Pregnancy in girls under 14 years old: Spatial analysis in Brazil, 2011-2021

Pinto, Isabella Vitral; Bernal, Regina Tomie Ivata; Souza, Juliana Bottoni; Andrade, Gisele Nepomuceno de; Araújo, Larissa Fortunato; Felisbino-Mendes, Mariana Santos; Souza, Maria de Fátima Marinho de; Montenegro, Marli de Mesquita Silva; Vasconcelos, Nádia Machado de; Malta, Deborah Carvalho

doi:10.1590/1413-81232024299.10582024EN

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THEMATIC ARTICLE • Ciênc. saúde coletiva 29 (09) • Sept 2024 • https://doi.org/10.1590/1413-81232024299.10582024EN copy

Pregnancy in girls under 14 years old: Spatial analysis in Brazil, 2011-2021

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective was to analyze the spatial distribution of pregnancy in children under 14 years and six months by Brazilian region and municipality and sociodemographic and health characteristics of pregnant women and live births. Ecological study analyzing the Live Birth Information System (SINASC) from 2011 to 2021 in three age groups (< 14 years and six months, 15-19 years, and 20 years and above) by demographic and birth variables. We applied the Global and Local Moran. A total of 127,022 live births to girls aged 10-14 years were identified during the period, most of whom were Black, 21.1% in common-law or married relationships, with a lower proportion of seven prenatal care appointments and enrollment in the first trimester, a higher proportion of low birth weight and low Apgar score, residing in the North and Northeast. The mean live birth rate for 10-to-14-year-old girls was significantly autocorrelated with space, especially in municipalities of the Midwest and North. Pregnancy from 10 to 14 years of age reveals several vulnerabilities suffered by these girls due to pregnancy at an early age, which is more common among Black women, with implications for morbimortality for them and their children and the presumed violence in these cases, including denied access to legal abortion.

Key words:
Live birth; Rape; Health information systems; Pregnancy in adolescence

Characteristics		10 to 14 years and 06 months N=127,022			14 years and 07 months to 19 years and 11 months N=4,863,105		20 years and above N=25,096,653
Characteristics		N	%	N	%	N	%
Parturient’s characteristics
Race/Skin color
	White	23,287	18.3	1,200,154	24.7	9,192,096	36.6
	Brown	87,379	68.8	3,160,945	65.0	13,279,834	52.9
	Black	6,153	4.8	260,035	5.3	1,446,933	5.8
	Yellow	292	0.2	14,871	0.3	106,918	0.4
	Indigenous	5,611	4.4	66,833	1.4	181,945	0.7
	Unknown	4,300	3.4	160,267	3.3	888,927	3.5
Schooling
	None	1,258	1.0	15,830	0.3	152,635	0.6
	1-3 years	6,681	5.3	104,129	2.1	698,326	2.8
	4-7 years	84,178	66.3	1,426,444	29.3	3,775,305	15.0
	8 years and above	32,529	25.6	3,234,996	66.5	20,111,280	80.1
	Unknown	2,376	1.9	81,706	1.7	359,107	1.4
Marital status
	Single	97,862	77.0	3,096,563	63.7	9,757,474	38.9
	Married	1,437	1.1	382,995	7.9	9,360,962	37.3
	Common Law Marriage	25,317	19.9	1,315,959	27.1	5,309,426	21.2
	Separated/divorced	54	0.0	5,564	0.1	349,689	1.4
	Widow	26	0.0	2,412	0.0	51,231	0.2
	Unknown	2,326	1.8	59,612	1.2	267,871	1.1
Brazilian Region*
	Midwest	10,080	7.9	395,055	8.1	2,128,707	8.5
	Northeast	50,568	39.8	1,666,156	34.3	7,003,463	27.9
	North	26,339	20.7	754,306	15.5	2,500,881	10.0
	Southeast	29,686	23.4	1,515,402	31.2	9,999,020	39.9
	South	10,276	8.1	529,530	10.9	3,452,260	13.8
Previous pregnancies
	None	106,226	83.6	3,259,725	67.0	7,461,543	29.7
	1 and above	6,430	5.1	1,211,831	24.9	16,824,722	67.0
	Unknown	14,366	11.3	391,549	8.1	810,388	3.2
Live births
	None	106,875	84.1	3,442,428	70.8	8,559,083	34.1
	1 and above	5,482	4.3	1,004,384	20.7	15,589,429	62.1
	Unknown	14,665	11.5	416,293	8.6	948,141	3.8
Characteristics of pregnancy and birth
Pregnancy type
	Single	125,572	98.9	4,800,317	98.7	24,490,378	97.6
	Twin	1,186	0.9	55,117	1.1	560,636	2.2
	Triplet and above	23	0.0	556	0.0	14,517	0.1
	Unknown	241	0.2	7,115	0.1	31,122	0.1
Delivery type
	Cesarean section	48,796	38.4	1,924,626	39.6	14,873,828	59.3
	Vaginal	78,022	61.4	2,931,457	60.3	10,193,592	40.6
	Unknown	204	0.2	7,022	0.1	29,233	0.1
Number of prenatal care appointments
	None	4,737	3.7	126,372	2.6	528,167	2.1
	1-3	18,246	14.4	489,340	10.1	1,407,157	5.6
	4-6	46,287	36.4	1,557,508	32.0	5,496,392	21.9
	7 and above	56,669	44.6	2,656,841	54.6	17,502,661	69.7
	Unknown	1,083	0.9	33,044	0.7	162,276	0.6
Gestation time
	Premature <37 weeks	23,993	18.9	620,973	12.8	2,747,327	10.9
	Term 37<41 weeks	92,423	72.8	3,900,458	80.2	21,076,226	84.0
	Post-term >41 weeks	4,739	3.7	188,685	3.9	688,089	2.7
	Unknown	5,867	4.6	152,989	3.1	585,011	2.3
Start of prenatal care
	Up to 3 months	68,674	54.1	3,170,562	65.2	19,384,101	77.2
	4-6 months	40,130	31.6	1,175,448	24.2	3,689,588	14.7
	7 months and above	6,140	4.8	169,773	3.5	592,868	2.4
	Unknown	12,078	9.5	347,322	7.1	1,430,096	5.7
Live birth characteristics
Birth weight (grams)
	? 2,500	18,467	14.5	478,684	9.8	2,146,724	8.6
	> 2,500	108,446	85.4	4,381,902	90.1	22,939,048	91.4
	Unknown	109	0.1	2,519	0.1	10,881	0.0
Apgar 5th minute
	0-3	893	0.7	20,124	0.4	85,036	0.3
	4-7	4,101	3.2	110,222	2.3	451,230	1.8
	8-10	116,807	92.0	4,582,469	94.2	24,019,118	95.7
	Unknown	5,221	4.1	150,290	3.1	541,269	2.2

