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.

Flooding in Malawi. Courtesy of the Malawi Red Cross Society

By Julitta Onabanjo and Michael Charles
UNITED NATIONS, Feb 2 2015 (IPS)

The flooding of the Zambezi River has had devastating consequences for three countries in Southern Africa. The three worst affected countries are Malawi, Mozambique and Zimbabwe. 

Livestock has drowned, crops have been submerged or washed away and infrastructure has been badly damaged.Imagine being a pregnant woman airlifted from the floodplains and placed in a camp with no midwives, no sterilised equipment nor medical supplies to ensure a safe delivery.

Worse still, hundreds of lives have been lost – and the dignity of women and girls is on the line.

In Malawi, an estimated 638,000 people have been affected and the president has declared a state of disaster. About 174,000 people have been displaced in three of the worst affected districts out of 15 districts hit by floods.

A total of 79 deaths have been reported and about 153 people are still missing. Data disaggregated by age and sex are not readily available, however, it is estimated that about 330,000 of the 638,000 displaced people in the camps are women and close to 108,000 are young people.

The situation is also critical in Zimbabwe. According to preliminary assessments, approximately 6,000 people (1,200 households) have been affected, of which 2,500 people from 500 households are in urgent need of assistance. An estimated 40-50 per cent will be women or girls. More than ten people have drowned while many more have been injured, displaced and left homeless.

In Mozambique, almost all 11 provinces have experienced extensive rainfall. The central province of Zambézia was the worst hit – a bridge connecting central and northern Mozambique was destroyed by the floods in Mocuba district. Niassa and Nampula provinces were also seriously affected.

These three provinces are already among the poorest in the country, and for the most vulnerable – women, girls and children – the impact of flooding can be devastating.

Around 120,000 people from 24,000 families have been affected. The death toll due to flooding, lightning and houses collapsing has risen to 64, while more than 50,000 people from 12,000 families are in need of shelter. Others have fled to neighbouring Malawi. At least 700 out of an estimated 2500 people have been repatriated to date.

Mozambique has a recent history of recurrent floods. UNFPA is supporting the government and other partners to scale up efforts to safeguard the dignity of women and girls. This includes the positioning of reproductive health kits, hygiene kits and promoting gender-based violence prevention.

Flooding in Mozambique. Courtesy of UNFPA

Health and reproductive health needs

As with most humanitarian situations, women, girls and children are usually the worst affected. In Mozambique, for example, close to 1,000 orphans and over 100 pregnant women and girls require urgent attention.

Imagine being a pregnant woman airlifted from the floodplains and placed in a camp with no midwives, no sterilised equipment nor medical supplies to ensure a safe delivery. This is a scenario that countless pregnant women are facing.

In addition to efforts by partners to address the food and infrastructural security needs of the people, women and girls are particularly vulnerable to exploitation and erosion of dignity, and deserve adequate attention.

In Malawi, about 315 visibly pregnant women were identified in the three worst affected districts. Between Jan. 10 and 24, 88 deliveries were recorded by 62 camps in the worst affected districts. Twenty-four of these deliveries were among adolescents aged between 15 and 19 years, as reported from Phalombe, where fertility rates and teenage pregnancies are generally high.

Malawi floods. Some of the pregnant women receiving dignity kits at Somba camp in T A Bwananyambi, Mangochi. Courtesy of UNFPA

Women living in camps for displaced people are fearful of gender-based violence, including rape and other types of sexual abuse. Several cases of gender-based violence have already been reported. In one of the districts, a total of 124 cases were brought to the attention of authorities.

The design of the camps and the positioning of toilets are said to be contributing to these cases. A woman from Bangula camp said: “The toilets are far away from where we are sleeping. We are afraid to walk to the toilets at night for fear of being raped. If the toilets could be located close by, this could assist us.”

Personal dignity and hygiene is a major challenge for women and young people, especially for adolescent girls. A teenager from Tchereni camp in Malawi said: “I lost everything during the floods. My biggest challenge is how to manage my menstrual cycle.”

It has been reported that women and girls are sharing sanitary materials, which seriously compromises their health and dignity.

Urgent action

In order to address the  sexual and reproductive health needs of affected populations, UNFPA Malawi has recruited and deployed full time Reproductive Health and Gender Coordinators to support the authorities with the management of SRH/HIV and gender-based violence (GBV) issues in the camps.

UNFPA has also distributed pre-positioned Reproductive Health kits as well as drugs and medical equipment to cater for clean deliveries, including by Caesarean section, and related complications of pregnancy and child birth in six districts and two central hospitals in the flood-affected areas.

Over 300 prepositioned dignity kits were distributed and 2,000 more have been procured, over half of which have already been distributed to women of child-bearing age in some of the most affected districts to allow the women to continue to live with dignity in their state of crisis.

The International Federation of Red Cross and Red Crescent Societies (IFRC) has launched an emergency appeal for CHF 2,7 million to assist Malawi Red Cross to step up emergency response activities, including a detailed needs assessment of the affected regions, the procurement of non-food items, the procurement and distribution of shelter materials, and the provision of water and sanitation services.

A similar process was applied for Mozambique and Zimbabwe, with the aim of saving more lives by providing immediate assistance to those in need.

But as partners working together to address the numerous problems that confront the affected populations – and warnings of more risks of flooding – we cannot neglect the plight of women and girls.

In humanitarian situations especially, the dignity and reproductive health and rights of women and girls deserves our full attention.

