On the occasion of the Day for the Prevention of Unplanned Pregnancy in Adolescents, it is a firm purpose of the health authorities of the province of Holguin to revert the indicators associated with the high incidence of pregnancies in this stage of life.
According to national statistics, during the last decade this territory has ranked among the top three in the country in terms of the prevalence of this health problem and, what is more worrying, there is a certain tendency for it to increase in the ages between 11 and 15 years of age.
A multifactorial analysis of the possible causes and behavior of this phenomenon is provided by Dr. María de la Caridad Osorio Mora, a second-degree specialist in Gynecology and Obstetrics, who leads the infant-juvenile Gynecology practice at the Pediatric Hospital Octavio de la Concepción de la Pedraja.
What is the incidence of teenage pregnancy in Holguin territory?
-I would like to insist on the fact that Holguín continues to be one of the three provinces in the country with the highest rate of teenage pregnancies. At the same time, it is among the provinces with the highest rate of pregnancy interruptions at this stage of life. Therefore, this leads us to believe that the pregnancy rate is much higher than what we can actually feel. In other words, we are looking at the tip of an iceberg, when there is a much deeper base. Within this we can see a repeated behavior by adolescents with a previous interruption and those who later decide to continue a pregnancy or vice versa”.
“The greatest concern is precisely the age group with the highest incidence between 11 and 14 years of age, that is, those under 15 years of age. This problem really motivates us to rethink what is happening. I insist that this is not only a problem of the health sector, not even of the media or education. We have to look at this as a social phenomenon.”
“This does not mean that in ancient times there were no teenage pregnancies. Historically it has been present even the pharaoh Tutankhamun was 19 years old when he died and his wife had already had two abortions, who was also a teenager. I am referring to an earlier history, although not looked at in the way it is done today.”
What are the causes of this upward trend in teenage pregnancy?
It is not logical that we behave as if there was no educational level according to this era, because at another time our grandparents or great-grandparents had 10 or 12 children, it was not strange because it was the social average, according to the cultural level they had. So, how is it that nowadays, in the 21st century, there are these difficulties? Although I know that there are many mothers who are extremely worried, sometimes they make mistakes because of an excess of love, let’s call it that way”.
“I am very interested in finding a solution to this problem from a comprehensive social perspective. Normally there are many adolescents who come to our office with a pregnancy and then their mother calmly and casually considers it better not to interrupt it, because although the pregnant woman is still studying, her partner is an adult with a certain economic level. The latter is seen as a phenomenon that we must be alert to. We must evaluate from what point of view that family is looking at it as a solution to their economic problems”.
When faced with an adolescent pregnancy, is it wiser to terminate it or to continue with it?
-I always insist that the only thing to do is to avoid it. But once a pregnancy has already occurred, there is as much risk in interrupting it as in continuing it, especially at these young ages. Perhaps the 18 or 19 year-old adolescent behaves like a young adult, however, they have a high risk with the interruption, such as uterine perforation, from infections to any other complication, including anesthesia.”
“In the same way, the continuity of pregnancy is affected in many ways, with many risks of complications, including preeclampsia, a potentially severe complication of pregnancy characterized by high blood pressure, nutritional disorders or susceptibility to anemia. Worst of all, the fruit of conception is also at risk. And one of the greatest risks is that these same deficiency situations predispose the mother to preterm births”.
“So the adolescent has a high risk of preterm birth and the quality of life of this fruit of conception is not good precisely for this reason. We are supposed to think that the adolescent did not have any difficulties, we would like them all to be like that. There are wonderful teenagers, disciplined, worthy of admiration, good mothers even before having their baby. Let’s think about this very good teenager, with great family support and great support from her partner. However, we should think about what happened to her life project”.
“Families with a pregnant teenager, especially the mother, are limited, even in their workplace, and once that baby is born, we give an obligation to the grandmother who did not have her conceived for that age. In a way we are talking about the rights of adolescents and it gives us the measure of how our country meets the tasks of Agenda 2030.”
