P2B102: Adolescent Pregnancy and Policy Prevention Strategies in Bolivia

Background: The plurinational state of Bolivia is an area rich in diversity and culture. Two-thirds of the population is indigenous, with the predominant group being Aymara, in addition to 35 other indigenous groups. Adolescent pregnancy is an issue throughout Latin America, and in particular, in Bolivia. Approximately one in three young women in Bolivia become pregnant before the age of 20. Adolescent pregnancy in Latin America is associated with numerous physical and mental health risks for both the mother and the baby, and women of lower socioeconomic status and those in rural areas are disproportionately affected. Becoming pregnant before the age of 20 limits women’s empowerment, financial independence, educational attainment, and social involvement. Careful consideration should be taken to address this public health issue in a culturally appropriate manner.

Methods: Through a practicum with the Bolivian Ministry of Health organized by Child and Family Health International, a literature search and stakeholder interviews were performed and analyzed qualitatively to better understand factors which contribute to high rates of adolescent pregnancy in Bolivia and identify three policies which address adolescent pregnancy from a primary, secondary, and tertiary prevention approach.

Results: The first evidence-based approach which I most highly recommend as a method for lowering the rate of adolescent pregnancy is adoption of a national comprehensive sexual and reproductive health education curriculum. The curriculum should be designed with a holistic multifaceted approach, including concepts of consent, self-efficacy, knowledge, perceived risks, values, attitudes, perceived norms, with clear health goals and outlines of how to achieve these health goals.
The second policy recommendation is the secondary prevention strategy of legalization of pregnancy termination. Safe abortion carries few health risks, where in contrast, unsafe abortion causes 12% of maternal mortality worldwide, disproportionately affecting women of lower socioeconomic status. Particularly, legalization of medical abortion may be the most reasonable start due to cultural acceptance. These two policies implemented together have the greatest potential for lowering the rate of adolescent pregnancy, more than either individually.
Finally, one policy recommendation at the tertiary level to mitigate health impacts on adolescent mothers would be to establish relationships with mental health professionals during and after the pregnancy to help reduce rates of anxiety, depression, and suicide by easing the burden of stigma, social pressure, and potentially complicated family dynamics.

Conclusion: The significant health risks associated with adolescent pregnancy in addition to the barriers it creates for opportunities for women make adolescent pregnancy a public health priority. The three policies which I recommend implementing based on the evidence of the current needs in Bolivia are a comprehensive sexual and reproductive health curriculum, legalization of abortion, and psychological counseling for all adolescent mothers.