Edited by Kitty Stapp

Excerpt:

Teenage pregnancy affects 1.4 million Filipino girls aged 15 to 19. Credit: Stella Estremera/IPS

By Diana Mendoza
MANILA, Dec 15 2014 (IPS)

Mae Baez sees some of the darkest sides of communications technology.

A child rights advocate with the secretariat of the Philippine NGO Coalition on the Convention on the Rights of the Child, Baez says, “Teenage pregnancies continue to rise, street children are treated like criminals who are punished, children in conflict with the law and those affected by disasters are not taken care of, and now, with the prevalence of child porn, children know how to video call.”“The government has not intervened in protecting children from early marriage and in ending the decades-long war between Muslims and Christians to achieve true and lasting peace." -- Mark Timbang

The most notable case of this last scourge was early this year in the island of Cebu, 570 kilometres south of Manila, where the Philippine National Police arrested and tried foreign nationals for pedophilia and child pornography in a large-scale cybersex business.

While the Philippines is praised by international human rights groups as having an advanced legal framework for children, child rights advocates like Baez said “violations continue to persist,” including widespread corporal punishment at home, in schools and in other settings.

The Bata Muna (Child First), a nationwide movement that monitors the implementation of children’s rights in the Philippines consisting of 23 children’s organisations jointly convened by Save the Children, Zone One Tondo Organization consisting of urban poor communities, and Children Talk to Children (C2C), said these violations were contained in the United Nations reviews and expert recommendations to the Philippine government.

The movement listed the gains on the realisation of children’s rights with the existence of the Juvenile Justice Welfare Act, Anti-Child Trafficking, Anti-Pornography Act and Foster Care Act, among other policies protecting children.

There is also the Pantawid Pamilyang Pilipino Program (4Ps), a social welfare programme intended to eradicate extreme poverty by investing in children’s education and health; the National Strategic Framework for the Development of Children 2001-2025; the Philippine Plan of Action for Children; and the growing collective efforts of civil society to claim children’s rights.

But Baez said these laws have not been fully implemented, and are in fact clouded by current legislative proposals such as amending the country’s Revised Penal Code to raise the age of statutory rape from the current 12 to 16 to align the country’s laws to internationally-accepted standard of age of consent.

The recently-enacted Responsible Parenthood and Reproductive Health Law, which endured 15 years of being filed, re-filed and debated on in the Philippine Congress, has yet to be implemented. Many civil society groups have pinned their hopes on this law on the education of young people on sexual responsibility and life skills.

Teenage pregnancy, which affects 1.4 million Filipino girls aged 15 to 19, is widespread in the country, according to the University of the Philippines Population Institute that conducted the Young Adult Fertility and Sexuality Survey in 2013.

There are 43 million young Filipinos under 18, according to 2014 estimates of the National Statistics Office, and these youth, especially those in the poorest households and with limited education, need to be informed about their bodies, their health and their rights to prevent early pregnancies.

The child advocates said early pregnancies deny young girls their basic human rights and prevent them from continuing their schooling. The advocates said if the Reproductive Health Law is implemented immediately, many girls and boys will be able to receive correct information on how to protect and care for their bodies.

On education, Baez said the government’s intention to provide more access has yet to be realised with the introduction in 2011 of the K to 12 program to provide a child ample time to be skilled, develop lifelong learning, and prepare them for tertiary education, middle-level skills development, employment, and entrepreneurship.

“While the programme does not solve the high drop-out rate in primary education, children in remote and poor areas still walk kilometres just to go to school,” Baez said.

This situation was echoed by Mark Timbang, advocacy coordinator of the Mindanao Action Group for Children’s Rights and Protection in the country’s predominantly Muslim south, who said the government has not shown its intentions to provide children a more convenient way of going to school.

Timbang also said “the government has not intervened in protecting children from early marriage and in ending the decades-long war between Muslims and Christians to achieve true and lasting peace” where children can grow safely.

Sheila Carreon, child participation officer of Save the Children, added that another pending bill seeks to raise the age of children who can participate in the Sangguniang Kabataan (Youth Council), a youth political body that is a mechanism for children’s participation in governance, from the current 15-17 years to 18-24.

“We urged the government not to erase children in the council. Let the children experience the issues that concern them. The council is their only platform,” said Carreon.

Angelica Ramirez, advocacy officer of the Philippine Legislators Committee on Population and Development, said existing laws do not give enough protection to children, citing as an example pending legislative measures that seek positive discipline instead of using corporal punishment on children.

Foremost among them is the Positive Discipline and Anti Corporal Punishment bill that promotes the positive discipline approach that seeks to teach children that violence is not an acceptable and appropriate strategy in resolving conflict.

It promotes non-violent parenting that guides children’s behaviour while respecting their rights to healthy development and participation in learning, develops their positive communication and attention skills, and provides them with opportunities to evaluate the choices they make.

Specifically, the bill suggests immediately correcting a child’s wrongdoing, teaching the child a lesson, giving tools that build self -discipline and emotional control, and building a good relationship with the child by understanding his or her needs and capabilities at each stage of development without the use of violence and by preventing embarrassment and indignity on a child.

Citing a campaign-related slogan that quotes children saying, “You don’t need to hurt us to let us learn,” Ramirez said corporal punishment is “rampant and prevalent,” as it is considered in many Filipino households as a cultural norm.

She cited a 2011 Pulse Asia survey that said eight out of 10 Filipino children experience corporal punishment and two out of three parents know no other means of disciplining their children.

Addressing this issue by stopping the practice can have a good ripple effect on future generations, said Ramirez, because nine out of 10 parents who practice corporal punishment said it was also used by their parents to discipline them.

