Two pregnant girls walk through the center of the capital of El Salvador, a country with one of the highest rates of pregnancies among girls aged 10 to 14, and where, as in the rest of Central America, what prevails are conservative views opposed to the teaching of sex education in schools, which is essential to reducing the phenomenon. CREDIT: Francisco Campos / IPS

By Edgardo Ayala
SAN SALVADOR , Aug 3 2023 (IPS)

Pregnancies among girls and adolescents continue unabated in Central America, where legislation to prevent them, when it exists, is a dead letter, and governments are influenced by conservative sectors opposed to sex education in schools.

The most recent incident reflecting this situation was the Jul. 29 veto by Honduran President Xiomara Castro of an Integral Law for the Prevention of Adolescent Pregnancy, approved by the single-chamber Congress on Mar. 8 and criticized by conservative groups and the country’s political right wing."When I became pregnant I didn't even know what a condom was, I'm not ashamed to say it." -- Zuleyma Beltrán

“We don’t know the arguments behind the veto, but we could surmise that the law is still being held up by pressure from these anti-rights groups,” lawyer Erika García, of the Women’s Rights Center, told IPS from Tegucigalpa.

The influence of lobbying groups

Conservative sectors, united in “Por nuestros hijos” (“for our children”), a Honduran version of the regional movement “Con mis Hijos no te Metas” (roughly “don’t mess with my children”), have opposed the law because in their view it pushes “gender ideology”, as international conservative populist groups call the current movement for the dissemination of women’s and LGBTI rights.

In June, the United Nations expressed concern about “disinformation campaigns” surrounding the Honduran law.

The last of the marches in favor of “family and children” took place in Tegucigalpa, the country’s capital, on Jul. 22.

These groups “appeal to people’s ignorance, to fear, to religion, with arguments that have nothing to do with reality,” said García. “They say, for example, that people will put skirts on boys and pants on girls.”

According to the United Nations Population Fund (UNFPA), one in four births is to a girl under 19 years of age in Honduras, giving the country the second-highest teenage pregnancy rate in Latin America.

According to the Honduran Penal Code having sexual relations with minors under 14 years of age is statutory rape, whether or not the girl consented.

In 2022, 1039 girls under 14 gave birth.

“The problem is quite serious, and it is aggravated by the lack of public policies to prevent pregnancies among girls and adolescents,” García said.

In the countries of Central America, which have a combined total of some 50 million inhabitants, ultra-conservative views prevail when it comes to sexual and reproductive health and education.

In El Salvador, Honduras and Nicaragua – as well as the Dominican Republic in the Caribbean – abortion is banned under all circumstances, including rape, incest or a threat to the mother’s life.

In the rest of Central America, abortion is only permitted in certain circumstances.

The Honduran president vetoed the law under the formula “return to Congress”, so that it can be studied again and eventually ratified if two thirds of the 128 lawmakers approve it.

Zuleyma Beltrán, 41, talked about becoming pregnant at the age of 15 because there is no proper sex education in El Salvador. A second pregnancy led to a miscarriage that landed her in jail in 1999, where many Salvadoran women who miscarry or have abortions end up due to a draconian anti-abortion law. CREDIT: Edgardo Ayala / IPS

“I didn’t even know what a condom was”

However, having laws of this nature does not ensure that the phenomenon will be reduced, since legislation is not always enforced.

Since 2017 El Salvador has had a National Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents, and although the numbers have declined in recent years, they are still high.

An UNFPA report noted that in this country the pregnancy rate among girls and adolescents dropped by more than 50 percent between 2015 and 2022.

However, “it is worrisome to see that El Salvador is one of the 50 countries in the world with the highest fertility rates in girls aged 10-14 years,” the UN agency said in its latest report, released in July.

Among girls aged 10-14, the study noted, the pregnancy rate dropped by 59.6 percent, from 4.7 girls registered for prenatal care per 1000 girls in 2015 to 1.9 in 2022.

The map of pregnancies in girls and adolescents in El Salvador added that the country “needs to further accelerate the pace of reduction, adopting policies and strategies adapted to the different realities of girls aged 10-14 years and adolescents aged 15-19 years.”

Such actions must be “evidence-based,” the report stressed.

The reference appears to be an allusion to the prevalence of conservative attitudes of groups that, in Honduras for example, reject sexual and reproductive education in schools.

This lack of basic knowledge about sexuality, in a context of structural poverty, led Zuleyma Beltrán to fall pregnant at the age of 15.

“When I became pregnant I didn’t even know what a condom was, I’m not ashamed to say it,” Beltrán, now 41, told IPS.

She added: “I suffered a lot because I didn’t know many things, because I lived in ignorance.”

Two years later, Beltrán became pregnant again but she miscarried, which landed her in jail in August 1999, accused of having an abortion – a plight faced by hundreds of women in El Salvador.

El Salvador not only bans abortion under any circumstances, even in cases of rape. It also imposes penalties of up to 30 years in prison for women who have undergone abortions, and women who end up in the hospital after suffering a miscarriage are often prosecuted under the law as well.

“The State should be ashamed of forcing these girls to give birth and not giving them options,” said Anabel Recinos, of the Citizens’ Association for the Decriminalization of Abortion.

“The State does not provide girls with sex education or sexual and reproductive health, and when pregnancies or obstetric emergencies occur as a result, it is too cruel to them, it only offers them jail,” she added.

Recinos said that, due to pressure from conservative groups, the State has backed down on the strategy of providing sexual and reproductive information in schools.

