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CHILE: Teen
Pregnancy, a Problem That Won’t Go Away
By Daniela Estrada
SANTIAGO (IPS) - Chile currently
stands out for its spectacular progress in a
number of health indicators, including
maternal and child mortality and chronic
malnutrition. But these successes obscure an
acute social problem that refuses to yield:
the steady rise in the number of teenage
mothers.
"It’s hard to get up the nerve to talk to
your parents or teachers about sex; it’s
embarrassing. And you can’t just go to a
clinic and ask for birth control, because
everyone there knows you," Maura Escobar, a
Chilean girl who gave birth four months ago
at the age of 15, told IPS.
When she discovered she was pregnant, she
tried desperately to self-induce an
abortion. She drank herbal concoctions, took
martial art classes and even considered
buying misoprostol, known as the "abortion
pill." But she had no money.
When she was in her fifth month, a friend
took her to Chile Unido, a private
non-profit foundation that provides
assistance to women with unwanted
pregnancies, to prevent them from having an
abortion.
This South American nation is one of the few
countries in the world where abortion is
illegal under any circumstances, even when
the mother’s life is at risk.
Near the end of her pregnancy, Escobar
suffered complications for which she was
hospitalised, and her daughter was born
premature.
Escobar’s story is far from unique, it is
repeated over and over again in Chile and
the rest of Latin America, the region with
one of the highest rates of teen pregnancy
in the world. Of the total number of live
births in Chile, almost 15 percent are to
mothers under 19. Most of these young women
are from the lowest socioeconomic sectors.
"These women are forced to change their life
plans; they have little chance of finishing
their studies or of working, because most
have to stay home to care for their babies,
unlike teenage fathers," IPS Claudia Dides,
director of the Gender and Equity Programme
of the Chilean chapter of the Latin American
School of Social Sciences (FLACSO), told IPS.
In addition to putting their health at risk,
being a mother before the age of 19
perpetuates poverty and gender inequalities,
experts says.
In La Pintana, a shantytown on the outskirts
of Santiago, there were 80.9 teenage births
per 1,000 girls aged 15 to 19 in 2006,
compared to only 6.8 births in that same age
range in the affluent suburb of Vitacura,
which doubles La Pintana in the Human
Development Index, in terms of income.
A joint study by FLACSO and the United
Nations Population Fund (UNFPA) identified
10 sexual and reproductive health challenges
in Chile in the framework of the Action Plan
adopted at the 1994 Cairo International
Conference on Population and Development,
and the 2000 U.N. Millennium Development
Goals agreed on by 189 nations.
"The first challenge deals precisely with
teenage pregnancy," Dides said. The other
challenges refer to lack of sex education
and inadequate sexual and reproductive
health (SRH) services for young people, an
increase in sexually-transmitted infections
among teenagers, and absence of abortion
statistics.
Other problems identified include
difficulties in accessing and delivering
contraception, lack of ethnic considerations
in the design of SRH and HIV/AIDS programmes,
and low participation of men in reproductive
care.
Pervasive teenage pregnancy
From 2000 to 2005, the number of live births
in the country dropped from 248,694 to
230,831, in line with the ageing of the
population. But the adolescent fertility
rate in this country of 16 million people
has not gone down at the same pace as that
of women over 19. The problem is
particularly alarming among girls under 15.
Between 1995 and 2005, the maternity rate in
the 15-to-19 age group dropped by 9.5
percent, while in the 20-to-24 age group it
fell by 30.6 percent. But the birth rate for
girls under 15 per 1,000 live births was
reduced less than one percentage point, from
4.2 to 4.1, in that same period.
In absolute terms, at the start of this
decade, 1,054 children were born of mothers
under 15 and 39,216 of mothers in the 15-19
age range. These figures declined steadily
until 2004, when they stood at 906 and
33,522 births, respectively, only to begin
climbing again after that year. In 2005,
there were 953 births among 10-to-14
year-olds, and almost the same number (954)
the following year.
The same upward trend was observed in the
15-19 age range, with 35,143 births
registered in 2005 and 36,819 in 2006.
A matter of political will
Forty different studies on teenage pregnancy
were conducted in Chile from 1991 to 2007.
