Here's a link to an article that was published about my experience with this program recently:
http://www.catholic-sf.org/news_select.php?newsid=&id=56393
You can also access a PDF version (which has a couple of additional photos) by clicking on the digital paper link, then download the Sep 25th issue and got to page 3 and 9.
Sunday, October 4, 2009
Need for continued funding...
...just a side note for anyone who has read through this blog and feels like they could support this university program in the future, since the program is looking for additional funding to keep the program going. If you think you can help out, please contact:
Julie Reed (jlreed@usfca.edu)
Director of the Office of Service Learning:
Leo T. McCarthy Center for Public Service & the Common Good
University of San Francisco
Here's an additional link to her biographical page on the university website:
http://www.usfca.edu/artsci/fac_staff/R/reed_julie.html
Julie Reed (jlreed@usfca.edu)
Director of the Office of Service Learning:
Leo T. McCarthy Center for Public Service & the Common Good
University of San Francisco
Here's an additional link to her biographical page on the university website:
http://www.usfca.edu/artsci/fac_staff/R/reed_julie.html
Research Paper
Hello, I know this is long overdue, but things have been quite busy beginning the Fall semester so soon after returning. But I am posting the paper I wrote here for the course in case anyone cares to read it. I think it could still use some polishing and a better focus on one specific issue, but with the time I had this what I wrote. Maybe later this year I will return to it and make improvements, so consider it a work in progress:
Adolescent Pregnancy and Sustainable Development in
Nicaragua
Richard Hackett
LAS 312 – Sarlo Scholars
Professor Friedman
August 28, 2009
Introduction
A young girl, wearing plastic sandals and carrying a small bag of belongings and a blanket her mother gave her, enters the Pre-Labor unit at the local hospital. She is nine months pregnant and will be delivering her first child in the next twenty-four hours. No family members are allowed inside of the unit, meaning she waits alone as the attending nurse and physician instruct her to change into a hospital gown and assign her to a bed in the crowded room. She can hear some screaming down the hallway of another woman in delivery, and the girl begins feeling very anxious, knowing her turn to move down that hallway will soon come. After being directed to the bathroom, she changes into the gown and wanders back to the bed, awaiting further attention from the staff.
One of the nurses sorts through some paper work and begins asking the girl questions. She states her name and gives an age of 15, but indicates that it is only an approximate age since the exact year of her birth is unknown, she does appear very young, perhaps a few years younger. When then asked to sign her name on some of the hospital records she says she is unable to read or write, even her own name. After a pause, the nurse instructs her to just do the best she can and explains orally what the documents she is signing refer to.
The above scenario is not fictional. It represents a noticeable share of young mothers in Nicaragua, a young adolescent girl with relatively little or no formal education, due to a lack of access, living in a difficult economic situation and now faced with an even more difficult situation as she will have to provide for a newborn baby. The child will also be carried to term whether the pregnancy was a result of consensual sex or not, as abortion in Nicaragua is completely illegal. The expecting-mother usually has significant support from her side of the family, but also often times little or no support from the biological father. The new single parent-mother will likely struggle financially to provide for herself and her child and it is unlikely that she will ever garner more of a living than what permits day-to-day subsistence, and several years from now she may have additional children to provide for.
For someone unaffected by this type of scenario, it is easy to not pay it much attention. It is easy to place blame on the young girl for her predicament, or to place blame on the parents for perhaps having set the same example in their own lives and not having “done better” for their children. But when you delve deeper into the issue many of these Nicaraguan girls are facing, the situation becomes much more complex and intertwined with institutional norms, values and official policies (and certainly many parallels exist between Nicaragua and other societies where this occurrence is common, but this paper will focus principally on Nicaragua). The overall effect of widespread adolescent pregnancy in this country manifests itself in more sinister forms as an impediment in the lives of these girls towards education and economic determinism. The lack of what these young women can in turn provide for their children (in regards to education and economic opportunity) then cycles back to the children once they become of child-rearing age, making them more susceptible to continue enduring the same conditions of financial poverty that existed for their parents.
This paper will explore the economic, social and health impacts of adolescent pregnancy on these women and their communities in relation to the Millennium Development Goals (MDGs) brought forth by the United Nations (UN) and sustainable development. I will then survey some of the scholarly literature on teen pregnancy in Nicaragua and Latin America. This will be followed by a discussion of data I gathered recently while in Nicaragua and finalized with a conclusion of the information presented here.