“Now they are more rigorous in not allowing organizations working in that area to go and give talks on comprehensive sex education in schools,” she noted.

Not even baby formula

In Guatemala, initiatives by civil society organizations that since 2017 have proposed, among other things, that the State should offer reparations to pregnant girls and adolescents, to alleviate their heavy burden, have made no progress either.

These proposals included the creation of scholarships, making it possible for girls to continue going to school while their babies were cared for and received formula.

“But unfortunately we have not been able to take the next step, to get these measures in place,” said Paula Barrios, general coordinator of Women Transforming the World, in a telephone conversation with IPS from the capital, Guatemala City.

Barrios said that most of the users of the services offered by this organization, such as legal and psychological support, “are girls and adolescents who are pregnant because of sexual violence and are forced to have their babies.”

She said that in the last five years some 500,000 girls under 14 years of age have become pregnant, and the number is much higher when teenagers up to 19 years of age are included.

“Today we have half a million girls who we don’t know what they and the children who are the products of rape are eating,” Barrios stressed, adding that as in El Salvador and Honduras, in Guatemala, having sex with a girl under 14 years of age is considered statutory rape.

“Society sees it as normal that women are born to be mothers, and so it doesn’t matter if a girl gets pregnant at the age of 10 or 12 years, they just think she has done it a little bit earlier,” she said.

Patriarchy and capitalism

The experts from Guatemala, Honduras and El Salvador consulted by IPS said the root of the phenomenon is multi-causal, with facets of patriarchy, especially gender stereotypes and sexual violence.

“The patriarchy has an interest in stopping women from going out into the public sphere,” said Barrios.

She said the life of a 10-year-old girl is cut short when she becomes pregnant. She will no longer go to school and will remain in the domestic sphere, “to raise children and stay at home.”

For her part, Garcia, the lawyer from Honduras, pointed out that there is also an underlying “system of oppression” that is intertwined with patriarchy and colonialism, which is the influence of a hegemonic country or region.

“We have girls giving birth to cheap labor to feed the (capitalist) system, and there is a greater feminization of poverty, girls giving birth to girls whose future prospects are ruined,” she said.

In the meantime, to avoid a repeat of her ordeal, Beltrán said she talks to and teaches her nine-year-old daughter about sexuality.

“In order to keep her from repeating my story, I talk to her about condoms, how a woman has to take care of herself and how she can get pregnant,” she said.

“I don’t want her to go through what I did,” she said.

Two Mexican teenage girls at their school. Investing in education for teenage girls in Latin America is regarded as the way forward for them to become future drivers of sustainable develpment in their societies. Credit: UNFPA LAC

By Estrella Gutiérrez
CARACAS, Jul 11 2016 (IPS)

Latin America’s teenage girls are a crucial force for change and for promoting sustainable development, if the region invests in their rights and the correction of unequal opportunities, according to Luiza Carvalho, the regional head of UN Women.

“An empowered adolescent will know her rights and will stand up for them; she has tools for success and is a driving froce for positive change in her community,” Carvalho told IPS in an interview from the regional headquarters of UN Women in Panama City.

Adolescent girls and boys will have a leading role in their societies when the Agenda 2030 for Sustainable Development has been completed, she said. One of the Sustainable Development Goals (SDG) is gender equality. Investing in today’s girls will have “a great transformative impact in future,” she said. “Investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as wellas for promoting gender equality” -- Luiza Carvalho.

The world today has a higher proportion of its population aged between 10 and 24 years old than ever before, with 1.8 billion young people out of a  total population of 7.3 billion. Roughly 20 percent of this age group live in LatinAmerica and the Caribbean, Carvalho said.

According to data given to IPS by the regional office of the United Nations Population Fund (UNFPA), 57million of the region’s 634 million people are girls aged between 10 and 19, living mainly in cities.

The theme for this year’s World Population Day, celebrated July 11, is “Investing in Teenage Girls”, on the premise that transforming their present situation to guarantee their right to equality will not only eliminate barriers to their individual potential but will also be decisive for the sustainable development of their countries.

Women Deliver, an international organisation, has calculated the benefits of this investment in financial terms. For every additional 10 percent of girls in school, national GDP rises by an average of three percent; for every extra year of primary schooling a girl has completed, her expected salary as an adult grows by between 10 and 20 percent.

This is fundamental because, as Carvalho pointed out, “lack of economic empowerment, together with generalised gender discrimination and the reinforcemet of traditional stereotypes, negatively affects the capability of women in Latin America and the Caribbean to participate on an equal footing in all aspects of public and private life.”

Luiza Carvalho, regional director of UN Women for Latin America and the Caribbean. Credit: UN Women LAC

That is why “investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as well as for promoting gender equality,” she said.

Teenage women, she said, “are an especially vulnerable group who face special social, economic and political barriers.” Their empowerment in the region may come up against difficulties such as unwanted pregnancy, forced early marriage or union, gender violence and limited access to education and reproductive health services.”

As an example of these obstacles, the regional director of UN Women said that a Pan-American Health Organisation (PAHO) study of women aged 15-49 years in 12 countries of the region “reported that for a substantial proportion of these women, their first sexual encounter had been unwanted or coerced.”

Carvalho stressed that “early marriage or union imposed on girls is a major concern in the region, and it significantly affects the exercise of adolescent girls’ rights developing their full potential.”

“It is a form of violence that denies them their childhood, interrupts their education, limits their social development, curtails their opportunities, exposes them to the risk of premature pregnancy at too young an age, or unwanted pregnancy and its possible complications, and increases their risk of contracting sexually transmitted infections, including HIV (human immuno-deficiency virus),” she said.

