A teenage mother and her toddler in Bonpland, a rural municipality in the northern province of Misiones in Argentina. Latin America has the second highest regional rate of early pregnancies in the world, after sub-Saharan Africa. Credit: Fabiana Frayssinet/IPS

By Fabiana Frayssinet
BUENOS AIRES, Jul 8 2016 (IPS)

In plain and simple language, an Argentine video aimed at teenagers explains how to get sexual pleasure while being careful. Its freedom from taboos is very necessary in Latin American countries where one in five girls becomes a mother by the time she is 19 years old.

“For good sex to happen, both partners have to want it and this is as much about being sure they want it, as about being in the mood or ‘hot’ with desire,” said psychologist Cecilia Saia who made the video “Let’s talk About Sex” (Hablemos de sexo), aimed at adolescents and preadolescents and posted on social networks.

The video was produced by Fundación para Estudio e Investigación de la Mujer (FEIM – Foundation for Women’s Studies and Research) as part of a Take the Non-Pregnancy Test campaign. It was also distributed to teenagers so they “would be able to take free and informed decisions about becoming mothers and fathers.” “Keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact” - Alma Virginia Camacho-Hübner.

During the campaign, teenagers of both sexes were given boxes similar in appearance to pregnancy test kits, containing information about teenage pregnancy and the myths surrounding how it is caused, as well as condoms and instructions on how to use them, Mabel Bianco, the president of FEIM, told IPS.

The campaign was broadcast on YouTube and other social networks, with candid messages in the language used by adolescents. “This meant we could reach a large numbers of 14-to-18-year-olds, an age group that such campaigns usually find hard to reach,” she said.

According to FEIM, in Argentina 300 babies a day, or 15 percent of the total, are born to mothers aged under 19.

“This percentage has shown a sustained increase over the last 10 to 15 years, and the proportion of births to girls under 15 years of age has also risen,” Bianco said.

Argentina exemplifies what is happening in the rest of Latin America, which is the world region with the second highest teenage fertility rate, after sub-Saharan Africa. The national rate in Argentina is 76 live births per 1,000 women aged 15-19 years, according to United Nations’ demographic statistics.

In order to call attention to this problem and to the general need to promote the equal development of women, Investing in Teenage Girls is the theme of this year’s World Population Day, to be celebrated July 11.

The United Nations Population Fund (UNFPA) states that one in five women in the Southern Cone of South America (Argentina, Brazil, Chile, Paraguay and Uruguay) will become a teenage mother, in an area where over 1.2 million babies a year are born to adolescents.

“Early pregnancy and motherhood can bring about health complications for mother and baby, as well as negative impacts over the course of the lives of adolescents,” says a UNFPA report about fertility and teenage motherhood in the Southern Cone.

The report says that “when pregnancy is unplanned, it is a clear indication of the infringement of teenagers’ sexual and reproductive rights and hence of their human rights.”

Alma Virginia Camacho-Hübner, UNFPA sexual and reproductive health adviser for Latin America and the Caribbean, told IPS that teenage pregnancy has implications for individual patients, such as maternal morbidity and mortality associated with the risks involved with unsafe abortions, among other factors.

Prematurity rates and low birthweights are also several-fold higher, especially among mothers younger than 15.

For health services, the costs of prenatal care, childbirth, postnatal care and care of the newborn are far higher than the cost of interventions to prevent pregnancy and promote health education.

“For society as a whole, from a strictly economic point of view, in countries that enjoy a demographic dividend, early motherhood represents an accelerated loss of that demographic dividend,” Camacho-Hübner said from the UNFPA regional headquarters in Panama City.

This is because “instead of increasing economic productivity by having a larger economically active proportion of the population, a rise in early motherhood causes a rapid rise in the dependency ratio, that is the proportion of the population that is not economically active and requires support from family or society,”she said.

The Southern Cone study found that dropping out of school usually preceded getting pregnant.

“Therefore, keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact,” Camacho-Hübner said.

In her view, teen pregnancy and motherhood are an issue of inequality which mainly affects women in lower socio-economic strata.

“It is teenagers from the poorest families and with the least education, living in underprivileged geographical regions, that are most prone to becoming adolescent mothers,” she said.

“Becoming mothers at an early age reinforces conditioning and the inequalities in the process by which teenagers who are, and who are not, mothers, effect the transition into adulthood,” she said.

“The main consequence of pregnancy is the interruption of schooling, although in many cases they have already dropped out by the time they become pregnant. But they do not go back to school afterwards because they have to look after the baby,” Bianco said.

