BY ELANOR COOK
Currently, over one tenth of births worldwide are to girls aged 15 to 19 years old.1 Although this number has been decreasing globally for the past few decades, there is one region in which fertility, meaning the number of births per women, has remained stagnant or even increased among teenage girls. In several countries in Latin America, teenage girls have experienced an increase in fertility, even though their older peers have been reproducing with less frequency,.2
Teenage pregnancy is not a problem in the abstract. It has proven negative effects on both the mother and the child. Globally, complications during childbirth are the second most prominent cause of death among 15 to 19-year-old girls1. Infants born to teenage mothers are also at increased risk of being born premature and underweight 3. Research of girls and young women in Latin America specifically has found that adolescent mothers had a greater risk of postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants. Adolescents aged 15 or younger were at greater risk of maternal death, early neonatal death, and anemia compared with their older counterparts.4
Beyond merely health-related problems, however, are social and socio-economic concerns regarding both mother and child. In the first place, many of the pregnancies that occur in adolescent girls are unwanted. Although many teenagers who become pregnant have already dropped out of school, of those who have not, a majority stop pursuing their education upon becoming pregnant, and the vast majority of those who do so never return to school.5 Even for those who try to continue their schooling, there exist obstacles to those who wish to remain enrolled beyond the extra work of balancing motherhood with education, such as expulsion from school for being pregnant. Furthermore, poor adolescent girls are more likely to become pregnant than their wealthier peers, which means that often those teenagers who give birth are those least financially capable of supporting a child. The poorest quintile of the population could have fertility rates of up to five times those of the richest quintile in Latin American countries.2 Becoming pregnant almost automatically puts girls on a path to poverty rather than success, and often leaves them dependent on others’ support.
Adolescent pregnancy in Latin America is thus an issue that merits considerable attention, but in order to try to solve the problem, it is important to understand its origins.
A particularly revelatory situation is that in Guatemala. In 2012 alone, there were 61,000 pregnancies among teenage girls, just under 4,000 of those girls were 11 to 14 years old, and 35 were 10-year-olds. This marked the highest teenage fertility rate in Latin America. These numbers do not show signs of improving, either. From 2000 to 2010, pregnancy rates in Guatemala remained stagnant.6 In a country which guarantees reproductive healthcare, it may seem counter-intuitive that the incidence of teenage pregnancy should be so high, and yet there exist many social structures in place which prohibit girls’ access to the healthcare they are promised.7
One particular barrier to girls receiving reproductive care is the stigma that surrounds it. Guatemala is a predominantly Roman Catholic nation8, which means that the Catholic Church’s ban on contraceptive use often dissuades girls from using effective methods of protection during intercourse. Furthermore, even for those who do seek contraception, cultural influences beyond religion prevent them. Often, in order to acquire birth control, a girl must be accompanied by a man to a health center, making contraceptives inaccessible at those centers for many women.7
Poverty, especially in rural areas is also a factor in teenage fertility, which has led especially to significantly large fertility rates among indigenous populations. After regimes that systematically oppressed them and a civil war that lasted longer than 30 years in which many found themselves in the crossfires, three quarters of indigenous individuals live in poverty, especially in Guatemala’s rural Western plateau and Northern region. The marginalization of indigenous, especially Mayan, populations in Guatemala has led to widespread poverty in their communities. Such poverty means that families, who struggle to support their children, look to marry off their daughters as soon as possible, so that someone else may be responsible for the girl, and may help support the rest of the family. This means that girls marry young, and thus reproduce young.7
Contributing to rampant rural poverty, but also partially as a result of it is widespread illiteracy and an inadequate education system in Guatemala. Around a quarter of the country is illiterate, and only 30% of rural, indigenous girls enroll in secondary school. Furthermore, Mayan girls are disproportionately likely to drop out of school compared to other populations, such as girls from urban areas.7 While pregnancy often causes girls to drop out of school, the negative dynamic also works the other way around. Girls who have dropped out of school are more likely to marry early and have children. This means that those already at a disadvantage pedagogically are those who end up most burdened by teenage pregnancy, as well.9
Another significant problem in Guatemala is sexual assault. Around a third of the approximately 4,000 10 to 14-year-old girls who became pregnant in Guatemala in 2012, were raped by their fathers. In 2009, Guatemala tried to address the problem of sexual assault against girls by outlawing sexual relations with girls under the age of 14 with the passage of the Law Against Sexual Violence, Exploitation, and Trafficking of People. This law also requires that a report be filed for every pregnant girl who goes to a hospital or medical center. What the law fails to catch, however, is pregnancies in girls who do not seek treatment at a hospital during their pregnancy. Again, it is largely girls in rural areas, a disproportionate number of whom are indigenous, who fall through the cracks, as they are less likely to visit a hospital than girls living in urban areas.9 This means that, in many instances, the only way perpetrators of sexual assault face punishment is if they are reported. Although 10,000 people report being raped in Guatemala each year, many instances go unreported.10
Furthermore, filing a report does not necessarily mean bringing a perpetrator of sexual assault to justice. As a result of the 2009 law, 20 men were convicted of rape in 2013,9 however many cases do not reach this point. In a particular instance of violent sexual assault, one girl describes how she was guaranteed safety as long as she did not press charges. Were she to bring the incident to court, she was told that her rapists would kill her family.10 Faced with inadequate structures to guarantee the wellbeing of victims and their families, even girls with the opportunity to report sexual assault may be deterred from doing so for fear of unwanted ramifications.