It also increases the girls’ exposure to “becoming victims of violence and abuse,” Carvalho said.

In Carvalho’s view it is very positive that all the countries inthe region have established minimum ages for marriage in their laws, but on the other hand, the laws fix different minimum ages for boys and for girls, and in certain cases such as pregnancy or motherhood, girls may legally marry before they reach the minimum age.

In Latin America, far from diminishing, teenage pregnancies have increased in recent years, due to cultural acceptance of early sexual initiation. As a result, the region ranks second in the world for adolescent birth rates, with an average of 76 live births per 1,000 women aged 15-19 years, second only to sub-Saharan Africa.

Furthermore, 30 percent of Latin American teenage girls do not have access to the contraceptive care services they need, according to UNFPA. Sexual and reproductive health face especially high barriers in this region because of patriarchal,culture, the weight of conservative sectors and the dominance of the Roman Catholic Church.

In Latin America, indigenous teenage girls, together with their rural counterparts, are the group most discriminated against in terms of opportunities and access to education. Credit: Rajesh Krishnan/UN Women

In contrast, the region has a good record on education. Over 90 percent of its countries have policies to promote equal access by teenagers to education. Ninety percent of teenage girls have finished their primary school education, although only 78 percent go on to secondary school, according to UNFPA.

The greatest educational access barriers are faced by rural and indigenous teenage girls, who have difficulties for physical access to some education centres. In the case of indigenous and Afro-descendant girls, this is added to inappropriate curricula or the absence of educational materials in their native languages (mother tongues). 

Carvalho highlighted as a positive element that education laws, especially those that have been reformed recently, “have begun to recognise the importance of establishing legal provisions that promote and disseminate human rights, peaceful coexistence and sex education.”

However, she regretted that “direct connections with prevention of violence against women and girls are still incipient.”

In her view, the school curriculum plays an essential role. Including contents and materials “related to human rights and the rights of women and girls, non-violent conflict resolution, co-responsibility and basic education about sexual and reproductive health,” will potentiate more non-violent societies, inside and outside of the classroom, she said.

Carvalho quoted a 2015 study carried out in 13 Latin American countries by UN Women and the United Nations Children’s Fund (UNICEF), which concluded that education systems are failing to prevent violence against girls.

“This is something that must be improved, because it is in the first few years of early childhood that egalitarian role modelling between girls and boys can occur and lay the foundations of the prevention of violence, discrimination, and inequality in all its forms,” she emphasised.

Carvalho said changes should start with something as simple as it is frequently forgotten: “Girls, teenagers and women are rights-holders and entitled to their rights.”

If girls are given “equal access to education, health care, sexual and reproductive education, decent jobs, and representation in political and economic decision-making processes, sustainable economies would be promoted and societies, and humanity as a whole, would benefit,” she concluded. 

Edited by Verónica Firme. Translated by Valerie Dee.

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.

Social Scientist, Carmen Barroso and Polish Organisation, Childbirth in Dignity received the United Nations Population Awards here Thursday for their outstanding work in population, improving individuals’ health and welfare, and specifically for their decades-long leadership in women’s rights.

“I dedicate this award to anonymous health providers everywhere, who day in and day out help women to exercise their rights and preserve their health,” said Barroso on accepting the award.

Barroso has been actively involved in reproductive health and population issues for more than forty years. She was selected for her leadership in developing programmes, funding and policies related to sexual and reproductive health and rights and for mobilising the voices of people in the South around those issues.

In 1966, Sao Paulo, Brazil, a country rising under the weight of a military dictatorship, Barroso was a 22 year old college student living off of her husband’s meagre salary. Committed to achieving social justice, they did not plan to start a family for many years, and had a very important vision of their future.

On birth control for a long time, she was becoming uncomfortable with the hormones she was putting into her body. A doctor offered her an alternative: IUDs. When she started, she began having copious periods of painful cramps, but she decided to wait in hope they would go away. But they didn’t. One day, she missed her period.

She froze with horror: “All of a sudden, the castle of my future came crashing down.”

At the time, abortion was a taboo subject. She never thought it was something that would happen to her, but now she knew that was what she wanted, and went to the doctor.

He performed the abortion, telling her to keep it secret and cover it up as a miscarriage.

“I would not be here today if it weren’t for the courage of a doctor operating under restrictive laws. Because of him, we were able to live the future we dreamed of.”

Later Barroso became a senior researcher with the Chagas Foundation, where she pioneered innovative evaluation methods and later created Brazil’s first and foremost women’s studies center, despite protest from colleagues who saw it as an “imperialistic import of feminist ideology.”

Dr. Barroso became the first non-American to be appointed as director in the US MacArthur Foundation, and she recently resigned from her tenure as Director of Planned Parenthood International, Western Hemisphere.

Childbirth in Dignity Foundation

Twenty years ago in Poland, pregnant women had little freedom to choose the environment in which they gave birth. Lack of privacy, loneliness and inadequate support were the rule, with women having to go through mandatory episiotomies, and other arcane procedures such as not having time with their newborn child immediately, or having their significant other in the room during childbirth, made the experience far from joyful, in fact, humiliating in many cases.

A nationwide campaign, “Childbirth with Dignity” which empowered women to share their stories, caught international attention, causing government legislative action like Perinatal and Postnatal Care Standards in line with World Health Organization (WHO) standards. Partners are now allowed in the delivery room, mothers can have visitors, and newborns are able to breastfeed, being placed in the mother’s arms to bond right after being born making childbirth an easier experience for mothers.

