Contextualizing Trajectories to Teenage Pregnancy: Evidence from Brazil

Background and Purpose:

Although teenage pregnancy rates have dropped across Latin America, prevalence remains high among marginalized subgroups. In Brazil, low-income, Afro-Brazilian women are the most likely to become teenage mothers. Recent research from Latin America suggests that poverty and a lack of opportunities are key determinants of teenage pregnancy (World Bank, 2016). However, the ways in which these determinants culminate in teenage pregnancy are not well understood. Particularly absent in the literature are studies that aim to identify and contextualize the various trajectories that lead to teenage pregnancy. Drawing from an ecological framework, this qualitative study aims to address the gap in literature by identifying, understanding, and contextualizing trajectories to teenage pregnancy.

Methods:

Data was collected using an ethnographic approach of 12 weeks of prolonged engagement in the city of Salvador, Brazil, including observation at two research sites for up to 25 hours per week; and semi-structured interviews conducted with 25 low-income mothers. Interview questions probed present and retrospective emotions, events, and relationships related to pregnancy and motherhood, yielding cross-sectional data on the life experiences related to teenage pregnancy. Interviews were performed at two types of locations (a public service agency and informal markets), and were conducted and transcribed in their original language.

Transcripts were coded in NVivo by two bilingual (Portuguese/English) researchers using an open coding method. Interrater reliability using Cohen’s kappa (k) was conducted to verify the coding scheme; all codes met the validity threshold (k ≥ 0.41). To further ensure data integrity, interview data was triangulated against observational field notes.

Analysis followed a life history approach, which allowed for longitudinal patterns of events, relationships, and beliefs related to teenage pregnancy to emerge. These patterns were then organized within an ecological framework, to contextualize the ways in which they interact and shape trajectories to teenage pregnancy. Trajectories of mothers who became pregnant prior to age 19 were then compared to those who became pregnant after age 19.

Findings:

Of the 25 participants, 20 became mothers as teenagers. Participant age ranged from 18-29, number of children mothered ranged from 1-4, and education attainment ranged from some secondary school to a university degree. All participants identified as low-income and Afro-Brazilian.

Study findings suggest that three layers of patterns culminate in teenage pregnancy: micro-level (i.e. behaviors, emotions, and beliefs, such as fantasizing motherhood as a teenager); mezzo-level (i.e. family, peer, and partner relationships, including support or lack thereof); and macro-level (i.e. culturally-embedded gender biases and power dynamics, such as encouragement of age-disparate romantic relationships). Findings also show that macro-level contexts shape mezzo and micro-level patterns in various ways, yielding distinct trajectories to teenage pregnancy.

Conclusion and Implications:

Interventions to reduce teenage pregnancy often target micro and mezzo levels (Salazar et al., 2010). This study’s findings indicate that more programmatic attention should be paid to the macro-level contexts that shape teenage girls’ sexual behavior and decisions. Interventions that challenge macro-level biases through multi-level community mobilization (e.g. Abramsky et al., 2014) may be particularly effective in mitigating teenage pregnancy in urban Brazil.