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Adolescent pregnancies in the Amazon basin of Ecuador: a rights and gender approach to girls' sexual and reproductive health
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.ORCID iD: 0000-0002-8114-4705
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adolescent pregnancy has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. In Ecuador, where 20% of girls aged between 15-19 years get pregnant, the adolescent fertility rate has increased and inequalities between adolescent girls from different educational, socio-economic levels and geographical regions are prominent: 43% of illiterate adolescents become pregnant compared to 11% with secondary education. The highest adolescent fertility rates are found in the Amazon Basin.

 

The overall aim of this study was to explore adolescent pregnancy in the Amazon Basin of Ecuador (Orellana province) from a rights and gender approach. Specific aims and methodologies included: to explore women‟s reproductive health situation, focusing on government‟s obligations, utilization of services, inequities and implementation challenges, assessed through a community-based cross-sectional survey and a policy analysis (Paper I); to examine risk factors associated with adolescent pregnancy, through a case-control study (Paper II); to explore experiences and emotions around pregnancy and motherhood among adolescent girls, using content analysis (Paper III); and to analyze providers‟ and policy makers‟ discourses on adolescent pregnancies (Paper IV).

 

Reproductive health status findings for women in Orellana indicated a reality more dismal than that depicted in official national health data and policies. Inequities existed within the province, with rural indigenous women having reduced access to reproductive health services. In Orellana, 37.4% of girls aged 15-19 had experienced pregnancy, almost double the national average. Risk factors associated with adolescent pregnancy at the behavioral level included early sexual debut and non-use of contraception, and at the structural level poverty, having suffered from sexual abuse, and family disruption. Gender inequity played a key role through the machismo-marianismo system. Girls were raised to be fearful and ignorant regarding sexuality and reproduction, to be submissive and obedient, to be fatalistic, and to accept the established order of the male and adult dominance. Sexuality was conceptualized as negative, while motherhood was idealized. Those gender structures constrained girls‟ agency, making them less able to make choices regarding their sexual and reproductive lives. Providers‟ discourses and practices were also strongly influenced by gender structures. Adolescent sexuality was not sanctioned, girls‟ access to contraceptives still faced opposition, adolescent autonomy was regarded as dangerous, and pregnancy and reproductive health issues were conceptualized as girls‟ responsibility. However, mechanisms of resistance and challenge were also found both among adolescent girls and providers.

 

Programs addressing adolescent pregnancies in the area need to look at the general situation of women‟s reproductive health and address the gaps regarding access and accountability. Adolescent pregnancy prevention programs should acknowledge the key role of structural factors and put emphasis on gender issues. Gender inequity affects many of the factors that influence adolescent pregnancies; sexual abuse, girls‟ limited access to use contraceptives, and girls‟ curtailed capability to decide regarding marriage or sexual intercourse, are strongly linked with young women‟s subordination. By challenging negative attitudes towards adolescents‟ sexuality, the encounter between providers and adolescents could become an opportunity for strengthening girls‟ reproductive and sexual agency.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2009. , 85 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1294
Keyword [en]
adolescent pregnancy, adolescent motherhood, reproductive and sexual health, right to health, gender relations, gender structures, Ecuador, Amazon, Sexuality, agency
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-26788ISBN: 978-91-7264-859-3 (print)OAI: oai:DiVA.org:umu-26788DiVA: diva2:274154
Distributor:
Epidemiologi och folkhälsovetenskap, 901 87, Umeå
Public defence
2009-11-20, Sal B, 9tr, NUS, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2009-10-28 Created: 2009-10-27 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Women's reproductive rights in the Amazon basin of Ecuador: Challenges for transforming policy into practicce
Open this publication in new window or tab >>Women's reproductive rights in the Amazon basin of Ecuador: Challenges for transforming policy into practicce
2008 (English)In: Health and Human Rights: An International Journal, ISSN 1079-0969, E-ISSN 2150-4113, Vol. 10, no 2, 91-103 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Harvard School of Public Health/François-Xavier Bagnoud Center for Health, 2008
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-26779 (URN)
Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2017-12-12Bibliographically approved
2. Risk factors for pregnancy among adolescent girls in Ecuador's Amazon basin: a case-control study
Open this publication in new window or tab >>Risk factors for pregnancy among adolescent girls in Ecuador's Amazon basin: a case-control study
2009 (English)In: Revista panamericana de salud pùblica, ISSN 1020-4989, E-ISSN 1680-5348, Vol. 26, no 3, 221-228 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To examine risk factors for pregnancy among adolescent girls in the Amazonbasin of Ecuador.Methods. A matched case-control study with cases and controls identified within a community-based demographic and health survey was conducted in Orellana, Ecuador, from Mayto November 2006. A questionnaire focused on socioeconomic status, family structure, education,reproductive health, and childhood-adolescent trauma was applied. Conditional logisticregression was used to adjust for potential confounders.Results. Respondents included 140 cases and 262 controls. Factors associated with increasedrisk of adolescent pregnancies through multivariate analysis were: sexual abuse duringchildhood-adolescence (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.08–8.68);early sexual debut (OR 8.51, 95% CI 1.12–64.90); experiencing periods without mother andfather (OR 10.67, 95% CI 2.67–42.63); and living in a very poor household (OR 15.23, 95%CI 1.43–162.45). Another two factors were statistically associated in the bivariate analysis:being married or in a consensual union (OR 44.34, 95% CI 17.85–142.16) and not being enrolledin school at the time of the interview (OR 6.31, 95% CI 3.70–11.27). For a subsampleof sexually initiated adolescents, “non-use of contraception during first sexual intercourse”was also found to be a risk factor (OR 4.30, 95% CI 1.33–13.90).Conclusion. The study found that early sexual debut, non-use of contraception during firstsexual intercourse, living in a very poor household, having suffered from sexual abuse duringchildhood-adolescence, and family disruption (living extended periods of life without both parents)were associated with adolescent pregnancy in Orellana.

Place, publisher, year, edition, pages
Organización Panamericana de la Salud, 2009
Keyword
Pregnancy in adolescence, sexual violence, contraception; family, risk factors, Ecuador
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-26782 (URN)
Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2017-12-12Bibliographically approved
3. Gender structures constraining girls' agency: exploring pregnancy and motherhood among adolescent girls in Ecuador's Amazon basin
Open this publication in new window or tab >>Gender structures constraining girls' agency: exploring pregnancy and motherhood among adolescent girls in Ecuador's Amazon basin
(English)Manuscript (preprint) (Other academic)
Identifiers
urn:nbn:se:umu:diva-26784 (URN)
Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2015-04-29Bibliographically approved
4. Adolescent pregnancies and girls' sexual and reproductive rights in the Amazon Basin of Ecuador: an analysis of providers' and policy makers' discourses
Open this publication in new window or tab >>Adolescent pregnancies and girls' sexual and reproductive rights in the Amazon Basin of Ecuador: an analysis of providers' and policy makers' discourses
2010 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 10, no 12Article in journal (Refereed) Published
Abstract [en]

Background: Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.

Methods: We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.

Results: Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.

Conclusions: Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.

Place, publisher, year, edition, pages
London: BioMed Central, 2010
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-26785 (URN)10.1186/1472-698X-10-12 (DOI)000289980800001 ()
Available from: 2009-10-27 Created: 2009-10-27 Last updated: 2017-12-12Bibliographically approved

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