"We have the scientific evidence necessary
to make policy decisions," Dides said.
Experts agree that the problem is linked to
low contraceptive use, especially in poor
sectors, to the absence or inadequacy of sex
education, and to a lack of
adolescent-friendly health services.
A recent major initiative by the government
is the Sex and Relationship Education
Participatory Action Plan (PlanEsa),
included in the health policies for the
2005-2010 period, which is aimed at
involving school authorities, teachers,
parents and students in efforts to help kids
make informed decisions about sex.
Education Ministry sources told IPS that the
goals set by PlanEsa are being met.
But Dides has a different view. "A number of
programmes dealing with teenage sexuality
have been introduced since 1993, but none
has succeeded in implementing a lasting
public policy. They don’t go beyond small
pilot trials that depend on the political
will of the minister of the moment," she
said.
According to this expert, the Education
Ministry "has been a bastion of conservative
thinking in sex education matters. I’d even
venture that (ministry authorities) have
been remiss in their duty to Chile’s young
people, because of their ideological
beliefs."
Since the return to democracy in 1990,
following 17 years of military dictatorship,
Chile has been governed by the centre-left
coalition Concertación de Partidos por la
Democracia, which includes the conservative
Christian Democrat Party.
Starting in 2010, the Education Ministry
will also promote "a dialogue involving
experts, teacher training institutions and
organisations involved with sex and
relationship education" to define an
"educational strategy" in this area,
ministry spokespersons told IPS.
It will also seek to improve coordination
with the Health Ministry to achieve more
effective interventions at the local level.
But with the government of socialist
President Michelle Bachelet - a firm
promoter of progressive social and
gender-sensitive policies - coming to an end
in March 2010, the future seems uncertain.
Making spaces available
A common complaint voiced by the young girls
who turn to the University of Chile Teenage
Reproductive Health and Integral Development
Centre for help and advice is that they
can’t talk to their parents about sex, the
centre’s assistant director, Electra
González, a social worker with 28 years of
experience, told IPS.
So any precautions these girls take depend
solely on how independent they are and
whatever information they’ve been able to
obtain on their own, González said.
"We need to have appropriate services for
teenagers and young people, services that
provide quality health care that is
specially designed for them, because, as
several studies have shown, young girls
always end up going where their moms and
grandmothers go, and that’s a problem,"
Dides noted.
A good step in this direction are the
"Teen-Friendly Units" opening up this year
in primary health care facilities, staffed
by birth attendants, psychologists and
social workers.
The same teams working in these units are
also reaching out to the community and going
out to work in the field, Paz Robledo, head
of the Health Ministry's Adolescent and
Youth Health Programme, told IPS.
The Teen-Friendly Units were developed under
the 2008-2015 National Health Policy for
Adolescents and Youth. Fifty-four units were
created this year alone in 54 communities,
and the budget to establish 277 new centres
in 2010 is currently under discussion.
Meanwhile, Congress has delayed
consideration of a bill dealing with
fertility planning information, guidance and
health care, submitted by Bachelet with the
aim of guaranteeing free, confidential
delivery of birth control, including
emergency contraceptives, to all girls and
women above the age of 14.
This responds to a 2008 Constitutional Court
ruling that banned distribution of the
so-called ‘morning after’ pill in public
health services, upholding an appeal filed
by conservative legislators against a 2007
presidential decree.
According to Robledo, the country has to
address the needs of its almost 4.3 million
teenagers and young people, who represent
over 25 percent of the population.
"What do we want from and for our young
people and adolescents? What is the most
efficient way of coordinating efforts among
the various sectors of the state towards
providing adequate social protection for
this sector of the population?" and how many
resources should be invested in these tasks
are all issues that Robledo feels should be
discussed by society.
Maura Escobar is "very hopeful" about her
future, but unfortunately her case is an
exception. She now has her mother’s full
support, she’s gone back to school, and
while she’s lost all contact with the baby’s
father - a young man of 23 - she’s confident
that she and her baby are going to be just
fine. One thing’s for certain, though: her
"life has changed for ever," she tells IPS
as she holds her daughter in her arms.
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