“This makes for a poorer future, as these girls will have access to lower-paid jobs and will be able to contribute less to the country’s development. On the personal level, they will have to postpone their adolescence, they cannot go out with friends, go dancing and other typical teen activities,” she said.

Federico Tobar, another UNFPA regional adviser, said that “in addition to strengthening health, education and social services, there must be investment to promote demand, with interventions to motivate young people to build a sustained life project.”

“This involves incorporating economic incentives as well as symbolic remuneration, and also concrete childcare support for teenage mothers so that they can finish school and avoid repeated childbearing, which is frequently seen in these countries,” he told IPS.

Among other positive experiences, Tobar mentioned the Uruguayan initiative “Jóvenes en red” (Young People’s Network) which includes returning to school and work, and promotion of sexual and reproductive health.

“I believe it is important to invest in the education of teenage women, including comprehensive sex education and the capacity to decide whether or not they wish to have children. It is not a question of eliminating all pregnancy in adolescence, but of making it a conscious choice rather than an accident,” Bianco said. 

Edited by Estrella Gutiérrez. Translated by Valerie Dee.

HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Dec 15 2014 (IPS)

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents.

Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally.

Drivers of HIV infection among adolescents include scarce information about sexual reproductive health and HIV, unprotected sex and sexual violence.

Between 2005 and 2012 the global AIDS death toll fell by 30 percent but increased by 50 percent among adolescents, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Late HIV diagnosis, fear of discrimination, low enrolment and adherence to antiretroviral treatment, and absence of specialized health services for HIV positive youths are some of the factors responsible for AIDS related deaths among adolescents in Africa.

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

In most Latin American countries schools now provide sex education, but with a focus that is generally restricted to the prevention of sexually transmitted diseases – an approach that has not brought about significant modifications in the behaviour of adolescents, especially among the poor.

The international community made the commitment to offer comprehensive sexuality education (CSE) during the 1994 International Conference on Population and Development in Cairo.

“Although some advances have been made in the inclusion of sexual and reproductive education in school curriculums in Latin America and the Caribbean, we have found that not all countries or their different jurisdictions have managed to fully incorporate these concepts in classroom activities,” Elba Núñez, the coordinator of the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM), told IPS.

Teenage mom Maura Escobar with her baby María. Credit: Daniela Estrada/IPS

The 2010 CLADEM study ‘Systematisation of sexuality education in Latin America’ reports that Argentina, Brazil, Colombia, Mexico and Uruguay are the countries that have come the closest to the concept of comprehensive sex education, and they are also the countries that have passed legislation in that respect.

Others, like Chile, Costa Rica, El Salvador, Guatemala and Peru, continue to focus on abstinence and birth control methods, while emphasising spiritual aspects of sexuality, the importance of the family, and the need to delay the start of sexual activity.

But programmes in the region still generally have problems “with respect to the enjoyment and exercise of this right,” especially among ethnic minorities and rural populations, said Núñez from Paraguay.

Countries such as Argentina, Brazil and Mexico have also run into difficulties in implementing sex education programmes outside the main cities.

These shortcomings are part of the reason that Latin America is the region with the second highest teen pregnancy rate – 38 percent of girls and women get pregnant before the age of 20 – after sub-Saharan Africa, as well as a steep school dropout rate.

In Argentina, a law on comprehensive sex education, which created a National Programme of Comprehensive Sex Education, was approved in 2006.

Ana Lía Kornblit, a researcher at the Gino Germani Research Institute, described the programme as “an important achievement because it makes it possible to exercise a right that didn’t previously exist.”

But in some provinces the teaching material, “which is high quality, is not used on the argument that [schools] do not agree with some of the content and they plan to design material in line with local cultural and religious values,” she said.

“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex,” Mabel Bianco, president of the Foundation for the Education and Study of Women (FEIM), told IPS.

“But in the media everything is eroticised, which incites them to engage in sexual behaviour. And the worst thing is they don’t have the tools to resist the pressure from their peers and from society to become sexually active,” she said. “CSE would enable them to say no to sexual relations that they don’t want to have.”“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex.” -- Mabel Bianco

Lourdes Ramírez, 18, just finished her secondary studies at a public school in Mendiolaza in the central Argentine province of Córdoba. She told IPS that in her school, many parents of students in the first years of high school “kick up a fuss” when sex education classes are given “because they say their kids are young and those classes will make them start having sex sooner.”

“It’s absurd that you see everything on TV, programmes with girls in tiny thongs, but then in school they can’t teach how to use a condom or that people should only have sex when they really want to,” Ramírez said.

In her school, the Education Ministry textbooks and materials arrived, but they were not distributed to the students “and were only kept in the library, for people to come and look at.”

