Draft first regional report on the implementation of the Montevideo Consensus on Population and Development

<strong>Draft</strong> <strong>first</strong> <strong>regional</strong> <strong>report</strong> on the implementation of the Montevideo Consensus on Population and Development
Chapter III
Looking beyond this preliminary picture, which shows the region and most of its countries in a favourable
light, many challenges remain. Mention may be made of the following:
(i) The sex education deficit, revealed in box III.1 and by the available AIDS indicators. 56 These reveal
that there is little knowledge of the epidemic and how AIDS can be contracted and prevented, a
shortcoming that connects to other challenges on this list. 57
(ii) Maternity in the group of girls aged 10 to 14, due in the overwhelming majority of cases to situations
of sexual violence and abuse. Although the rates are low by comparison with the 15-19 age group,
every case is a drama, and the trend cannot be said to be towards eradication. This precocious
motherhood is heavily concentrated in the most excluded groups in society and requires specific
initiatives, for example regarding emergency contraception and abortion, where the law permits, in
addition to universal initiatives in the areas of sex education and the prevention and punishment of
sexual violence and abuse.
(iii) Access to contraception, which has increased but is still inadequate in most of the countries owing to
the persistence of different types of barriers to access and limitations in the public network. 58 Supply
remains constrained, since the most advanced and effective methods play only a secondary or marginal
role 59 and are still being used inefficiently, because of both the quality of the methods and the difficulties
entailed by their use among adolescents, male and female. 60 Thus, deficiencies in sex education
(see box III.1), gender equality and women’s empowerment are crucial and should be urgently addressed.
(iv) The impossibility of calculating the agreed indicator for access to emergency contraception, which is
an efficient resource for exercising reproductive rights in emergency situations.
(v) Uncertainty about the continuity and future improvement of key programmes, such as adolescentfriendly
spaces, that is directly connected to the challenge of expanding and improving efficient and
timely contraception for adolescents. Even countries where these spaces have expanded recently, such
as Argentina and Colombia, “need continued support to sustain the gains and have lasting impact”
(PAHO/UNICEF, 2018, p. 37). In countries with fewer resources, such as Suriname, it is mentioned
that most initiatives and efforts to improve the ability of health service workers to provide adolescentfriendly
services were funded by donors and in the form of temporary programmes or projects, which
obviously entails risks to financial sustainability (Government of Suriname, 2018).
(vi) Inequality, which remains very high, as shown in table III.3, according to a proxy version of indicator
B.18. 61 The scale of inequality varies considerably between countries, but in most the percentage of
mothers or <strong>first</strong> pregnancies is at least four times as high in the poorest socioeconomic quintile as in
the richest. As disturbing as this inequality is the fact that in countries where adolescent fertility fell
in the latest period, inequality rose (Colombia, Peru), meaning that adolescent motherhood declined
more slowly among the poorest. This confirms once again that reducing adolescent motherhood
means redoubling efforts to bring down barriers to contraceptive access for poor adolescent girls.
56
These are not the ones agreed to for follow-up of priority measure 11 of the Montevideo Consensus on Population and Development, since metadata are still lacking.
57
In the Demographic and Health Survey conducted in Colombia in 2015, for example, less than half of all men and women aged 15 to 19 were categorized as having
“accurate comprehensive knowledge about HIV” (see [online] www.measuredhs.com).
58
They include the requirement for parental authorization to receive sexual and reproductive health care that still applies to under-eighteens in a number of the
region’s countries (UNAIDS, 2017). These countries include several in the Caribbean, such as Jamaica, whose national <strong>report</strong> explicitly recognizes a dissonance
of the law with the age of consent and the age of access to services. Medical care can only be provided with the patient’s consent. Since persons below the legal
age of majority (18 years) are presumed to be legally incapable of consent, and parental permission is used as a substitute for the minor’s consent, in order to
prevent civil liability for trespass (sometimes known as battery but more often called an assault). The age of consent, however, remains at 16 years old and this
poses a challenge for the administration of sexual and reproductive health services in these instances (Government of Jamaica, 2017).
59
Like implants and intrauterine devices (IUDs), which are often surrounded by stigmas lacking any scientific basis (although they can admittedly have side-effects
and certainly do not protect against risks other than pregnancy). The exceptions are Chile and Uruguay, where there are programmes and initiatives to provide
access to high-quality methods, with the requisite ethical and health protocols.
60
Argentina is an extreme example, since although a national survey in 2013 recorded high levels of protected sexual initiation, this did not translate into a reduction
in adolescent fertility. The limitations of the indicator aside, this suggests ineffective use (Binstock, 2016, table 5). In any event, less effective contraceptive use by
adolescents is not peculiar to Argentina but typical of adolescents in all countries of the region and indeed the world (Rodríguez, Di Cesare and Páez, 2017, p. 11).
61
Use is made in this case of information from specialized surveys, which includes <strong>first</strong> pregnancies.
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