started antenatal care late, and had fewer appointments than the seven recommended contacts during pregnancy^7-9. However, to date, no study has proposed to analyze the start of antenatal care for each year of the adolescent’s age.

The Child and Adolescent Statute (ECA) highlights the relevance of protecting the rights of adolescents and implementing public policies that ensure their health and well-being, recognizing the vulnerabilities arising from teenage pregnancy¹⁰. Furthermore, Article 217-A of the Brazilian Penal Code defines rape of a vulnerable person as “having sexual intercourse or practicing another lewd act with a minor under the age of 14”, which characterizes the pregnancy of girls aged 14 or younger as the result of a criminal act¹¹. In this context, Article 128 of the same code authorizes abortion in cases of pregnancy resulting from rape, without restriction as to gestational age¹².

Contrary to the Penal Code, a bill was proposed in 2024 in the House of Representatives (Bill No. 1,904/2024), equating abortion after 22 weeks of gestation to the crime of homicide, even in rape situations¹³. However, this period may be too short for abused adolescents due to several factors, such as delays in recognizing the pregnancy, fears about communicating with the family and seeking care, and difficulties in obtaining judicial authorization and accessing hospitals that perform legal abortions. We should describe inequalities associated with the initiation of antenatal care per the age of adolescents to support this discussion, which may prevent abused adolescents from having access to a legal abortion before their pregnancy completes 22 weeks. We analyzed more than 1 million pregnancies among Brazilian adolescents to document age patterns of timely initiation of antenatal care by Brazilian region, ethnicity/skin color, and the adolescent’s schooling level.

Methods

A retrospective study was conducted using data from SINASC for 2020, 2021, and 2022. The system is based on the Live Birth Declaration (DNV). This document must be issued by the service where the birth occurred and whose primary purpose is to characterize the conditions of pregnancy, labor, and birth throughout the national territory. The DNV contains much information about the parturient and the pregnancy, including age in whole years (mandatory field), the parturient’s date of birth, and the month of pregnancy in which antenatal care began.

Adolescent parturients (up to 19 years of age at the time of delivery) were the focus of the analyses, stratified by age in whole years. Adolescents aged 12 or younger were grouped to ensure sample size. Some analyses used parturients aged 20 years or older as a comparison group. Notably, the age of the pregnant woman at conception is approximately nine months less than her age at the time of delivery. Therefore, for parturients aged 14 or older, the age at conception was estimated by subtracting the number of gestational age weeks (divided by 52 to be expressed in fractions of a year) from the exact age of the girl at the time of delivery.

As the Ministry of Health recommended, the timely start of antenatal care was defined as occurring during the first quarter of pregnancy (first 12 weeks)¹. The percentage of parturients whose antenatal care began at five months or more of gestation was also calculated, corresponding to approximately 21.7 weeks. Since the DNV does not record gestational age in weeks at the time of the first appointment, we used the cutoff point of five months in the analyses as corresponding to the 22 weeks proposed in the legislation.

The proportions of births with timely antenatal care initiation were calculated by region of residence (North, Northeast, South, Southeast, and Midwest), ethnicity/skin color (white, brown, Black, Indigenous), and schooling (less than 4 years, 4 to 7 years, and 8 years and more). The ‘yellow’ ethnicity/skin color category (Asian/Oriental origin) was not included in the analyses stratified by ethnicity/skin color because it included only 3,943 adolescent parturients, concentrated in the 18-19 age bracket.

The analyses of the association between the proportion of timely antenatal care initiation and age adjusted for sociodemographic variables were based on prevalence ratios (PR) and the respective 95% confidence intervals (95%CI), estimated by Poisson regression models. Interaction between age and region of residence, ethnicity/skin color, and schooling level were tested.

The Ministry of Health makes SINASC data publicly available on its electronic portal (https://datasus.saude.gov.br/transferencia-de-arquivos/), and all information on parturients and live births is anonymous. Analyses were performed using Stata statistical software (StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC.).

Results

From 2020 to 2022, Brazil registered 7,968,916 births. Among the parturients, 1,061,967 were adolescents (13.3% of the total), ranging from 1,958 aged 12 or under to 314,342 aged 19 (Table 1). The group aged 12 or under included 1 girl reported to be 8, 18 aged 10, 284 aged 11, and 1,654 aged 12, totaling 1,958 under 13 at birth. There were also 9,793 births to girls aged 13 and 37,576 to girls aged 14. Among the latter, 61.4% became pregnant before their 14^th birthday, totaling 23,072 births. When these are added to the parturients aged 13 or younger, the total is 34,823 births in the 2020-2022 triennium, or 11,607 annual births resulting from the rape of adolescents who became pregnant before the age of 14.