Carmen Dueñas, a high school biology teacher in Berazategui, 23 km southeast of Buenos Aires, said it was surprising that even when available birth control methods are explained to the students, “many girls want to get pregnant anyway.”

“They think that when they get pregnant they will have someone to love, that they’ll have a role to play in life if they have a family of their own,” said the teacher, who forms part of a municipal-national CSE project.

“There are conflicts and violence in a significant proportion of families, and teenagers don’t feel they have support; families are torn apart, and there is domestic abuse, violence, alcohol and drug use,” said Marité Gowland, a specialist in preschool education in Florencio Varela, 38 km from the Argentine capital.

“All of this leads to adolescents falling into the same cycle, and it is difficult for them to put into practice what they learn in school,” she said. “Many schools provide the possibility for kids to talk about their problems, but the school alone can’t solve them.”

A project in Berazategui is aimed at breaking the mould. Students are shown a film where a girl gets pregnant when she is sexually abused by her stepfather, but manages to stay in school after talking to her teacher.
“We chose this scenario because sometimes we have clues that there are cases like this in our schools,” Dueñas said.

Through games, the project teaches students how to use condoms. In addition, students can place anonymous questions in a box. “There are girls who comment that although they haven’t even gotten their first period, they have sex, because they have older boyfriends. Then the group discusses the case,” Dueñas said, to illustrate how the project works.

Another member of CLADEM, Zobeyda Cepeda from the Dominican Republic, said that what prevails in most of the region is a “biological approach, or a religious focus, looking at sexuality only as part of marriage.”

Until the focus shifts to a rights-based approach, experts say, Latin America will not meet its international obligations to ensure that “every pregnancy is wanted […] and every young person’s potential is fulfilled.”

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

By Hinda Deby Itno and Julitta Onabanjo
JOHANNESBURG, Sep 15 2014 (IPS)

Adolescence is a time of transition from childhood to adulthood. It is also a time of change and challenge. 

Today’s adolescents, connected to each other like never before, can be a significant source of social progress and cultural change.

But they are also facing multiple challenges that seriously impact their future. And nowhere in the world do adolescents confront as formidable barriers to their full development as in Africa.

Today, adolescents and young people make up over one third of Africa’s population. They form a sizeable part of the population yet they lack critical investments, especially where it matters most – in sexual and reproductive health services, comprehensive sexuality education and skills building.

This calls for the serious and committed attention of all.

  Challenges facing adolescent girls

It is estimated that Africa has the world’s highest rates of adolescent pregnancy and maternal mortality. In Chad, Guinea, Mali, and Niger, where child marriage is common, half of all teenage girls give birth before the age of 18.

This was the case for Zuera, a girl from Kano in northern Nigeria, who became a wife and a mother at just 14 years. She suffered the agony of two stillbirths and was treated for obstetric fistula, which is damage caused by childbirth that leaves a woman incontinent, that arose from her first pregnancy.

Zeura was robbed of her childhood. She also missed out on the transition phase of adolescence and finally, she missed life.

All over Africa, stories like Zeura’s are commonplace. Millions of girls become brides before the age of 15. Close to 30 percent of girls on the continent give birth by age 18, when they are still adolescents. These adolescents face a higher risk of complications and death due to pregnancy than older women.

Nearly two thirds of them lack the basic knowledge they need to access crucial sexuality education and health information to protect themselves from early pregnancy and sexually transmitted diseases.

Research has found that at least 60 percent of young people aged 10 to 24 years are unable to prevent HIV, due to a lack of sexuality education. We cannot allow this to continue.

A resilient and informed generation

Young people will carry the African continent into the future. They need a safe and successful passage to adulthood.

And this is not a privilege but a right. Yet this right can only be fulfilled if families, society, and government institutions make focused investments and provide opportunities to ensure that adolescents and youth progressively develop the knowledge, skills and resilience they need for a healthy, productive and fulfilling life.

Comprehensive sexuality education, sexual and reproductive health services, education and skills building for adolescents and young people need to be placed at the heart of the Sustainable Development Goals (SDGs), with specific indicators and targets.

By building a strong foundation and investing in programmes that focus on delivering and achieving specific results for adolescents, Africa can achieve its transformation agenda.

Our desire is for every young person in Africa to be resilient and informed. We want every young African to be able to make their own decisions, to foster healthy relationships, access proper health care, actively participate in their education and ultimately, contribute to the development of their community and their future.

This means that programmes that are achieving results for adolescents in various parts of Africa must be scaled up. These include the husbands’ schools that have been developed in Niger, the girls’ empowerment initiative in Ethiopia, and the child marriage-free zones in Tanzania.

International institutions need to increase their commitments to adolescents, and address the nagging problems that confront adolescent girls and women across the African continent.

