**3.2 Unplanned pregnancy**

Regarding unplanned pregnancy, it is observed that in high-income countries half of the pregnancies are unplanned, which increases sanitary costs for women care, originates personal and family crisis for women and commits timely health care [49, 50]. In the period 2015–2019, there were 121.0 million of unwanted pregnancies per year, which represent a rate of 64 unwanted pregnancies for every 1000 women between 15 to 49 years old. Out of the total, a 61.0% of the unwanted pregnancies resulted in abortion, that is to say, a global rate of 39 abortions per 1000 women. The rates of unwanted pregnancies are higher in countries where abortion is illegal [51]. It is pointed out that 63 million of these unwanted pregnancies are, at least, consequence that 22 million women around the world have an unsatisfied need of family planning [49, 52]. In the United States 50% of pregnancies are unplanned, a 50% result in abortion and increases women's depression and 47.0% of the live births come from an unplanned pregnancy [50, 53].

In Chile, in the five-year period of 2010, the unplanned pregnancy represented a 51,0% out the total of the pregnant entered to the public health system, prenatal care, higher in the extreme age groups, reaching an 85.6% in pregnant under 15 years old and a 66% in older than 45 years old [54]. In the United States, there are disparities in the rates of unwanted pregnancies between poor and non-poor women, being the rate 5 times higher in the first group [25]. In addition, Also, pregnancy disparities have been observed regarding unplanned pregnancies in the poor women subgroups of 18 to 24 years old or who cohabit with a partner, since they have twice or three times the national rate [55, 56]. It is possible that the unplanned pregnancy is related to social naturalization of motherhood, in addition to the access difficulties and the lack of information about the fertility regulation means [56, 57].

Timely access to health centers in order to search early for pregnancies is very important for women who did not plan a pregnancy, since they find out 2 weeks later than women with wanted pregnancies. Fetal organs are formed at the 8th week, so a 2-week delay further than the normal 6 weeks' recognition period could prevent a form taking fast responses regarding reproductive health, especially in women with unwanted pregnancies. The possible effect of unhealthy behaviors, such as smoking and drinking, could be continuously unnoticed during the embryonic period, when most of the malformations occur [57]. It has been reported that women from minority ethnic groups have noticed very late, compared to white non-Hispanic women, since they have less information about family planning and less access to health care [57, 58]. The evidence show that unplanned pregnancy is related to disparities in women health and perinatal health in relation to the late prenatal care: low birth weight, child abuse and negligence, child behavior problems, exposure risk to illicit drugs or tobacco, not preventing alterations due to not taking folic acid timely, high prevalence of depression, depression during pregnancy and postpartum [52, 59, 60].

## **3.3 Inmigrant pregnant women**

Illegal immigrant pregnant women constitute a socially vulnerable group, since they have legal limitations to access to prenatal and obstetric care to protect their health and their children's health [52, 61]. Scientific evidence demonstrate that

immigrant women's reproductive health is exposed to a high rate of unplanned pregnancies, pregnancy rejection and late prenatal care. It is possible that the access difficulties and the lack of information about the fertility regulation means predispose women to unplanned pregnancy in this group [56, 57]. The possible effect of unhealthy behaviors, such as smoking and drinking, could be unnoticed during the embryonic period, when most of the malformations occur [58]. Inadequate prenatal health care to migrant women has as consequence 4 times more risk to give birth children with low birth weight and seven times more risk of prematurity [61].

#### **3.4 Maternity in adolescent women**

Regarding early motherhood, it has been informed that when reproductive timing has been examined in teenager women who start their sexual life early, the results show that teenagers with subsequent children with short/long gestational intervals belong to social groups differentiated by structural and cultural determinations. In poor women, early motherhood is considered as a non- normative crisis that determines reproductive inequity and, in some cases, excess of unwanted fertility [62, 63]. Within this framework, the concern about what happens with teenage pregnancy is not only based on studies on pregnancy rate trends and biomedical morbidity, but also on the consequences of sexual and reproductive behavior pattern and its path on education, work, and family life after delivery [63, 64]. In developing countries, longitudinal follow-up studies of teenage mothers have observed that the mother-son binomial is a strong candidate to lead-up to poverty from one generation to the next one, especially when the father is absent, because in addition to producing economic deprivation it has a negative effect on the child's socialization process [63, 65]. The disadvantage situation of the adolescent mother tends to be repeat harder on her daughter, who shows school problems and become pregnant earlier than her mother the reproductive and sexual behavior perpetuated [66].