Although each country’s teenage pregnancy problem is slightly different, they often show similar trends. Both Ecuador and Colombia are among the 40 countries with the highest fertility rates.11 In Ecuador, from 1990 to 2001, the fertility rate among 15 to 19-year-olds increased from 13.5 to 16.3 percent of girls with the age group.2 More recently, however, political stability has led to increased investment in healthcare. The government has worked to make healthcare accessible and free for everyone, and healthcare use has certainly increased.
Nonetheless, a considerable number of teenage girls still become pregnant. A 2013 report found that 21% of women in Ecuador from the ages 20 to 24 had given birth before the age of 18. This is less than Guatemala’s 24 %, but is still high.11 Although use of contraceptives in Ecuador has increased significantly in the past two decades, have rates of intercourse among adolescents has, as well. Contraceptive use is also not consistent in many instances, and many girls report not using a condom during their first sexual encounter.5 Often, this is because contraceptives as basic as condoms are simply not available to the teenagers.12
In Colombia, where one in five women aged 20 to 24 were found to have given birth before 18, unprotected sex occurs frequently among teenagers, as well. In addition to lack of access to contraceptives, ignorance is also a catalyst. Urban myths claim that girls cannot get pregnant during their first sexual encounter, or that girls cannot become pregnant if they perform intercourse while standing. Believing erroneously that their risk of pregnancy is low, teenagers take fewer precautions during intercourse.12
Both in Ecuador and Colombia, pregnancy can also be used as an escape, as a way for a girl to gain status. Girls in Colombia at risk of gang violence will sometimes seek to become pregnant with a member of a gang in order to secure her own protection, and to escape expectations of performing gang-related activities herself.12 In Ecuador, becoming pregnant can be a way to escape abusive families.13
Sexual assault is also a significant problem in countries beyond Guatemala. Many Ecuadorian women report having experienced sexual violence in their lifetimes, and many cases certainly go unreported. There exists a culture in which girls often do not feel the right to say no to sexual advances.5 Girls are especially powerless in their relations with older male family members, including fathers. Like in Guatemala, rape by male family members is a significant force driving up rates of teenage pregnancy in Colombia.
Furthermore, indigenous groups in Ecuador, like in Guatemala, tend to be less healthy on average. With regards to teenage pregnancy specifically, a study in 2004 found that the proportion of girls ages 15 to 19 in the Orellana province, which has a significant indigenous population was more than four times that of the same age group in the most populous province, Guayas.5
Given the situations in these countries, it is important that action be taken. Currently, much of the need being addressed is by private organizations. Doctors Without Borders, for example, tells of a clinic it runs in Guatemala City intended specifically for survivors of sexual assault.10 Other groups focus on educating adolescents about reproductive health and pregnancy.7
One model for government action which has proven successful is a national program established in Ecuador in 2007. The program focused on providing healthcare specifically for adolescents, distinct from that for adults. By establishing an environment with assured respect, confidentiality, and friendliness, such facilities established trusting relationships between teenagers and health professionals, and the number of young people who sought reproductive healthcare rapidly increased. Unfortunately, in 2011, the government pushed instead for integrated family health care, which meant a drop in support for adolescent-specific services.5 Ecuador, as a model, however, demonstrates the need for differentiated care, specifically for teenagers when it comes to reproductive healthcare in Latin America.
