Early adolescent pregnancy: A comprehensive look - Sexual and reproductive rights in adolescents below 15

Dos niñas abrazadas

Montevideo, November 21, 2023. The Latin American Center for Perinatology - Women's and Reproductive Health (CLP/WR), in conjunction with the International Federation of Infant and Adolescent Gynecology (FIGIJ), the Argentine Society of Infant and Adolescent Gynecology (SAGIJ) and the Latin American Association of Infant and Adolescent Gynecology (ALOGIA), organized the webinar: Early adolescent pregnancy: A comprehensive look - Sexual and reproductive rights in adolescents below 15.

The seminar proposed an approach from different perspectives to an issue that has a strong impact on the health of girls and adolescents in the region of the Americas.

Initiation of sexual relations in minors under 15: Decision or coercion?

The first speaker was Dr. Carlota Lopez Kaufman, president of ALOGIA, who presented the study: Initiation of sexual relations in minors under 15. Decision or coercion?, carried out in Buenos Aires and Santa Fe, Argentina. Lopez Kaufman referred to the complexity of this issue that "expresses and combines psychosocial aspects of gender, justice and human rights".  Through a survey of 323 adolescents, the aim was to learn more about the characteristics of the first sexual intercourse, the prevalence of coercion in the initiation of sexual relations and the consequences.

Among other aspects, this research shows that the younger the adolescent, the greater the probability of forced sexual initiation. In addition, the decision to initiate sexual relations is not always a conscious decision, nor is it a decision in which the risks and consequences are evaluated. More information on this survey can be accessed here.

Although Lopez Kaufman acknowledged the difficulties in extrapolating the results of the study to a national level, she pointed out that they are contributions that "enrich the existing literature and can be applied to public policies and strategies for the prevention and promotion of sexual and reproductive health, aimed at promoting a healthy sexuality, free of violence and responsible".

Comprehensive Sexuality Education

María Eugenia Otero, coordinator of the Comprehensive Sex Education (ESI, for its acronym in Spanish) postgraduate program at the Instituto Superior del Profesorado Joaquín V. González in Buenos Aires, Argentina, explained how ESI is a tool for the identification and prevention of situations of abuse and violence.

Otero began her presentation by stating that, despite what is often thought to the contrary, everyone has had sex education. The specialist said that there is "a strong indoctrination in relation to sexuality and gender, both at school, at home, in families, in the media, in the street... A lot of situations in which we were indoctrinated, disciplined, in relation to how we should be women and men, what behaviors, what roles and what places we could occupy".

She also referred to the National Program of Integral Sexual Education (ESI) that addresses sexual education articulating biological, psychological, social, affective and ethical aspects. "When we talk about ESI we are talking about a positioning, a look... about being able to accompany girls and boys to develop their autonomy and be able to make their own decisions," she pointed out and mentioned the approaches through which the contents are worked on.

Otero then referred to the positive impact that ESI has on the identification and prevention of situations of abuse and violence. However, she expressed that, despite the evidence, there is still resistance to these approaches and pointed out that it is necessary to join efforts in order not to regress in acquired rights "that guarantee full and dignified lives".

Understanding the impact of trauma

For her part, Dr. Judith Simms Cemdam, President of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) of the United States, spoke about the appropriate approach to consultations in children under 15 years of age and the importance of understanding the impact of trauma.

She began by defining trauma as "an event, situation or circumstance that produces physical, emotional or life-threatening harm and can lead to adverse effects on mental, physical, social, emotional and emotional health". Simms mentioned the most frequent traumas faced by adolescents and girls, among which are sexual assault and traumatic obstetric experiences, such as childbirth or abortion. The specialist also mentioned that "trauma is defined by the person who experiences it" and that is why it is not possible to judge how a person experiences a certain situation.

The specialist said that a history of trauma is a risk factor for teenage pregnancy. "Trauma has an enormous impact on the neurodevelopment of children and adolescents, alters the formation of identity, increases risk behaviors and has an impact on sexual decision-making," she said.

For this reason it is of utmost importance that health teams are trained to understand these situations and have the tools to accompany the processes of adolescent girls.

Simms mentioned that there are barriers to dealing with these issues both from the patients (embarrassment, lack of confidence, among others); barriers from the individual physicians (discomfort, lack of linguistic tools, exhaustion) and from the system (little time for consultations, insufficient resources to address these issues). For this reason, it is essential to have properly trained teams capable of creating safe environments where patients can feel confident and where those who have undergone or are undergoing a traumatic process are not re-victimized.

Risks of pregnancies in adolescents bellow 15

Fanny Corrales, president of the Society of Obstetrics and Gynecology for Children and Adolescents (SOGIA) of Paraguay, gave a presentation focused on the health risks involved in pregnancies in children under 15 years of age. Corrales referred to a study carried out in the United States which concludes that adolescents have a higher prevalence of premature births, low birth weight babies and neonatal mortality.

She also pointed out that, although reference is often made to the low socioeconomic level, inadequate prenatal care and inadequate weight gain during pregnancy, these are not the main risk factors, but rather uterine immaturity has a greater incidence.

The president of SOGIA elaborated on specific aspects of uterine immaturity and the impact it has on adolescent girls during pregnancy and childbirth, particularly the complications it entails.

Immediate Post-Obstetric Event Contraception

Finally, the PAHO Regional Advisor on Sexual and Reproductive Health, Dr. Rodolfo Gómez Ponce de León, spoke about the importance of Immediate Post Obstetric Event Contraception (AIPEO for its acronym in Spanish) and, in particular, its relevance in preventing second pregnancies in adolescence.

Gómez expressed that, in the region, during the period from adolescence to 20 years of age, 60% or 65% of adolescents repeat a new pregnancy before adulthood and considered that this is a failure of the health system. The expert presented a series of studies that demonstrate the efficacy of long-acting reversible methods and mentioned the strategy promoted by PAHO.

In this regard, he highlighted the training through free virtual courses for health professionals (Family Planning and Immediate Post Obstetric Event Contraception); the organization of workshops in which simulators are used to train trainers who then replicate the knowledge at the local and national level; and the creation of simulation centers in AIPEO, with the donation of materials to be able to continue scaling up training in priority countries.   

In addition, Gómez expressed that this is one of the necessary interventions, but it is not the only one. Among the priority aspects to be considered to reduce adolescent pregnancy, the expert mentioned: the need to make the problem visible; clearly define the messages and interventions that should be directed to the most vulnerable populations; involve and empower adolescents; stop using ineffective interventions (such as promoting sexual abstinence); strengthen intersectoral collaboration; scale up initiatives that have proven to be effective; and foster environments for gender equality in health and in access to sexual and reproductive rights. "PAHO is committed to continue moving forward to drastically reduce adolescent pregnancy in the region. That is why we welcome this type of meeting and we are committed to working together to address this issue. It is a matter of justice and human rights," he concluded.

The event was moderated by Dr. Gabriela Perrotta and was attended by the presidents of FIGIJ, Dr. Marisa Labovsky, and SAGIJ, Dr. Silvia Bonsergent.