Search

AbstractThis paper presents the results of formative research conducted from January to June 2020 in the Department of Atlántico, Caribbean region of Colombia, whose findings were used as inputs to design the national strategy for comprehensive sexuality education (CSE) outside school – Tírala Plena – including its curriculum. This is within the framework of the multi-country project coordinated by UNFPA and WHO aimed at generating evidence on the role of facilitators in the delivery of CSE in non-school contexts. The research was carried out in four municipalities in northern Colombia, in rural and marginal urban contexts with conditions of vulnerability for the adolescent population, including a strong presence of migrant populations from Venezuela. A total of 150 male and female adolescents ages 10–17 participated in the formative research. Workshops such as patchwork quilt, body mapping and talking maps were used as methods to gather information. The groups were divided by sex and age (10–13 years old and 14–17 years old). Knowledge, attitudes and social norms regarding adolescent pregnancy, sexually transmitted infections, including human immunodeficiency virus, and gender-based violence, were identified in adolescents (schooled and not schooled, but with minimal or no access to CSE). All of the above enabled us to establish a set of recommendations for the strengthening of the CSE strategy Tírala plena.

La iniciativa Todas las Mujeres Todos los Niños América Latina y el Caribe (EWEC-LAC, por su sigla en inglés) se estableció en el 2017 como un mecanismo interinstitucional regional. Coordina la implementación regional de la Estrategia Mundial para la Salud de la Mujer, el Niño y el Adolescente 2016-2030 en América Latina y el Caribe (ALC), lo que incluye su adaptación a necesidades específicas de la Región, para poner fin a las muertes evitables, garantizar la salud y el bienestar, y ampliar los entornos propicios para la salud y el bienestar de mujeres, niños y adolescentes. Para promover el logro equitativo de estos objetivos, los tres grupos de trabajo de EWEC-LAC apoyan colectivamente a los países de ALC en la medición y el monitoreo de las desigualdades sociales en la salud, la promoción de la disminución de estas y el diseño e implementación de estrategias, políticas e intervenciones orientadas a la equidad. Este apoyo para cerrar las brechas actuales asegura que nadie se quede atrás. Los miembros de la iniciativa EWEC-LAC incluyen al UNFPA, la OPS, ONU-Mujeres, ONUSIDA, UNICEF, el Banco Mundial, el Banco Interamericano de Desarrollo, USAID, la Alianza Regional Neonatal para ALC y el Grupo de Trabajo Regional para la Reducción de la Mortalidad Materna. A la fecha, EWEC-LAC ha desarrollado y recopilado herramientas y recursos innovadores, y ha comenzado a colaborar con los países para utilizarlos a fin de reducir las brechas en la equidad. Estos incluyen un marco de medición de las desigualdades sociales en la salud, herramientas de promoción de datos, como un tablero de datos para visualizar tendencias en las desigualdades sociales en la salud, una metodología para establecer metas en la disminución de las desigualdades, y un compendio de herramientas y métodos para identificar y abordar las desigualdades sociales en la salud. EWEC-LAC ha trabajado en la Región para enfatizar la importancia de reconocer estas desigualdades a los niveles sociales y políticos, y ha abogado por su disminución. La atención para cerrar las brechas de equidad en la salud es cada vez más crítica frente a la pandemia de COVID-19, que ha agudizado las vulnerabilidades existentes. Los sistemas de salud más equitativos estarán mejor preparados para hacer frente a futuras crisis de salud.

Resumen La iniciativa Todas las mujeres, Todos los niños América Latina y el Caribe (EWEC-LAC, por su sigla en inglés) se estableció en 2017 como un mecanismo interinstitucional regional. Coordina la implementación regional de la Estrategia Mundial para la Salud de la Mujer, el Niño y el Adolescente en América Latina y el Caribe (ALC), incluyendo la adaptación a necesidades específicas de la región, para poner fin a muertes evitables, garantizar la salud y el bienestar y ampliar entornos propicios para la salud y el bienestar de mujeres, niños, niñas y adolescentes. Para promover el logro equitativo de estos objetivos, los tres grupos de trabajo de EWEC-LAC colectivamente apoyan a los países de ALC en la medición y monitoreo de las desigualdades sociales en salud, la abogacía por la disminución de estas y el diseño e implementación de estrategias, políticas e intervenciones orientadas a la equidad. Este apoyo para cerrar brechas actuales asegura que nadie se quede atrás. Miembros de EWEC-LAC incluyen FPNU, OPS, ONU Mujeres, ONUSIDA, UNICEF, el Banco Mundial, el Banco Interamericano de Desarrollo, USAID, la Alianza Regional Neonatal para ALC, y el Grupo de Trabajo Regional para la Reducción de la Mortalidad Materna. A la fecha, EWEC-LAC ha desarrollado y recopilado herramientas y recursos innovadores y ha comenzado a colaborar con los países para utilizarlos a fin de reducir brechas de equidad. Estos incluyen un marco de medición de desigualdades sociales en salud, herramientas de promoción de datos incluyendo un tablero de datos para visualizar tendencias en desigualdades sociales en salud, una metodología para establecer metas en la disminución de las desigualdades y un compendio de herramientas y métodos para identificar y abordar las desigualdades sociales en salud. EWEC-LAC ha trabajado en la región para enfatizar la importancia de reconocer estas desigualdades a niveles sociales y políticos, y ha abogado por la disminución de éstas. La atención para cerrar las brechas de equidad en salud es cada vez más crítica frente a la pandemia de COVID-19, que ha agudizado las vulnerabilidades existentes. Sistemas de salud más equitativos estarán mejor preparados para hacer frente a futuras crisis de salud.