A Brief Background – Economy and Education
To understand the life of this girl, it is necessary to consider the traits of the country she is from. Nicaragua is situated at the heart of Central America, with a population of about 5 million people, but is economically one of the poorest nations in Latin America. Approximately 50% of the population lives below the national poverty line (Human Development Report 2007/2008, 337). Public education is also poorly funded, and many people completely lack access, especially in rural areas. The Economist Intelligence Unit reports and illiteracy rate of five years of primary education (13). While not directly related to adolescent pregnancy in this region perhaps, these economic and educational factors have surfaced as a central theme to this topic, as both a symptom and a cause.
How Adolescent Pregnancy Relates to Development –
The Millennium Development Goals
What does the issue of adolescent pregnancy have to due with development? Using the UN’s MDGs, it becomes apparent that the negative effects of young motherhood are very relevant. Of the eight MDG’s proposed in the Millenium Declaration in 2000, more than half of them deal directly with common consequences of adolescent maternity. Goal 1, to “eradicate extreme poverty and hunger,” is impacted by the inability of a young mother to adequately support herself, since she usually has no tangible market-wage job skills and little, if any, formal education. Goal 2, to “achieve universal primary education,” is impacted by a young mother’s inability to attend a school if it is available, in lieu of caring for children at home. Goals 3, 4 and 5 are also equally relevant, addressing issues of gender equality and women empowerment, a reduction of child mortality and improving maternal health. All of these are issues which arise when looking at the root causes and effects of this issue in Nicaragua (as is mentioned repeatedly in scholarly literature and witnessed in my personal experiences), and any efforts to reach these goals through development work must focus on this widespread occurrence.
Literature Review
How exactly does a poor economy and marginal access to education contribute to teenage pregnancy? Are there other contributing factors? What are the health implications for the mother and child? Have there been any successful development strategies to intervene on behalf of these mothers and other at-risk youth? These were the types of questions I sought to address in reviewing this topic as specifically to Nicaragua as possible in the articles available.
The first article, by Berglund et al., aimed to understand the reasons for the prevalence of adolescent pregnancy amid Nicaraguan youth despite the fact that these young girls must see and experience the negative consequences of it among their own family and friends. As the authors state, “they know that having unwanted children often leads to infant malnutrition, child abuse, family instability, and difficulties in caring for all of the children, as well as keeping them off the street with their material as well as educational needs” (1). All of these consequences reflect back to the MDGs previously mentioned.
Factors attributed to these pregnancies by the authors included economic deprivation, broken family relations, low self-esteem, strict religious practices (Catholic church teaching of sex for procreation and disapproval of contraceptive use or abortion), lack of education, and social isolation. Another factor the authors mentioned is Nicaragua’s dependence on an agricultural export economy, which requires large numbers of working men to migrate throughout the country for months at a time and may contribute to a loss of the traditional family structure (2). This would contribute to men who are away from their partners for long periods of time, selecting other women to have relations with, and then being unable to provide adequate support for multiple mother’s of fathered children. Likewise, the abandoned young mothers and growing daughters are left at home, and are more likely to suffer sexual abuse resulting in unwanted pregnancy from boyfriends or stepfathers (2, 4).
Berglund et al., conclude their article by calling for increased access to sexual education. They point out that many of the youth actually have moderate access to contraceptives, but do not use them (or do not use them properly) because of misconceptions about the effects and use, or social values, such as machismo and religious attitudes, that frown on contraceptive use. The authors state that “access to sexual education is evidently the most effective insurance against unwanted pregnancy,” and that Nicaragua as a whole, must “reveal and publicize, as widely as possible, the reality of unwanted pregnancy in the country” (11).
A separate article by Castillo picked up on a point, also mentioned by Berglund et al., by examining the overt social pressures placed on young women in Nicaragua to marry and have children as soon as possible. The article says that many times it is the actual parents of the young woman that place the most pressure on her to have children, often saying things such as “’ be careful that you don’t discontinue the train, you must have children so that someone cares for you when you are older’” (5). Additionally, because of the elevated status that married women and mothers receive, progressing from a young single teenage girl to a married woman and/or mother can be seen as a quick way to increase your social status; as one young woman says in the article, “’for [our] society a married woman is a respected woman...the civil status of a woman is like a title, as if it is a professional degree’” (6).