Childbirth in Dignity Foundation was awarded for their strong advocacy and support of the rights of women and newborns for over 20 years, and for empowering women, as patients, to demand their rights in relation to childbirth.

Both laureates were chosen from among several international nominees, by the Committee for the United Nations Population Award chaired by Paraguay, and including Antigua and Barbuda, Bangladesh, Benin, Gambia, Ghana, Haiti, Iran, Israel and Poland. The UN Population Fund (UNFPA) serves as secretariat for the award.

Past laureates selected by the Committee included individuals and organizations, such as Bill and Melinda Gates, Dr. Allan Rosenfield, the Addis Ababa Fistula Hospital and the Population Council.

Maternal care during the pregnancy, birth and post-partum period is essential to reduce the high maternal mortality rate in Latin America. Credit: Courtesy of the Tigre municipal government

By Marianela Jarroud
SANTIAGO, Sep 23 2015 (IPS)

In the last 15 years, Latin America and the Caribbean have met several key targets included in the Millennium Development Goals (MDGs), such as reducing extreme poverty, hunger and child mortality, incorporating more girls in the educational system, and expanding access to clean water.

However, as the world is setting out on a new challenge, meeting the Sustainable Development Goals (SDGs) – the roadmap from here to 2030 – the region must make a bigger effort to fight, for example, maternal mortality and teen pregnancy, two of its biggest failures with regard to the MDGs, partly due to a patriarchal, sexist culture.

“We don’t have to wait for an analysis of the MDGs to understand that the region is lagging in these areas,” Chilean Dr. Ramiro Molina, founder of the Centre for Reproductive Medicine and Adolescent Development, told IPS.

“The spending needed on sexual and reproductive health is low,” he added. “It hasn’t been clearly understood that it is absolutely indispensable to invest more in this area.”

The eight MDGs, approved in September 2000 by 189 heads of state and government at a United Nations summit, were aimed at addressing development deficits in the first 15 years of the new millennium.

And on Sunday Sept. 27, at another summit in New York, leaders from around the world will approve the post-2015 sustainable development framework, which includes 17 SDGs that make up what is now called the 2030 Agenda for Sustainable Development.

With these new goals, the international community will continue to fight inequality and work towards sustainable and inclusive development.

“Latin America and the Caribbean: looking ahead after the Millennium Development Goals”, a regional monitoring report published this month by the Economic Commission for Latin America and the Caribbean (ECLAC), says the region has met the goal for reducing extreme poverty and hunger.

Between 1990 and 2015, this region more than cut in half the proportion of people living on less than 1.25 dollars a day: from 12.6 percent in 1990 to 4.6 percent in 2011.

The proportion of hungry people, meanwhile, was slashed from 14.7 percent in the 1990-1992 period to 5.5 percent in 2014-2016.

In addition, employment statistics are better today than at any other point in the last 20 years; access to and completion of primary education have increased; and the illiteracy rate among 15 to 24-year-olds fell from 6.9 percent in 1990 to 1.7 percent in 2015.

The region has also made significant progress in girls’ access to primary, secondary and tertiary education, and has narrowed the gender gap in politics.

But these advances stand in contrast to the lack of progress in other areas, especially with regard to MDG 5: reducing maternal mortality and achieving universal access to reproductive health.

The ECLAC report stresses that in 2013 the overall maternal mortality rate in Latin America and the Caribbean was 85 deaths per 100,000 live births, representing a 39 percent reduction with respect to 1990 – far from the 75 percent drop called for by the MDGs.

Adolescent pregnancy also remains a pressing problem in the region, with a live birth rate of 75.5 per 1,000 girls and women between the ages of 15 and 19.

Miriam Toaquiza and her daughter Jennifer in a hospital in Latacunga, Ecuador. She is the only girl in a special room for teenage mothers, thanks to public policies fighting the phenomenon. Credit: Gonzalo Ortiz/IPS

“Adolescence, their development and fertility are based on ignorance in our countries,” said Molina.

Tamara, now 23, is an illustration of this. When she was 13, her 27-year-old boyfriend got her pregnant.

The unexpected pregnancy forced her to drop out of school, although she was later able to complete her primary education. She never went to high school. Three years later she had her second son, with the same father.

“I missed out on several things: of course, support from my mother and my father, but above all, sex education,” the young woman, who preferred not to give her last name, told IPS.

Tamara had a difficult life. Her mother did not finish primary school and her father was a drug addict and alcoholic. She was a witness to domestic violence throughout her childhood.

From a young age, she was raped by the oldest of her six brothers, who went to prison for 10 years for what he did, when she finally decided to go to the police, without her mother’s consent.

Today, about to have her third child – with a different man this time, but someone just as absent as the father of her first two – she said she is fighting to make sure her children get an education.

“I make an effort every day for my kids to study, I try hard to educate them, because I don’t want them to suffer like I did. I want to break the circle,” she said.

In Molina’s view, to address the gaps in sexual and reproductive health, political intentions should translate into spending on primary sexual and reproductive health care services for adolescents, training on these issues for health professionals, and effective sex education programmes.

“Mexico’s good sex education programmes are only partially functioning; the excellent programmes that Costa Rica had have been discontinued; and Colombia has made enormous efforts to come up with really good sex education teaching materials, but they have practically been doomed to fail by political and strategic questions,” Molina said.

“Something similar is happening in Peru, where there have also been good programmes but they don’t have strategic or political support from the government,” he added. “Argentina gets good results, but with strong support from the government in developing sex education programmes. The same is true in Uruguay.”

