When Getting Pregnant Isn’t About Being a Mother

Angela Castellanos

In Colombia, young women may be getting pregnant intentionally -- but not necessarily because they want to become mothers. Sexuality education advocates differ on how best to tailor a pregnancy prevention and sexual health curriculum to reach Colombian teens.

In Colombia, one in
every five women under 19 years old is a mother or is pregnant. The rate of teen motherhood is on the rise in
most of the Latin American countries. In Colombia, this situation is partly the result of young women wanting to become mothers, and partly the result of young women seeking some benefits early motherhood might provide them.

According
to the 2005 National Survey on Demography and Health, carried out every five
years by Profamilia, a sexual and reproductive health provider, 42% of the
teenagers expressed a wish to become mothers.
However, this fact does not
change the consequences of teen motherhood in terms of maternal mortality and
poverty cycle reproduction. From
1986 and 1995, the rate of teen motherhood increased from 70 to 89 per 1000
young women, and in 2005 it reached 90 teens per 1000.

Why Early Motherhood?

One
of the factors that pushed up teen pregnancy is violence resulting from the
armed conflict. Statistics show that the
rate of teen motherhood is higher among displaced population.

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Profamilia,
which runs a program for displaced families, has concluded that teen pregnancy
is a way for poor young women to reach objectives other than motherhood. For
instance, for such women, getting pregnant by a rich man — even if he is married to someone else — is
a way to get income for their families and to gain social status among their
neighborhood. "For many of these displaced young
women, having a baby is a means to solving a lack of affection and income,"
said Susana Moya, national coordinator of Profamilia’s
Program for Youth.

In
addition, young mothers in poverty can apply for assistance at the Instituto de
Bienestar Familiar, a governmental body in charge of social welfare and family
care, which offers integrated assistance, including food supplies, training,
and housing subsidies. This social
welfare is provided only to women who are mothers.

But
not only the displaced young women are choosing to become mothers. What could be the
causes that push other teenagers to get pregnant?

In
addition to the early initiation of sexual relations and the lack of a comprehensive
sexual education, there are social and economic factors which push teenagers to
motherhood.

Many
women are living in aggressive environments where their rights are ignored and
violated. Young women are often abused;
their opinions are not taken into account within their own families, and
sometimes are suffering pressure and mistreatment from their teachers.

"They
are running away from the ‘hell’ they are living at home," pointed out Germán
Salazar, coordinator of the Department for Youth from the Fundación Cardio-Infantil.
Various researchers have concluded that for poor women, having a baby accords
them more status, and a child can become their source of affection.

Diverging Views on Effective Sexuality Education

Although
sexual education at schools has a long history in Colombia,
not all the organizations involved have similar approaches. For some
organizations the emphasis is on values, duties and
responsibilities, encouraging teenagers to avoid sexual relations until they
feel certain they’re ready to start their sexual life and have the resources to afford
protection methods. "Sexual education is not talking about condoms but about values,
and is not only a matter of sexual rights but of duties," Germán
Salazar said.

Pro-values organizations do not promote abstinence until marriage. They argue that "saying
no" is an option for teenagers with enough autonomy, decision-making capacity and
self-esteem, whereas it is not for those who are only taught about contraception
and safer sex methods.

Others
organizations have an approach based on sexual rights combined with the
responsible exercising of sexuality and strengthening of autonomy. They argue that interventions have to be
done quickly and based on the current
reality, including early sexual initiation. According to the survey mentioned above,
the percentage of women between 25 and 49 years old that have their first
sexual relation before their fifteenth birthday passed from 8% in 2000 to 11% in 2005.

"If
we wait until teenagers get high levels of self-esteem, decision-making capacity and
autonomy as preconditions to talk them about contraception methods, teen
pregnancies will continue to rise," pointed out Susanna Moya.

The organizations that
support the pro-rights approach insist that interventions for teen motherhood prevention
and STI protection must be done, as well as sexual education programs for
self-esteem and autonomy.

However,
representatives of both approaches agreed on the opinion that the media –
advertisements and entertainment – is playing an important role. The media is sending messages that
tend to ignore sexual protection and is promoting sexual
relations among young audiences.

Neither the pro-values nor
the pro-rights groups support the idea that the only appropriate expression of sexuality
is within a heterosexual marriage. Such
a position could only be seen within some Catholic groups.

Currently,
the Ministry of Education is implementing a pilot pedagogic
methodology called Education for Sexuality and Citizenship Building in a number of cities.
This curriculum is a transversal program based on civil rights, and covers sexuality, and reproductive and
sexual health. Teachers are being trained to develop innovative ways to develop
this transversal program. If this innovative
program brings successful outcomes, it could be used not
only for the rest of Colombia but throughout Latin
America. 

