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To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America.We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad.We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively).Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.

This study aims to conduct a search of public-policy instruments seeking explicit references to subsequent adolescent pregnancy, as well as to discern what kinds of actions have been proposed as part of the international and national agendas to facilitate subsequent adolescent pregnancy prevention and care. During June 2021, we used an integrative review to search and to analyze national and international public policy instruments along with other documents related to subsequent adolescent pregnancy. We observed, for each, the presence of statements on subsequent adolescent pregnancy. The research team was then divided into triads to discuss and to classify each reference under one of the following categories: (a) a symbolic statement, that is, an intention not implying a specific action but rather presenting a vision for the future; (b) a substantive-material statement concerning an action intended to solve a problem; and (c) a procedural-material statement indicating specific actions, processes, budgets, and actors. We analyzed a total of 135 public-policy documents: 102 in Mexico and 33 internationally. Only four national and six international documents contained either symbolic or substantive-material references to the subject of interest and only one specified a procedural-material statement. The prevention and care of subsequent adolescent pregnancy are addressed only secondarily on the public agendas. Only a minimal number of actions comprise specific and standardized measures to prevent subsequent adolescent pregnancy according to the different actors involved. Designing a greater number of procedural-material policies will help to reduce morbidity and mortality in the mother-child binomial and promote a comprehensive development of this population. El objetivo de este estudio fue realizar una búsqueda de instrumentos de políticas públicas que hagan referencia explícita a los embarazos subsecuentes en adolescentes, así como distinguir qué tipo de acciones forman parte de las agendas internacionales y nacionales para su prevención y atención. Durante el mes de junio de 2021, realizamos una revisión integradora para buscar y analizar instrumentos de políticas públicas nacionales e internacionales, junto con otros documentos relacionados a los embarazos subsecuentes en adolescentes. Para cada uno, registramos la presencia de declaraciones sobre embarazos subsecuentes en adolescentes. El equipo de investigación se dividió en tríadas para discutir y clasificar cada referencia en una de las siguientes categorías: (a) declaración simbólica, es decir, intención que no implica una acción específica, sino una visión hacia el futuro; (b) declaración material-sustantiva, hace referencia a una acción enfocada en resolver un problema; y (c) declaración material-procedimental, indica acciones, procedimientos, presupuestos y actores específicos. En total se analizaron 135 documentos de políticas públicas: 102 de México y 33 a nivel internacional. Solamente cuatro documentos nacionales y seis internacionales contenían referencias simbólicas o materiales sobre el tema de interés, únicamente uno refirió una declaración material-procedimental. La prevención y la atención de embarazos subsecuentes en adolescentes son temas secundarios en las agendas públicas. Pocas son las acciones que comprenden medidas específicas y estandarizadas para prevenir los embarazos subsecuentes en adolescentes de acuerdo con los diferentes actores involucrados. La elaboración de más políticas procedimentales y sustantivas contribuirá a una reducción de la morbimortalidad en el binomio madre-hijo y a una promoción del desarrollo integral de este grupo poblacional. 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.

Study Objective: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. Results: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. Conclusion: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.

Adolescent pregnancy is considered a priority public health issue because of its implications in the lives of young mothers, their children, and the well-being of the general population. In this paper, we describe an intervention targeting adolescents (aged 11–19 years old) in a rural context and estimate its impact on key outcomes relevant to early pregnancy prevention: knowledge and self-efficacy concerning sexual and reproductive health, knowledge of sexual and reproductive rights, and attitudes toward gender roles. Our study used a quasi-experimental design comprising 747 adolescents. Three difference-in-differences models (raw, adjusted, and by exposure level) with fixed effects estimated the changes in all outcome measures. Our results showed that the intervention community had a significant improvement in all outcomes, and this improvement was larger in those who received the highest-exposure level of intervention compared to a control community. Our study provides evidence that a community-based intervention, founded on comprehensive sexual education, is a promising approach to improve key outcomes related to early pregnancy in rural contexts. Further research should be undertaken to test how similar strategies focusing on multi-layer early pregnancy determinants work on other sub-groups of vulnerable adolescents, such as school dropouts or those living in disadvantaged circumstances.

