All the Opportunities Lost for Lack of Sexual Health

Foto: Ana Ferreira, Bolivia. 

[This article has been published in Spanish in El País-Planeta Futuro]

Despite global progress towards gender equality in the last decades, adolescent girls remain an extremely vulnerable group that is lagging behind. Globally, an estimated 16 million girls between 15 and 19 years old give birth each year – of which 90% occur within marriage. 

Globally, an estimated 16 million girls between 15 and 19 years old give birth each year –of which 90% occur within marriage

Latin America and the Caribbean is one of the regions where girls and adolescents still face a larger number of inequalities. Despite efforts and more visibility in the past years to reach more gender equality, sexual and reproductive health and rights of girls and young women remain a neglected topic and are far from being evenly distributed –throughout the continent as well as within countries. Female adolescents are a particularly vulnerable group when it comes to sexual and reproductive health and rights.

Adolescence, defined as the period from 10-19 years, is characterized by important physical and psychosocial developments with a relevant impact on their future. However, violation of female adolescents’ sexual and reproductive rights due to traditional role models, religious beliefs and historically grown gender ideas often leads to early marriages, informal unions and high adolescent pregnancy rates which have a significant long-term impact on the socioeconomic wellbeing as well as educational and employment opportunities of young women.

Despite a remarkable overall decline of the total fertility in Latin America and the Caribbean in the past three decades from 3.95 births per women in 1980–1985 to 2.15 in 2010–2015, adolescent fertility only decreased minimally during the same period and keeps being the second highest in the world (after Sub-Saharan Africa). Besides, it has been the only region worldwide where the fertility of adolescents younger than 15 years even increased slightly.

Latin America and the Caribbean has been the only region worldwide where the fertility of adolescents younger than 15 years even increased slightly

Those relatively high fertility rates do not affect everyone equally in Latin America and the Caribbean though. Numbers vary significantly between and within countries. According to current reports, there are 63 births per 1000 women aged 15-19 in Latin America and the Caribbean, compared to 42 worldwide. Though, we find big regional differences between high-income countries such as Chile (41), where the adolescent fertility rate ranks below the global average, and lower-middle-income-countries such as Nicaragua and Venezuela (both 85) that double the global average.

Data also reveal that pregnancy among adolescents mostly occur in the poorest and most vulnerable groups of populations of each country. Girls from households in the lowest wealth quintile are three to four times more likely to be affected by early pregnancy compared with girls from the highest wealth quintile. Further risk factors are no or only primary education, living in rural areas or belonging to an indigenous community.

Early pregnancy hampers development as it often results in interrupted schooling, social isolation and financial insecurity, and therefore perpetuates circles of poverty and dependence. Furthermore, adolescent pregnancy is related to serious health consequences for mother and child. The World Health Organization reports that complications of pregnancy and childbirth continue to be the leading cause of death among 15-19 years old girls globally. 

Early pregnancy hampers development as it often results in interrupted schooling, social isolation and financial insecurity, and therefore perpetuates circles of poverty and dependence

One of the main reasons for the high-remaining adolescent pregnancy rate is the unmet need of family planning among girls. Of the currently 27.5 million girls aged 15-19 living in Latin America and Caribbean, nine million girls need contraception because they are married or sexually active and do not want to have a child at least for the next two years. Only 62% of those have access to modern contraception methods, while the other 38% have unmet need for contraception. The highest number of unmet need is found in Central America (49%), followed by the Caribbean (40%) and South America (34%).

The lack of effective contraception leads to a high number of unintended pregnancies: recent data reveal that nearly 80% of pregnancies among girls aged 15-19 are unintended and about half of these end in abortion. Because of restrictive abortion laws in Latin America, a big share of those abortions is unsafe and can result in severe health consequences. Though, unsafe abortion predominantly occurs among the poorest and most vulnerable girls, since safe abortions in private clinics are often related to high costs and therefore remain a privilege to the wealthiest groups.

As recent studies show, unintended pregnancy rates among adolescents would drop by 58%, if every girl’s need of family planning would be met, and significantly reduce consequences such as unsafe abortions, miscarriages and maternal deaths.

Unintended pregnancy rates among adolescents would drop by 58% if every girl’s need of family planning would be met, and significantly reduce consequences such as unsafe abortions, miscarriages and maternal deaths

Inequalities in the access to sexual and reproductive health and rights among girls and adolescents are slowly becoming more visible in the public health debate in Latin America and the Caribbean over the last years. In 2018, the Pan-American Health Organization presented the Plan of Action for Womens’, Childrens’ and Adolescents’ Health (2018-2030), which aims to reduce adolescent pregnancy rates and promote universal access to contraception, among other things.

On a global level, the 2030 Agenda for Sustainable Development set out universal access to sexual and reproductive health-care [8] as one target, using adolescent fertility rate as an indicator to measure progress. However, more data and studies are necessary to better understand dynamics and multifactorial causes of inequalities, if we want to reach those global and regional goals.

In this regard, in ISGlobal and together with my colleagues Anna Lucas and Clara Pons, we are working on a new study on inequalities in womens’ and girls’ health opportunities in Latin America. For this, we will use a methodology developed by the World Bank to measure inequalities –the Human Opportunity Index– that was also applied in our previous study about maternal health inequalities in Sub-Saharan Africa. Our main goal is to contribute information from a new perspective on the analysis about the array of factors for the unequal distribution of maternal and reproductive health services in the region, including the group of adolescents.

Girls and young women in Latin America and the Caribbean deserve attention and should not be left behind. We must prioritize their needs and rights in regional and global actions to include them in the global progress towards a more equitable world.