Abstract Background Adolescents in the Latin American and Caribbean region continue to experience poor reproductive health outcomes, including high rates of first birth before the age of 20 years. Aggregate national level data fails to identify groups where progress is particularly poor. This paper explores how trends in adolescent births have changed over time in five countries (Bolivia, Colombia, Dominican Republic, Haiti, and Peru) using data disaggregated by adolescent age group, wealth and urban / rural residence. Methods The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence. Results There has been little progress in reducing adolescent first births over the last two decades in these countries. Adolescent first births continue to be more common among the poorest and rural residents, and births among the youngest age-group (

Abstract Adolescent fertility rates in Latin America and the Caribbean (LAC) remain unacceptably high, especially compared to the region’s declining total fertility rates. The Region has experienced the slowest progress of all regions in the world, and shows major differences between countries and between subgroups in countries. In 2013, LAC was also noted as the only region with a rising trend in pregnancies in adolescents younger than 15 years. In response to the lack of progress in the LAC region, PAHO/WHO, UNFPA and UNICEF held a technical consultation with global, regional and country-level stakeholders to take stock of the situation and agree on strategic approaches and priority actions to accelerate progress. The meeting concluded that there is no single portrait of an adolescent mother in LAC and that context and determinants of adolescent pregnancy vary across and within countries. However, lack of knowledge about their sexual and reproductive health and rights, poor access to and inadequate use of contraceptives resulting from restrictive laws and policies, weak programs, social and cultural norms, limited education and income, sexual violence and abuse, and unequal gender relations were identified as key factors contributing to adolescent pregnancy in LAC. The meeting participants highlighted the following seven priority actions to accelerate progress: 1. Make adolescent pregnancy, its drivers and impact, and the most affected groups more visible with disaggregated data, qualitative reports, and stories. 2. Design interventions targeting the most vulnerable groups, ensuring the approaches are adapted to their realities and address their specific challenges. 3. Engage and empower youth to contribute to the design, implementation and monitoring of strategic interventions. 4. Abandon ineffective interventions and invest resources in applying proven ones. 5. Strengthen inter-sectoral collaboration to effectively address the drivers of adolescent pregnancy in LAC. 6. Move from boutique projects to large-scale and sustainable programs. 7. Create an enabling environment for gender equality and adolescent sexual and reproductive health and rights.

Abstract Background The main objective is to examine how the Paraguayan laws, policies and regulations (hereafter referred to as normative guidance) specifically address adolescents and their contraceptive information and service needs using a human rights analytic framework. It must be noted that this paper examines the adolescent content of national laws, policies and regulations on contraception, not how they were applied. Methods The recommendations on “Ensuring human rights in the provision of contraceptive information and services” from the World Health Organization (WHO) were used as an analytic framework to assess current Paraguayan laws, policies and regulations. Three questions were explored: 1) whether the Paraguayan normative guidance relating to each WHO recommendation was present and specifically addressed adolescents 2) whether the normative guidance for each WHO recommendation was present but did not specifically address adolescents, or 3) whether Paraguayan normative guidance relating to each WHO recommendation was absent. This assessment led to the development of an analytic table which was used by the co-authors to generate conclusions and recommendations. Results The analysis found specific normative guidance for adolescents relating to six out of nine WHO summary recommendations and nine out of the 24 sub-recommendations. The guidance included strategies to overcome contraceptive service barriers and to improve access for displaced populations. Further, it supported gender-sensitive counselling, quality assurance processes, competency-based training, and monitoring and evaluation of programmes. Conclusions Paraguay’s contraception laws and policies are grounded in human rights principles. However, there are a number of aspects that need to be addressed in order to improve the quality of contraceptive provision and access for adolescents. Our recommendations include improving accessibility of contraceptive information and services, ensuring acceptability, quality, and accountability of contraceptive information and services, and promoting community and adolescent participation in contraceptive programmes and service delivery.

Background: Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15–19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups. Methods: We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15–19 to 45–49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios. Findings: The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20–24 years (maternal mortality ratio 260 [uncertainty 100–410] vs 190 [120–260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns. Interpretation: Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women's educational, social, and economic development. Funding: WHO, UN Population Fund.