Background Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. Methods: Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. Results According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88–6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14–5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29–5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26–4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21–4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10–3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03–3.11). Conclusions Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.

Objective To explore demographic, socio-economic, and reproductive factors associated with pregnancy desire among adolescents in five Latin American countries. Design Secondary analysis using nationally representative, cross-sectional data from UNICEF Multiple Indicator Cluster Surveys (MICS). Setting Cuba, the Dominican Republic, El Salvador, Mexico, and Panama. Population Adolescents 15-19 years old who were pregnant or mothers (n = 4207). Methods Chi-square tests, simple linear regressions, and multilevel Poisson regression models were used to estimate associations between individual- and country-level factors associated with pregnancy desire among adolescents. Main outcome measures Desire for pregnancy among adolescents who were pregnant or had given birth in the last 2 years. Results The proportion of adolescents who reported they desired their last pregnancy ranged from 79.3% in Cuba to 37.6% in Panama; approximately half the adolescents in Mexico, El Salvador, and the Dominican Republic desired their last pregnancy. The multilevel analysis shows that pregnancy desire was more likely among adolescent women who were less educated [prevalence ratio (PR) = 0.97, 95% confidence interval (CI) 0.96-0.98], older (PR = 1.39, 95% CI 1.04-1.09), married or cohabiting with a partner (PR = 0.70, 95% CI 0.53-0.93), and had low parity (PR = 0.67, 95% CI 0.58-0.76). Conclusions Adolescents with less education, who are older, married or cohabiting, and with low parity were more likely to desire their pregnancy. These data constitute evidence that, in conjunction with qualitative and implementation research, can be used to better design services for adolescents so they can exercise their sexual and reproductive rights, and plan healthier and more satisfying futures. Funding All the databases used on the performance of this study are open access. We did not receive any funding for the present analysis. Tweetable abstract Parity and marital status showed the strongest association with adolescent pregnancy desire in five Latin American countries.

Objective. To analyze the perception in relation to when and how to perform actions for the early detection of breast and cervical cancer among women and health care providers in communities with a high percentage of indigenous population in Morelos, Mexico. Materials and methods. Ten health providers and 58 women users of health services were interviewed which have a first level of attention in five communities. The analysis was developed under the approach of the Grounded Theory. Results. Providers are poorly informed about current regulations and specific clinical indications for the detection of cervical and breast cancer. Few propitiate health literacy under intercultural sensitization. The users have imprecise or wrong notions of the early detection. Conclusions. The need for training in adherence to norms is evident. It is urgent to assume a culturally relevant approach to enable efficient communication and promote health literacy for early detection of these two cancers.

Objective. To explore the opinions of Mexican male adolescents regarding teenage pregnancy and analyze its association with sexual behavior. Materials and methods. This is a cross-sectional study using a self-administered questionnaire among a conventional sample of male students (15-19 years old) in eight public schools in Morelos and Mexico City. Analyses include multivariate models to identify the association between opinions and sexual behaviors. Results. Overall, 68% agree that a teenage pregnancy is a negative event. In a hypothetical case, if a girlfriend got pregnant in this moment 56% would continue in the school whereas 18% would definitely abandon it. Those who affirm that a teenage pregnancy is something very bad have greater odds of using condoms (OR=1.8; p menor que 0.05). Conclusions. Male adolescents’ views about teenage pregnancy are associated with some sexual behaviors; however their opinions reflect several contradictions. The design of surveys directed exclusively to explore male adolescents’ opinions about reproductive health is urgent.

