Políticas públicas de prevenção de gestações sucessivas na adolescência: que tipo de política prevalece?

Estrada, Fátima; Romero-Pérez, Irma; Campero, Lourdes; Hubert, Celia; Villalobos, Aremis

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REVISÃO • Cad. Saúde Pública 38 (9) • 2022 • https://doi.org/10.1590/0102-311XEN025922 copiar

Políticas públicas de prevenção de gestações sucessivas na adolescência: que tipo de política prevalece?

Autoria SCIMAGO INSTITUTIONS RANKINGS

O objetivo foi realizar uma busca de instrumentos de políticas públicas que busquem referências explícitas a gestações sucessivas na adolescência, bem como discernir que tipos de ações têm sido propostas como parte das agendas internacionais e nacionais para facilitar sua prevenção e cuidado. Durante junho de 2021, utilizamos uma revisão integrativa para pesquisar e analisar instrumentos de políticas públicas nacionais e internacionais, juntamente com outros documentos relacionados a gestações sucessivas na adolescência. Para cada um, registramos a presença de declarações sobre gestações sucessivas na adolescência. A equipe de pesquisa então se dividiu em tríades para discutir e classificar cada referência sob uma das seguintes categorias: (a) uma declaração simbólica, ou seja, uma intenção sem implicação de uma ação específica, mas uma apresentação de visão para o futuro; (b) uma declaração substantiva sobre uma ação destinada a resolver um problema; e (c) uma declaração processual-material indicando ações, processos, orçamentos e atores específicos. Foram analisados um total de 135 documentos de políticas públicas: 102 no México e 33 internacionalmente. Apenas quatro documentos mexicanos e seis internacionais continham referências simbólicas ou substantivas ao tema de interesse e apenas um especificava uma declaração processual-material. A prevenção e o cuidado de gestações sucessivas na adolescência são abordados como secundários nas agendas públicas. Apenas um número mínimo de ações compreende medidas específicas e padronizadas para prevenir gestações sucessivas na adolescência de acordo com os diferentes atores envolvidos. A elaboração de um maior número de políticas processual-material ajudará a reduzir a morbidade e a mortalidade no binômio mãe-filho e promover um desenvolvimento abrangente desse grupo populacional.

Palavras-chave:
Política Pública; Adolescente; Gravidez

TYPE OF DOCUMENT	DESCRIPTION
INTERNATIONAL
Regional/Global strategies and action plans	Initiatives that have tangible and measurable repercussions in terms of improving the quality of life of the population in a sustainable way; models that countries and regions can adapt to their own circumstances
Handbooks and guidelines	Ways of promoting quality in the operating criteria of programs and standardized health-care services, based on scientific evidence
Recommendations	Actions to improve the health of the population according to best practices
NATIONAL
National Development Plan	Priority objectives for each 6-year presidential term; basis for designing and implementing policies, rules, and regulations, among others
Sector program	Institutional objectives, priorities, and responsibilities of a sector for each 6-year presidential term
Specific action programs (PAEs) and national strategies	Efforts targeting specific problems; revisions are implemented as required
Rules and regulations	Rules: legal and normative documents concerning the rights and obligations of individuals; regulations: operational and administrative criteria for complying with the rules in force
Technical guidelines and care models	Standardized activities and processes in the provision of health-care services for specific problems, based on up-to-date scientific evidence
Official Mexican Standards (NOMs)	Technical regulations issued by the Mexican Ministry of Health to establish the types of services and care processes that must be guaranteed to the population as mandatory at the federal level; they are submitted to a regulatory committee every five years for approval, modification, ratification, or cancelation
Clinical practice guidelines (GPC)	Legally non-binding tools applicable nationally; they promote quality health care through recommendations based on the best scientific evidence, facilitating decision-making for health-care providers and patients. They are reviewed every three or five years by a multidisciplinary committee and revised when necessary