The government in Bogota, Colombia has taken another approach and is pushing efforts to combat ignorance about reproduction. They have trained 1,000 youth leaders, and plans to train many more, to talk with their peers about and inform them on sex and sexual health. The government is also using cultural phenomena, such as television shows, to encourage discussion about teenage pregnancy and safe sex. As more attention is paid to the problem of teenage pregnancy, in Colombia, rates have decreased. The World Bank noted a marked improvement in Colombia from 2000 to 2010,6 and last year, the number of pregnant teenagers in Bogota was reported as just over three fifths of what it was in 2010.12
Although private initiatives can make a difference where they operate, it is mostly broad government action that seems to make a dent in the overwhelming quantities of teenage pregnancy in Latin America. Legislation, education, and increased access to healthcare have proven helpful in Guatemala, Ecuador, and Colombia. The underlying politics and causes of teenage pregnancy, however, are different in every country, but these efforts to combat teen pregnancy rates in Latin America are promising.
References:
1. Adolescent Pregnancy Fact Sheet. (2014, September). Retrieved from World Health Organization website: http://www.who.int/mediacentre/factsheets/fs364/en/
2. Teenage motherhood in Latin America and the Caribbean. (2007, January). Challenges, 4. Retrieved from https://www.unicef.org/lac/desafios_Nro4_eng_Final(1).pdf
3. Althabe, F., Moore, J. L., Gibbons, L., Berrueta, M., Goudar, S. S., Chomba, E., … McClure, E. M. (2015). Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reproductive Health, 12(2). https://doi.org/10.1186/1742-4755-12-S2-S8
4. Conde-Agudelo, A., Belizán, J. M., & Lammers, C. (2005). Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 192(2), 342-349. https://doi.org/10.1016/j.ajog.2004.10.593
5. Svanemyr, J., Guijarro, S., Riveros, B. B., & Chandra-Mouli, V. (2017). The health status of adolescents in Ecuador and the country’s response to the need for differentiated healthcare for adolescents. Reproductive Health, 14(29). https://doi.org/10.1186/s12978-017-0294-5
6. LAC: Poverty, Poor Education and Lack of Opportunities Increase Risk of Teenage Pregnancy [Press release]. (2013, December 12). Retrieved from http://www.worldbank.org/en/news/press-release/2013/12/12/lac-poverty-education-teenage-pregnancy
7. Ospina, G. A. (2015, June 17). Why is Guatemala’s teen pregnancy rate so high? Retrieved from Council on Hemispheric Affairs website: http://www.coha.org/why-is-guatemalas-teen-pregnancy-rate-so-high/
8. Guatemala [Fact sheet]. (2017, October 26). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html
9. Volpenhein, S. (2013, December 9). Child Pregnancy on the Rise in Guatemala (T. Tripp, Ed.). Retrieved from Institute for International Journalism in the E.W. Scripps School of Journalism at Ohio University website: http://scrippsiij.blogspot.com/2013/12/child-pregnancy-on-rise-in-guatemala.html
10. Guatemala: Treating Sexual Violence, Breaking the Cycle of Fear. (2009, July 20). Retrieved from http://www.doctorswithoutborders.org/news-stories/field-news/guatemala-treating-sexual-violence-breaking-cycle-fear
11. Loaiza, E., & Liang, M. (2013). Adolescent Pregnancy: A Review of the Evidence. Retrieved from United Nations Population Fund website: https://www.unfpa.org/sites/default/files/pub-pdf/ADOLESCENT%20PREGNANCY_UNFPA.pdf
12. Olfarnes, T. (2010, August 26). Preventing Teenage Pregnancy in Ecuador. Retrieved from United Nations Population Fund website: http://www.unfpa.org/news/preventing-teenage-pregnancy-ecuador
13. Moloney, A. (2017, May 16). Colombia teen mothers see getting pregnant ‘synonymous with protection’. Reuters. Retrieved from https://www.reuters.com/article/us-colombia-women-teens/colombia-teen-mothers-see-getting-pregnant-synonymous-with-protection-idUSKCN18C2DG
14. Goicolea, I. (2010). Adolescent pregnancies in the Amazon Basin of Ecuador: a rights and gender approach to adolescents’ sexual and reproductive health. Global Health Action, 3, 10.3402/gha.v3i0.5280. http://doi.org/10.3402/gha.v3i0.5280
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