Objetivos: Describir las prácticas médicas realizadas en la atención prenatal en mujeres en Perú e identificar si las prácticas de control prenatal (CPN) recibidas por mujeres adolescentes y adultas fueron distintas. Material y métodos: Estudio descriptivo y comparativo. Se utilizaron datos recolectados por la Encuesta Demográfica y de Salud Familiar continua 2004-2008, con 994 adolescentes (15-19 años) y 12556 adultas (20-49 años). Se efectuaron comparaciones entre adolescentes y adultas en relación con las prácticas médicas efectuadas durante la atención prenatal. Resultados: El 50% de las adolescentes inició el CPN en el tercer mes de embarazo en comparación con la mitad de las adultas que lo inició en el segundo mes. La mitad de las adolescentes reportaron 7 visitas de CPN en total mientras que el 50% de adultas reportaron 8. Menor proporción de adolescentes reportó haber recibido algunas de las acciones y prácticas médicas que se efectúan durante la atención prenatal. Conclusiones: Las adolescentes inician la atención prenatal un poco más tarde que las mujeres adultas, tienen menos CPN y hay diferencias en las acciones efectuadas en los CPN. Esto sugiere que las adolescentes están en desventajas de recibir una atención prenatal que incluya todas las acciones recomendadas por la normatividad. Diversas estrategias deben ser planteadas para favorecer el acceso temprano a un control prenatal de calidad. Objective: To describe medical practices reported by women that received prenatal care (PNC) in Peru. Particularly, we aim to identify differences in the services provided to adolescents compared to adult women. Methods: Descriptive study. Data came from the Demographic Health Surveys 2004-2008 in Peru, which included information of 994 adolescents (15-19 years old) and 12 556 adult women (20-49 years old). Comparisons were made between adolescents and adult women regarding the practices received during prenatal care visits. Results: Among adolescents, 50% initiated PNC during the third month of pregnancy whereas half of the adult women started on the second month. Adolescents received 7 prenatal visits comparing to 8 in adult women. Comparing to adult women, adolescents reported in lower proportions that they received some of the medical practices during prenatal care. Conclusions: Adolescents accessed PNC later than adult women. This suggests that they have less opportunities of receiving services that include all the medical actions recommended. Effective strategies should be implemented in order to promote an adequate and early prenatal care.

Objective. To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. Materials and methods. A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. Results. A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). Conclusion. It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.

Objective: to assess the association between non-clinical factors and the incidence of caesarean section (CS); to estimate the effect of a prenatal instructor's presence during childbirth on birth outcome (vaginal or CS). Design: cross-sectional study from a register of women who attended prenatal classes. Multivariate logistic regression was used to measure the effects of each variable on whether the birth was vaginal or CS. Setting: Mexico City, Mexico. Participants: 992 births to 847 women from the register of the Birth Education Centre (CEPAPAR) between 1987 and 2000. Findings: the incidence of CS was 33%. The most commonly reported (by the women) reason for performing a CS was dystocia (53%). Most women were middle or upper-middle class professionals, and 85% of the women gave birth in private institutions. Odds of having a CS were higher among women who gave birth in a large hospital, women who were over 25 years of age, primigravidae, and women who were not supported by a prenatal instructor during childbirth. Conclusions: non-clinical factors considerably affect the type of birth outcome (vaginal vs. CS). A system in which a prenatal instructor provided support to the woman during childbirth could contribute significantly to reducing initial and repeat CS.

This study aims to explore adolescents' intentions related to the early formation of a family.We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974).Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13).In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

Background: Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents’ or children’s reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication. Objective: The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics. Subjects: A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study. Methods: The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents. Results: Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p Conclusion: Our findings suggest a low congruence between parents’ and adolescents’ reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.

To describe the trend of cesarean section practice in Mexico, and its association with women's sociodemographic and reproductive characteristics.Based on the 2000, 2006 and 2012 National Health Surveys, information on c-section was analyzed. A multivariate logistic regression model was used in 2012.A 50.3% increase in the use of c-section was observed nationally from 2000 to 2012. Women more likely to undergo a c-section include those whose delivery care takes place in the private sector (OR=2.84, 95%CI:2.15-3.74). When associating women's age and parity, the greatest risks are observed among primiparous women between 12 and 19 years of age, and those aged 35 years and more (OR=6.02, 95%CI:1.24-29.26 and OR=5.20, 95%CI:2.41-11.21, respectively).Some recommendations to revert the increase of this clinical practice, especially when there is no full justification for its realization, are proposed.