Regarding adolescent pregnancy as a global health issue, a third article by Conde-Agudelo, Belizán, and Lammers examined the more independently the physiological health consequences from adolescent pregnancy in Latin America. Given that close to 20% of all births in Latin America are attributed to teenage mothers (World Health Organization, as cited in Lammers et al., 342), these authors conducted a research study to look for an increase in adverse outcomes while adjusting as possible for confounding variables.
Using a hospital-based retrospective cross-sectional study, the researchers screened over 850,000 pregnancy outcomes of Latin American women under the age of 25. According to their study, adolescent mothers actually had less likelihood of requiring a cesarean delivery, experiencing third-trimester bleeding, or developing gestational diabetes (345-346). However, women under 15 had a higher risk for maternal death, early neonatal death, and anemia, compared to mothers in their early twenties. All adolescent mothers had a greater incidence of postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for gestational-age infants (345-346). Additionally, the researchers cited additional studies relating increased adverse maternal outcomes for young mothers, as being independent of socioeconomic status, meaning the occurrence of adolescent pregnancy should be prevented even in communities where poverty is of less concern (348).
Two final articles, by Langer and by Meuwissen et al., in addition to commenting on many of the risk factors and consequences already elaborated on here, call for a solution which incorporates improved and increased access to sexual education and related healthcare services. Langer states that given the trend in Latin America, it is necessary to develop “mass communication programs that address gender issues, education, programs for girls, and sex education [in addition to] health services that include family planning methods” (203). Meuwissen et al., support this finding, but also specify the importance of a “free-of-charge, easy and confidential access to meet the needs for sexual and reproductive health care among poor adolescents” (1866).
Personal Data Analysis
I originally chose to write about the subject of adolescent pregnancy in Nicaragua after my experience working in a labor and delivery unit in a public hospital in the city of Masaya. I spent almost six weeks working on the unit as a student nurse, and was able to have many discussions with expecting mothers and the working staff. I was first amazed at the number of young mothers (less than 18 years old) having not only their first child, but perhaps a second or third. At the same time, it was apparent in discussions with them, that they often had very little formal education, as evidenced by low levels of literacy or complete illiteracy. The women with the lowest levels of literacy often came from the surrounding rural areas of Masaya, and it was not uncommon that a woman would report the pregnancy was a result of non-consensual sex, meaning she was a victim of rape. She was still obligated to carry the baby to term given the government’s complete ban on abortion, or risk an illegal induced abortion which can have grave health consequences for the mother. The common Catholic teaching in Nicaragua of “all life is sacred” further encourages pregnant women, even those who have been raped, to deliver and nurture the child regardless of the circumstances surrounding the pregnancy or the situation (economic, psychological, social) of her personal life at the time.
While working at the hospital I gathered both quantitative and qualitative data. For quantitative data I relied on the Registry of Deliveries and Births, maintained by the hospital I was working in, Hospital Dr. Humberto Alvarado. Assessing all births between July 27th and August 5th, a total of 155, 34 were deliveries to mothers age 18 and younger, about a 24% adolescent birth rate for the sample selected. This is relatively consistent with overall adolescent maternity rates on the national level that I have reviewed in the articles above, and also found in the 2006/2007 Survey of Demographics and Health, published by the Nicaraguan Ministry of Health (MINSA) (38).
Of the 34 adolescent births I surveyed, 6 of the mothers had experienced some sort of problem such as requiring a cesarean delivery, having a premature membrane rupture, pelvic problems, and/or delivering a pre-term underweight child. With the data available in the registry, I was not able to compare more long term complications or more concrete demographic information. This ratio of complications also did not appear much different when compared with the 126 births to older mothers in the registry, but the sample size is too small to make any meaningful conclusions from this.
Other primary information contained in the MINSA report included the statistic the women were 13% (a total of 79% of the women surveyed) more likely to use contraceptives if they had received formal education on their benefits and use compared to only 66% of the women who had not received formal education that reported using contraceptives (13). Education overall was seen as the greatest coordinating factor for women avoiding an unwanted adolescent pregnancy (7,11).
Seeing the repeated significance of education in preventing the adverse outcomes of adolescent pregnancy, why has not more been done to address this? I interviewed several local Nicaraguans, including a retired social worker, labor and delivery nurse, and government attorney regarding this issue and other aspects of the occurrence.
Rosa Gonzalez worked at the local hospital in Masaya for over 15 years as a social worker and has a Master’s degree in Public Health. She often witnessed and had to work with the complications experienced by young mothers, who sometimes prove unable (psychologically or economically) or unwilling to care for a newborn child. In cases such as these her job was often to supervise interventions to see that the child is cared for, or in more sever cases, find other placement for the child. She describes the current rate of adolescent motherhood as “a crisis of public health” that results in poor outcomes for the mother and child, and is exacerbated by the lack of education and resources for youth in Nicaragua.
