Photo: Banco Interamericano de Desarrollo.
[This article has been published in Spanish in Planeta Futuro-El País]
Jenny Benalcazar Mosquera is coordinator of the delivery room of the Isidro Ayora Obstetrician Gynecology Hospital in Loja (Ecuador). She participated in the first regional edition for Latin America of the leadership workshop “Safe Mothers and Newborns” organized by ISGlobal, a center supported by "la Caixa", in collaboration with AECID and OPS.
The World Health Organization (WHO) defines adolescence as the period between the ages of 10 and 19 years, a time of life characterised by growth and development. In my country, Ecuador, 12% of girls in this age group have had a child or at least one pregnancy—the highest rate of adolescent pregnancy in South America. According to the statistics published by Ecuador’s National Institute of Statistics and Census (INEC), 49.3 of every 100 live births in the country involve adolescent mothers. These statistics are cause for concern.
Equally worrying is the fact that over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years. According to the National Sexual and Reproductive Health Plan, Ecuador has the third highest rate of adolescent pregnancy in Latin America and the highest in the Andean region, surpassed only by Nicaragua and the Dominican Republic.
Over the last decade we have seen a 78% increase in births among girls in the 10 to 14 year age group and an 11% increase in motherhood among girls aged between 15 and 19 years
Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods. Access to family planning has improved over the last two decades in Ecuador, but gaps still exist between different social, ethnic, and age groups.
According to research carried out for UNICEF by the Observatory for the Rights of Children, 50% of indigenous adolescents do not complete their basic education, and this figure is higher among girls who become pregnant. Consequently, these adolescent girls are less likely to be integrated into the educational system and improve their living conditions than their non-indigenous peers. From childhood, these children grow up in poverty and inequality and live in a culture of punishment, especially in the provinces of the Ecuadorian Highlands (Chimborazo, Cotopaxi and Imbabura).
Sexual and reproductive health rights imply guaranteeing girls and women safe and effective control of their own fertility, enabling them to decide how many children they want and when they have them, facilitating access to contraception and other family planning methods
Even though they may know something about contraceptive methods, in most cases they do not use them. However, the main cause of adolescent pregnancy continues to be sexual abuse and violence, which affects 42.7% of adolescents. In more than half of all cases (55%) this sexual violence occurs within the family circle. The national survey of family relations and gender violence against women carried out by the INEC estimated that 60.6% of women in the country have experienced some kind of gender violence (physical, psychological and/or sexual).
Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions. For example, while the school dropout rate in Ecuador has fallen (and pregnancy is the cause in only 2.8% of cases), the number of pregnancy-related deaths has increased by 2.5% among adolescent girls (aged 10 to 19 years).
Pregnancy in adolescence is associated with serious health effects as well as economic and social repercussions
The available data are essential to inform decisions on public policy relating to the present adolescent population. After two decades marked by an increase in adolescent fertility, during which profound gender gaps have persisted, the challenge for the state as well as for international and local organizations working in the field of reproductive health is to prioritise strategies aimed at avoiding or postponing motherhood in the adolescent population. Indispensable prerequisites to progress include strengthening the state and the role of public institutions, especially by way of the National Plan for the Eradication of Gender Violence Against Children, Adolescents and Women—a comprehensive plan that addresses the problem of violence—and by implementing the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030).
Among the interventions announced in July 2018, the Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents 2018-2025 is of particular interest. This strategy will involve the cooperation of four ministries: Health, Education, Justice, and Economic and Social Inclusion. The strategy will work towards ensuring universal access among adolescents to sexual and reproductive health information, education and services, with a view to giving young people the freedom to make their own decisions; facilitating access to contraception will also be a priority. The ultimate goal is to achieve the targets for adolescent health defined by the WHO’s Global Strategy.
To reduce adolescent pregnancy rates, Ecuador must successfully tackle major challenges. Early pregnancy is a problem with serious implications for the present and future of girls and adolescents. Beyond that, it is a problem that affects not only young mothers but also the country as a whole because it is a determining factor in the intergenerational cycle of poverty.
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