To explore the causes and circumstances that determine the way in which migrants experience their sexuality and how this impacts their sexual rights.Qualitative study conducted between April 2009 and July 2010 in Chiapas, Oaxaca, San Luis Potosí, and Tamaulipas. We conducted 22 in-depth interviews to migrants in transit and to ten different key actors. For the analysis we used elements of grounded theory.Migrants know and identify the risks they may encounter in their transit but have scarce access to services to effectively exercise their sexual and reproductive rights. Their vulnerability makes them internalize and accept the violence enacted on them as part of their destiny and as what they must suffer in order to reach the USA.Violence, including sexual violence, determines much of the experiences of their transit through Mexico. Differences between groups and between male and female migrants are determined by gender inequalities and power.

To examine the effects of educational interventions that incorporate parent participation to modify adolescent sexual behavior.We conducted a systematic search of 5 electronic databases for articles published between 2002 and 2009 that evaluated educational interventions involving parents.Nineteen articles evaluated 15 interventions that met all the criteria for inclusion. They found a significant increase in adolescents' intentions to postpone sexual intercourse and use contraceptives, a reduction in self-reported sexual relations and an increase in condom use. Positive results were also found for individual protective factors such as knowledge and attitude, and family factors such as parent-child communication, perception of rules, monitoring/supervision by parents and family support.Educational interventions that include parents support healthy sexual behavior among adolescents. Parental participation can be included in any intervention aimed at adolescents.

In this article reporting on our qualitative study, we describe changes in parent—adolescent sexual health communication following an intervention for parents of 10th graders in Mexico. The intervention was aimed to sensitize and develop skills for appropriate parent—child communication about the prevention of sexually transmitted infections (STIs), unplanned pregnancy, and birth control, and focused on encouraging condom use with emergency contraception backup. We conducted 66 in-depth interviews with adolescents and parents after the intervention. Following the principals of grounded theory, we carried out inductive analysis to create codes and organize central themes. Our findings identify previously undefined critical steps or movements important for parent—child communication about sex. When parents are sensitized to the risks their adolescent children face, it is easier to initiate communication about prevention. These initial movements are essential to achieve substantive conversation, and must be considered in future strategies that aim to promote parent—adolescent communication about sexuality and the prevention of STIs and unplanned pregnancy.

Objective To present, through an evaluation in Latin America and the Caribbean, the current regulatory and curricular landscape of sexuality and HIV prevention in the school setting, and contrast it with sexual behaviors as reported by demographic and health surveys. Methods In May 2008, with the support of the United Nations Population Fund (UNFPA), a survey was conducted involving key contacts in 34 countries of the Region. The self-administered questionnaire sought in-depth information on school-based HIV/AIDS prevention programs from the staff of various stakeholders, including ministries of education and of health. Results Twenty-seven countries responded to the survey, representing 95.5% of the target population (6-18 years of age). Most countries reported having at least one textbook or one specific chapter devoted to teaching sex education and HIV prevention. Many, but not all of the important sex education topics, were covered in secondary school; for example, the issue of discrimination based on sexual orientation/ preference is not included in school curricula. Conclusions Sex education materials should be reviewed and updated periodically to reflect progress being made on the issues and the handling of the subject matter. In each country, the curriculum should address the issue of respecting differences in sexual orientation, preference, and identity, and especially, an appropriate approach toward sexually-transmitted infection (STI) prevention education among males who have sex with males. Efforts to assess the programs' effectiveness should consider outcomes, such as biomarkers (STI incidence and prevalence and pregnancy), not just indicators of self-reported sexual knowledge and behavior.

Objective To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents’ sexual behavior, knowledge and access to contraception. Material and methods Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent–child dyads in the control and intervention schools were matched according to parents’ propensity score; the average treatment effect (ATE) was estimated for adolescent’s outcome variables. Results At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. Conclusions Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health.