Table 1
Characteristics of adolescent parturients by age in complete and total years and parturients aged 20 years or older, by sociodemographic variable. SINASC, 2020-2022.

Characteristic		≤12 years	13 years	14 years	15 years	16 years	17 years	18 years	19 years	Total (<20 years)	≥20 years
Region of residence
	North	28.1%	25.1%	21.8%	20.2%	19.1%	18.1%	17.0%	15.7%	17.6%	10.3%
	Northeast	38.9%	39.6%	38.8%	37.5%	36.0%	34.7%	33.6%	31.7%	34.2%	27.3%
	Southeast	17.6%	20.4%	23.7%	25.8%	27.3%	29.0%	30.4%	32.4%	30.0%	39.5%
	South	5.9%	6.4%	7.9%	8.5%	9.4%	9.9%	10.6%	11.6%	10.3%	14.3%
	Midwest	9.5%	8.5%	7.8%	8.0%	8.2%	8.3%	8.5%	8.6%	8.4%	8.6%
Ethnicity/Skin color
	White	14.8%	14.8%	17.3%	18.7%	20.4%	21.5%	22.8%	24.8%	22.2%	35.7%
	Black	4.9%	5.0%	5.4%	5.8%	5.9%	6.4%	6.7%	6.9%	6.5%	7.1%
	Brown	66.8%	72.6%	72.4%	72.0%	70.7%	69.5%	68.2%	66.3%	68.8%	55.8%
	Indigenous	13.5%	7.2%	4.6%	3.2%	2.6%	2.2%	1.8%	1.6%	2.2%	0.9%
Schooling
	Less than 4 years	6.7%	4.7%	2.8%	2.0%	1.7%	1.4%	1.3%	1.2%	1.5%	1.7%
	4-7 years	70.7%*	63.5%*	48.0%	35.1%	25.8%	20.2%	16.5%	14.3%	21.1%	11.0%
	8 years or more	22.6%*	31.8%*	49.2%*	62.9%	72.5%	78.4%	82.2%	84.5%	77.4%	87.3%
Absolute Number		1,958	9,793	37,576	89,513	148,702	203,625	256,458	314,342	1,061,967	6,596,529

• *Possible inconsistencies in the classification of the variable “schooling”, as the number of schooling years is incompatible with age.
• Source: Authors.

The total proportion of adolescents who initiated antenatal care in the first quarter was 70.2%. This coverage increased with age, ranging from 55.6% in the group aged 12 or younger to 77.8% for those aged 19; among women aged 20 or older, 84.9% had timely initiation of antenatal care (Figure 1 and Table 2). The test for linear trend in proportions was significant (p<0.0001), with an increase of 3.0 percentage points (pp) per year of age (Figure 1 and Table 3). Although the association between age and timely initiation is not perfectly linear, we chose to cite the regression coefficient, which indicates the mean value of increase per year of age throughout adolescence.

Table 2
Proportion of adolescent parturients who started prenatal care in the first quarter of pregnancy by age in full years, per region of residence, ethnicity/skin color and schooling years. SINASC, 2020-2022.

Characteristic (%)		≤12 years	13 years	14 years	15 years	16 years	17 years	18 years	19 years
Region
	North	46.4	51.2	56.4	59.5	61.6	63.9	65.3	67.1
	Northeast	61.0	64.3	68.2	70.5	72.4	73.6	75.2	76.5
	Southeast	65.4	66.9	69.7	73.4	76.3	78.7	80.1	81.7
	South	51.9	61.4	70.9	73.2	77.1	79.3	81.3	82.5
	Midwest	44.4	61.4	69.3	72.9	75.7	77.5	79.0	80.3
Ethnicity/Skin color
	White	63.6	66.0	70.6	74.5	77.5	79.9	81.5	83.1
	Black	53.8	56.1	61.4	65.6	67.9	71.5	73.2	75.7
	Brown	55.4	61.1	66.3	68.9	71.5	73.2	74.9	76.4
	Indigenous	46.3	52.5	54.5	58.5	58.2	60.2	61.6	61.7
Schooling
	Less than 4 years	53.6	49.7	58.4	59.9	60.9	65.3	63.3	63.9
	4-7 years	-*	-*	64.2	66.7	67.9	68.3	68.7	69.5
	8 years or more	-*	-*	-*	71.3	73.9	76.0	77.7	79.4
Total		55.6	61.1	66.3	69.5	72.2	74.3	76.1	77.8

• *Possible inconsistencies in the classification of the variable “schooling”, as the number of schooling years is incompatible with age.
• Source: Authors.