She also blames the lack of effective sexual education not only on economic poverty, but also on a political and religious unwillingness to address the issue. In her words, she says that these groups “have launched a war on meaningful sex education in Nicaragua.” This viewpoint can be supported in articles, such as those by Kampwirth and by Mannen, that elaborate the government’s antifeminist stance and “war on women’s rights,” especially in regards to reproductive rights and empowerment.
Interviews with Milena Hernandez, a labor and delivery nurse, and Carlos Andrés, an attorney with the Ministry of Justice, further supported the comments made by Gonzalez and the discussed literature. They both agreed that adolescent maternity is a public health issue, contributing to the continuance of poverty for the affected families, but an issue that has not been adequately addressed by government and religious institutions due to the traditional Catholic teachings discouraging sex education and reproduction rights.
Conclusion
The literature I gathered on this topic, from primary and secondary sources, as well as the raw data and discussions I had with other people, all seem to support the same ideas. Those outside of strict religious circles or machismo ideals, agree that adolescent pregnancy is a serious problem in Nicaragua that is detrimental to the lives of the mothers, children, and affected community. The reasons for the high prevalence include broad economic, social, and religious, as well as more specific individual factors that combine to create a vulnerable environment. But overall, the fundamental issue that can be addressed through development efforts is improving access and quality of effective sex education for adolescents that may not have a means of paying for services. As the national government has proven both unable and unwilling to do so, non-governmental organizations (NGOs) need to assume the responsibility of providing this type of outreach into the community, where it is accepted with local approval and direction. Recipients of this education should also be encouraged to refer or instruct any friends or family that could benefit from resources and information. These efforts will help make progress towards the stated MDGs and promote improved human development in the Nicaraguan community.
*Bibliography
Andrés, Carlos. “Re: Interview Questions – FSD.” Email to the author. 14 Aug. 2009.
ºBerglund, Staffan, Jerker Liljestrand, Flor de María Marín, Norma Salgado, and Elmer Zelaya. "The Background of Adolescent Pregnancies in Nicaragua: A Qualitative Approach." Social Science and Medicine 44.1 (1997): 1-12.
ºNote: this article may appear dated, being published in 1997, but I chose to use it because it still is very relevant and illustrative of my experiences this year in 2009.
Castillo, Ericka. "Cuidado Te Deja El Tren! Le Presion Social Para Casarse Y Tener Hijos (Don't Miss the Train: Social Pressure to Marry and Have Children)." La Boletina.6 (2007): 5-11.
Conde-Agudelo, Agustin, Jose M. Belizan, and Cristina Lammers. "Maternal-Perinatal Morbidity and Mortality Associated with Adolescent Pregnancy in Latin America: Cross-Sectional Study." American Journal of Obstetrics and Gyneocology.192 (2005): 342-49.
Economist Intelligence Unit. "Country Profile 2008: Nicaragua". 2008. Overview of Nicaraguan politics, resources, and economy. Economist Intelligence Unit. 8/15/2009.
.
Gonzalez, Rosa. Personal interview. 8 Aug. 2009.
Hernandez, Milena. Personal interview. 5 Aug. 2009.
Kampwirth, Karen. "Neither Left nor Right: Sandinismo in the Anti-Feminist Era." NACLA Report on the Americas.January/February (2008): 30-43.
Langer, Ana. "El Embarazo No Deseado: Impacto Sobre La Salud Y La Sociedad En America Latina Y El Caribe (Unwanted Pregnancy: Impact on Health and Society in Latin America and the Caribean)." Revista Panamericana de Salud Publica (Panamerican Journal of Public Health) 11.3 (2002): 192-205.
Mannen, Laura. "The Government War on Women's Rights in Nicaragua." Industrial Worker 106.4 (2009): 14.
Meuwissen, Liesbeth E., Anna C. Gorter, Zoyla Segura, Arnold D.M. Kester, and J.A.Knottnerus. "Uncovering and Responding to the Needs for Sexual and Reproductive Health Care among Poor Urban Female Adolescents in Nicaragua." Tropical Medicine and Internatioal Health 11.12 (2006): 1858-67.