#### **3.5 Motherhood in ethnic groups**

Finally, some reflections on poverty and reproductive health of women from Mapuche ethnicity. In Chile, poverty and marginalization are eminently rural and affect, mostly, to the regions with a highest proportion of rural and indigenous population [67]. In a study carried out in a rural area of southern Chile, a social reality of accumulated disadvantages and a situation of vulnerability was observed in Mapuche's women whose determinants of the inequity and discrimination were gender (woman), ethnicity (indigenous), class (poverty) and territory (rural) [68]. Many of the health risks of indigenous women were directly related to their reproductive health, since they had a high fertility rate, early motherhood, short birth interval and poor access to family planning services [68]. Another study analyzed the relative risk (RR) concepts of perinatal mortality and the findings revealed a direct relation between maternal poverty of Mapuche's women and perinatal mortality [69].

#### **4. Public health policy management**

There is concrete evidence that gender stereotypes are maintained and naturalized in health policies and programs [70]. Women's health programs have paid more attention to aspects related to reproductive health rather than to reproductive rights [71]. Everyday life elements present in people's life style has been rescued and put in a leading role by promotion and prevention programs, however, they are partially included in the institutional practice.

#### *Poverty, Reproductive Health and Public Health Policies in Chile DOI: http://dx.doi.org/10.5772/intechopen.96100*

Regarding the health care providers and the female users of the public health network, the trend is to regulate the habits, modify beliefs and cancel the explanations reports by women. That is, it is excluded people's social dimension and cultural meanings [71]. Consultant women tend to inform their cases relating their symptom's to diverse aspects of their daily lives, as well as with their own opinions and beliefs about what is happening to them. For their part, health professionals emphasize objectivity and the separation between the subject who knows and the objects that are known, they tend to direct the conversation in strictly clinical terms, without allowing women to express themselves as they wish. Professionals decide what issues are appropriate and what not to manage the context of the interview. This hierarchical relationship is exacerbated in case of lower-class women and represents the fundamental asymmetry that explains many of the disagreements between providers and female users. This form of social interaction categorizes the human reproduction as a biological event, which establishes the basis to exclude the contextualization [72].

It is in these poverty contexts, where the challenge is generated for midwifery professionals to open a space to make effective the sexual and reproductive rights and, as a consequence, to modify the inequalities relationships in the reproduction and sexual day-to-day labour. This space gives an opportunity for midwives and social science professionals to give an integrated contribution to acknowledge the existing bonds between the women's health condition and the socially structured environments where they live. The changes required in the models and processes of "how to do, with what and whom with" are due to the scenarios of deep and complex social transformations generated by the growing social inequality [73, 74]. Due to the above mentioned, it is imperative to give better and greater attention to the poorest, most vulnerable, and unprotected groups, not only to strengthen prevention and promote skills that allow them their sexual and reproductive rights, but also to facilitate resilience, personal and family psycho-social development and respect for their social rights [37]. On the other hand, from the lessons learned in the Primary Health Care, the evaluation of the effectiveness of the transfer benefits of the social programs is key in the development of capabilities in the integrated management of the Primary Health Care level and from the intersector, because they are in a privilege position to take the challenge and commitment to guarantee the access to benefits to vulnerable people [75].

The general and local social, economic and political situation deserves to make balances and permanent checking on the sexual and reproductive health management to primary health level as a way to keep a dialog among the different institutions in charge to execute preventive convergent policies. In this balance, social and human capital women's in vulnerable societies require leaders that create bonds, trust, and social networks to construct synergy processes where the appreciation and mutual respect coexist [76]. Due this, it is urgent a permanent strengthening of female and male midwives as managers and executors of humanized reproductive health policy and social protection, increase the etno-cultural knowledge, apply gender perspective in health practice, streghthen management in integrated network and participate in the local analysis of integrated information systems [76].
