By: OLGA LUCIA MUÑOZ LÓPEZ.
Adolescent pregnancy, one of the main factors contributing to maternal and infant mortality and to the circle of disease and poverty, is declining in Colombia and the world, but it continues to impact the future possibilities of this population.
If a girl or teenager is pregnant today, she will not be abandoned on Punishment Island or thrown down a cliff, as was usual many years ago in some regions of Uganda in Africa. But it is certain that this early pregnancy negatively impacts the potential of their future, and having their child reproduces a perpetual circle of poverty derived from fewer opportunities.
When a teenager becomes pregnant or has a child, her health, education, earning potential and all her future are in danger: the risk of being trapped in a life of poverty, exclusion, and impotence increases significantly. Teenage pregnancy occurs in all corners of the world, but poor and uneducated people, ethnic minorities, marginalized groups, and inhabitants of remote and rural areas are 3 times more likely to become pregnant than their educated and urban peers, according to annual reports of the United Nations Population Fund (UNFPA).
One of the objectives of the Convention on the Rights of the Child (1989) is the strong reduction of teenage pregnancies. In terms of public policy, it is important to take care of it, given its effects on health, human capital accumulation, and work performance of young women who are exposed to early motherhood. In terms of health, pregnant teenagers are less likely to have access to prenatal care, institutional care for childbirth, and postpartum care, making them more likely to experience complications in pregnancy and childbirth that endanger their life or that of the baby. In addition, they are at increased risk of unsafe and illegal abortions.
Hence, complications of pregnancy and childbirth are the leading cause of mortality among women aged 15-19 years in low and middle-income countries. It is estimated that in 2008, 3 million unsafe abortions were made to adolescents in these countries. As for the baby, the children of young mothers are at higher risk of pre-term birth, low birth weight, asphyxia and perinatal mortality (World Health Organization -WHO-, 2011).
And, in economic matters, teenage pregnancies have negative repercussions for young women, their families, and their communities. Early pregnancy tends to induce girls to drop out of school: with little or no education, they will have less work skills, so they will accumulate less human capital and reduce their chances of finding a job. In the long run, they will have lower incomes, which negatively affects the economic growth of the country, since the annual income that a young woman would have earned throughout her life, had she not had an early pregnancy, is lost. The probability of completing higher education is also reduced. For this reason, the adolescent pregnancy rate is one of the main obstacles at the national level for women in the country to overcome the contexts of poverty and inequality.
Drop in adolescent pregnancies in the world
Although there has been a considerable, albeit erratic decline in birth rates since 1990, about 11% of all births in the world (equivalent to about 16 million) still occur among girls aged 15 to 19, and one million more among children under 15 years of age, according to WHO. The vast majority of these births (95%) occur in low and middle-income countries.
World Health Statistics from 2014 indicate that the average global birth rate among teens aged 15 to 19 is 49 per 1,000 girls. National rates range from 1 to 299 births per 1,000 girls, with the highest data coming from sub-Saharan Africa.
Early pregnancy is a global problem: Every day in developing countries, 20,000 girls under the age of 18 give birth and 200 die from complications related to pregnancy or childbirth. Globally, 7.3 million adolescents become mothers each year, of which 2 million are under the age of 15, a figure that can increase to 3 million by 2030 if the trend does not reverse.
Adolescents account for approximately 18% of the world's population, and 88% of them live in developing countries. An estimated 70,000 adolescents in these countries die each year from complications during pregnancy or childbirth. In addition, pregnant girls before the age of 15 have twice the risk of maternal death.
Latin America: the region with most teenage pregnancies.
Although programs aimed at safer sexualities, family planning, and contraceptive methods have been effective in regions of the world such as Africa or Southeast Asia, in Latin America the number of teenage pregnancies continues to grow. This was confirmed at the First Conference of Latin America and the Caribbean to reduce inequities in Sexual and Reproductive Health (LAC2016), in September 2016 in Cartagena.
Representatives of 22 governments and civil society organizations analyzed increases in adolescent pregnancy, childbirth deaths, and poorly performed abortions, despite improvements in educational and health coverage in each country. A call was made, in addition to specific laws and protocols, to promote sexual and reproductive health services among young people, to get them to postpone, plan and/or prevent unwanted pregnancies.
In Latin America, maternal mortality is among the top 3 causes of death between 15 and 19 years, unsafe abortions approach 670,000 per year, and adolescent pregnancy rates (16.5%) are higher than those in Africa (14.1%). States and civil organizations should join efforts to promote family planning programs.
2% decrease in adolescent pregnancy in 2015 in Colombia: ENDS 2015
Last December, the National Demographic and Health Survey (ENDS) 2015 highlighted the decline in teenage pregnancy in Colombia by around 2 percentual points: from 19.5% in 2010 to 17.4% in 2015. This means that 17.4% of women between the ages of 15 and 19 are already mothers or have been pregnant: one in five women under the age of 19 has had a pregnancy. This figure is the first decline in this indicator in 20 years, and the lowest in the last 15 years, which shows a significant turning point in the growing trend of the problem.
The situation in the rural area is more worrying, because there the rate is 26%, compared to 17% in urban areas. The departments with the highest index are Amazonas, Guainía, Vichada, Chocó and Cesar.