República de Nicaragua, Ministerio de Salud (Republic of Nicaragua, Ministry of Health). "Encuesta Nicaragüense de Demografía y Salud (Survey of Nicaraguan Demographics and Health)." Ed. Ministerio de Salud (Ministry of Health): Instituto Nacional de Información de Desarollo (National Institute of Development Information), 2007.
---. Registro de Partos y Nacimientos (Registry of Deliveries and Births). Hospital Dr. Humberto Alvarado. Masaya, Nicaragua, 2009.
United Nations Development Programme (UNDP). "Millennium Development Goals". 2009. Description of United Nations Development Goals. United Nations. 8/16/2009.
.
--- “Human Development Index.” Human Development Report 2007/2008. United Nations.
*Note: all translations into English from Spanish language sources made by author.
Adolescent Pregnancy and Sustainable Development in
Nicaragua
Richard Hackett
LAS 312 – Sarlo Scholars
Professor Friedman
August 28, 2009
Introduction
A young girl, wearing plastic sandals and carrying a small bag of belongings and a blanket her mother gave her, enters the Pre-Labor unit at the local hospital. She is nine months pregnant and will be delivering her first child in the next twenty-four hours. No family members are allowed inside of the unit, meaning she waits alone as the attending nurse and physician instruct her to change into a hospital gown and assign her to a bed in the crowded room. She can hear some screaming down the hallway of another woman in delivery, and the girl begins feeling very anxious, knowing her turn to move down that hallway will soon come. After being directed to the bathroom, she changes into the gown and wanders back to the bed, awaiting further attention from the staff.
One of the nurses sorts through some paper work and begins asking the girl questions. She states her name and gives an age of 15, but indicates that it is only an approximate age since the exact year of her birth is unknown, she does appear very young, perhaps a few years younger. When then asked to sign her name on some of the hospital records she says she is unable to read or write, even her own name. After a pause, the nurse instructs her to just do the best she can and explains orally what the documents she is signing refer to.
The above scenario is not fictional. It represents a noticeable share of young mothers in Nicaragua, a young adolescent girl with relatively little or no formal education, due to a lack of access, living in a difficult economic situation and now faced with an even more difficult situation as she will have to provide for a newborn baby. The child will also be carried to term whether the pregnancy was a result of consensual sex or not, as abortion in Nicaragua is completely illegal. The expecting-mother usually has significant support from her side of the family, but also often times little or no support from the biological father. The new single parent-mother will likely struggle financially to provide for herself and her child and it is unlikely that she will ever garner more of a living than what permits day-to-day subsistence, and several years from now she may have additional children to provide for.
For someone unaffected by this type of scenario, it is easy to not pay it much attention. It is easy to place blame on the young girl for her predicament, or to place blame on the parents for perhaps having set the same example in their own lives and not having “done better” for their children. But when you delve deeper into the issue many of these Nicaraguan girls are facing, the situation becomes much more complex and intertwined with institutional norms, values and official policies (and certainly many parallels exist between Nicaragua and other societies where this occurrence is common, but this paper will focus principally on Nicaragua). The overall effect of widespread adolescent pregnancy in this country manifests itself in more sinister forms as an impediment in the lives of these girls towards education and economic determinism. The lack of what these young women can in turn provide for their children (in regards to education and economic opportunity) then cycles back to the children once they become of child-rearing age, making them more susceptible to continue enduring the same conditions of financial poverty that existed for their parents.
This paper will explore the economic, social and health impacts of adolescent pregnancy on these women and their communities in relation to the Millennium Development Goals (MDGs) brought forth by the United Nations (UN) and sustainable development. I will then survey some of the scholarly literature on teen pregnancy in Nicaragua and Latin America. This will be followed by a discussion of data I gathered recently while in Nicaragua and finalized with a conclusion of the information presented here.
A Brief Background – Economy and Education
To understand the life of this girl, it is necessary to consider the traits of the country she is from. Nicaragua is situated at the heart of Central America, with a population of about 5 million people, but is economically one of the poorest nations in Latin America. Approximately 50% of the population lives below the national poverty line (Human Development Report 2007/2008, 337). Public education is also poorly funded, and many people completely lack access, especially in rural areas. The Economist Intelligence Unit reports and illiteracy rate of five years of primary education (13). While not directly related to adolescent pregnancy in this region perhaps, these economic and educational factors have surfaced as a central theme to this topic, as both a symptom and a cause.
