June 6, 2014
June 6, 2014
With Mexico’s teen fertility rate rising over the past 15 years, experts and teen mothers evaluate government prevention efforts.
MEXICO CITY, MEXICO – At 15, María Isabel Ibarra Hernández is pregnant with her second child.
She was 13 when she first became pregnant. At the time, she had been dating her baby’s father for nine months and living with him for four months, she says.
This morning, María Isabel is visiting the Community Health Center in the Hank González neighborhood of Ecatepec de Morelos municipality in Mexico state.
Teenagers carry nearly one-fifth of the pregnancies in Mexico state, according to the National Institute of Geography and Statistics. More than 40 percent of the residents of Ecatepec – which adjoins Mexico City, the nation’s capital – are poor, according to the Municipal System of Statistical and Geographical Information.
The weekly workshop for pregnant teenagers is part of Holistic Care for the Teenage Mother, a program managed by Mexico’s National System for the Integral Development of the Family.
The program operates in neighborhoods that account for most of Ecatepec’s teenage pregnancies, says Tania Pelcastre Ángel, who runs the system’s office in the municipality.
This is María Isabel’s first time at the workshop. She knew nothing about preventing pregnancy before she got pregnant because she left school after the second grade and had never been to the health center, she says.
María Isabel would have preferred to wait for motherhood, but her boyfriend was eager to have a child, she says. She asked him to wait until she had her “quinceañera” party, a celebration that marks the transition of a 15-year-old girl into adulthood. But they did not use protection.
“The truth is that I did fall in love with my husband,” she says. “He used to ask me for a child, and I gave it to him.”
María Isabel and her boyfriend, the father of both of her children, fought constantly and are separated. Now living with her parents, she says all she wants to do is to support her children.
She plans to look for a stable job after her second child is born. Meanwhile, she sells merchandise in subway cars.
Aiming to reduce unplanned teen pregnancies, the Mexican government has promoted prevention for three years. But critics says its campaigns target teenagers who can control their sex lives without taking into account how marginalization, gender violence, and access to sex education and contraception affect other teens. Although the government has also implemented actions to guarantee teenagers access to contraception, reproductive rights activists say access will not reduce the pregnancy rate unless programs ensure that teens obtain contraceptives and learn to use them effectively. Furthermore, sex education should go beyond providing information and promote sexual and reproductive rights, activists say.
Although the country’s overall fertility rate fell between 1999 and 2013, the fertility rate among 15- to 19-year-olds increased from 64 to 66 births per every 1,000 teens, according to the National Institute of Geography and Statistics.
More than 40 percent of pregnancies among 15- to 19-year-olds are not planned or desired, according to the National Population Council.
The Mexican government has focused on teenage sexual and reproductive health only in the past few years, according to the council. In 2011 and 2013, the council and the Ministry of Health launched campaigns aimed at helping 15- to 19-year-olds avoid unplanned pregnancies and sexually transmitted diseases.
The campaigns strive to empower teenagers to assume responsibility for sexual decisions, says Rufino Luna Gordillo, deputy director general of sexual and reproductive health for the National Center of Gender Equity and Reproductive Health, which is under the Ministry of Health.
“If you take the responsibility to initiate an active sexual life, there [is] the responsibility of protection for themselves, including for their partner,” he says. “The idea is to empower these teens that if they can make this decision, they must also decide to protect themselves.”
Marisol, 17, a participant in the Holistic Care program in Ecatepec’s San Agustín neighborhood, agrees that teens must protect themselves. Marisol, who is nine months pregnant, requests partial anonymity for fear of being stigmatized.
“You have the responsibility,” she says. “You know what you want for your future. I think it would be an issue in which each person would know how to take care of themselves.”
Isabel Fulda, executive analyst of Grupo de Información en Reproducción Elegida, which means “information group for reproductive choice,” an organization that promotes and defends women’s reproductive rights, criticizes the government for promulgating the idea that teenagers alone are responsible for unplanned pregnancies.
“The idea is always: The youth get pregnant because they do not take care of themselves,” Fulda says. “But in reality, the responsibility there is the state’s, and the large number of teen pregnancies that there are, are the product of structural problems and deficiencies that the state should cover.”
The government must address social factors that contribute to teenage pregnancies, including poverty, social inequality, discrimination, gender violence, and a lack of access to contraception and sex education, Fulda says.
Marisol says she left school because of family problems and moved in with her boyfriend. They had been living together for two months when she became pregnant.
Marisol says she got pregnant because she was not careful with contraceptives. She had previously used the calendar method, in which a woman tracks her menstrual cycle and refrains from sex while ovulating, but abandoned it when she started living with her boyfriend. They sometimes used a condom.
Although 90 percent of young people ages 12 to 19 have at least heard about contraceptive methods, only about 33 percent of sexually active females and 15 percent of sexually active males used protection in their first sexual encounters, according to the 2012 National Health and Nutrition Survey.
Further, 36 percent of sexually active teens have never used contraception, according to the National Population Council.
Mexican law requires all public clinics, health centers and hospitals to provide free informational services, advice and contraceptives to anyone 15 to 49 who requests such assistance.
Despite the law, teenagers do not have sufficient access to contraception from public health services, Fulda says. There is a shortage of contraceptives, and many health center employees defy the law, refusing to give teenagers information and contraceptives.
Jaqueline Gabriela Salinas Hernández, an 18-year-old in her fourth month of pregnancy, attends the Holistic Care program in San Agustín. Before becoming pregnant, she never visited a health center to request information on sexuality or contraception because she thinks adults frown on teen sexual activity.