ID	# OF MENTIONS	DOCUMENTS/MENTIONS	TYPE OF POLICY
Preventing Early Pregnancy and Poor Reproductive Outcomes among Adolescents in Developing Countries: What the Evidence Says
I1	1	“One study showed a reduction in repeat pregnancies as a result of an intervention that included home visits for social support” (p. 3)	Symbolic policy
Montevideo Consensus on Population and Development
I2	1	“Design intersectoral strategies to help young women avoid subsequent pregnancies, including antenatal, childbirth and postpartum care, access to contraceptive methods, protection, support and justice...” (p. 16)	Substantive-material policy
Accelerating Progress Toward the Reduction of Adolescent Pregnancy in Latin America and the Caribbean
I3	1	“Create an enabling environment for gender equality and adolescent sexual and reproductive health and rights. (Item 7) Accelerating progress in the reduction of adolescent pregnancy will require addressing these levels of the ecological framework simultaneously through the development and implementation of packages of interventions that translate and adapt globally recognized standards and best practices to national and local contexts. These packages of actions should respond to and support adolescents to prevent a first pregnancy, as well as reach pregnant adolescents and young parents to prevent repeat unplanned pregnancies. Interventions must utilize a rights-based approach to adolescent health and prioritize gender equality and the elimination of gender stereotypes In addition, greater attention should be devoted to promoting civil society engagement in order to build support for adolescent health, in general, and adolescent sexual and reproductive health and rights, specifically. The members of the community (including parents, teachers, and religious authorities) can play an important role in protecting adolescent girls and creating opportunities for their future. However, there is a considerable lack of awareness raising and sensitization about adolescent sexuality among these groups. A robust civil society movement is essential for overcoming political resistance or inertia on this issue and utilizing accountability mechanisms to remediate injustices” (p. 37)	Substantive-material policy
Clinical Updates in Reproductive Health (Abortion)
I4	1	“A large 2017 systematic review and meta-analysis exploring risk factors for repeat pregnancies among teens, which included 26 studies reporting on more than 160,000 adolescent women, found that use of long-acting reversible contraceptives exerted a significant protective effect, along with improved educational attainment and school continuation” (p. 148)	Symbolic policy
WHO Recommendations on Adolescent Sexual and Reproductive Health and Rights
I5	1	“Offer and promote postpartum and post-abortion contraception to adolescents through multiple home or clinic visits to reduce the chances of second pregnancies among adolescents” (p. 12)	Substantive-material policy
Programming Strategies for Postpartum Family Planning
I6	1	“If there is a significant percentage of first births for women age 18 years and under, there is an opportunity to promote healthy timing and spacing to delay second and subsequent births” (p. 6)	Substantive-material policy

ID	# OF MENTIONS	DOCUMENTS/MENTIONS	TYPE OF POLICY
National Strategy for the Prevention of Teen Pregnancy (ENAPEA)
N1	3	“Improve the quality of counseling and enhance the supply of post-obstetric contraceptive methods for adolescents at the primary and secondary levels of care” (p. 89)	Substantive-material policy
		“Reinforce postpartum-family-planning counseling for adolescent mothers during well-child appointments at the primary-care level” (p. 89)	Substantive-material policy
		“Enhance the clinical practice guidelines for pregnancy and postpartum care, incorporating contraceptive counseling during antenatal care for adolescents, with special emphasis on the advantages of spacing pregnancies and favoring free choice among the full range of contraceptive methods including LARC” (p. 89)	Substantive-material policy
Specific Action Program for Sexual and Reproductive Health, 2020-2024
N2	1	“Prevent adolescent subsequent pregnancies among women receiving antenatal care through follow-up actions, informative sessions, counseling and access to modern contraceptive methods” (p. 77)	Substantive-material policy
Guide for Implementing a Comprehensive Protection and Care Pathway for Girls, Adolescent Mothers and Pregnant Women under 15 Years of Age
N3	3	“It has been documented that a significant percentage of adolescents who give birth to their first child without having access to CPOE experience a second pregnancy in less than a year. This situation may lead to problems and health risks for adolescent women, which can be avoided through the provision of effective contraceptive services” (p. 28)	Symbolic policy
		“The health-care provider should listen to and offer support to these women, encouraging them to express and clearly explain their needs and desires such as to avoid future pregnancies. If a woman wishes to adopt a contraceptive method, she and the provider, together, should determine which one is most appropriate for her personal needs and circumstances, according to the WHO Medical Eligibility Criteria, Third Edition 2019” (p. 28)	Procedural-material policy
		“Most contraceptive methods can be used immediately after an abortion has been completed. Compared to other methods, LARC (IUDs and implants) has shown higher rates of continued use and lower rates of repeat pregnancies” (p. 28)	Symbolic policy
Nursing Interventions for the Promotion of Family Planning among Men and Women of Childbearing Age (12 to 49 Years) at the Three Levels of Care
N4	3	“Approximately 20% of repeated childbirths occur among adolescents. Evidence shows that home visits and support programs reduce pregnancy rates... Health personnel should integrate the parents of pregnant adolescents into the promotion of family planning through home visits and other programs” (p. 20)	Substantive-material policy
N4	3	“This study tested the effectiveness of a cell-phone-counseling intervention focused on postponing adolescent subsequent pregnancy and strengthening healthy relationships as well as safe reproductive practices... Promote sex education and adolescent pregnancy prevention through mobile and electronic media” (p. 21)	Substantive-material policy
“Targeted motivational interventions reduce the risk of adolescent subsequent pregnancy by 44%... Counseling through motivational interviews, emphasizing personal goals” (p. 23)	Substantive-material policy

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[1] Correspondence
L. Campero Instituto Nacional de Salud Pública. Av. Univeridad 655, Col. Sta. María Ahuacatitlán, Cuernavaca / Morelos - 62100, México. lcampero@insp.mx