Looking back and moving forward: can we accelerate progress on adolescent pregnancy in the Americas?

Abstract

Adolescent fertility rates in Latin America and the Caribbean (LAC) remain unacceptably high, especially compared to the region’s declining total fertility rates. The Region has experienced the slowest progress of all regions in the world, and shows major differences between countries and between subgroups in countries. In 2013, LAC was also noted as the only region with a rising trend in pregnancies in adolescents younger than 15 years. In response to the lack of progress in the LAC region, PAHO/WHO, UNFPA and UNICEF held a technical consultation with global, regional and country-level stakeholders to take stock of the situation and agree on strategic approaches and priority actions to accelerate progress. The meeting concluded that there is no single portrait of an adolescent mother in LAC and that context and determinants of adolescent pregnancy vary across and within countries. However, lack of knowledge about their sexual and reproductive health and rights, poor access to and inadequate use of contraceptives resulting from restrictive laws and policies, weak programs, social and cultural norms, limited education and income, sexual violence and abuse, and unequal gender relations were identified as key factors contributing to adolescent pregnancy in LAC. The meeting participants highlighted the following seven priority actions to accelerate progress:1. Make adolescent pregnancy, its drivers and impact, and the most affected groups more visible with disaggregated data, qualitative reports, and stories.2. Design interventions targeting the most vulnerable groups, ensuring the approaches are adapted to their realities and address their specific challenges.3. Engage and empower youth to contribute to the design, implementation and monitoring of strategic interventions.4. Abandon ineffective interventions and invest resources in applying proven ones.5. Strengthen inter-sectoral collaboration to effectively address the drivers of adolescent pregnancy in LAC.6. Move from boutique projects to large-scale and sustainable programs.7. Create an enabling environment for gender equality and adolescent sexual and reproductive health and rights.

Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveys

“…As adolescent pregnancy is often underpinned by social, economic and cultural factors, it is increasingly understood that individual-level focused interventions are likely to have limited impact, and that it is vital to involve families, communities, and wider society [31]. As Caffe et al have noted, addressing the issue of adolescent first births in LAC is likely to require a broad and multisectoral approach, and strategies that address both the proximal and the distal determinants of adolescent fertility within the LAC context have been widely supported [32]. …”

Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015

“…Low coverage of vaccines against the human papillomavirus (HPV) has also been observed in Brazil 10 and it is caused by insufficient adherence of parents and adolescents, due to religious motives, relation of HPV with sexual intercourse and adverse effects, including mistaken information without any scientific evidence 10,11 . Besides, many adolescents do not recognize HPV as being a STI 12 The lack of information about health and rights, difficult access to contraceptive methods, cultural and social aspects, low schooling and income, violence and sexual abuse, as well as gender inequalities, are factors that contribute with the persistence and increase of these problems among adolescents 2,12,13 . Other causes have been investigated in several countries, and evidence shows that the lack of a formal and structured sexual education by the schools and parents is implied in the process 4,12,14 .…”

Intersectoral strategies between health and education for preventing adolescent pregnancy in Chile: Findings from a qualitative study

“…Worldwide, the adolescent fertility rate for 2010‐2015 was of 51 births per 1000 girls aged 15‐19 . Latin America and the Caribbean were above the world average and presented the second highest adolescent fertility rate in the world, estimated in 67 births per 1000 girls for 2010‐2015, only after Sub‐Saharan Africa . During the same period, Chile presented an adolescent fertility rate of 49.3 per 1000, one of the lowest rates of the Region .…”

“…Internationally, some standalone adolescent health centres and out‐of‐facility settings, such as school‐based healthcare delivery, have been developing for decades . However, in Chile and Latin America, such initiatives are recent and incipient, and little is known about them . In this context, a qualitative research project was carried out, which aimed to describe the provision of sexual and reproductive health services focussed on preventing adolescent pregnancies in five YFHS in Chile's Metropolitan Region.…”