The U.N. defines corporal punishment as the physical, emotional and psychological punishment of children in the guise of discipline. As one of the cruelest forms of violence against children, corporal punishment is a violation of children’s rights. It recommends that all countries, including the Philippines as a signatory to the convention, implement a law prohibiting all forms of corporal punishment in schools, private and public institutions, the juvenile justice system, alternative care system, and the home.

Edited by Kitty Stapp

*The story that moved on Dec. 15 misstated the matter of statutory rape in the Philippines. Child rights advocates are recommending that the age be raised from 12. The government has responded positively to it and legislation on the matter is ongoing. Likewise, the advocates would also like to see the minimum age of criminal responsibility raised higher than the current 15.

Most South Asian nations struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Pakistan, Jul 11 2014 (IPS)

If 22-year-old Rashda Naureen could go back six years in time, she would never have agreed to get married at the tender age of 16.

“Looking back, I know I was not ready for marriage,” she told IPS. “How could I have been, being merely a child myself?”

With only a third-grade education, Naureen became a mother at 17 and got a divorce soon after she delivered.

According to Naureen’s mother, Perween Bibi, who works for a small daily wage as a cleaning woman in Pakistan, “I have two more daughters [in addition to two sons] and we gave Rashda away in order to have one less responsibility on our hands.”

Nearly 7.3 million teenage girls become pregnant every year -- of these, two million are aged 14 or younger.
But the opposite turned out to be true. Today Bibi and her husband, who is a private chauffeur, must now find a way to provide for their grandson in a family of seven struggling to survive.

Perhaps the most unfortunate part of the story is that Naureen’s pregnancy could easily have been avoided.

“Before marriage my best friend urged me to take contraceptive pills, but I refused to listen to her,” Naureen confessed.

“Even my husband, who had been forced to marry me by his parents, said we should wait, but I didn’t pay any heed; I thought having a child immediately would cement our relationship, and my husband would begin to love me,” she said forlornly.

Dr. Tauseef Ahmed, Pakistan country director of Pathfinder International, a non-profit organisation working to improve adolescent and youth access to sexual and reproductive health services in more than 30 countries, says that early pregnancy is not uncommon among teenage brides.

In fact, having a baby is a way of proving one’s fertility, and the values of adolescent pregnancy are “protected by women and girls themselves,” he told IPS.

According to the United Nations Population Fund (UNFPA), nearly 7.3 million teenage girls become pregnant every year — of these, two million are aged 14 or younger. Meanwhile, an estimated 70,000 adolescents in developing countries die each year from complications during pregnancy and childbirth.

The World Health Organisation (WHO) says stillbirths and newborn deaths are 50 percent more likely among infants of adolescent mothers than among mothers aged 20 to 29.

Infants who survive are more likely to have a low birth weight and be premature than those born to women in their 20s.

The problem is particularly pronounced in Pakistan, a country of 180 million people where 35 percent of married women between the ages of 25 and 49 years were wed before the age of 18, according to the latest figures in the 2012-2013 Pakistan Demographic Health Survey.

Experts say one of the main reasons behind the widespread occurrence of chid marriages and early pregnancies is a lack of education.

Naureen agrees, saying her disrupted education stands out as a glaring “missing link” in her early development

Dr. Farid Midhet, who heads the USAID’s flagship Maternal and Child Health Integrated Programme (MCHIP) in Pakistan, says there is a strong link between teenage pregnancy and female illiteracy.

“Together these contribute to high infant and child mortality and morbidity, high fertility, illiteracy in general, and production of children who are a burden on society,” he told IPS.

He added that this exacerbates poverty, which in turn fuels a vicious cycle of militancy, crime and social unrest.

Pathfinder International’s Ahmed believes a strong conservative current in Pakistani society – where 97 percent of the population identifies as Muslim – also conspires against the girl child, making early marriage and adolescent pregnancy a foregone conclusion for thousands of girls.

“Early marriage and not getting permission to attend school are the two main indicators of conservative forces here,” he stressed, adding that the “fear of backlash from conservative forces” has resulted in a glaring lack of positive initiatives within the public sector to tackle the problem.

This, despite the fact that study after study has shown that countries that improve school enrollment rates for girls also see a decline in adolescent child-bearing.

Asked how to tackle the health crisis caused by teenage motherhood, Zeba Sathar, country director of the Population Council of Pakistan, answered immediately that she would first and foremost invest in girls’ education.

“Globally proven strategies include keeping adolescent girls in schools, using economic incentives and livelihood programmes, offering life skills, informing families and communities about the adverse effects of adolescent pregnancy, and mobilising them to support girls to grow and develop into women before becoming mothers,” Sathar told IPS.

A regional problem

The phenomenon is not exclusive to Pakistan, with several other countries in the region experiencing equally challenging situations.

Most South Asian nations, like Pakistan, struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say.

But this is easier said than done, as laws surrounding the ‘official’ marriage age are difficult to enforce and complicated by traditional societal values.

According to a 2013 report by the UNFPA entitled ‘Motherhood in Childhood’, India and Bangladesh remain among the countries where a girl is most likely to be married before she is 18.

Pakistan and Sri Lanka, on the other hand, show much lower rates of pregnancies among women aged 15 to 19.

The U.N. Department of Economic and Social Affairs (UNDESA)’s World Population Prospects report states that the adolescent fertility rate among women in the 15-19 age group is 87 per 1,000 women in Afghanistan, 81 in Bangladesh, 74 in Nepal, 33 in India, 27 in Pakistan, and just 17 in Sri Lanka.

India’s eastern state of Bihar had the worst score card for child marriage. Referring to a survey of more than 600,000 households conducted for India’s health ministry between 2007 and 2008, Sathar said nearly 70 percent of women in their early twenties reported having been married by the age of 18.

Bangladesh does not fare any better. One in 10 teens has had a child by the age of 15, while one in three girls gets married by the age of 15.

But numbers, according to Ahmed, do not tell the whole story.

“Early childhood marriages and fertility rates may be four times higher in Bangladesh than in Pakistan, but the former experiences higher aspirations [among women] for better education and gainful employment than Pakistan,” he stated.

Bangladesh’s Population Reference Bureau’s 2013 Data Sheet on Youth states the female labour force participation in Bangladesh is 51 percent, compared to just 20 percent in Pakistan.

Additionally, the percentage of women in secondary education in Bangladesh was 55, while in Pakistan it was just 29.

For women like Naureen, staying in school could have spared her a lifetime of pain.

“I would not have been married and become a mother at such a young age; I would have had time to think about what I was getting myself into… I would have been just a little bit wiser,” she said.

Excerpt:

Zimbabwe has seen a significant increase in the number of teen mothers in recent years. Credit: Jeffrey Moyo/IPS

By Thandeka Moyo
BULAWAYO, Mar 14 2014 (IPS)

She is only 17, but each morning is a reminder of her losses in life. As Pretty Nyathi* forces herself out of bed, feeds her baby, bundles him on her back and rushes to the market to buy vegetables to sell on the streets of Bulawayo, Zimbabwe she wishes her life were different.

“There is nothing fancy about being a teen mother,” she told IPS. “I wish I could reverse the hands of time and go back to school and be like any other girl.”

Five years ago her mother died and Nyathi went to live with her grandmother, who runs a shebeen (informal bar) in Tsholotsho, 116 kms north-east of Bulawayo, Zimbabwe’s second-largest city.

At age 14, she was raped by a shebeen client. “I tried reaching out to my grandmother but she would threaten to throw me out,” she said.

Soon the grandmother forced the girl into prostitution with clients. “I have lost count of the men I slept with and I did not use protection,” said Nyathi.

In 2012 she ran away to Bulawayo, where she lived in the streets and survived through commercial sex. Two months later she found herself pregnant and was told at the clinic that she was HIV positive. A pastor took her to a shelter, and Nyathi started antiretroviral (ARV) treatment at Mpilo hospital.

“By the grace of the Lord, my baby is HIV negative,” said Nyathi.

She lives with a relative but struggles to follow the ARV treatment and have “a balanced diet that would help me live longer and at least see my daughter go to school.”

Nyathi is one example of the trend of rising teen pregnancies in Zimbabwe.

In 2011, the fertility rate among teenage girls aged 15-19 was 112 births per 1,000 girls, compared to 99 births per 1,000 girls in 2006, according to the Zimbabwe Demographic and Health Survey (ZDHS).

“That is a significant increase,” Stewart Muchapera, communications analyst with the United Nations Population Fund (UNFPA) in Zimbabwe, told IPS.

Girls living in the rural areas, like Nyathi, are twice as much affected by teenage pregnancies, at a rate of 144 births per 1,000 girls, compared to 70 births per 1,000 urban girls.

Risky pregnancies

“Puberty is a time of rapid biological change and this stage of development needs to be well managed for young people to pass through it safely,” said Muchapera.

Among the many causes of teenage pregnancy, he mentions the lack of adequate, accurate information on puberty, which leaves young people dependent on uninformed peer sources or unguided internet searches.

Some cultural or religious norms such as child marriage and social issues like intergenerational sex, sexual coercion and transactional sex also contribute to teenage pregnancy, he said.

The ZDHS reports that nine out of ten sexually active women aged 15 to 19 are in some form of a marriage, and that for two out of three girls who first had sex before age 15, sex was forced against their will.

In addition, the political and economic crisis of the last decade has brought widespread poverty and disruption of health and education services. Girls engage in risky transactional sex as a means to food, clothes, school and security.

Simanga Nkomo, a midwife in Bulawayo, told IPS that every year she assists younger mothers, some aged 14 and even younger.

“The increase is worrisome, as most of these teenagers are uninformed about maternal health and they risk succumbing to maternal mortality,” she said.

The risk of maternal death is twice as high for girls aged 15 to 19 than for women in their 20s, and five times higher for girls aged 10 to 14 years.

Sipho Ncube* is another teen mother from Bulawayo. She had good grades in her last year of high school but quit studying when she fell pregnant and gave birth to a baby boy, now seven months old.

“It started as a fling and one thing led to another until I discovered I was pregnant. I had knowledge of contraceptives but for some reason I did not use any,” she told IPS.

Ncube and her baby are HIV negative.  But it could easily have been otherwise: national seroprevalence is nearly 15 percent among adults aged 15-49.

Some 120,000 young Zimbabweans aged 15-19 contracted HIV in 2012, and 63.000 of these were girls, estimates the United Nations Children’s Fund.

Ncube’s parents, who work in South Africa, visit three times a year and send a little money. She looks after her siblings, aged 13 and seven, in a two-room rented house in Mpopoma, a high-density suburb. The baby’s father is working in Victoria Falls and helps financially whenever he can.

“I regret everything but I have to live with the silly choices I made,”  Ncube told IPS. “I wish to go back to school and be able to fend for the baby.”

* Names withheld to protect privacy

In Nepal, many children who suffer from malnutrition belong to young mothers. In fact, teen marriages and pregnancies are common and over 23 percent of women give birth before they are 18 years old. Credit: Naresh Newar/IPS

By Joan Erakit
UNITED NATIONS, Oct 30 2013 (IPS)

Before we begin, perhaps we can set aside the stereotypes: no, she didn’t “mess herself up by following boys around”, and no, it is not in fact her fault that she became pregnant.

Adolescents rarely have children because they want to. Yet 7.3 million girls under the age of 18 give birth every year, with two million of those births to girls under the age of 14.

“The powerlessness girls experience is often a symptom of human rights violations of one form or another,” Richard Kollodge, editor of a flagship report launched Wednesday by the United Nations Population Fund (UNFPA), told IPS.

“When a girl is married against her will before 18, her rights are violated. When a girl becomes pregnant and is forced to leave school, her right to an education is denied,” he said.

This powerlessness affects young women deeply, and many are faced with excruciating choices that can lead to illegal abortion, social exile and even death.

Titled “Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy,” UNFPA’s annual report looks at the most important factors driving adolescent pregnancy: poverty, lack of education, forced marriage and inequality.

In his forward to the report, UNFPA Executive Director Babatunde Osotimehim writes that, “A pregnancy-prevention intervention, whether an advertising campaign or a condom distribution programme, is irrelevant to a girl who has no power to make any consequential decisions.”

The report sheds light on a key problem when it comes to adolescent pregnancy: the lenses used to view young women are tainted.  An unnecessary burden of being solely responsible for a pregnancy is put on the back of a young girl, and she is rarely looked at as a victim.

UNFPA is calling for a new perspective on adolescent pregnancy, one that includes not only the teen’s behaviour as a cause of early pregnancy, but also at the actions of their families, communities and governments.

Outside factors

Using a diagram, UNFPA describes five determinants (national, community, school/peers, family and individual) that can determine a teen parent’s path.

For example, when governments make laws limiting access to contraception, it contributes to negative views towards sexuality and women in the general community.  This trickles down to the schools, where sex education and available resources for young women are limited because they are not seen as necessary.

Parents can then develop negative views about sexuality and even about their own daughters, investing very little in their education and reinforcing a gender inequality in a young girl before she is even given a chance.

All this carries a high cost to national development aspirations as well. In Kenya, if the more than 200,000 teen mothers had jobs instead of children, they would have added 3.4 billion dollars to the economy – a sum equal to the value of Kenya’s entire construction sector.

If adolescent girls in Brazil and India had only waited to bear children until their early twenties, their nations would have greater economic productivity equal to over 3.5 billion and 7.7 billion dollars, respectively, the report says.

Meanwhile, just two cents of every dollar directed toward international development is spent on adolescent girls.

Powerful conversations

“One of the points the report makes is that the conversation cannot start in only one place,” Kollodge said. “The conversation has to occur simultaneously at all levels – at the national and policy levels, at the community level, in schools, among parents, among men and boys, and among peers.

“Research shows that interventions aimed at girls, and especially at changing girls’ behaviour, rarely have a positive impact,” he added. “No single intervention, or action by a single stakeholder, will make a real or lasting difference.”

Power is the most important aspect of a girl’s life – the power to stand up for herself, to protect herself and to choose when she is ready to have a family.

“The report makes the case that more often than not, pregnancy is not the result of a deliberate choice but rather, the result of an absence of choices and opportunities in life,” Kollodge said.

“When, for example, a 13-year-old girl is forced into marriage and is then expected by her husband, her parents, and her community to start having children right away, that girl clearly lacks power to decide whether, when and how often to have children.

Placing high emphasis on developing human capital of young girls, and giving them the opportunity to make sexual reproductive choices for themselves, not only promotes the health and protection of young girls, it also gives them a seat at the global development table.

Cameroon has shown only a moderate decline in new HIV infections, according to the Joint United Nations Programme on HIV/AIDS. Credit: Nastasya Tay/IPS

By Dorine Ekwe
YAOUNDÉ, Oct 29 2013 (IPS)

With a wide smile Beatrice M.* says that she lives by the motto “life is short and beautiful — live it to the full.” The 20-year-old, HIV-positive mother refuses to be defeated by her new circumstances.

Beatrice, a second year anthropology student at the University of Yaounde I, found out she was pregnant and HIV-positive when she was 18.

“When the doctor broke the news, I thought my life was over. But my gynaecologist put me on Zidolan [an anti-retroviral treatment] to prevent mother-to-child infection and told me things would be fine,” she tells IPS. Her doctor was right and her now two-year-old daughter is HIV-negative.

Looking into the distance, with her hands crossed on her lap, she recalls: “The pregnancy was not wanted. My boyfriend asked me to have an abortion, but I refused. When I told him about my HIV status, he said he had gone for testing and was HIV-negative. Then he left me.” She was five months pregnant at the time.

Beatrice believes that her 25-year-old boyfriend — a fellow student at the same university — infected her. She says that she was a virgin when they met.

According to Flavien Ndonko, an anthropologist at the German International Cooperation Agency or GIZ, an alarming 20 to 30 percent of Cameroonian girls aged 15 to 24 years have unwanted pregnancies.

The 2013 Joint United Nations Programme on HIV/AIDS (UNAIDS) report on the global AIDS epidemic states that around 600,000 people or 4.2 percent of Cameroon’s population of 19 million are HIV-positive. Women and youth are the worst affected groups. This West African nation is among UNAIDS’ 20 priority countries on the continent, and has shown only a moderate decline in new infections.

Beatrice learned about these statistics after finding out her status. “During our relationship, we never thought of contraception or AIDS. I had heard of them, but I didn’t feel they had anything to do with me.” During high school, she had not been interested in attending the Education for Life and Love (ELL) programmes, a life skills course given in high schools across the country.

Social worker Arlette Ngon says that the country needs a new approach to raising awareness. “Apart from science courses, the ELL programme is the only time when sexually transmitted infections and AIDS are discussed in depth at school. The message doesn’t seem to getting through to the youth.”

Yvonne Oku, from the National Network of Aunties’ Associations (RENATA), believes that much more should be done to bring down the rate of new infections. RENATA, a non-governmental organisation, educates youth on how to prevent teenage pregnancy and HIV through “aunties,” who are young mothers trained in health matters.

Aubin Ondoa, an anthropologist, explains to IPS that the major risk factor for young girls is early sexual activity combined with a glaring lack of information. According to the U.N. Population Fund, the average age of the first sexual encounter in Cameroon is 15.8 years, while one out of three girls aged 20 to 24 years is a mother before the age of 18.

“Furthermore, young girls are prime targets for older men who give them money,” Ondoa adds.

For many ill-informed young women with little or no income, the consequences of unprotected sex are pregnancy and HIV.

Beatrice now uses condoms with her partner. She is in a relationship with a high school teacher who is HIV-negative, knows her status and wants to marry her. But she has refused, fearing that she may infect him. She worries that if they get married they will no longer use condoms.

Positive Generation — an anti-AIDS organisation created in 1998, which has 60 members who are mostly students — has been a source of support for Beatrice. The group has helped her to come to terms with living with HIV.

The young woman has decided to keep her status a secret. “My parents are not ready; I prefer to leave them in the dark. I am afraid of the stigma,” she says.

Because she lives with her two sisters, she has to be very secretive so they do not discover her status. “I am very discreet. It would be difficult if someone found out that I take medicine at specific times,” she confides.

She even brings her child, who lives with her parents in a village in the west of the country, all the way to the capital Yaoundé for medical check ups. In the village, she says, “there is no such thing as medical confidentiality.”

In Cameroon, antiretroviral medication is free; she only has to pay for the bi-annual blood count and CD4 tests, which cost about 34 dollars. “It would be difficult if I had to pay for everything,” she says. Patients in remote areas are not as lucky. They often have to travel 44 km on foot, through a forest, to get to a healthcare centre.

Beatrice is proud of her little girl and would like to have more children, but she wishes that healthcare staff had a more professional attitude.

“I tore during childbirth, but the midwife refused to suture me. She also refused to take my child for routine tests,” says with tears in her eyes.

For her, this behaviour is nothing more than a form of stigmatisation and is one thing she does not need in her quest to live her life to the full.

*Not her real name.

When the U.N. Population Fund (UNFPA) participates in a regional review conference in the Uruguayan capital of Montevideo next week, it will take stock of the successes and failures of a wide range of gender-related issues, including reproductive health, sexual violence, women’s rights, maternal mortality, and the spread of HIV/AIDS – all of them relating to Latin America and the Caribbean (LAC).

A young pregnant Argentine woman contemplates the risks and difficulties of pregnancy and motherhood. Credit: Carolina Camps/IPS

And the question lingering in the minds of most delegates will be how LAC has fared in implementing the landmark Programme of Action (PoA) adopted at the 1994 International Conference on Population and Development (ICPD) in Cairo.

The question appears even more relevant considering the fact that a high-level meeting of the General Assembly is due to take place in 2014 to review ICPD achievements – and shortcomings – over the last 20 years.

Maria Jose Alcala, director of the Secretariat of the High-Level Task Force for ICPD, insists the international community must build on the Cairo commitments.

She told IPS that Cairo was a landmark, placing the reproductive rights of women at the centre of sustainable development.

“Their implementation has brought tremendous benefits to individuals, families, economies and countries, though they remain unfulfilled for millions across the region,” Alcala said.

But at the Montevideo Conference, scheduled to take place Aug. 12-15 and organised by the U.N. Economic Commission for Latin America and the Caribbean (ECLAC), “We must also go beyond agreements made 20 years ago to make the promise of Cairo, and the sexual and reproductive rights for all, a reality regardless of who you are or where you come from,” she noted.

Speaking at the 30th anniversary of the UNFPA Population Awards ceremony last week, Secretary-General Ban Ki-moon underlined the fact that “population is not a matter of numbers”.

“It is all about people – the choices they make and the choices they are able to make,” he said. “We must empower individuals. We must protect their freedom, ability and right to make informed decisions. This will enable people to fulfil their potential. And that will advance whole societies.”

UNFPA Executive Director Dr. Babatunde Osotimehin concurs with Ban’s view that development is not sustainable unless it is equitable and serves all people.

“I couldn’t agree with him more. We at UNFPA continue to emphasise that people and the principle of equity must be kept at the centre of sustainable development,” he said.

Dr. Osotimehin says it means recognising the need to invest in women and young people and promoting human rights. “It means increasing equity to build a world of opportunity for all.”

Alcala said that among the issues to be discussed at Montevideo, a high priority would be fundamental human rights.

“Governments in the region need to make strong commitments to advance gender equality, the rights of women and girls, the empowerment of young people, and sexual and reproductive health and rights,” she said.

These are basic rights to make decisions about one’s own private life and free of any form of discrimination, coercion or violence.

“They include deciding if, when and how many children to have, if and whom to marry, decisions about one’s body, sexuality and health and to have the information and services to do so,” she noted.

But for too many women and adolescent girls in the LAC region – and for too many young people and communities living in poverty – enjoyment of these rights is still far from reality, she warned.

As the United Nations embarks on its post-2015 development agenda, described as a logical successor to its Millennium Development Goals (MDGs) with a 2015 deadline, population and reproductive health are expected to be an integral part of the new agenda, including the proposed Sustainable Development Goals (SDGs).

The Montevideo conference will include a general discussion on national experiences relating to population and development, prospects for the period beyond 2014, and the role of adolescents and youth.

Alcala told IPS a key issue is bringing more policy attention and investments to adolescents and youth.

She pointed out adolescent girls in Latin America and the Caribbean, have the second highest pregnancy rates in the world after sub-Saharan Africa. About 20 percent of all births in the region are to adolescent mothers between 10 and 19 years of age.

And young women in the Caribbean are 2.5 times more likely to be infected with HIV than young men, she added.

She said her task force is calling for universal access to comprehensive sexuality education for all young people, in and out of school.

Countries in the region are already taking concrete steps in this direction: this must be a priority of any common-sense 21st century education agenda, Alcala said.

She said more needs to be done to intensify prevention of violence against women and girls and bring perpetrators to justice. Some 36 percent of women in the LAC region have experienced sexual or physical violence in their lifetime and, despite increased efforts in various countries, impunity for these crimes remains rampant.

Alcala said governments meeting in Montevideo must also address ending unsafe abortion as a major killer of women and adolescent girls. Latin America and the Caribbean has the highest rate of unsafe abortions in the world: 4.2 million unsafe abortions every year.

Beyond ensuring every woman and adolescent girl has access to sexual and reproductive health information and modern contraception – including emergency contraception – this includes expanding access to safe abortion, which is one of the safest medical procedures available.

“We must put a stop to the fear unleashed upon women, and the cruel imprisonment and punishment of women and girls who have sought life-saving care after undergoing an unsafe abortion,” Alcala said.

“We must remember that even where it is illegal, in the region as across the world, wealthy women and couples will find a way to obtain a safe procedure; but it is poor women and girls who will be forced to risk their lives when they are left with no other recourse but an unsafe abortion.”

This issue is a fundamental matter of social equity, she said, adding that the need for abortion will not go away.

“So we have a choice: to continue standing on the sidelines as women and girls risk and lose their lives, or allow women and adolescent girls the basic right to make decisions about their own bodies, health and lives,” she said.

Indigenous women hauling water in Chiapas, Mexico. Credit: Mauricio Ramos/IPS

By Purnima Mane
WASHINGTON, Aug 6 2013 (IPS)

In the last decade, several countries in the Latin America and Caribbean (LAC) region have had the opportunity to experience economic growth and establish redistributive fiscal policies aimed at reducing poverty, reducing inequality and improving the coverage and quality of health, education and social protection services.

And yet significant gaps exist in the area of reproductive health and rights, both between countries and as a whole, when it comes to some of the key objectives of the Cairo Programme of Action.

Let us take one of the basic indicators of reproductive health, the maternal mortality ratio. The decline overall in the region is not enough to guarantee the achievement of the target set for 2015.

The average maternal mortality rate in LAC is 80 maternal deaths per 100,000 live births, according to estimates by WHO, UNFPA, UNICEF and World Bank, 2011. Moreover, there are significant inequities between countries.

For example, the estimated maternal mortality rate in Uruguay was 29 deaths per 100,000 live births in 2010, while it was 120 in Guatemala; Haiti exhibits the highest ratio in the region, with 350 maternal deaths per 100,000 live births.

A significant proportion of maternal deaths are caused by unsafe abortions, which represent a serious public health concern in the region.

In 2008, the annual rate of unsafe abortion estimated for the region was 31 abortions per 1,000 women aged 15-44. In 2008, 12 percent of all maternal deaths in Latin America and the Caribbean (1,100 in total) were due to unsafe abortions, according to the World Health Organisation.

Abortion is only legal in six countries, and together, these countries account for less than five percent of the region’s women aged 15-44. (Guttmacher Institute, 2012).

In addition to the discrepancies noted in regard to maternal mortality and access to safe abortion between countries, there are also intra-country disparities.

For example, while the total fertility rate has reduced considerably, in Bolivia (DHS, 2008), the total fertility rate of women with no education was 6.1 compared to 1.9 for women with higher education, and the urban-rural difference is 2.8 to 4.9, respectively; in Panama, maternal mortality is five times higher among indigenous women.

What is even more tragic is that Latin America and the Caribbean has the second highest rate of adolescent pregnancy in the world, with approximately 70 live births per 1,000 women aged 15-19. On an average, 38 percent of women in the region become pregnant before they reach the age of 20 and nearly 20 percent of live births in the region are by adolescent mothers.

The conclusion is clear: universal access to reproductive health is still far from being a reality in the LAC region.

Looking specifically at the seven components of the programme of action, the LAC countries have achieved much higher rates of contraceptive prevalence than Africa or Asia as a whole.

For example, in 2012, the average contraceptive prevalence rate (CPR) among married women in Africa was only 26 percent and 47 percent in Asia (excluding China); in Latin America and the Caribbean it was as high as 67 percent of married women [Population Reference Bureau].

As I said before, the LAC countries have brought down their collective maternal mortality rate to 80 deaths per 100,000 live births – a striking improvement over the Sub-Saharan African average of 500 per 100,000 live births and the South Asian average of 220 per 100,000 live births (UNICEF, 2010).

However, in other key areas of the Programme such as expression of and protection for sexual and reproductive rights including access to safe abortion, post-abortion care, and expression of gender identity or sexual orientation, the LAC region continues to be challenged.

The reasons for the progress in this region were mentioned earlier – development as a whole, higher rates of education and access to contraception have helped considerably.

Let us not forget however, that the lack of progress in ensuring reproductive rights and access to safe abortion in particular comes from the fact that a large number of LAC countries stated formal reservations to many of the rights components in the Programme of Action, including concern over abortion, a national belief and/or laws asserting a need to protect life from the moment of conception, and concern over alternate expressions of family beyond that of formal marriage between a man and a woman.

In contrast, while several other countries in other regions expressed similar reservations (notably many Islamic and Catholic countries), only one African and one Asian country (Djibouti and Philippines) presented formal reservations to this effect. These reservations have continued to hamper progress in these areas and produced the situation we see today in this region.

Purnima Mane, PhD, is President and Chief Executive Officer of Pathfinder International, a global leader in sexual and reproductive health.

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.

Carina Vance: “Our constitution guarantees free access to services, contraceptive methods and family planning visits.” Credit: Courtesy of Health Ministry of Ecuador

By Leisa Sánchez
QUITO, Apr 19 2013 (IPS)

The government of Ecuador is determined to curb the growing number of teen pregnancies, and has begun to knock down barriers that stand in the way of the right to a responsible sexual and reproductive life.

The question of sexual and reproductive health has been a focus of public debate since new regulations were announced on availability and access to birth control methods, including emergency contraception known as the morning-after pill.

Making emergency contraception freely available forms part of the National Multi-Sector Strategy for Family Planning and Teen Pregnancy Prevention (ENIPLA), which has been given a budget of 4.4 million dollars.

Ecuador has the highest teen pregnancy rate in South America: 81 births per 1,000 females between the ages of 15 and 19. Seventeen percent of girls in that age group have at least one child. And the number is on the rise: according to official figures, the number of births to adolescents in that age group rose from 31,053 in 2004 to 45,708 in 2011.

The Catholic Church and other critics claim the morning-after pill is an abortifacient, even though studies show that what the pill actually does is delay ovulation.

The pill has been legally available in Ecuador since 1998, but a prescription was needed. Today it is freely available, without cost, in all public hospitals and health centres in this South American country.

Public Health Minister Carina Vance discussed the ENIPLA strategy, its achievements and challenges with IPS.

Q: Why was the decision reached to make the morning-after pill freely available?

A: We have disturbing statistics with respect to family planning and the spacing of children, in terms of the number of desired children and how many people actually have.

ENIPLA, a joint programme of the ministries of education and economic and social development, has been implemented since 2011 in Ecuador, which has the highest teen pregnancy rate in South America.

Q: Is the controversy over the morning-after pill based more on moral values than on knowledge of rights?

A: We believe there is no real controversy, because there is actually wide acceptance, of ENIPLA and of the fact that the method is freely available.

We have received a favourable response from social organisations and national and international institutions involved in health and women’s rights. The great majority of opinions against (the morning-after pill) are not based on scientific information, but on a mistaken understanding.

They claim that in some cases, emergency contraception is abortive, but there is scientific evidence that it is not. And they also want parental consent in order for an adolescent to have access to birth control methods.

Q: Are young people in Ecuador mature enough to decide on their own?

A: If young people are mature enough to have sexual relations, we have the obligation to respect their right to unlimited access to the pill, without barriers or the approval of third parties. We believe in working with parents to strengthen family communication on sexuality and sexual and reproductive rights.

There are people who because of principles or religious beliefs don’t consider it appropriate to make this kind of contraceptive freely available. We completely respect that position, but we have to integrate public policies in a framework of rights, and understand that the Ecuadorean state is secular.

Q: How many health centres distribute the emergency contraception pill?

A: We have 1,900 units nationwide.

Q: With respect to the promotion of a responsible reproductive and sexual life, what efforts are needed?

A: The Health Ministry has the obligation to provide objective, science-based evidence and provide medication totally free of charge. For example, we have condom dispensers in our health units, but that’s not enough.

Multi-sectoral work is needed, which is why it is so important to work with the Education Ministry. And there is also the shared responsibility of society: conversations on sexuality and rights should not be limited to visits to health centres. We also work with the parents of young people.

We carry out an ongoing effort in prevention, attention and studies on sexually transmissible diseases and the various problems that influence their spread.

We definitely have challenges: high teen pregnancy rates; the fact that 13 percent of maternal deaths occur among adolescents between the ages of 15 and 19; and the fact that six out of 10 women overall have suffered some kind of violence: physical, psychological or sexual.

We also face big challenges in achieving an equitable society free of violence, where sexual and reproductive rights are fully respected.

Q: Does this mark a watershed in sexual and reproductive rights?

A: Use of the emergency contraception pill has been legal since March 1998. With these latest regulations, we are now guaranteeing access to the pill without a prescription, as well as adequate supplies in all public health centres and hospitals, and the exercise of the right to a birth control method without parental or partner consent, a requirement that used to be a barrier for women.

Our constitution guarantees free access to services, contraceptive methods, family planning visits, and the possibility for everyone to lead a healthy life with universal access to health care, with a central focus on primary care.

Q: How does the government plan to move forward in the struggle to consolidate sexual and reproductive rights?

A: I don’t know if I would call it a struggle. A 2011 survey found that 84 percent of respondents agreed with the free provision of birth control methods – in other words, we have a high level of acceptance, and a government that is totally committed to the exercise of rights, including sexual and reproductive ones.

We are going to do everything necessary to implement sustainable policies, to make sure there is no backsliding.

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