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Aspectele medico-sociale ale sarcinii şi naşterii la adolescente în Republica Moldova

Author: Larisa Boderscova
Degree:doctor of medicine
Speciality: 14.00.33 - Social Medicine and Management
Scientific adviser: Dumitru Tintiuc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Veaceslav Moşin
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 6 April, 2005
Approved by NCAA on the 23 June, 2005


Adobe PDF document0.29 Mb / in romanian


reproductive health, adolescents, pregnancy, abortion, birth, family planning


In the frame of the „Global Forum for Health Research” were discussed the question regarding the reproductive health. Experts highlighted two main questions: adolescents’ sexual relations risks and mortality caused by pregnancy and childbirth.

To avoid the adolescents’ sexual behaviors we group risk factors in three levels: individual, family and community, and health system.

Actual scientific research is a non-experimental study – descriptive and case-martor studies. By the sample’s volume were executed two kind of studies: integral and selective.

In the Republic of Moldova, as in the other countries, we may find some circumstances that rise up the level of sexual behavior risk among adolescents: early debut of the sexual life, absence of the sexual education in the vulnerable groups that may lead to promiscuousness, sexual abuse, non-protected sexual relations.

Abortion rate among the 15-19 years old women in the Republic of Moldova decreased in 1.9 times for 2003 in comparison with the 1997 (10,4 and 19,8 on 1000 15-19 years old women). Abortion’s structure is presented by the 4 principle groups: legal abortion, mini-abortions, spontaneous and medical abortions.

We studied that the medium age of women who practiced abortion is 18,1±0,05 years.

Unregistered marriage was registered for 7,04±1,56% cases (p<0,001). Rate of the single women that addressed in the medical institutions for abortion is 92,96±1,56% (p<0,001).

Occupational characteristic’s established the for 52,96±3,04% (p<0,001) of women do their study and for 43,03±3,13% (p<0,001) do practice any occupation.

Identification of the abortion’s causes revealed that just for 11,1±1,9% of cases (p<0,001) abortion was done by the medical emergency cause. More than 65% of women didn’t want to ask this question (65,92±2,88%, p<0,001), and this is their right. Every third women (29,63±2,78%, p<0,001) at the same age didn’t want to have a child. For 4,2±0,8% of cases (p<0,05) the cause of abortion were studies, but for 3,1±0,9% (p<0,05) – living conditions.

For 93,7±1,48% (p<0,001) of cases women didn’t use any contraception.

In the hierarchy of risk factors that may lead to an abortion among women of 15-19 years old the first place reveals to the age of the sexual relation’s debut, the second – absence of contraception, the third – civil status (single), the forth – absence of occupation. The fifth place reveals risks for women’s health and for future child – secondary sterility because of the interruption of the first pregnancy. The sixth place is for social causes – social status (they are pupils, students).

Fertility rates in the group of the 15-19 years old women decreased in 1.7 times and at the end of the 2003 are 29.2 on 1000 of women of the same age.

In the birth structure for women of 15-19 years old maximum weight (44,3%) reveals to the age of 19 years, 30,8% - for the age of 18 years, 17,1% - for the age of 17 years, 6,1% - for the age of 16 years, and for age of 15 years – 1,7%.

Birth ratio for the total republic has increasing tendency from 14 to 16 years old (5,87±1,2% and 36,27±2,5%) in 6 times, with reduction of 2 times for the age of 17 years old (18,93±2,02%) and the next increasing to 18 years old on 1,4 times (24,8±2,2%).

During the pregnancy at every second pregnant were established extragenital pathology (50,67±2,6%), anemia’s - for 78,74±2,84% of cases.

Present pregnancy was wished for 18,2±2,1% of cases.

Rate of preterm births is for 51,1±2,6% of cases in total republic.

Delivery’s complications is for 55,16±2,6% of cases. Most frequent complications for the total republic are: preterm irruption of the amniotic sac - 62,56±3,4%; complicated delivery – 58,13±3,5%; hypotonic hemorrhage – 50,25±3,5%.

Medium weight at birth of children from the urban region was for 2630±4,73 gr (p<0,001), in the rural region - 2970±43,2 gr (p<0,001) and for the total republic - 2810±45,1 gr (p<0,001).

Obstetrical traumatism was established for 16,03±1,9% of cases.

Regarding the obtained outcomes the first place is reveals to the social phenomena – childbearing of the not wanted children. The second place – for extragenital pathology, third place – children with low weight at birth, for forth and fifth places are the premature birth and obstetrical traumatism; complications during the labor is placed on the sixth place. Many of the complications is correlated with an another risk factor that is placed on the seventh place – pregnant noninvestigated during the pregnancy. On the eight place is mortinatality and on the ninth place – later registration of the pregnant.

Quality management in the elaboration and implementation of the Reproductive Health Programs for adolescents is presented by the main compartments: educative programs for families with social risk; creation of the adolescents’ normative behavior; adolescents’ trainings for the family life; early evidence of the pregnant (of 15-19 years) to reduce the complications during pregnancy and labor.