Adolescents have the potential to shape their world and indeed, the world in its entirety. It is in our interest to connect with them and enable them to change our world. Yes indeed!

Edited by: Nalisha Adams

Excerpt:

Many countries in Latin America have made progress in introducing sex education in schools. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Nov 13 2012 (IPS)

Learning about respect in a relationship, sexual orientation, sexuality, gender equality and family planning forms part of the right to sex education that is still not enjoyed by all children and adolescents in Latin America.

“They talk to us in school about teen pregnancy and safe and responsible sex,” Leonardo Martínez, a 12-year-old student in Havana, told IPS. “I did homework about children’s rights, and thanks to that we learned more about how important sex education is.”

However, Javier García, who is the same age, commented, “We have to talk more about other things,” after participating in a community meeting about violence against women as part of a national event that was held this month in eight Cuban provinces. “We experience these differences, but we don’t know how to deal with them.”

“Sexuality needs to be thought of in terms of pedagogy and human rights. We need to move from a medical approach to a more educational approach,” said Argentine sexologist Mirta Marina, coordinator of her country’s National Programme for Comprehensive Sex Education.

Latin America is “going through a process of development” in this field, but “it still has many restrictions, mostly because of the conservatism that has been passed down for centuries, which makes it difficult to talk about these matters within the family and at school,” Marina told IPS in Havana, during a regional meeting on comprehensive sex education.

In classrooms and other educational spaces, teaching staff should provide guidance about sexuality with the goal of promoting health. “But we have to progressively add other aspects, such as gender equality, respect for gender diversity, and the elements of affection, expression of feelings and pleasure,” she added.

In her opinion, “it is a battle that will continue, to a lesser or greater extent, based on the progress made in each country. We have to work more on the rights of boys and girls to enjoy their bodies and gender equality.”

A 2011 study published this year by the nongovernmental organisation Mesoamerican Coalition for Comprehensive Sex Education found more progress was made in health than in education in implementing the Mexico City Ministerial Declaration – “Educating to Prevent.”

This agreement, which was signed in 2008 by 30 health ministries and 26 education ministries from Latin American and the Caribbean, outlined paths to curb the spread of HIV/AIDS.

The countries committed themselves to achieving two major goals by 2015: cutting in half the number of adolescents and young people who do not have access to health services that fully meet their sexual health needs, and reducing by 75 percent the number of schools — under ministerial jurisdiction — that do not provide comprehensive sex education.

According to the study, which covers the 2008-2011 period, the Mesoamerican region — southern Mexico and Central America — advanced by 49 percent in implementing that strategy, and South America made 41 percent progress. However, it did not include Brazil or the Caribbean islands.

The countries that made the most progress were Colombia, Argentina, Guatemala and Costa Rica. And bringing up the rear were Panama, Belize, Paraguay, Bolivia and Venezuela, the study found.

According to the United Nations, in Latin America some 68,000 adolescents (10 to 19 years old) are living with HIV/AIDS: 34,680 of them female and 33,320 male. And more than half of new HIV cases worldwide due to sexual transmission are detected among young people between the ages of 15 and 24.

In recent years, teen pregnancy rates have shot up in the region, exceeded only by those of Africa.

The Economic Commission for Latin America and the Caribbean reports that adolescents in the region accounted for 14 percent of births between 2000 and 2005 – nearly double the proportion of previous five-year periods.

From January to July of 2012, 1,448 girls between the ages of 10 and 14 gave birth in Guatemala.

And in Bolivia, 18 percent of mothers were 12 to 18 years old in 2008. But by 2011, that number had increased to 25 percent, according to the U.N. Population Fund, which on Nov. 14 will publish its annual world report focusing on the links between family planning, human rights and development.

That is why governments must guarantee sexual and reproductive rights from an early age, Uruguayan Dr. Stella Cerruti told IPS.

However, it is a slow process, and a subject of debate between specialists, politicians and the population in general, she said.

While many countries in the region have national programmes or have signed regional and international agreements, the reality is more complex.

Some religious groups and many parents are opposed to sex education in schools, and governments do not always put a priority on the issue, Cerruti said.

Cuba’s National Centre for Sex Education (CENESEX) organised a gathering of 57 Latin American experts and activists in Havana Nov. 5-7 to review strategies and strengthen alliances in “comprehensive sex education with an approach based on gender, human rights and diversity.”

Civil society organisations “have an important role to play in social auditing and pressing governments to enforce legal frameworks on sex education,” activist Roberto Luna told IPS. “They can also provide them with specialised technical assistance,” added the founder of Incide Joven, a Guatemalan network that promotes political participation on the issue.