Primeiros Laços (First Ties) – A program for home visits for pregnant adolescents in order to promote early brain development
Beyond the strong impact of adolescent pregnancy on life, these pregnancies can also result in complications that affect the development of both the baby as well as the mother. Primeiros Laços is an innovative program in which trained nurses visit adolescent mothers living in poverty to teach them skills in child-rearing, secure emotional attachment, and care of the baby. In addition, the program has an expert group of doctors and nurses who promote early development of the children through strategies that help the mothers manage stress. The innovative program is constantly evaluated and has studied the effectiveness of electronic diaries as a low-cost digital tool to record daily behavior in order to measure maternal well-being and the impact of the care strategies.
Problematic
Pregnancy during adolescence is associated with risks such as maternal and child mortality, insecure emotional attachment, maternal depression, infections, and other complications that affect the mothers and their babies. What is more, the pregnancy in contexts of socio-economic vulnerability and insecurity exposes the mothers and their babies to high levels of toxic stress. All of these conditions adversely affect the healthy development of the child and limit the response capacity of the mother, weakening the connections between them that are fundamental to their development.
Solution
This program of home visits is first carried out during weeks 8 and 12 of the pregnancy and continues until the baby is 2 years old. A group of nurses visits the adolescent mothers living in adverse conditions and provides them with information about strategies to manage stress and prevent their children from growing up exposed to violence and abuse. In addition, the nurses address such topics as health and care practices, parental development, strengthening the connection between mother and child, and the importance of cognitive development. The program is designed for mothers between 14 and 20 years old. During the COVID-19 pandemic, the program of household visits has been adapted so that nurses can continue to provide information and training virtually.
Evaluation and Impact
A random assignment experiment was conducted under which a group of 40 adolescents between 14 and 19 years old and pregnant for the first time was randomly assigned to receive household visits, while a second group of pregnant adolescents received standard prenatal care. Children of adolescents in the group that received household visits showed positive developments in their cognitive, language, and motor development. The trial also compared the level of maternal depression during weeks 16 and 30 of the pregnancy, with a finding that the prevalence of depression affects the care of the children. The program was again evaluated, particularly the effectiveness of the electronic diary, through a mobile application that enabled participants to record their level of well-being and the activities carried out with their children. The study found that the use of the diary to measure activities and well-being was generally accepted by the adolescents.