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M. Fernanda Abella
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Despite Better Education and Later Marriage, Young People in Central America Face Considerable Sexual Health Risks

Although adolescent fertility rates have fallen over the past 15 years in Central America, current levels far exceed the Latin America regional average, according to a comparative study released today. In El Salvador, Guatemala, Honduras and Nicaragua 36–64% of young women in their 20s have some secondary education, compared with only 21–33% of women in their 40s.While the study found that young women are postponing marriage and having fewer children overall, there has been no comparable postponement of childbearing: Currently, two-fifths to one-half of women in the four countries have their first child as a teenager. These proportions are far higher among rural, poorer and less educated women and, in Guatemala, among indigenous women.

Published by the Guttmacher Institute and institutional partners in the region, “Ensuring a Healthier Tomorrow in Central America,” provides a picture of the sexual and reproductive health issues confronting 15–24-year-olds in Central America as they transition into adulthood. The report features new analyses of national surveys from El Salvador, Guatemala, Honduras and Nicaragua conducted between 1998 and 2006.

Given the region’s conservative cultural climate—where women are expected to abstain until marriage while sex among young single men is tolerated and even encouraged—it is not surprising that reported levels of sexual activity among young people differ broadly by gender. For example, 79–92% of 20–24-year-old men report having had sex before they turned 20, compared with 58–67% of women that age. For young women, but not young men, sexual activity generally takes place within a legal or a consensual union.

Access to contraceptives remains a major challenge for young people. One-third to one-half of sexually active young women in the four countries have an unmet need for modern contraceptives; the level of unmet need is considerably higher among single women than married women and is especially high among adolescent women. These disparities may reflect the social barriers young unmarried women face in obtaining specialized family planning services.

Ignorance about HIV also poses a serious threat. As of 2004, HIV prevalence among 15–24-year-olds in the four focus countries was highest in Honduras (1.8%) and lowest in Nicaragua (0.2%). In addition, knowledge of how to prevent sexually transmitted infections (STIs) was low in all four countries. About two-thirds of young men, but fewer than half of young women, spontaneously mentioned condoms when asked how to protect themselves from HIV. Even smaller proportions of young people cited monogamy and abstinence as methods of prevention. Young people, the study authors conclude, need better information to protect themselves from HIV and other STIs.

The study’s in-depth interviews with government officials, national health advocates and representatives of international organizations working in the region reveal major policy gaps in protecting young people from sexual health risks. According to these key stakeholders, promising adolescent health policies—including laws to increase young people’s access to contraceptive services and medically accurate sex education in schools—have been adopted, but few have been fully implemented. Burdensome provisions, lack of adequate funding and contradictions across laws were identified as elements undermining the usefulness of these policies. For example, while one policy in Honduras requires providers to offer family planning services to 15–19-year-olds, irrespective of their marital status, another requires that unmarried people younger than 21 be accompanied by a parent to receive family planning services.

Among the report’s key recommendations is increasing young people’s ability to protect themselves from unwanted pregnancy and disease by improving their access to family planning information and services. This can be achieved by providing affordable, youth-friendly services targeting those who avoid seeking care because they cannot afford services or fear judgmental treatment. The report also strongly recommends the provision of comprehensive and accurate sex education aimed at arming young people with the information and skills they need to delay sexual debut, resist pressure to have sex and engage in safer sex.

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