The high number of adolescent pregnancies in most Latin American countries can be explained by the precocity with which young women begin to have sex and the scarce use of effective contraceptive methods.
The fact that these adolescent women often have unprotected sex largely greatly increases the probability of pregnancy. The average age of first intercourse in Latin America and the Caribbean differs in among countries and regions and also depends on factors such as the socioeconomic context in which young people live, in addition to their sex. Thus, males tend to have started having sex with other people earlier than women. The average age of first intercourse for males was 12.7 in Jamaica and 16 in Chile. For women it was 15.6 years in Jamaica and 17.9 in Chile (Lundgren, 2000). The results of demographic and health surveys for persons ages 25 to 29 interviewed when they were consulted confirm an earlier age at first intercourse among men than women. In Peru, the difference between average ages at first intercourse was 2.7 years (16.6 for men and 19.3 for women) in 1996. For Nicaragua it was 2.6 years (15.6 and 18.2 respectively) in 1998. In Brazil it was 2.3 years (16.5 and 18.8) in 1996. In Bolivia, it was 2 years (16.7 and 18.7) in the year 2000. In the Dominican Republic, it was 1.7 years (17 and 18.7) in 1999, whereas in Haiti it was 1.3 years (16.7 years for men and 18 years for women) in the year 2000.
These averages give us a general idea about the sexual behavior of young people in the region but fail to reflect certain worrisome aspects of it. For example, 40% of the adolescents that took part in the survey carry out by the Jamaican Health Ministry in 1998 declared that at the age of 10 they had already had some kind of sexual relationship (CRLP and Demus, 1997).
Contraceptive use among adolescents in the region is extremely variable in terms both of prevalence and of the type of method used. It is estimated that 50% of sexually active adolescent in Latin America do not use any contraception (Paho, 2004). The results of surveys undertaken in the Caribbean suggest that 40% of female adolescents and 50% of male adolescents do not have access to contraceptives during their first sexual encounter (UNICEF, 1997 quoted in Schutt-Aine and Maddaleno, 2003).
For women aged 15 to 19 who are sexually active, unmarried and live in one of the 7 countries where the Demographic and Health Survey was conducted between 1995 and 2000, contraceptive practice differ in key ways by country. Rates of use range from 31% in Guatemala, to 41% to 43% in the Dominican Republic, 49% in Haiti, 53% in Bolivia and Nicaragua, 66% in Brazil, 72% in Peru and 79% in Colombia. In Peru and Colombia, adolescents primarily employ natural methods such as abstinence and withdrawal. In Brazil, young women mainly use the pill and condoms. Injections, the pill and condoms are utilized in Nicaragua, whereas in other countries pregnancy is prevented by using these and other contraceptive methods. Condom use is associated with consequent problems of negotiation, since the use of it depends on male acceptance.
In Jamaica, approximately 50% of adolescents that engage in sexual activity do not use any form of contraception. A large number of young people consulted in a study said that they lacked information on the different types of contraceptives in existence when they began to have sex (CRLP and Demus, 1997).
Studies on adolescent women in Peru have shown relatively high rates of sexual relations practiced with very little knowledge of contraceptive methods. This leads to low levels of condom use, inadequate capacity for sexual negotiation among young women, and, when natural methods are used, lack of knowledge of their fertile periods. Two surveys conducted in Colombia on middle-class adolescents aged 15 to 18 showed that a high percentage lacked any kind of sexual education in addition to being ignorant of key aspects of reproductive health. The youngest women proved to know very little about contraception (Ramírez, 1991).
In Mexico, in 1997, adolescent and young women used contraceptives least among all age groups. Moreover, it has been shown that between 1978 and 1997, the unmet demand for contraceptive methods among Mexicans aged 15 to 19 fell from 33.8 to 26.7% but continued to be high (Consejo Nacional de Población, 2000). A difference by socioeconomic stratum, according to the study mentioned earlier by Menkes and Suárez (2005) is also reflected in this age group: 80.7% of young women belonging to a very low stratum had never used a contraceptive method before the birth of their first child, as opposed to 57.6% among the lower classes and 59.9% among the middle and upper classes.
In his study on the evolution of adolescent pregnancy in Cuba, González (2005), describes the early start of sexual relations, the irregular use of contraceptives and alternation between the latter and abortion. He observes that contraceptive use mainly takes place after the first pregnancy and/or abortion. However, a high index of abortions in this island country is due to frequent contraceptive failure and insufficient sex education. Likewise, says the author, although within the current Cuban context, adolescent motherhood goes against the existing cultural norm, according to which schooling is a priority at this age, a large proportion of pregnancies among unmarried mothers take place during adolescence (40%).
At the same time, emergency contraception (EC) is still relatively uncommon in Latin America and the Caribbean, where there have been very few studies on the use of this method among adolescents. Certain countries introduced EC into their family planning programs, but despite the coverage it has been given, it is still relatively unknown. It should be pointed out, however, that even the providers of the method usually lack knowledge about it, in addition to being unwilling to prescribe it. This partly explains the still scant use of the method, as does the fact that, without any scientific proof, conservative groups have attributed an abortive effect to it.
In Brazil, the government included EC in technical guidelines for family planning (Galvao et al., 1995). Likewise, certain programs related to the method have been developed in countries such as Peru, Brazil, Colombia (Heimburger et al., 2003) and Ecuador (ICRW et al., 2000) but these programs continue to have insufficient coverage. Despite the opposition of conservative groups, in Mexico EC was incorporated in January 2004 into the official family planning service norms. This contraceptive method, which is particularly useful in the event of sexual abuse, could contribute to reducing the number of unwanted pregnancies and therefore, abortions, which in conservative societies such as Mexico’s continue to be stigmatized. However, for this to be true, medical personnel must be trained in the use of EC, and women must use it correctly (Gould et al., 2001; Hardy et al., 2001).
The conditions and behaviors described here, common to Latin American youth, explain the high incidence of unwanted pregnancies and abortions among this part of the population.