ENDS 2015 also concluded that education plays a crucial role as a determinant of reproductive behaviors and as the main vehicle for people to overcome poverty and exclusion. 7 out of 100 teenagers leave school because they are pregnant, and the reduction of teenage pregnancies has a higher impact on high socioeconomic levels than on low ones.
Between 2008 and 2016, teenage pregnancy in Colombia fell by 20%: Dane
As in most Western countries, where births have fallen in recent years and the aging of the population has increased, in 2016 Colombia recorded a minimum of births and a maximum number of deaths. According to a report by Dane, 641,493 births were recorded, the lowest preliminary figure since records began in 1998, and 207,158 deaths, the highest number of deaths since 1998.
The number of births denotes the sustained reduction of the birth rate, and the death rate displays the continuous aging of our population: the growth of the Colombian population continues to decline.
And, within that reduction of birth rates, teenage pregnancies continued to fall in numbers and proportion: at the national level, it went from a high of 167,422 cases in 2008 to 134,454 in 2016, a 20% reduction in 8 years. In 2012 it reached a proportion of 24% on the total of national births, and in 2016 that proportion was reduced to 20.9%.
According to Health Minister Alejandro Gaviria, part of the fall in teenage pregnancies is attributable to a 6% increase in condom use in this population group (according to ENDS 2015, which implies a significant sociocultural change).
In Antioquia, the drop in teenage pregnancies was much higher than the national average, from 23,898 cases in 2006 to 16,537 in 2016, a drop of 31% in 10 years. However, the proportion of births by adolescent mothers over total births in Antioquia continues to exceed the national average by more than one percentual point: while the national average was 20.9% in 2016, that of Antioquia was 22.1%.
In Bogota, according to the Department of Health, 233 births of teen girls were recorded in 2016: every 36 hours a girl became a mother. Although there were improvements over 2015, when there was a child giving birth every 24 hours, it is still a very high figure, considering the socio-economic factors behind those numbers.
The first is the direct correlation of early-age pregnancies and sexual abuse; According to statistics from 2016, in 11 cases the father was a male under 14 years, in 147 it was someone between 15 and 19 years of age, and 75 were men between 20 and 60 years. Another factor: a pregnant minor is much more likely to drop out of school and be trapped in contexts of poverty, which can limit her chances of developing a different life plan than raising children and increasing gender inequality in the country. And another factor is to assume motherhood as a protection mechanism in violent contexts.
In the last 6 years, 2,892 girls in Bogotá had their first child before reaching the age of 14: 2010 being the year with the highest index, with 515 cases. However, comparing year after year, the rate of pregnancy of girls in the city fell by 58%.
It is noteworthy the case of La Candelaria, a municipality that in 2013 reached a rate of 29 pregnancies of children under 14 years for every 100,000 inhabitants, and then, in 2016, the indicator fell to zero, through psychosocial care to prevent pregnancies. 400 students were attended, because of their socioeconomic status and environment, were at high risk of having premature pregnancies. The awareness campaigns carried out by the hospital network in the south of Bogota, which worked on prevention methods with children, were also very useful.
Slight decrease according to Medellín: Cómo Vamos
In Medellín, the proportion of adolescent pregnancy reached a maximum of 23.7% in 2007, and then began to decline, reaching a rate of 18.9% in 2016, according to the report "Medellín Cómo Vamos 2016". The decrease was primarily due to the proportion of pregnancies in women aged 15 to 19 years, from 8,038 cases in 2008 to 5,840 in 2016, a reduction of 27%, which equals to a decrease from 22.6% to 18.1%. The proportion of pregnancies in girls aged 10 to 14 years remained relatively stable, ranging from 0.9% to 1.0%, although in absolute terms the number of pregnancies fell from 382 in 2006 to 277 in 2016.
Despite the decline in the proportion of pregnancies and the rate of fertility in adolescents, there are clear territorial differences in Medellín. For girls between 10 and 14 years of age the fertility rate varies significantly by communes and settlements: each year several districts considerably exceeded the Medellin fertility rate for that age group. Between 2013-2016, the areas of Popular, La Candelaria, San Javier, Santa Cruz, Manrique, Aranjuez and Villa Hermosa had rates higher than those of the city. This contrasts with Poblado and Laureles-Estadio, whose general rate is close to zero; in 2015 the teenage fertility rate in La Candelaria doubled the rate of the city.
In adolescents between 15 and 19 years old, in popular districts and suburbs, there are clearer and more persistent patterns of teen pregnancy concentration: 8 communes exceed Medellín’s fertility rate, with no significant advances between 2013 and 2016: Popular, Manrique, San Javier, Villa Hermosa, Santa Cruz, Aranjuez, Robledo and Buenos Aires. Meanwhile, the neighborhoods El Poblado and Laureles-Estadio had the lowest rate of fecundity in adolescents. The case of Popular and Manrique stands out, with fertility rates that far exceed those of the city: during the 4 years analyzed Popular's fertility rate was, on average, 1.8 times that of Medellín for this age group, and in Manrique it was 1.5 times that of Medellin.