“MY BODY GOT really big.” That was a shock to Radhaisis Martínez Nuñez, who was just 15 when she got pregnant. As she reminisces, a naked two-year-old streaks into her kitchen. His grandmother whisks him away. Ms Martínez, now 18, has not been back to school. She hopes to return, but now her body is changing again. She is seven months pregnant by another man (her son’s father died in a motorcycle accident, she says).
Ms Martínez lives in Estebanía, a small farming town near the Dominican Republic’s southern coast known as “la villa de las bellas” (“the town of beauties”). Two-fifths of its new mothers are teenagers, the highest share of any municipality in the country, which in turn has the highest rate of teen motherhood outside Africa. That is not because the women in Estebanía are beautiful, says a nurse in the town. She blames a lack of sex education and a “libertine environment”. Adults and youngsters mingle in boozy gatherings on the streets. “The mothers have one man a day, and a different one the next. It rubs off on the kids,” says the nurse.
Almost a third of Latin American women can expect to have a baby before reaching the age of 20. That is a higher rate of teen motherhood than in any region except sub-Saharan Africa, which is much poorer. Latin America has an unusually high birth rate among teens, defined as births per 1,000 women aged 15-19, for its overall level of fertility (see chart). East Asia, which has fertility rates and incomes per person similar to Latin America’s, has much lower rates of teen childbearing. Latin America is the only region where births among girls younger than 15 have been rising. In Ecuador, the birth rate among under-15s tripled between 1990 and 2012.
The region’s governments have started to realise that this is a problem. Most have adopted national plans over the past decade or so to reduce teen pregnancy. Progress, so far, has been slow. Last year three UN agencies, including the Pan American Health Organisation, observed that “adolescent fertility rates have dropped minimally” over the past 30 years.
Premature motherhood is bad for mothers, babies and countries. Maternal mortality for girls under 16 is four times that of women in their 20s. Young mothers are less likely than older ones to seek prenatal care. That omission increases the chance that a child will have a low birth weight and learning problems later on. Latin American women marry later than do women in Africa and South Asia; thus, teen mothers are disproportionately likely to be single mothers. In Mexico, where the median age of marriage for women is 27, nearly a quarter of mothers aged 15-19 are single.
Teen childbearing derails mothers’ careers. A study from Brazil showed that it reduces women’s participation in the labour force. Often, it is the grandmother who stops paid work to take care of her daughters’ kids. In the Dominican Republic, adolescent girls who have had babies have two years’ less schooling on average than those who have not. They are less than half as likely to attend university.
Early pregnancy is partly a symptom of deprivation. Girls from poor families are both less apt to study and more likely to get pregnant. But the causation works both ways. A third of Dominican women who drop out of school in their teens say they did so because they got pregnant.
Latin American culture seems to encourage teen pregnancy, and governments have done too little to change it. Some girls see pregnancy as a fast track to adulthood and the status it brings, says Claire Brindis, a professor at the University of California, San Francisco. “We tell people not to get pregnant, but once they do they get care, parties and attention,” she says. Darlenis, a 16-year-old mother in Estebanía, echoes her. “To be a mother, the whole world respects you,” she says.
Many girls in dangerous circumstances form new families to improve their security. Moving in with a boyfriend is often the easiest way to leave an abusive home. Girls pair up with gang members who would otherwise threaten their families, says Karen Medina, a psychologist in Honduras. Rafael Cortez of the World Bank interviewed young mothers in crime-ridden El Salvador and was surprised to learn that half had intended to get pregnant.
But for most teenagers, pregnancy comes as a surprise. Many schools do not offer sex education. Contraceptives can be hard to find. Ms Martínez says that Estebanía’s clinic did not have any when she sought them. Men press girls to have sex, and girls are not taught how to refuse.
The Catholic church, which is influential in Latin America, stifles discussion about sexuality. In Honduras, Catholic and Evangelical churches last year opposed the use of sex-education textbooks, even ones that did not have images of genitalia. A woman from Estebanía who gave birth at 16 recalls the church’s message on birth control: “They said that the only way to stop yourself from getting pregnant is to put a one-peso coin between your knees and make sure it doesn’t touch the ground.”
Such norms discourage governments from taking steps to reduce teen pregnancy. Experts suggest that they should offer better sex education, easier access to contraception and medical care that is not censorious. With such policies Britain and the United States have halved teen-pregnancy rates since 2000, albeit in richer societies where the opportunity cost of motherhood, in terms of income forgone, is much higher than in Latin America.
But better policies can work in Latin America, too. A school in a poor area of Bogotá, Colombia’s capital, introduced a “sexual-citizenship” curriculum, which involved older students talking to younger ones about sex. The number of pregnancies among its 4,000 pupils fell from 70 a year to zero. That sort of programme could be introduced to schools on a large scale.
Latin American governments say they are trying to cut rates of teen pregnancy. Several published plans in the past 15 years. But they often aimed at cities rather than rural areas, where the problem is gravest. Sometimes, governments simply did not implement their plans. The presidents of Argentina and Chile promised to introduce sex education in their national curriculums. In Argentina fewer than half the provinces have adopted it. Sex education is still almost unheard of in Chile’s state schools. Mexico presented a strategy in 2015 but repeatedly shifted responsibility from one agency to another. Venezuela’s plan, unveiled in 2013, came to nothing. Its economy collapsed and the government stopped offering free contraceptives. A box of condoms costs more than a week’s average pay (see article).
There are some exceptions. One of the biggest reductions in teen motherhood over the past 30 years has occurred in Haiti, which shares an island with the Dominican Republic. It is the region’s poorest country but has its lowest rate of births among teens. That may be because the government is so weak that resources for programmes like discouraging teen pregnancy flow mainly through NGOs. These are more competent, and less vulnerable to political pressure, than are the agencies of many governments. The biggest reduction in the past decade has been in Colombia. That may be in part because the end of a long-running insurgency gave the state access to guerrilla-controlled areas, where teen pregnancy had been common.
The Dominican Republic plans to try again to reduce its region-topping teen birth rate. This week it launched a plan that focuses on rural areas rather than on cities. That comes too late for Ms Martínez. She is resigned to motherhood. Her children “are here now”, she says. “I have to work for them.” Perhaps her younger neighbours will have more choices.