Commentary Contraception

For Students at Religious Universities, Contraception Coverage Isn’t an Academic Debate

Alison Tanner

When the U.S. Supreme Court sent a case about faith-based objections to the Affordable Care Act's contraceptive mandate back to lower courts, it left students at religious colleges and universities with continuing uncertainty about getting essential health care. And that's not what religious freedom is about.

Read more of our articles on challenges to the Affordable Care Act’s birth control benefit here.

Students choose which university to attend for a variety of reasons: the programs offered, the proximity of campus to home, the institution’s reputation, the financial assistance available, and so on. But young people may need to ask whether their school is likely to discriminate in the provision of health insurance, including contraceptive coverage.

In Zubik v. Burwell, a group of cases sent back to the lower courts by the U.S. Supreme Court in May, a handful of religiously affiliated universities sought the right to deny their students, faculty, and staff access to health insurance coverage for contraception.

This isn’t just a legal debate for me. It’s personal. The private university where I attend law school, Georgetown University in Washington, D.C., currently complies with provisions in the Affordable Care Act that make it possible for a third-party insurer to provide contraceptive access to those who want it. But some hope that these legal challenges to the ACA’s birth control rule will reverse that.

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Georgetown University Law Center refused to provide insurance coverage for contraception before the accommodation was created in 2012. Without a real decision by the Supreme Court, my access to contraception insurance will continue to be at risk while I’m in school.

I’m not alone. Approximately 1.9 million students attend religiously affiliated universities in the United States, according to the Council for Christian Colleges and Universities. We students chose to attend these institutions for lots of reasons, many of which having nothing to do with religion. I decided to attend Georgetown University Law Center because I felt it was the right school for me to pursue my academic and professional goals, it’s in a great city, it has an excellent faculty, and it has a vibrant public-interest law community.

Like many of my fellow students, I am not Catholic and do not share my university’s views on contraception and abortion. Although I was aware of Georgetown’s history of denying students’ essential health-care benefits, I did not think I should have to sacrifice the opportunity to attend an elite law school because I am a woman of reproductive age.

That’s why, as a former law clerk for Americans United for Separation of Church and State, I helped to organize a brief before the high court on behalf of 240 students, faculty, and staff at religiously affiliated universities including Fordham, Georgetown, Loyola Marymount, and the University of Notre Dame.

Our brief defended the sensible accommodation crafted by the Obama administration. That compromise relieves religiously affiliated nonprofit organizations of any obligation to pay for or otherwise provide contraception coverage; in fact, they don’t have to pay a dime for it. Once the university informs the government that it does not want to pay for birth control, a third-party insurer steps in and provides coverage to the students, faculty, and staff who want it.

Remarkably, officials at the religious colleges still challenging the Affordable Care Act say this deal is not good enough. They’re arguing that the mere act of informing the government that they do not want to do something makes them “complicit” in the private decisions of others.

Such an argument stands religious freedom on its head in an attempt to impose one group’s theological beliefs on others by vetoing the third-party insurance providers’ distribution of essential health coverage to students, faculty, and staff.

This should not be viewed as some academic debate confined to legal textbooks and court chambers. It affects real people—most of them women. Studies by the Guttmacher Institute and other groups that study human sexuality have shown that use of artificial forms of birth control is nearly universal among sexually active women of childbearing years. That includes Catholic women, who use birth control at the same rate as non-Catholics.

Indeed, contraception is essential health care, especially for students. An overwhelming number of young people’s pregnancies are unplanned, and having children while in college or a graduate program typically delays graduation, increases the likelihood that the parent will drop out, and may affect their future professional paths.

Additionally, many menstrual disorders make it difficult to focus in class; contraception alleviates the symptoms of a variety of illnesses, and it can help women actually preserve their long-term fertility. For example, one of the students who signed our brief told the Court that, “Without birth control, I experience menstrual cycles that make it hard to function in everyday life and do things like attend class.” Another woman who signed the brief told the Court, “I have a history of ovarian cysts and twice have required surgery, at ages 8 and 14. After my second surgery, the doctor informed me that I should take contraceptives, because if it happened again, I might be infertile.”

For these and many other reasons, women want and need convenient access to safe, affordable contraceptives. It is time for religiously affiliated institutions—and the Supreme Court—to acknowledge this reality.

Because we still don’t have an ultimate decision from the Supreme Court, incoming students cannot consider ease of access to contraception in deciding where to attend college, and they may risk committing to attend an university that will be legally allowed to discriminate against them. A religiously affiliated university may be in all other regards a perfect fit for a young woman. It’s unfair that she should face have to risk access to essential health care to pursue academic opportunity.

Religious liberty is an important right—and that’s why it should not be misinterpreted. Historically, religious freedom has been defined as the right to make decisions for yourself, not others. Religious freedom gives you have the right to determine where, how, and if you will engage in religious activities.

It does not, nor should it ever, give one person or institution the power to meddle in the personal medical decisions of others.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.