Figure 1
Proportion of adolescent parturients who started antenatal care in the first quarter of pregnancy by age in full years. SINASC, 2020-2022.

The results on the percentages of adolescents whose first appointment was at 22 weeks or later were also very relevant, ranging from 28.3% among girls aged 12 or younger to 12.2% for those aged 19 (Table 4).

The age pattern of timely onset varied among the Brazilian regions (Figure 2 and Table 2). In all regions, the proportion increased with age. In most age groups, the frequencies observed in the North were approximately 10 pp lower than those observed in the other regions. The exception occurred among adolescents aged 12 or younger in the Midwest, with 44.4%, lower than 46.3% in the North. Notably, 65% of parturients under 13 in the Midwest were Indigenous. From the age of 14 onwards, coverage was similar to that observed in the other regions, except for the North. There was an interaction between age and region (p<0.0001). The most significant increase per year of age was observed in the South (3.1 pp) and the smallest in the North (1.8 pp) (Table 3). We should underscore that smaller increases are associated with higher coverage among young adolescents than older adolescents.

Table 3
Prevalence ratio (PR) and confidence intervals (95%CI) between the proportion of timely prenatal care initiation and age adjusted for region of residence, ethnicity/skin color, and schooling variables.

Characteristic		PR	95%CI	P-value
Age		1.030	1.029-1.032	<0.0001
Region
	North	1.018	1.016-1.020	<0.0001
	Northeast	1.027	1.025-1.028	<0.0001
	Southeast	1.030	1.029-1.032	<0.0001
	South	1.031	1.029-1.032	<0.0001
	Midwest	1.029	1.028-1.031	<0.0001
Ethnicity/skin color
	White	1.032	1.031-1.034	<0.0001
	Black	1.026	1.024-1.028	<0.0001
	Brown	1.028	1.026-1.029	0.0001
	Indigenous	1.016	1.014-1.018	<0.0001
Schooling
	Less than 4 years	1.014	1.012-1.016	<0.0001
	4-7 years	1.019	1.018-1.021	<0.0001
	8 years or more	1.026	1.024-1.027	<0.0001

• Source: Authors.

Table 4
Number of adolescent parturients by age in years, and percentages with first prenatal care appointment at 12 weeks or more and at 22 weeks or more of gestation. SINASC, 2020-2022.

Age in years	Number of adolescents	Timely prenatal care (%)	95%CI	Prenatal care started at 22 weeks or later (%)	95%CI
? 12	1,958	55.6	53.3-57.9	28.3	26.3-30.5
13	9,793	61.1	60.1-62.2	23.3	22.4-24.1
14	37,576	66.3	65.8-66.8	19.2	18.8-19.6
15	89,513	69.5	69.2-69.8	17.2	17.0-17.5
16	148,702	72.2	72.0-72.4	15.4	15.2-15.6
17	203,625	74.3	74.1-74.5	14.2	14.0-14.3
18	256,458	76.1	75.9-76.2	13.3	13.1-13.4
19	314,342	77.8	77.7-78.0	12.2	12.0-12.3
≥20	6,596,529	84.9	84.9-85.0	7.9	7.9-7.9

• Source: Authors.

Figure 2
Proportion of adolescent parturients who started antenatal care in the first trimester of pregnancy by age and region of residence. SINASC, 2020-2022.

The timely antenatal care initiation pattern also varied by the parturients’ ethnicity/skin color (Figure 3 and Table 2). In all groups analyzed, we observed an increase in timely initiation with age. However, this increase was less pronounced among Indigenous parturients, who showed low frequencies at all ages (46.3% among those aged 12 or younger and 61.7% among those aged 19). The highest coverage rates were recorded among white adolescents (63.6% aged 12 or under and 83.1% aged 19), followed by brown and Black adolescents, with a slight disadvantage for the latter. The test for interaction was significant (p<0.0001), with increases per year of age ranging from 1.6 pp among Indigenous adolescents, 2.6 pp among Black adolescents, 2.8 pp among brown adolescents, and 3.2 pp among white adolescents (Table 3).

Figure 3
Proportion of adolescent parturients who started antenatal care in the first quarter of pregnancy by age and ethnicity/skin color. SINASC, 2020-2022.