“I’m still talking about the wanted, loved baby who has a wonderful, supportive family, but there are still limitations on the family and on this teenager’s future. So how many things are affected for that to happen. In the case of continuing her studies, it is time that she is taking away from that baby, to whom she unfortunately cannot dedicate all the time required for her education. We also have to work on this and think about it”.
“In general, the adolescent with a life project rarely gets pregnant, extreme protection, even adolescents who do not have an adequate sexual behavior, but whose projection is elsewhere and it is incredible how they come to consultation worried about contraception because they do not intend to interrupt that project”.
What actions can be taken to prevent this phenomenon?
-The school and the family must insist that young people need to have more than just a curricular life. Having homework is not enough. It is necessary for adolescents to practice sports, to be in culture, to do something from the point of view of free time. It is precisely when they adopt these attitudes that they look for a way to avoid getting pregnant”.
“The family worries about this early initiation when it is obvious, when it is evident or when the pregnancy is already there, but sometimes you have to listen to the songs that they play when they are children. On the other hand, many times the lyrics are stimulating to early initiation, to early sexual discovery, because they really describe a sexual activity, an intercourse, in the most vulgar way sometimes.”
“I have had princesses who have not yet seen menstruation and already have an active sex life. So, by asking the mom they do a denial effect. You have to understand the need to achieve contraception. To talk about contraception, you have to have knowledge about it and go to the consultation without myths, with a naturalness so that the girls see it in a natural way. Sometimes mothers don’t want it to be known that they already have a sex life, but if they are in front of the doctor who is going to help them, sometimes this happens to us”.
When talking about contraception, how does its availability behave in the territory?
-There are many limitations we have had with contraceptives, we cannot deny it. Many are the activities carried out to favor these terms. Some condoms have appeared. We are in a coverage of oral hormonal contraception and implants in all consultations. In the hospital it is on Wednesdays and in the different health areas there is a family planning day where they are placed.”
“On the subject of contraception, we always point out that there is no contraceptive contraindicated for a specific age, although we always suggest that it be evaluated by a health professional, because there could be many difficulties. For example, implants are wonderful, with proven effectiveness, but they have as a disadvantage possible menstrual disorders, but as long as they know about it and tolerate it, there is no problem.”
“I always insist that teenagers who opt for an implant must have more than two years of gynecological age. I am talking about gynecological age, starting from the age since her first menstruation appeared. We would not like it before, which does not mean that we are not flexible, there are cases and cases. We also have injections, there are not in all scenarios, but in some areas we also have some injectables. We have to banish the myths related to contraceptives because there are myths even in white coats, so these things we have to manage.”
What would be the ideal age for a woman to seek motherhood and be able to assume it with full capacity, knowledge and physical maturity?
-Since 1999, at El Cairo conference, a woman was given the right to decide when and how many children she would have. We cannot talk about this ideal moment, because it is a personological right to begin her life and to decide when and with whom. I insist on future projection as something necessary. The ideal for a population is for pregnancies to be between 25 and 29 years of age.”
“There begins to be maturity of the functional axis when the gynecological age is more than five years old, when Tanner stage five is reached, which is when the maturity of the gynecological apparatus is reached. This is not always the case and not all of them evolve in the same way”.
“On the other hand, Cuba historically has an early behavior, that is, our pregnancies in Cuba for more than three decades have been mostly between the ages of 20 and 24. We are concerned about precociousness, that is, we move in a national fertility rate of approximately 50 teenage pregnancies per 100 thousand, which is worrisome. This means that one out of every four pregnant women are teenagers. Holguín is moving at almost 1.5 for every four.”
“That every three pregnant women, one is an adolescent we must modify, because the extreme ages are framed in a risk group and it cannot be that our births are from patients at risk. This adds morbidity to normal gestation”.
In adolescence it is necessary to try to avoid pregnancies, either to interrupt them or to continue them. Motherhood and fatherhood is a unique gift that goes hand in hand with a responsibility that should not come too soon. This stage of life is precious for those who enjoy each stage with its challenges and nuances but with the full knowledge of the ideal time to procreate.
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