Pregnancies of girls aged 10 to 13 indicate major underreporting of sexual violence in Maranhão Freestocks/Joanna Malinowska Every day, girls aged 10 to 14 become mothers in Brazil. In 2024, there were 12 thousand (Data from the Ministry of Health). More than 60% of these girls became pregnant when they were under 14 years old. These are, therefore, pregnancies resulting from sexual violence – in Brazil, any sexual relationship with a child under 14 is considered rape of a vulnerable person. Still, these pregnancies continue to occur and, often, without the violence being officially registered. To investigate this reality, we chose to look at cases of early pregnancy in Maranhão. The option was due to the context of high social vulnerability, evidenced by low socioeconomic development, low coverage of primary health care and prenatal care. Studies also indicate a greater concentration of early pregnancies in the North and Northeast regions, associated with worse socioeconomic conditions and income and gender inequalities. The objective of our study, published in the journal Cadernos de Saúde Pública (Fiocruz), was to estimate how many pregnancies occurred in girls aged 10 to 13 in the period from 2012 to 2022, to check how many cases of rape were reported and to compare the outcomes of these pregnancies with those of women aged 20 to 29. To do this, we analyzed data from the main national health information systems: Live Birth Information System (SINASC), Mortality Information System (SIM), SUS Hospital Information System (SIH/SUS) and Notifiable Diseases Information System (SINAN). The results show a worrying picture: pregnancies in this age group are more frequent than records indicate, reporting of sexual violence is low and health risks are significantly greater. What the data reveals In the period from 2012 to 2022, we identified 4,839 pregnancies in girls aged 10 to 13 registered in the state of Maranhão for an estimated population of 2,851,664 girls in this age group in the same period. This corresponds to a fertility rate of 1.7 per thousand in the period analyzed. However, when estimating pregnancies that ended when the girl was already 14 years old, but whose conception probably occurred at 13, the total number increased 2.5 times, reaching more than 12 thousand pregnancies. This indicates that many pregnancies in children under 14 do not appear directly in the usual statistics. During the period analyzed, 1,410 cases of rape involving girls aged 10 to 13 were reported in Maranhão. When we compare this number to the total number of pregnancies registered in children under 14 years of age, we estimate that notification coverage would be 29.1%. When also including estimated pregnancies, coverage fell to around 11.5%. We know that this comparison has limits: not all rape results in pregnancy, and we do not know whether pregnancies in children under 14 were reported as rape. However, these numbers give an idea of ??how the issue of rape of minors is much more frequent than official statistics show. In Brazil, research by the Brazilian Public Security Forum indicates that only a small portion of cases of sexual violence come to the attention of authorities. Violence against female children and adolescents usually occurs at home and is committed by someone they know or their own family. This makes reporting difficult and reinforces silence. In other words: the majority of pregnancies that, by legal definition, result from rape are not accompanied by official notification of the violence. Inequalities within the state Fertility rates and notification coverage varied significantly between the Regional Health Units of Maranhão. These differences reflect known social inequalities, as national and international studies show that early pregnancy is associated with poverty, low education and limited access to health services and information. In Maranhão, this is possibly also related to cultural norms, as regions with a higher proportion of indigenous people had higher fertility rates and lower notifications. In Brazil, the proportion of live births among indigenous girls aged 10 to 14 years in the period from 2012 to 2022 was approximately eight times higher than that observed among white girls, being 3.9% in indigenous girls and 0.44% in white girls. These data may reflect greater social vulnerability, due to less education and access to health services, in addition to specific cultural practices, such as unions or marriages at an early age. More health risks Compared to women aged 20 to 29, girls aged 10 to 13 had more negative outcomes during pregnancy. Prematurity (born less than 37 gestational weeks) and low birth weight (weight