“It still looks very bad,” she says. “It looks like taboo, so that the youngest are not given information. I would not have gone. In school, well, yes, but [to come] here to be given a condom, not me.”
At Salina’s school, student-run campaigns made sexual education and contraceptives available. To avoid facing criticism or rejection, teenagers would go to the public health centers if other teens were staffing them, she says.
Luna says the government is working to eliminate these obstacles.
The low rates of contraception use among teenagers signify that teens do not have sufficient access to contraceptives, not that the government prevention campaigns are ineffective, Luna says. He blames the shortage of contraceptives on the states’ failure to adequately manage their funding. Starting this year, the federal government has assumed responsibility for buying contraceptives for distribution to public health centers.
Luna acknowledges that health center employees commonly deny teens information and contraceptives. The Ministry of Health is working to change that, he says.
Since 2000, it has operated a program, Friendly Services for Teens, to train ministry employees to provide information about sexual and reproductive health. The ministry is about to publish a care model to sensitize those in charge of this program to adequately attend to young clients.
The program exists at about 1,000 of the 16,000 health centers the ministry operates, Luna says. He aims to increase that number.
Fulda stresses that making contraceptives available does not ensure that teens will obtain them, know how to use them and use them adequately. She also sees a deeper obstacle to contraceptive use.
“In many cases, it is a matter of gender equality in the couple and how the women, despite them knowing about [contraceptive methods], still do not have the power to tell their partner to use them, or to use them themselves, or to refuse to have a relation if there is not a condom or another type of contraceptive,” she says.
Salinas says girls often are not mindful of the consequences of unprotected sex at the moment they consent. The desire to resist parental authority is another factor.
“I feel that it is more the rebellion, and that when the moment happens, you forget everything,” she says. “You do not think about what you are going to do afterwards, what is going to happen.”
Salinas learned about contraception in a high school class on sexuality. But her boyfriend did not want to use condoms.
“He did not like it,” she says. “He said that it [sex] was not the same.”
Her teacher suggested she use birth control pills. Agreeing, she bought the pills at a pharmacy because she was uncomfortable going to a public health center.
Salinas became pregnant because she sometimes forgot to take her birth control pills, she says.
Pelcastre says girls and young women who lack clear goals are especially likely to become pregnant because they see pregnancy as an alternative for the future. About 80 percent of the approximately 1,500 pregnant teens Pelcastre has worked with in the Holistic Care workshops became pregnant despite knowing about contraception.
Some girls fail to prevent conception because teen pregnancy is normal in their communities, she says. The mothers of many pregnant teens also began having children in their youth.
Sex education is not obligatory in Mexican schools. Sex is addressed in courses on natural sciences, civics and ethics, according to Democracia y Sexualidad, a regional network of Latin American civic organizations promoting sex education and sexual and reproductive rights.
In 2008, Mexico was one of 30 Latin American and Caribbean countries to sign the “Prevent with Education” declaration, a commitment to provide comprehensive sex education to teenagers and youth. Mexico still needs to improve the inclusion of information on sexual and reproductive health in school curricula as required by the declaration, according to a 2012 evaluation by Democracia y Sexualidad.
Fulda says Mexico has yet to fulfill that obligation.
Proposals to incorporate sex education in school curricula have been debated for years. The inclusion of sexuality in science, civics and ethics courses has come about despite resistance from conservatives.
The sex education course that Salinas took was held outside school hours, and attendance was voluntary.
A counselor at Marisol’s high school occasionally spoke to her class about sexuality, but the information was basic, she says. For example, the teacher spoke about the importance of using condoms but did not explain how to use them or advise students what to do if one breaks.
Teachers of sex education in a Mexican school typically explain the functions of reproductive organs, list contraceptive methods and sexually transmitted diseases, and tell teenagers to use protection, says Manuel Amador Velázquez, a high school teacher in the Hank González neighborhood.
Sex education should promote the full exercise of teenage sexuality, addressing issues such as pleasure, sexual diversity, gender violence and emotional bonds, Amador says.
Amador teaches classes at the high school as part of an alternative education project that promotes dignity and liberation for teenagers in marginalized environments. Familial and partner violence, a loss of emotional bonds, poverty, parental abandonment, educational backwardness, insecurity, discrimination and drug use mark daily life for young people in the neighborhood, he says.
“With all of these elements, where does the full exercise of sexuality truly come into play?” Amador asks.
Like Fulda, Amador questions how effective government prevention programs can be if they do not consider the context of the lives of young people.
“There is no public policy that can really influence the education for the parents, the education for the students, the full exercise of sexuality,” he says.
Luna agrees that sex education should be comprehensive, but he says education is not the sole responsibility of government agencies. Comprehensive education requires a change in mindset, beginning with the family.
In addition to providing information on sexual and reproductive health, government sex education programs must help girls discover their abilities so they can appreciate their options for the future, Pelcastre says. They also must teach pregnant teenagers that motherhood need not restrict their possibilities.
The Holistic Care program, for example, limits itself to providing information about prenatal care instead of encouraging girls to build a life plan, she says.
The key is the liberty to choose, Amador says.
“Many girls could have an aspiration to decide freely whether to become pregnant,” he says. “The problem is not becoming pregnant. … The problem is if you really choose it freely or it was the cultural or economic situation or the poor quality of bonds that you have in your family.”
GPJ translated this article from Spanish.
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