According to the doctor, the case of Chile “is the worst of all,” because “we are plagued with opprobrium and shame.”

“We were the last country in the region to have a law protecting young people with sex education, which was passed in 2010 but did not enter into force until July 2014. The situation here is embarrassing,” he said.

He added that in order to meet the Agenda 2030 target for preventing teen pregnancies, merely making birth control available is not enough, “because I could drop condoms and pills from a helicopter but it wouldn’t be an effective measure.”

The issue, he said, is that people have to actually use the contraceptives, and need to know when and how to do so – which requires education.

“The goal is preventing the first pregnancy, and to do that what is needed is education, education, and when everything else has failed, education and more education. And as part of that education – broad, in-depth sex education, without ideological bias,” he added.

Molina also stressed that both maternal mortality and adolescent pregnancy “are no longer technical, but political, problems” which require that states be responsible and implement effective public policies, without worrying about facing up to conservative power groups “who are ignorant traditionalists, and cause us terrible damage.”

As the region gets ready to sign on to the SDGs, the new challenges call for a more holistic, participative, interdisciplinary and universal approach.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Two women hugging at a Day Against Homophobia in Havana organised by the lesbian, gay, bisexual and transsexual (LGBT) community. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Apr 1 2015 (IPS)

In addition to other forms of discrimination, lesbian and bisexual women in Cuba face unequal treatment from public health services. Their specific sexual and reproductive health needs are ignored, and they are invisible in prevention and treatment campaigns for women.

Many lesbian and bisexual women are afraid of gynaecological instruments and procedures which they experience as particularly distasteful given their sexual orientation. Many are unaware of their risks of contracting sexually transmitted infections (STI) and postpone attending gynaecology appointments in order to avoid questions about their love life, activists and health experts told IPS.

Dayanis Tamayo, a 36-year-old education specialist who lives in Santiago de Cuba, 862 kilometres from Havana, feels that health professionals are judgmental when they discover that her partner is a woman. They make lesbophobic comments and give her disapproving looks.

“Sometimes I get by unnoticed because I don’t fit the stereotype of a butch lesbian, but otherwise I always feel judged,” said Tamayo, who is engaged in research at Universidad de Oriente.

Recent studies back up Tamayo’s statement, pointing to prejudice against lesbian and bisexual women among the country’s health personnel, and ignorance about their particular sexual health needs.

Cuban psychiatrist Ada Alfonso presented a report on “Salud, malestares y derechos sexuales de las lesbianas” (Lesbians’ sexual health, illnesses and rights) at the 2014 Cuban Day Against Homophobia. She said that when they go to see the doctor, these women are asked more about their sexual experiences than about their reason for seeking treatment.

“If we look at women’s health through the lenses of inequality, the gap between lesbians and heterosexuals in regard to health services has a lesbophobic subtext hidden behind the discourse on ‘social needs’,” said Alfonso, an expert with the National Centre for Sex Education (CENESEX).

In her view, social pressure on women who are not heterosexual, amounting to homophobia, causes various forms of psychological and sexual malaise.

Alfonso interviewed women in several of the island’s provinces. She found that ethical deficiencies in the system are leading women to postpone clinical tests until they can see a doctor who has been recommended, or a health professional sharing their own sexual orientation.

The women are particularly averse to gynaecological tests because of the instruments used and invasive procedures such as pelvic and vaginal examinations.

Gynaecology outpatient consultations total 925,549 a year, for a population of 4.7 million women aged over 15, according to the National Office of Statistics.

Personnel working in preventive screening services for cervical and uterine cancer told Alfonso that lesbian women tend to come forward for testing too late for any therapeutic action to be taken.

“We generally think that since we do not have sex with men, we are exempt from those risks, because the information campaigns in the media only portray heterosexual couples,” an accountant resident in the Diez de Octubre neighbourhood of Havana told IPS, requesting anonymity.

The 39-year-old accountant, who works in the state sector, has never had a Papanicolau (Pap) test, which involves collecting cells from the uterine cervix and checking them for abnormalities. The Pap test is recommended for women aged over 25 to prevent cervical and uterine cancer and in Cuba it is offered free to women every three years.

“Although I do know that it is important, I find it psychologically difficult to face this test because I feel so exposed, assaulted even, and I personally do not like penetration,” she said.

All Cubans enjoy health coverage by a local family clinic, which is responsible for reminding women when it is time for their next Pap test. However, many women put it off.

In 2013, a total of 765,822 Cuban women aged over 25 had a Pap test done, a take-up rate of 195.8 per 1,000 according to the most recent figures from the Cuban Annual Health Statistics.

All treatment in the Cuban health system is free of charge and is delivered without institutionalised discrimination. But prejudice against non heterosexual people continues to grow.

“Health personnel are part of society, and society rejects lesbians,” José Martínez, a medical doctor in the eastern province of Granma, told IPS.

According to Martínez, medical training in Cuba is too narrowly focused on a biological approach and makes hardly any reference to psychosocial determinants of health.

“When a lesbian woman goes to see a gynaecologist, the doctor will probably assume that she is at lower risk (of cervical or uterine cancer) because penetration is not involved in her relationship, because this is what they have been taught,” Martínez said.

Yenis Milanés, who has a degree in hygiene and epidemiology, told IPS that “medical students are not required to take a single course on sexuality” during their training.

Women who have intimate relations with women tend to have a low perception of their own risk, and seldom take protective measures during sex, Milanés and Martínez said.

They both collaborated in a 2013 study of 30 lesbian and bisexual women in the province of Granma, which found these women thought they were unlikely to acquire sexually transmitted infections.

