Standing over the stove in the humid kitchen, peeling vegetables for her family’s lunch while her young daughter tugged at her jeans, Kayla told me that she wished she never met him. She was referring to her live-in partner, the father of her child who is still technically married to another woman, whom she first met when she was 15 and he 28. Now at 19, Kayla lives with him and her in-laws in Managua, the capital of Nicaragua. She goes to school one day a week, on Saturdays, bringing her daughter Angela, while she works towards her high school diploma. She wants to be a pharmacist or journalist one day. Her more immediate ambition is to get a job, leave him, and start a new life with her daughter.
We just met that day, but soon Kayla and I are talking about sex, whispering as her mother-in-law walks by the kitchen. Before getting pregnant with Angela, Kayla and her boyfriend didn’t use contraceptives, but she would pick up morning-after pills regularly. They were easy to get at the pharmacy and didn’t require the shame-inducing encounter with a healthcare provider she would face if she went to the public family planning clinic for contraception. She had been pregnant once before at age 14, but was able to keep it a secret from her family – her teacher gave her Misoprostol, an abortion-inducing medication, which she took alone at home. Although it made her bleed and was painful, she didn’t go to the doctor because she knew it was illegal for her to have an abortion, and she was worried her parents would find out. She now tries to use condoms, but her boyfriend – who has three other children with three other women – doesn’t like them. Kayla had no sex education at home or in school when she first got pregnant. Her daughter is not yet three years old, but when the time comes Kayla plans to have open communication about sex and is determined to provide Angela with the knowledge she needs to make informed choices.
About one in four teen girls in Nicaragua have gotten pregnant or have given birth, in part, because they lack access to sexual and reproductive services, information, and products. Unintended teen pregnancy not only prevents girls like Kayla from finishing school and earning a living, it also puts them and their babies at risk of complications from pregnancy and childbirth. In fact, complications from pregnancy and childbirth is a leading cause of death for girls 15-19 years old in Nicaragua. In 2010, according to the Pan American Health Organization (PAHO), 20 percent of all maternal deaths in Nicaragua were among adolescents. With abortion outlawed – even if the woman’s life is in danger – and sex education forbidden in public schools, it’s unrealistic to think the government would address this public health crisis on its own. That’s why the private healthcare sector, nonprofit advocacy groups, and young women themselves are leading the way toward a future where girls have the power to make informed, healthy decisions for themselves and their families.
One leader in this movement is PASMO, the PSI affiliate in Central America that has been active in Nicaragua since 1998. PASMO is now the leading supplier of family planning methods in Nicaragua and holds an impressive 89% share of the condom market. Led by Dr. Guadalupe Canales, PASMO also manages a network of health clinics across Nicaragua through its social franchise called Red Segura. One such clinic is housed at the National University of Managua (UNAM), offering students and other young people in the area comprehensive sexual and reproductive health education and counseling. I had the opportunity to visit the clinic, where 26-year-old Dr. Ericka Arróliga leads group classes and private counseling sessions. After giving a lesson on IUDs to a group of pre-med students, Ericka reflected that many teenagers feel ashamed that they don’t have a complete sex education. Since they don’t learn about sex at home or in school, they gather what they can from their equally misinformed peers. She noted that most girls who are sexually active take the morning-after pill instead of using a regular contraceptive method, despite the high cost and health consequences of repeated use. It is easy to get over the counter or on the street, hidden from parents and teachers, and seen by boys as the best way to ensure they don’t have to wear a condom. Through her work at the clinic and in the community, Ericka hopes to create a friendly environment for young people to learn about sex, ask questions, understand their options, and help inform their peers as well.
There are thousands of young women like Ericka and Kayla who are committed to ensuring that their peers and future generations of girls have access to the information, resources, and services they need to make healthy decisions. Women and girls need to be at the center of any decision about their bodies, families, and future, but too often they are left out of the discussion. Organizations like PASMO recognize that young women, including young mothers, know their challenges best and are vital to creating solutions that last. We need to scale this type of thinking across the healthcare sector. Young women know what they need and what they want – when they have the power to make those decisions, the whole world thrives.
Caitlin is a member of Maverick Collective, an initiative of Population Services International, a global health non-profit with operations in 65 countries and 9000 staff. Maverick Collective members partner on PSI programs to tackle critical challenges faced by women and girls through innovative projects to develop game-changing interventions that government and businesses cannot advance on their own. Members are working shoulder to shoulder with a global community providing proof for solutions that radically impact the lives of girls and women in the most undeserved parts of the world.