How Adolescent Pregnancy Relates to Development –
The Millennium Development Goals
What does the issue of adolescent pregnancy have to due with development? Using the UN’s MDGs, it becomes apparent that the negative effects of young motherhood are very relevant. Of the eight MDG’s proposed in the Millenium Declaration in 2000, more than half of them deal directly with common consequences of adolescent maternity. Goal 1, to “eradicate extreme poverty and hunger,” is impacted by the inability of a young mother to adequately support herself, since she usually has no tangible market-wage job skills and little, if any, formal education. Goal 2, to “achieve universal primary education,” is impacted by a young mother’s inability to attend a school if it is available, in lieu of caring for children at home. Goals 3, 4 and 5 are also equally relevant, addressing issues of gender equality and women empowerment, a reduction of child mortality and improving maternal health. All of these are issues which arise when looking at the root causes and effects of this issue in Nicaragua (as is mentioned repeatedly in scholarly literature and witnessed in my personal experiences), and any efforts to reach these goals through development work must focus on this widespread occurrence.
Literature Review
How exactly does a poor economy and marginal access to education contribute to teenage pregnancy? Are there other contributing factors? What are the health implications for the mother and child? Have there been any successful development strategies to intervene on behalf of these mothers and other at-risk youth? These were the types of questions I sought to address in reviewing this topic as specifically to Nicaragua as possible in the articles available.
The first article, by Berglund et al., aimed to understand the reasons for the prevalence of adolescent pregnancy amid Nicaraguan youth despite the fact that these young girls must see and experience the negative consequences of it among their own family and friends. As the authors state, “they know that having unwanted children often leads to infant malnutrition, child abuse, family instability, and difficulties in caring for all of the children, as well as keeping them off the street with their material as well as educational needs” (1). All of these consequences reflect back to the MDGs previously mentioned.
Factors attributed to these pregnancies by the authors included economic deprivation, broken family relations, low self-esteem, strict religious practices (Catholic church teaching of sex for procreation and disapproval of contraceptive use or abortion), lack of education, and social isolation. Another factor the authors mentioned is Nicaragua’s dependence on an agricultural export economy, which requires large numbers of working men to migrate throughout the country for months at a time and may contribute to a loss of the traditional family structure (2). This would contribute to men who are away from their partners for long periods of time, selecting other women to have relations with, and then being unable to provide adequate support for multiple mother’s of fathered children. Likewise, the abandoned young mothers and growing daughters are left at home, and are more likely to suffer sexual abuse resulting in unwanted pregnancy from boyfriends or stepfathers (2, 4).
Berglund et al., conclude their article by calling for increased access to sexual education. They point out that many of the youth actually have moderate access to contraceptives, but do not use them (or do not use them properly) because of misconceptions about the effects and use, or social values, such as machismo and religious attitudes, that frown on contraceptive use. The authors state that “access to sexual education is evidently the most effective insurance against unwanted pregnancy,” and that Nicaragua as a whole, must “reveal and publicize, as widely as possible, the reality of unwanted pregnancy in the country” (11).
A separate article by Castillo picked up on a point, also mentioned by Berglund et al., by examining the overt social pressures placed on young women in Nicaragua to marry and have children as soon as possible. The article says that many times it is the actual parents of the young woman that place the most pressure on her to have children, often saying things such as “’ be careful that you don’t discontinue the train, you must have children so that someone cares for you when you are older’” (5). Additionally, because of the elevated status that married women and mothers receive, progressing from a young single teenage girl to a married woman and/or mother can be seen as a quick way to increase your social status; as one young woman says in the article, “’for [our] society a married woman is a respected woman...the civil status of a woman is like a title, as if it is a professional degree’” (6).
Regarding adolescent pregnancy as a global health issue, a third article by Conde-Agudelo, Belizán, and Lammers examined the more independently the physiological health consequences from adolescent pregnancy in Latin America. Given that close to 20% of all births in Latin America are attributed to teenage mothers (World Health Organization, as cited in Lammers et al., 342), these authors conducted a research study to look for an increase in adverse outcomes while adjusting as possible for confounding variables.
Using a hospital-based retrospective cross-sectional study, the researchers screened over 850,000 pregnancy outcomes of Latin American women under the age of 25. According to their study, adolescent mothers actually had less likelihood of requiring a cesarean delivery, experiencing third-trimester bleeding, or developing gestational diabetes (345-346). However, women under 15 had a higher risk for maternal death, early neonatal death, and anemia, compared to mothers in their early twenties. All adolescent mothers had a greater incidence of postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for gestational-age infants (345-346). Additionally, the researchers cited additional studies relating increased adverse maternal outcomes for young mothers, as being independent of socioeconomic status, meaning the occurrence of adolescent pregnancy should be prevented even in communities where poverty is of less concern (348).