Another study in 2014 by Martínez and Milanés confirmed that sexual and reproductive health programmes in Cuba generally do not include information about the risks of contracting STI and HIV/AIDS that specifically addresses lesbian women’s issues.

Lesbians receive less information about STI prevention than other population groups and they have fewer welcoming institutional spaces where they can socialise and discuss their problems, said the report, to which IPS had access.

The research study debunks the myth that engaging in lesbian sex avoids all infection risks, although these are indeed much lower than for other sexual behaviours.

Depending on the sexual practices of a same-sex lesbian couple, unprotected contact with exchange of vaginal secretions and menstrual blood can lead to infection with the HIV/AIDS and Herpes simplex viruses, bacterial vaginosis, gonorrhoea, syphilis, vaginal parasites and other diseases.

Women represented 18.5 percent of the 2,156 new HIV-positive cases diagnosed in Cuba in 2013, bringing the total number of people living with the virus to 16,400, according to the Ministry of Public Health.

Training health professionals to be sensitive to sexual diversity has been a long-established demand by groups of lesbian women supported by CENESEX in the provinces of Camagüey, Ciego de Ávila, Cienfuegos, Granma, La Habana, Santiago de Cuba, Trinidad and Villa Clara.

Through community activism, these groups are struggling for their rights to responsible enjoyment of sexual health, including equality of treatment in the health services and access to assisted reproduction technology.

Editado por Estrella Gutiérrez/Translated by Valerie Dee

Teen mothers give birth to 81 out of every 1,000 children in Nepal. Credit: Mallika Aryal/IPS

By Mallika Aryal
CHAMPI, Nepal, Jul 11 2013 (IPS)

Radhika Thapa was just 16 years old when she married a 21-year-old boy three years ago. Now, she is expecting a baby and is well into the last months of her pregnancy. This is not the first time she has been with child – her first two pregnancies ended in miscarriages.

“The first time I conceived I was just 16, I didn’t know much about having babies, nobody told me what to do,” Thapa tells IPS in between assisting customers at the vegetable store she runs with her husband in the small town of Champi, some 12 km from Nepal’s capital, Kathmandu.

"When girls get pregnant their education stops, which means a lack of employment opportunities and poverty." -- Bhogedra Raj Dotel
“The second time I wasn’t ready either, but my husband wanted a baby so I gave in,” she admitted.

After the second miscarriage, Thapa’s doctors urged her to wait a few years before trying again, but she was under immense pressure from her in-laws, who threatened to “find another woman for her husband if she kept losing her babies”.

What might seem like a horror story to some has become an accepted state of affairs in Nepal, the country with the highest child marriage rate in the world.

On average, two out of five girls are married before their 18^th birthday. The legal age for marriage in Nepal is 18 years with parental consent, and 20 without, a law that is seldom observed, least of all in rural parts of the country.

Studies show that child marriages occur most frequently among the least educated, poorest girls living out in the countryside.

According to the 2011 Nepal Demographic and Health Survey (NDHS), 17 percent of married adolescent girls between 15 and 19 years are either pregnant or are mothers already. In fact, research shows that adolescent mothers give birth to 81 out of every 1,000 children in Nepal.

The survey also shows that 86 percent of married adolescents do not use any form of contraception, meaning that few girls are able to space their births.

Disturbed by trends in countries like Nepal, the UNFPA spotlighted teen pregnancy as the theme for this year’s World Population Day, observed annually on Jul. 11.

“Globally there are 16 million girls aged 15-19 who give birth each year – they never had the opportunity to plan their pregnancy. It is a developmental issue that goes beyond health,” Vallese stressed.

In reality, teen pregnancy can be a matter of life and death. Adolescent girls under the age of 15 are up to five times more likely to die during childbirth than women in their 20s.

The number one cause of death among girls aged 15-19 relates to complications in childbirth. Young mothers are at a high risk of suffering from complications such as obstetric fistula and uterine prolapse.

Furthermore, “the first child born to a mother aged 12-20 is at greater risk of being stunted or underweight, suffering from anaemia or even of dying before the age of five,” says Vallese.

Less visible, but equally troubling, is the host of social complications that teen mothers must navigate.

“When girls get pregnant their education stops, which means a lack of employment opportunities and poverty,” says Bhogedra Raj Dotel of the government’s family planning and adolescent sexual reproductive health division.

According to the UNFPA, 37 percent of married adolescent girls are not working and 76 percent of those who are employed are not paid in cash or kind for the work they do.

Menuka Bista, 35, is a local female community health volunteer in Champi, assisting about 55 households in her area. Bista has been advising Thapa, to ensure that the girl has a safe pregnancy.

“Radhika (Thapa) is educated, she knows she needs to go to the doctor and eat nutritious food for her baby to be safe, but she doesn’t make decisions about her body: her husband and in-laws do,” Bista told IPS.

This observation finds echo in research carried out by various experts: according to Dotel, husbands and in-laws make all the major decisions about a woman’s reproductive health, from what hospital she visits to where she will deliver her child.

For this reason, Vallese believes it is important to train husbands and family members on reproductive health and rights.

Another problem, experts say, is that almost all national policies have been designed with the assumption that adolescent pregnancies affect only married women, with little acknowledgement of the fact that unmarried teenaged girls also engage in sexual activities, said Vallese.

The penetration of the Internet and mobile phones into every aspect of daily life, coupled with a massive wave of migration of young rural men into urban areas, has created “a significant teenage population that engages in pre-martial sex,” she stressed.