The timely initiation of antenatal care also varied by the parturient’s schooling level (Figure 4 and Table 2). In general, more educated adolescents had higher coverage at all ages. Among parturients aged 15 with more than 8 schooling years, 71.3% received timely antenatal care, while the frequency was only 59.9% among those with less than 4 schooling years (Figure 4 and Table 2). Figure 4 omits results when adolescents’ ages are likely inconsistent with their schooling years. The heterogeneity test (p<0.0001) showed that increases with age were positively associated with schooling, ranging from 1.4 pp for girls with less than 4 schooling years to an increase of 2.6 pp for those with 8 or more schooling years per year of age (Table 3).

Figure 4
Proportion of adolescent parturients who started antenatal care in the first trimester of pregnancy by age and schooling years. SINASC, 2020-2022.

Discussion

Timely initiation of antenatal care is one of the main strategies to reduce maternal and perinatal morbimortality rates¹. However, this practice is related to sociodemographic, cultural, and economic factors influencing access to health services. Inequalities in access result in variable coverage among different population strata. Our results show that the parturient’s age was directly associated with timely initiation of coverage, which reached only 55.6%, 61.1%, and 66.3% of adolescents aged 12 or younger, 13, and 14, respectively. In comparison, coverage was 84.9% among women aged 20 or older. Equally relevant was the finding that 14.1%, or approximately one in seven adolescents, initiated antenatal care after 22 weeks of gestational age, while this percentage was 28.3% in those aged 12 or younger.

Our analyses showed that inequalities by age were superimposed on disparities per the adolescent’s region, ethnicity/skin color, and schooling, characterizing different types of intersectionality resulting from the interaction between these different dimensions, leading to unique experiences of inequalities.

Regarding geographic distribution, the North and Northeast have lower timely antenatal care rates among adolescents than the South and Southeast, highlighting disparities in access to health services. Victora et al.¹⁴ identified marked regional inequalities in access to maternal and child health, the origin of which would be linked to the predominant social inequalities in the most vulnerable Brazilian regions. The low coverage observed in the Midwest among adolescents aged 12 or under, 65% of whom are Indigenous (data not shown), is noteworthy, which refers to the ethnic inequalities discussed below. Regional characteristics such as early marriage and teenage pregnancy may be related to these inequalities^5,15,16.

Young Indigenous people face more significant difficulties in starting antenatal care, highlighting the intersection between ethnicity/skin color and social inequality. The First National Survey on the Health and Nutrition of Indigenous Peoples conducted between 2008 and 2009, which investigated a representative sample of women aged 14-49 and children under five, found that only 30% of Indigenous women started antenatal care in the first quarter¹⁶. Our results for 2020-2022 indicate an increase in coverage of slightly over 50% but still well below the recommended level. Healthcare for Brazilian Indigenous women is precarious. Although the Unified Health System (SUS) organizes services in villages through the Special Indigenous Health District (DSEI), low coverage levels persist due to cultural issues^8,16. For example, the percentages of requests for laboratory tests during antenatal care appointments are much lower than those obtained for non-Indigenous pregnant women treated by the SUS, and we observe low percentages of vaccination against diphtheria and tetanus (64%) and prescription of ferrous sulfate (44%)¹⁶.

Black and brown adolescents also had lower coverage of timely antenatal care initiation than white girls at all ages, which reflects an already identified pattern of racial inequalities in antenatal care regardless of the woman’s age, revealing the systemic influence of racism and discrimination in the provision of care^17,18. Thus, our results reaffirm the importance of historical contexts and processes that will cause girls and women to experience unequal exercise of their reproductive rights.

The timely initiation of antenatal care was also positively associated with the adolescent’s schooling level within each age group. Considering that many adolescents, especially the younger ones, have not yet had the opportunity to complete their school records, most existing studies have focused on the positive relationship between schooling and timely initiation of antenatal care among adults¹⁹. However, the literature corroborates the analyses presented here, indicating that more educated adolescents have greater autonomy to take care of their health and awareness of the importance of using health services during pregnancy²⁰.

Our study has some limitations. Although SINASC covers almost all births in the country²¹, the data may be affected by omissions and errors in the DNV records. Furthermore, our analyses do not include legal or clandestine abortions, nor stillbirths for which the DNV does not apply²². Notably, the parturient’s age refers to the time of birth, that is, approximately nine months after conception. Although it would have been possible to estimate the age at conception for most parturients, we chose to present the main results by age at the date of delivery, reporting the estimated age at conception only for parturients aged 14 to identify those who had been victims of rape. Despite the information systems data limitations, they are a valuable source for guiding policies for caring for pregnant women and newborns at the municipal, state, and national levels^21,22.