Two final articles, by Langer and by Meuwissen et al., in addition to commenting on many of the risk factors and consequences already elaborated on here, call for a solution which incorporates improved and increased access to sexual education and related healthcare services. Langer states that given the trend in Latin America, it is necessary to develop “mass communication programs that address gender issues, education, programs for girls, and sex education [in addition to] health services that include family planning methods” (203). Meuwissen et al., support this finding, but also specify the importance of a “free-of-charge, easy and confidential access to meet the needs for sexual and reproductive health care among poor adolescents” (1866).
Personal Data Analysis
I originally chose to write about the subject of adolescent pregnancy in Nicaragua after my experience working in a labor and delivery unit in a public hospital in the city of Masaya. I spent almost six weeks working on the unit as a student nurse, and was able to have many discussions with expecting mothers and the working staff. I was first amazed at the number of young mothers (less than 18 years old) having not only their first child, but perhaps a second or third. At the same time, it was apparent in discussions with them, that they often had very little formal education, as evidenced by low levels of literacy or complete illiteracy. The women with the lowest levels of literacy often came from the surrounding rural areas of Masaya, and it was not uncommon that a woman would report the pregnancy was a result of non-consensual sex, meaning she was a victim of rape. She was still obligated to carry the baby to term given the government’s complete ban on abortion, or risk an illegal induced abortion which can have grave health consequences for the mother. The common Catholic teaching in Nicaragua of “all life is sacred” further encourages pregnant women, even those who have been raped, to deliver and nurture the child regardless of the circumstances surrounding the pregnancy or the situation (economic, psychological, social) of her personal life at the time.
While working at the hospital I gathered both quantitative and qualitative data. For quantitative data I relied on the Registry of Deliveries and Births, maintained by the hospital I was working in, Hospital Dr. Humberto Alvarado. Assessing all births between July 27th and August 5th, a total of 155, 34 were deliveries to mothers age 18 and younger, about a 24% adolescent birth rate for the sample selected. This is relatively consistent with overall adolescent maternity rates on the national level that I have reviewed in the articles above, and also found in the 2006/2007 Survey of Demographics and Health, published by the Nicaraguan Ministry of Health (MINSA) (38).
Of the 34 adolescent births I surveyed, 6 of the mothers had experienced some sort of problem such as requiring a cesarean delivery, having a premature membrane rupture, pelvic problems, and/or delivering a pre-term underweight child. With the data available in the registry, I was not able to compare more long term complications or more concrete demographic information. This ratio of complications also did not appear much different when compared with the 126 births to older mothers in the registry, but the sample size is too small to make any meaningful conclusions from this.
Other primary information contained in the MINSA report included the statistic the women were 13% (a total of 79% of the women surveyed) more likely to use contraceptives if they had received formal education on their benefits and use compared to only 66% of the women who had not received formal education that reported using contraceptives (13). Education overall was seen as the greatest coordinating factor for women avoiding an unwanted adolescent pregnancy (7,11).
Seeing the repeated significance of education in preventing the adverse outcomes of adolescent pregnancy, why has not more been done to address this? I interviewed several local Nicaraguans, including a retired social worker, labor and delivery nurse, and government attorney regarding this issue and other aspects of the occurrence.
Rosa Gonzalez worked at the local hospital in Masaya for over 15 years as a social worker and has a Master’s degree in Public Health. She often witnessed and had to work with the complications experienced by young mothers, who sometimes prove unable (psychologically or economically) or unwilling to care for a newborn child. In cases such as these her job was often to supervise interventions to see that the child is cared for, or in more sever cases, find other placement for the child. She describes the current rate of adolescent motherhood as “a crisis of public health” that results in poor outcomes for the mother and child, and is exacerbated by the lack of education and resources for youth in Nicaragua.
She also blames the lack of effective sexual education not only on economic poverty, but also on a political and religious unwillingness to address the issue. In her words, she says that these groups “have launched a war on meaningful sex education in Nicaragua.” This viewpoint can be supported in articles, such as those by Kampwirth and by Mannen, that elaborate the government’s antifeminist stance and “war on women’s rights,” especially in regards to reproductive rights and empowerment.