Whether the teenaged girls are married or unmarried, sex education plays a major role in decreasing the number of pregnancies.

Sex education is a part of the national school curriculum from Grade 6 upwards, but teachers are not trained, and are uncomfortable talking about it. When the subject comes up in a classroom, most teachers simply skip that chapter, or defer to a health worker to explain the process of reproduction.

“There’s a general (perception) that teaching about sexual health makes girls promiscuous, but we have found it to be exactly the opposite,” says Shova KC, chair of a local cooperative that works with women in Champi.

Public health experts, meanwhile, have criticised the government for not implementing existing policies that could spare thousands of young girls from the trauma of complicated pregnancies so early on in life.

For instance, “more than 500 youth friendly service centers have been set up but progress is about more than just ticking boxes,” UNFPA Assistant Representative Latika Maskey Pradhan, told IPS.

In the future, she said, advocates must keep a close eye not only on how policies are designed but also on how they are implemented.

At the Women Deliver conference in Kuala Lumpur, advocates shared strategies for breaking religious taboos on reproductive rights. Credit: Stella Paul/IPS

By Stella Paul
KUALA LUMPUR, May 31 2013 (IPS)

Liberian journalist Mae Azango says she spent a year living “like a bat, going from tree to tree” with her daughter in order to escape religious fanatics who were threatening to kill her for exposing the practice of female genital mutilation in her home country last year.

A senior reporter at the local FrontPage Africa publication, Azango told IPS that although the Liberian government signed a treaty in 2012 promising its citizens the right to information, it continues to hold back data on sexual and reproductive health and rights from journalists.

“With every story that I write, I take a great risk,” she says, adding that she is entirely dependent on “secret sources” within the government to gather information, since very little is shared in the public domain.

Her woes found echo among hundreds of women and health experts gathered in the Malaysian capital of Kuala Lumpur for the third annual Women Deliver global forum that ended Thursday.

Hailing from different corners of the globe, participants at the conference had no trouble identifying common goals: breaking taboos surrounding sex education and creating a safe climate for advocates, health professionals and educators to spread awareness on safe sex and family planning.

In Morocco, a country of 32 million people, schools are banned from offering sex education to young people because parliamentarians believe it to be an “evil concept, designed to promote promiscuity,” sexual and reproductive advocate Amina Lemrini told IPS.

She says progress on improving sexual health services in her country has been particularly slow due to taboos introduced by religious leaders.

With a government unwilling to challenge clerics, the job of providing crucial health services falls entirely on the shoulders of civil society, who are then threatened for their efforts.

Lemrini says she does not know a single reproductive rights activist who has not been threatened, yet the government offers them no protection.

Their distress has been recognised by leading experts in the field, including the executive director of the United Nations Population Fund (UNFPA), Babatunde Osotimehin, who told IPS that religious fundamentalism is a “indeed a worry” when it comes to progress on sexual health.

Still, he urged activists to continue their work, adding, “Fundamentalism exists in all societies and all religions – what matters is how we communicate our message.”

He believes that if more people are made aware of their rights and choices, they will not hesitate to defy archaic laws and so-called “cultural taboos.”

“The average person on the street does not want a situation where death comes calling every day for reasons that can be prevented,” he stressed.

Indeed, even a cursory glance at global statistics is enough to make a strong case for the need for better communication: according to the UNFPA, nearly 800 women die every single day as a result of pregnancy-related complications; in a year, that number is closer to 350,000 deaths, of which 99 percent occur in developing countries.

Sex-selective abortions and neglect of newborn baby girls have resulted in an estimated 134 million “missing” women worldwide.

Doing a wide sweep of global data, the UNFPA estimates that “millions of girls” practice unsafe sex and lack information on contraceptives. Osotimehin recently wrote that an “unmet need for family planning exists among 33 percent of girls between 15 and 19 years old…in Ethiopia, 38 percent in Bolivia, 42 percent in Nepal, 52 percent in Haiti and 62 percent in Ghana.”

Nyaradzayi Gumbonzvanda, head of the Young Women’s Christian Association (YWCA), told IPS that giving up on communication about sexual and reproductive health and rights was not an option.

“We need an operative environment for those who are discussing this issue,” she said. “We need to protect the media — this isn’t a choice. Governments must scale up the level of cooperation with the media and provide supportive legal backup where it is not yet available.”

Gumbonzvanda thinks that citizen journalism could be an effective way to mitigate the risk posed by fundamentalists, not only by amplifying the voices of those who often go unheard, but also by empowering common citizens to take action.

Nowhere was the power of citizen journalism more evident than during the revolution in Egypt in 2011, where blogs, tweets, and Facebook posts replaced TV channels, newspapers and radio stations in reaching millions of people.

Today, as Egyptians struggle against the conservative policies of the ruling Muslim Brotherhood, that network of citizen journalists has turned its attention to reproductive health and safe sex, topics that are frowned upon by Islamists.

Ahmed Awadalla, sexual and gender-based violence officer for Africa and Middle East Refugee Assistance (AMERA), told IPS that anyone discussing the issue risks detention, arrest, harassment and imprisonment.

As a result, the number of bloggers increases every day, as citizens and advocates flee to cyberspace in search of safe forums to share information and ideas.

“When I blog about the sexual rights of women I break two rules,” Awadalla said. “First, by speaking about a forbidden issue and secondly by speaking as a man, who is not supposed to take the side of women.” Though he faces harsh repercussions, nothing will persuade him to give up his advocacy.

But even while citizens innovate new ideas to get around the deadly threats of engaging in sex education, experts say governments must not be let off the hook for failing to provide these basic services.

