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HEALTH-CHILE: Teen Pregnancy Bucks Global Downward Trend

Daniela Estrada

SANTIAGO, Feb 26 2007 (IPS) - She is only 24 and has already had three children. The first was born when she was 14, the second when she was 20, and the third, who she gave in adoption, was born just a few weeks ago. Her story is a reflection of teen pregnancy and early motherhood, which are on the rise in Chile.

She did not want to reveal her name – we will call her Claudia – but she did agree to share her story, which contains elements common to many teen mothers: a difficult childhood fraught with poverty, domestic violence and alcoholism.

“I have worked hard since I was 10, going to school in the evenings. In my house there were economic problems and alcoholism, and my father physically abused my mother,” said Claudia.

“The father of my oldest daughter left me after physically mistreating me for a year and a half,” she said. “He smoked ‘pasta base’ (cocaine sulphate) and drank a lot too. He forced me to do drugs during the pregnancy, and in the first five months of my little girl’s life.”

Claudia has good memories of the father of her second child, who assumed his paternal responsibilities. But the father of her third baby, a married man, abandoned her when he found out she was pregnant.

Because she was not in a position to properly raise her third child, she decided to give him a chance for a better life, and gave him up for adoption through the San José Foundation for Adoption, a private non-profit institution linked to the Catholic Church.

More than 30,000 adolescents between the ages of 15 and 19 give birth every year in this country of 15.6 million people, according to Health Ministry statistics. From 1990 to 2003, the proportion of live births to teenage mothers rose from 13.8 percent of all births to 14.9 percent, reaching a record of 16.2 percent in 1998.

Teen pregnancy is on the rise in Chile, as it is in most of the countries of Latin America and the Caribbean – with the exception of Belize, Guatemala, Nicaragua and Paraguay – by contrast with the global downward trend seen in birth rates among both adults and adolescents since the 1970s, as indicated by the United Nations Department of Economic and Social Affairs (UNDESA) projections for 2007.

Fertility rates among adult women have also declined in this region. According to UNDESA figures, this year’s global birth rate will average 2.55 children per woman, compared to 2.38 for Latin America and the Caribbean.

But with respect to teen pregnancy, the global rate is projected at 52.9 pregnancies per 1,000 female adolescents, and the rate for Latin America and the Caribbean at 75.68 per 1,000.

The quarterly bulletin published in January by the Economic Commission for Latin America and the Caribbean (ECLAC) and the United Nations Children’s Fund (UNICEF) expresses concern over the rising teen pregnancy rates in the region.

Teenage maternity is a grave problem in Latin America and the Caribbean as it is not declining, and because it involves greater reproductive health risks than among adult women, and places teenage mothers at risk for life-long social exclusion, since most are poor and single and have little to no formal education, says the bulletin.

Pregnant girls under 18 are at higher risk of pregnancy, birth and postpartum complications, such as hypertension, eclampsia, anemia and difficult labour and childbirth as a result of cephalopelvic disproportion – all of which are causes of maternal mortality.

The infant mortality rate for babies born to teenage mothers is also higher. In 2003, 17 of the 994 babies (1.7 percent) born to mothers under 15 died, as did 335 of the 33,838 babies (1.0 percent) born to mothers between the ages of 15 and 19.

Consequently, adolescent maternity threatens Chile’s prospects of reaching the Millennium Development Goals (MDGs) agreed by the international community in 2000, particularly the targets of cutting the maternal mortality rate by three-quarters and the mortality rate among children under five by two-thirds from 1990 levels, by 2015, as well as the goals for reducing poverty and achieving universal primary education.

A decline in the age of sexual activity and low rates of birth control usage among adolescent boys and girls are two of the reasons that explain the diverging trends of teen and adult pregnancy rates in the region, says the report.

According to the Fourth National Survey on Youth, carried out in 2003, the average age of first intercourse in Chile is 17 for girls and 16 for boys. The poll also found that 41 percent of youngsters between the ages of 15 and 18 used contraceptives the first time they were sexually active and 58 percent had used birth control the last time they had sex.

Alejandra Baeza, a 19-year-old Chilean who had her son at the age of 14, got pregnant the very first time she had intercourse. “It was carelessness. Neither I nor my partner used any birth control method. It didn’t cross our minds to use any,” she told IPS.

Ramiro Molina, the head of the Centre for Reproductive Medicine and Integral Development of the Adolescent (CEMERA) at the public University of Chile, explained to IPS that it has been clearly demonstrated at the international level that an effective teen pregnancy prevention policy is based on three pillars: the existence of a sex education programme that involves young people, teachers and parents; access for young people to personalised, confidential health services; and direct access to birth control.

In Molina’s view, Chile is far from achieving all three pillars. He said that although the government of socialist President Michelle Bachelet has good intentions and took an important step towards the establishment of new reproductive health standards, further progress must be made on several key issues.

In September 2006, the Health Ministry announced new “national norms on fertility regulation”, which include a programme for emergency contraception for adolescents that is controversial but has been applauded by ECLAC and UNICEF.

Under the new regulations, public health services are authorised to prescribe, and to provide free of charge, traditional and emergency contraceptives to adolescents over 14, without the need for parental consent.

Molina said the new regulations were an achievement in the field of sexual and reproductive rights but that they would not have the desired effect if health centres fail to create spaces for providing assistance to adolescents, something that has not yet been done.

He also said the impact of the use of the “morning after pill” or “emergency contraception” on teen pregnancy rates would be tiny, given that it is only recommended in cases in which use of the condom failed or in cases of rape.

Sex education is more important, said Molina. However, he criticised the sex education policy followed by the four centre-left Coalition for Democracy administrations that have governed Chile since 1990. He said that although the policy is based on an accurate assessment of the problems and on ambitious goals, it lacks effective concrete actions.

The sex education plan for 2005-2010 which was launched by the Education Ministry in 2005 includes training for teachers and students, support for ongoing initiatives in educational and municipal establishments, panels in which media leaders take part, and the creation of mechanisms for assessing the results.

But Molina says it is just another “pilot project” that fails to build on experiences and methods developed and successfully tested by universities and non-governmental organisations over the past few decades.

The free distribution of the morning after pill drew howls of outrage from conservative sectors like the Catholic Church and the right-wing Independent Democratic Union (UDI), who argue that the pill is actually an abortion method, and that it is parents who should be in charge of educating their children about sexuality.

Several right-wing mayors even filed legal injunctions to block distribution of the morning after pill in the health centres located in their districts.

The legal battle played out in the Constitutional Court, which forced the president to give the national norms on fertility regulation the status of a “supreme decree” rather than a health regulation, in order to make them obligatory.

If the mayors do not allow the morning after pill to be distributed in municipal health centres – as three of them have threatened to do – they will face penalties to be determined by the comptroller-general’s office.

The executive branch is currently preparing to purchase the morning after pill for distribution in the public health system and is consulting the public with respect to their views on “norms for counselling on sexual and reproductive health care for adolescents”.

The Health Ministry is receiving comments and suggestions from the public on its web site up to Mar. 15.

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