Interviews with Milena Hernandez, a labor and delivery nurse, and Carlos Andrés, an attorney with the Ministry of Justice, further supported the comments made by Gonzalez and the discussed literature. They both agreed that adolescent maternity is a public health issue, contributing to the continuance of poverty for the affected families, but an issue that has not been adequately addressed by government and religious institutions due to the traditional Catholic teachings discouraging sex education and reproduction rights.
Conclusion
The literature I gathered on this topic, from primary and secondary sources, as well as the raw data and discussions I had with other people, all seem to support the same ideas. Those outside of strict religious circles or machismo ideals, agree that adolescent pregnancy is a serious problem in Nicaragua that is detrimental to the lives of the mothers, children, and affected community. The reasons for the high prevalence include broad economic, social, and religious, as well as more specific individual factors that combine to create a vulnerable environment. But overall, the fundamental issue that can be addressed through development efforts is improving access and quality of effective sex education for adolescents that may not have a means of paying for services. As the national government has proven both unable and unwilling to do so, non-governmental organizations (NGOs) need to assume the responsibility of providing this type of outreach into the community, where it is accepted with local approval and direction. Recipients of this education should also be encouraged to refer or instruct any friends or family that could benefit from resources and information. These efforts will help make progress towards the stated MDGs and promote improved human development in the Nicaraguan community.
*Bibliography
Andrés, Carlos. “Re: Interview Questions – FSD.” Email to the author. 14 Aug. 2009.
ºBerglund, Staffan, Jerker Liljestrand, Flor de María Marín, Norma Salgado, and Elmer Zelaya. "The Background of Adolescent Pregnancies in Nicaragua: A Qualitative Approach." Social Science and Medicine 44.1 (1997): 1-12.
ºNote: this article may appear dated, being published in 1997, but I chose to use it because it still is very relevant and illustrative of my experiences this year in 2009.
Castillo, Ericka. "Cuidado Te Deja El Tren! Le Presion Social Para Casarse Y Tener Hijos (Don't Miss the Train: Social Pressure to Marry and Have Children)." La Boletina.6 (2007): 5-11.
Conde-Agudelo, Agustin, Jose M. Belizan, and Cristina Lammers. "Maternal-Perinatal Morbidity and Mortality Associated with Adolescent Pregnancy in Latin America: Cross-Sectional Study." American Journal of Obstetrics and Gyneocology.192 (2005): 342-49.
Economist Intelligence Unit. "Country Profile 2008: Nicaragua". 2008. Overview of Nicaraguan politics, resources, and economy. Economist Intelligence Unit. 8/15/2009.
Gonzalez, Rosa. Personal interview. 8 Aug. 2009.
Hernandez, Milena. Personal interview. 5 Aug. 2009.
Kampwirth, Karen. "Neither Left nor Right: Sandinismo in the Anti-Feminist Era." NACLA Report on the Americas.January/February (2008): 30-43.
Langer, Ana. "El Embarazo No Deseado: Impacto Sobre La Salud Y La Sociedad En America Latina Y El Caribe (Unwanted Pregnancy: Impact on Health and Society in Latin America and the Caribean)." Revista Panamericana de Salud Publica (Panamerican Journal of Public Health) 11.3 (2002): 192-205.
Mannen, Laura. "The Government War on Women's Rights in Nicaragua." Industrial Worker 106.4 (2009): 14.
Meuwissen, Liesbeth E., Anna C. Gorter, Zoyla Segura, Arnold D.M. Kester, and J.A.Knottnerus. "Uncovering and Responding to the Needs for Sexual and Reproductive Health Care among Poor Urban Female Adolescents in Nicaragua." Tropical Medicine and Internatioal Health 11.12 (2006): 1858-67.
República de Nicaragua, Ministerio de Salud (Republic of Nicaragua, Ministry of Health). "Encuesta Nicaragüense de Demografía y Salud (Survey of Nicaraguan Demographics and Health)." Ed. Ministerio de Salud (Ministry of Health): Instituto Nacional de Información de Desarollo (National Institute of Development Information), 2007.
---. Registro de Partos y Nacimientos (Registry of Deliveries and Births). Hospital Dr. Humberto Alvarado. Masaya, Nicaragua, 2009.
United Nations Development Programme (UNDP). "Millennium Development Goals". 2009. Description of United Nations Development Goals. United Nations. 8/16/2009.
--- “Human Development Index.” Human Development Report 2007/2008. United Nations.
*Note: all translations into English from Spanish language sources made by author.
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