The prevalence of obesity in childhood and adolescence has increased in Mexico. This increase can be explained partly by a decrease in physical activity. The objective of this study was to assess the association between the prevalence of obesity and overweight with physical activity and inactivity among Mexican adolescents. We analyzed data from a longitudinal study with baseline and follow-up measures in 446 adolescents 12 to 17 years old, attending public schools in Cuernavaca, Morelos, Mexico. We collected information on weight, physical activity and demographic characteristics. Obesity and overweight were determined using as indicador the body mass index, and the cutoff points proposed by the International Obesity Task Force. The baseline prevalence of obesity or overweight was 37.22% (42.99% for males and 30.95% for females), and in the final measure 34.30% (38.46% for males and 32.28% for females). The median time of TV viewing was 3.90 h/d, with 0.73 h/d dedicated to vigorous physical activity and 0.58 h/d to moderate physical activity. Using logistic regression, after adjustment for obesity in the baseline measure, sex and clustering by school, we found no significant associations between the prevalence of obesity or overweight with time dedicated to TV viewing, vigorous or moderate physical activity. However, when conducting the analysis with an interaction term by sex, we found significantly lower risk of obesity or overweight associated with an increase in vigorous physical activity among males only (beta = 0.22, 95% CI (0.05, 0.89). Results suggest that vigorous physical activity may reduce the risk of obesity or overweight among male adolescents.

To identify the influence of reproductive characteristics and women empowerment with the use of family planning services.Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use.The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95% 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95% 1.4-9.3); and a greater number of pregnancies (6 children: OR 4.4, CI95% 1.4-13.8).Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

To document the under-registration of violent deaths related to pregnancy and the importance of considering these violent deaths within the definition of maternal mortality.The study was carried out in the state of Morelos, based on the review of all death certificates (394) of reproductive aged women (12-49 years) who died during 2001. Based on a list of diagnostic criteria we eliminated 167 certificates that were neither violent deaths nor maternal deaths. The remaining 227 certificates were further evaluated through verbal autopsy and/or review of medical charts.Fifty-one violent deaths were found. Eighteen maternal deaths were officially reported in 2001, however, our study identified 23 direct maternal deaths and four violent deaths during pregnancy and the post-partum period. We found that this reproductive event was the direct trigger for the homicide or suicide of these four women, and only one of these cases was documented officially.Violent deaths related to pregnancy should be included in official maternal mortality statistics as indirect causes of maternal deaths. This would allow for a greater and more accurate understanding of violent maternal deaths and guide appropriate prevention and care policies, programs and services. Verbal autopsy is a useful technique for identifying cases of violent maternal deaths.

To describe the trends in caesarian sections (CS) associated with non-clinical factors in women who attended a birthing educational facility, also known as 'Centro de Educación,' (CEPAPAR) in Mexico City.Data from 992 births of 847 women that occurred from 1988-2000 were analyzed using linear regression to identify the association between non-clinical factors and time-trends in CS.The overall incidence of CS was 32.8%, with an 8% average annual increase. Until 1994 the percentage of CS remained relatively steady at 30%, increasing to 40% in subsequent years. In analyzing trends in CS and their relationship with non-clinical factors from 1988-2000, the increased incidence of CS during this period was higher among births where no birth attendant was present, for first-time mothers, and in larger hospitals (50 beds).Results show that the increased incidence of CS is associated with non-clinical factors such as size of the hospital and the presence of a birth attendant. A model of support for women which includes information, counseling, and the presence of a birth attendant during labor can contribute to reducing the risk of unnecessary CS in populations such as that studied.

This report presents the main qualitative results of a verbal autopsy study carried out in three states of Mexico, which aimed at identifying the factors associated with maternal mortality that could be subject to modifications through concrete interventions. By reviewing death certificates issued in 1995, it was possible to identify 164 households where a maternal death had occurred. One hundred forty-five of these households were visited, and a precoded questionnaire was completed to explore socioeconomic and living conditions, as well as causes of death. An open-ended question to prompt the relatives to narrate all the facts that led to the maternal deaths was included in the questionnaire. This study presents an analysis of that question, focusing on the delays in the care-seeking process and organized according to the model of the three delays: in deciding to seek care, in reaching a care facility, and in actually receiving care after arrival. Additionally, problems related to quality of care are examined. For analysis of the accounts, structural, interactional/community, and subjective variables were identified that allowed refining of our understanding of the problem of maternal deaths. Finally, based on the findings of the study, this article presents a series of recommendations, highlighting that interventions should address the early stages of a complication and focus on decreasing the various forms of inequality (gender and socioeconomic) associated with the occurrence of maternal deaths.