Governments in Asia, Africa and Latin America must be held accountable by foreign funders, says Agnes Callamard, executive director of the London-based ‘Article 19’, an organisation dedicated to freedom of expression.

“Every government has committed to spending a certain amount of the funding they receive (on sexual health),” she said, so tracking aid flows could pressure governments to improve their track records on information sharing.

In fact, when the Mexico-based Grupo de Información en Reproducción Elegida (GIRE) started to track aid supposed to be allocated to providing information on sexual and reproductive health in 2011, “we found that nearly a million dollars were missing,” said GIRE Information Rights Advocate Alma Luz Beltrán y Puga. “We sued the government over that.  If the same tracking is done the world over, it can lead to greater accountability.”

According to a study done by the World Health Organisation (WHO), developed countries donated nearly 6.4 billion dollars to help provide access and information on reproductive health in developing countries. It is now up to civil society to ensure that money is responsibly allocated.

Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

By Stella Paul
KUALA LUMPUR, May 29 2013 (IPS)

“If I am thirsty and want a bottle of Coca-Cola I can get it, no matter where in the world I am. Why can’t I get contraceptives or sexual heathcare?” asked Carlos Jimmy Macazana Quispe, a youth representative from Peru currently in Kuala Lumpur for the third edition of the Women Deliver global conference on the “health and well-being of women and girls.”

A member of the Lima-based Instituto Peruano de Paternidad Responsable (INPPARES), a non-profit organisation that helps young Peruvians learn about sexual and reproductive rights, Quispe was expressing frustration that 36 percent of sexually active Peruvians – the majority of them youth – do not have access to contraceptives.

There are over a hundred youth like Quispe participating in the three-day conference that started on May 28, most of them from developing countries in Asia, Africa and Latin America where “contraceptives” are equated with condoms, teen pregnancy is on the rise and child marriage is often considered a social norm.

One of these ambassadors is Shreejana Bajracharya, a youth consultant from the Nepal-based Ipas, an NGO working to prevent deaths and disease from unsafe abortions in a country where 21 percent of all mothers are aged below 18 years.

Bajrachayra, who counsels young married and unmarried women factory workers about safe sex, says that over 80 percent of sexually active young women practice unsafe sex and risk pregnancy because they fear that contraceptives could cause them physical harm.

“I meet youth who tell me that…(birth control) pills could damage their kidneys or their heart,” she told IPS, adding incredulously: “And these are women who live in the capital (Kathmandu). If awareness levels in the capital are so low, imagine what youth in rural areas are experiencing.”

According to Pablo Aguilera, head of the New York-based HIV Young Leaders Fund, the situation is particularly bad for minority communities like those who identify as transgender, or people living with HIV/AIDS.

Aguilera, himself a young person living with HIV, identified two simultaneous problems: not only are at-risk populations unaware of the most basic information regarding safe sex and reproductive health, but they are also unaccounted for, passing under the radar of surveys or other attempts to identify target populations.

“We need to engage more youth from marginalised and stigmatised communities, such as transgender (people),” he told IPS, adding that vulnerable youth must be included in studies and surveys “not as interviewees but as interviewer. This will not only help them receive information firsthand, but will also sensitise them on the issue instantly.”

Leading experts in the field are keenly aware of the need to step up efforts. Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA), admits that there is a lack of hard data on sexual and reproductive health, but says the UNFPA is helping government agencies across the world recognise the need to overcome this.

Even in cases where data exists, governments do not utilise it for “practical purposes such as planning, and that is a big challenge,” Osotimehin told IPS.

Jyoti Shreshtha, a post-graduate student from Kathmandu, says the Nepali government “does not make a conscious effort to educate” youth on issues like HIV/AIDS and sexual rights.

In countries like Bangladesh, says student leader Umme Mahbuba, events and conferences around pregnancy, early motherhood, safe sex and contraceptives are targeted mostly at professionals, experts or academics. “Youth often stay away from these forums thinking ‘this issue is not for me’,” Mahbuba told IPS.

This can be attributed partly to the jargon that surrounds conversations about sexual health. According to Faustina Fynn-Nyame, country director for Marie Stopes International (MSI) in Ghana, young people are put off by “incomprehensible literature” and terms like “family planning”, which they cannot identify with.

“There is a need to take communication more seriously and coin terms that are youth-friendly,” she said.

But none of these tactics on youth engagement will go far without massive investment in this global effort.

“There is an urgent need to invest more (in)…creating effective tools of communication and building communication skills,” said Aguilera.

Some countries are feeling the financial crunch more than others. Sinthuka Vive, a student from the war-ravaged town of Jaffna in northern Sri Lanka, says the state is struggling to fund reproductive health services.

“During the war, many hospitals were damaged,” she told IPS. “The few that survived are struggling to provide care to married women. Youth, meanwhile, have nowhere to go, no one to provide them with counseling or information.”

The issue of funds has been a major topic of debate at the conference underway in Malaysia, particularly with regards to promises made at the July 2012 London Summit on Family Planning, where global leaders pledged a total of 2.6 billion dollars to provide 120 million more women and girls in the world’s poorest countries with voluntary access to contraceptive services, supplies and information by 2020.

It remains to be seen whether or not these funds will be leveraged to improve the sexual health and reproductive rights of youth around the world.

By Nasseem Ackbarally
Nov 13 2012 (IPS)

Mauritius, held up as an economic success story, is undergoing a lot of social change. However it seems the education system is not keeping pace with the rapid change as the number of teenage pregnancies is on the rise.

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