Federative Unit	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	Percentage variation (2021-2011)	Difference 2021-2011
Rondônia	0.58	0.56	0.47	0.52	0.39	0.47	0.41	0.41	0.32	0.34	0.36	-61.17	-0.22
Acre	1.11	1.01	0.87	0.95	0.94	1.20	0.96	0.94	0.70	0.69	0.88	-25.98	-0.23
Amazonas	1.05	1.05	1.07	0.90	1.00	0.94	0.89	0.91	0.89	0.73	0.84	-24.75	-0.21
Roraima	0.96	1.19	1.24	1.04	1.17	1.10	0.91	1.02	0.75	0.76	0.80	-20.69	-0.17
Pará	1.06	0.91	0.91	0.85	0.85	0.84	0.70	0.71	0.71	0.66	0.70	-51.44	-0.36
Amapá	0.87	0.80	0.93	0.82	0.84	0.68	0.75	0.63	0.56	0.71	0.56	-55.17	-0.31
Tocantins	0.83	0.82	0.73	0.67	0.70	0.63	0.60	0.64	0.58	0.58	0.54	-54.45	-0.29
Maranhão	0.96	0.87	0.85	0.81	0.77	0.78	0.73	0.67	0.68	0.64	0.71	-34.53	-0.25
Piauí	0.66	0.61	0.64	0.59	0.63	0.64	0.62	0.51	0.49	0.53	0.45	-45.50	-0.20
Ceará	0.61	0.59	0.59	0.58	0.56	0.55	0.48	0.43	0.43	0.39	0.40	-50.51	-0.20
Rio Grande do Norte	0.70	0.62	0.63	0.51	0.64	0.55	0.45	0.49	0.42	0.38	0.41	-69.81	-0.29
Paraíba	0.56	0.55	0.51	0.51	0.56	0.50	0.48	0.43	0.44	0.37	0.37	-51.05	-0.19
Pernambuco	0.64	0.60	0.61	0.58	0.51	0.48	0.47	0.47	0.40	0.38	0.40	-57.52	-0.23
Alagoas	0.94	0.99	0.99	0.86	0.79	0.84	0.76	0.67	0.66	0.58	0.58	-61.46	-0.36
Sergipe	0.65	0.62	0.68	0.65	0.61	0.58	0.50	0.55	0.51	0.49	0.46	-40.04	-0.18
Bahia	0.67	0.64	0.64	0.61	0.60	0.56	0.52	0.53	0.48	0.41	0.46	-43.86	-0.20
Minas Gerais	0.35	0.32	0.31	0.28	0.28	0.26	0.25	0.21	0.22	0.19	0.18	-95.39	-0.17
Espírito Santo	0.37	0.34	0.45	0.41	0.39	0.40	0.32	0.29	0.26	0.30	0.28	-35.35	-0.10
Rio de Janeiro	0.44	0.42	0.42	0.42	0.39	0.36	0.32	0.31	0.30	0.28	0.25	-74.25	-0.19
São Paulo	0.27	0.27	0.27	0.27	0.24	0.21	0.19	0.18	0.16	0.15	0.15	-77.91	-0.12
Paraná*	0.00	0.42	0.41	0.39	0.35	0.28	0.28	0.23	0.23	0.19	0.20	-112.94	0.20
Santa Catarina	0.33	0.28	0.26	0.29	0.21	0.22	0.17	0.16	0.14	0.13	0.13	-161.96	-0.21
Rio Grande do Sul	0.35	0.31	0.31	0.32	0.28	0.26	0.21	0.21	0.18	0.16	0.17	-99.92	-0.17
Mato Grosso do Sul	0.73	0.66	0.64	0.68	0.58	0.58	0.58	0.47	0.47	0.46	0.40	-79.62	-0.32
Mato Grosso	0.57	0.60	0.65	0.63	0.51	0.52	0.48	0.44	0.44	0.39	0.45	-26.12	-0.12
Goiás	0.48	0.43	0.43	0.40	0.40	0.37	0.31	0.29	0.28	0.23	0.25	-94.06	-0.23
Distrito Federal	0.31	0.26	0.25	0.22	0.19	0.21	0.16	0.20	0.17	0.17	0.12	-159.86	-0.19
Brazil	0.60	0.50	0.50	0.47	0.45	0.43	0.39	0.37	0.35	0.32	0.33	-79.79	-0.27

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[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva