[This article has been published in Spanish in Planeta Futuro-El País]
This article has been written by Andrea Jiménez, Resident of Gynecology and Obstetrics at the Monterrey Institute of Technology (Mexico), and Grecia Villa, head of residents of Gynecology and Obstetrics at the Monterrey Institute of Technology. As a student of the Master in Global Health ISGlobal-UB, she participated in the first edition of the leadership workshop "Safe Mothers and Newborns" organized by ISGlobal, a center supported by "la Caixa", together with the School of Public Health of Harvard and the University Aga Khan.
Mexico has the highest adolescent birth rate of all the member countries of the Organisation for Economic Co-operation and Development (OECD), with 62 out of every 1,000 pregnancies occurring in girls and adolescents. While the rate declined by 8% between 2000 and 2006, it went on to rise by almost 15% between 2007 and 2012. Two out of every ten mothers who gave birth in Mexico in 2017 were under 20 years of age.
Globally, adolescent pregnancy is the leading cause of mortality in girls aged between 15 and 19 years. Some 90% of these deaths occur in developing countries, including Mexico and other Latin American countries and most of them are preventable. Other troubling aspects of the problem include the high rate of clandestine abortions and the fact that adolescents do not know how to seek help and prenatal care.
Globally, adolescent pregnancy is the leading cause of mortality in girls aged between 15 and 19 years. Some 90% of these deaths occur in developing countries, including Mexico and other Latin American countries and most of them are preventable
Several risk factors have been identified. These relate to the individual, the family and the social situation, and include early menarche, low self-esteem, drug use, having a teenage mother and/or an absent father, not using family planning methods, and a lack of knowledge about sex. There are also protective factors, including a supportive family, good interpersonal communication skills, a sense of the importance of employment and working life, and abstinence.
Adolescent pregnancy is not only a global health problem, it is also an expression of inequality because it occurs more often in low-income than high-income social groups. In Mexico, the rate varies from 97 adolescents per 1,000 pregnancies in the poorest groups to 15 adolescents per 1,000 pregnancies in the most affluent classes. It has been documented that the most marked differences in reproductive health outcomes are mainly related to inequities in access to health services, which is clearly differentiated by socioeconomic strata.
National Strategy for the Prevention of Teenage Pregnancy. Mexico City, 2015. Author: Government of Mexico
In addition, access to contraceptives among sexually active adolescents aged between 15 and 19 years is not the same in all areas of the country. According to the latest State of the World's Mothers annual report, published by the non-governmental organisation Save the Children, there is a clear discrepancy in the prevalence of contraceptive use between the southernmost Mexican states, such as Chiapas with 35.5%, and the rest of the country, where it is estimated to be around 59%.
Adolescent pregnancy is not only a global health problem, it is also an expression of inequality because it occurs more often in low-income than high-income social groups
High unemployment and school dropout rates are additional problems among young women who are facing the challenges of a pregnancy. A number of different strategies have been implemented to address this problem, including PROMAJOVEN, a scholarship programme run by the Secretariat of Public Education which helps young pregnant women and young mothers to complete their basic education. However, indicators show that this programme has had little success, achieving only a 22% effectiveness rate. The social problems of adolescent parents also have repercussions on their children, who are affected by higher rates of abuse and neglect, have a greater probability of becoming involved in criminal activities, and are more likely to become adolescent mothers themselves, thereby perpetuating the problem.
In order to address this social problem, which has considerable impact on young people all over the world, many attempts have been made to understand the situations that lead adolescent girls to make decisions that put them at risk of pregnancy. There have been multiple interventions, many of them multidisciplinary, focused on sexual and reproductive health. These programmes have also include educational and employment opportunities and none have had much success.
In view of the lack of theory to guide inform teen pregnancy practice and prevention programmes, research into the factors that predispose adolescent girls to early motherhood is urgently needed. The ultimate aim should be to create culturally appropriate and inclusive programmes that can improve the living conditions of adolescents and enable them to make better decisions about the best time to start a family.
Accelerating the Reduction of Adolescent Pregnancy in Latin America and the Caribbean: What Do We Need to Move Forward?
Let Them Be Girls, and Not Mothers Before Time