We believe this study is the first to document the timely initiation of antenatal care for adolescents stratified by age in exact years. Other positive aspects of the analyses include the national representativeness and the large number of pregnancies studied. Although SINASC has population coverage, we calculated inferential statistics (such as tests of statistical significance and confidence intervals) as if the data were a sample of similar populations in other periods. Due to the large sample size, the tests showed high statistical significance levels (even when the differences were minor) and great precision in the estimated parameters.

Our results may contribute to the current debate about the gestational age at which legal abortions are permitted in Brazil. This discussion has been affected by political and religious choices to the detriment of scientific knowledge and the reproductive rights of girls and women. Considering that Brazilian legislation classifies sexual intercourse with minors under 14 as rape of a vulnerable person and that most cases involve perpetrators close to the victims¹⁵, delays in adolescents recognizing their pregnancy and communicating it to their families contribute to the late start of monitoring and to the difficulty in conducting the abortion provided for by law. We showed that no less than 28.3% of girls who had children aged 12 or younger only sought antenatal care at 22 or more gestation weeks. After initial contact with health services and the option for legal abortion, it is necessary to gain access to a health service authorized to perform it. In several recently documented cases²³, it was necessary to resort to the judiciary to ensure that health services carry out the procedure. The importance of implementing communication strategies and educational programs related to sexual and reproductive health to promote autonomy over sexuality and address sexual violence⁹ is also highlighted.

The termination of pregnancy resulting from sexual violence is supported by Brazilian law, with no restrictions regarding the gestational week¹¹. However, in June 2024, Bill 1,904/2024 was proposed in the House of Representatives, which equates abortion performed after 22 gestation weeks with the crime of homicide, even in cases where the termination is legally permitted, such as in situations of rape of a vulnerable person¹². This proposal establishes penalties equivalent to those for simple homicide and may even result in a more significant penalty for the victim than for her attacker. Thus, it not only ignores the vulnerability of young women who suffer sexual violence but also disregards the social inequalities that affect early diagnosis of pregnancy and access to legal rights. After intense mobilization by popular women’s movements, the bill did not advance, but it can still be reintroduced. Considering the age at conception, we estimate that approximately 11,607 births occur annually as a result of rape of girls under 14, not counting pregnancies resulting in stillbirths and spontaneous or induced abortions (legal or clandestine)²⁴. The 22-week limit for performing legal abortions is incompatible with the situation described above.

Inequalities in antenatal care coverage among Brazilian adolescent mothers are evident and manifest themselves in troubling fashion when analyzed by region, ethnicity/skin color, and schooling level. Several initiatives - particularly the Rede Cegonha launched in 2011 and restructured in 2024 as Rede Alyne - have promoted a more equitable distribution of resources to reduce regional, socioeconomic, and racial disparities in the comprehensive care of pregnant women and children⁹. Such initiatives must be continually monitored and evaluated to ensure that their objectives are achieved. Despite significant reductions in health inequalities for women and children observed since the creation of the SUS in 1988^10,25, our current results highlight the continued need for integrated, evidence-based actions to ensure the protection of adolescents and their access to legal abortion.

References

• ¹ World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. 2016 [cited 2024 out 17]. Available from: https://iris.who.int/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1
  » https://iris.who.int/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1
• ² United Nations (UN). Department of Economic and Social Affairs, Population Division. Fertility among very young adolescents aged 10-14 years - A global assessment [Internet]. 2020 [cited 2024 set 3]. Available from: www.unpopulation.org
  » www.unpopulation.org
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• ⁶ Costa SF, Taquette SR, Moraes CL, Souza LMBM, Moura MP. Contradições acerca da violência sexual na percepção de adolescentes e sua desconexão da lei que tipifica o "estupro de vulnerável". Cad Saude Publica 2020; 36(11):e00218019.
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• Funding
  Departamento de Ciência e Tecnologia (DECIT) of the Ministério da Saúde (CNPq Process: 445214/2023-6) and Programa de Saúde da Mulher, da Criança e do Adolescente da Associação Umane.

• Chief editors:
  Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Publication Dates

• Publication in this collection
  27 Jan 2025
• Date of issue
  Jan 2025

History

• Received
  23 Oct 2024
• Accepted
  01 Dec 2024
• Published
  03 Dec 2024