The United Nations Population Fund (UNFPA) has highlighted the issue of “demographic anxiety” faced by women across the world. The report states that women in developing countries face pressure to have fewer children while in developed countries with low birth rates, women are encouraged to have more. The case of the Dominican Republic is notable with a fertility rate of 2.2 children per woman; maternal mortality is closely related to early childbirth with 20.4% of girls aged between 15 and 19 being mothers in the country. Yésica Prensa is a 26-year-old from a rural community who exemplifies the UNFPA’s report as she has suffered as a wife, an adolescent mother and lacked access to correct information about contraceptives in a country where abortions are illegal. The fight to reduce adolescent pregnancy and maternal mortality is a struggle against misinformation, taboos and myths surrounding contraceptive methods.
In the Dominican Republic, a large proportion of women are not free to make decisions about their own bodies with 23% not having control over their sexual relations and 46% not having access to contraceptives. Sterilization has been widely used, with 30.5% of women having undertaken the procedure. Shockingly, 25% of women did not know that it was an irreversible intervention. One reason behind the high rate of adolescent pregnancies is the lack of knowledge surrounding contraceptive methods. Girls don’t tell their parents about their sexual relationships, making it difficult to keep birth control pills in the house. The intradermal method (an implant in the arm) is the most suitable contraceptive method for adolescents, however, some girls request to have it removed after being fitted with it. This method can cause menstrual irregularities which may be misconstrued as ill health.
Adolescent pregnancies have serious implications for maternal mortality and morbidity rates, hence, the urgent need for intervention in the Dominican Republic. The country has higher maternal mortality rates than expected for its income bracket. With 107 deaths per 100,000 live births, the rate is higher than the average in Latin America and the Caribbean, despite 98% of deliveries being overseen by qualified personnel. Babies born to teenage mothers have a higher likelihood of suffering from health problems or dying. The statistics of maternal and child experiences have been borne out in Yésica Prensa’s life; she lost her first child two months after childbirth and has had three more children. In addition, she lacks adequate care and support and does not have the means to earn an income.
Prensa’s background is in a rural community with poor economic opportunities and a lack of access to education. Only 45.9% of girls between the ages of 15 to 19 who become mothers attend high school or university compared to 89.8% of peers who haven’t given birth. Pregnant teenagers are likely to have to abandon their education, which leads to limited professional development, less work and a greater likelihood of earning lower wages. Prensa fell pregnant aged 16, the father of her child pushed her into motherhood, threatening to cheat on her if she didn’t have sex with him. She wishes she’d had access to better information and believes her life would have been different had she attended high school.
The cost of teenage pregnancy and early motherhood in the Dominican Republic has been put at $240m per year in a 2018 study by the UNFPA. This includes the costs associated with healthcare expenses and the economic impact of limited job opportunities for young women. Women who become teenage mothers earn 20% less than women who gave birth as adults.
Prensa has realised the cost associated with early motherhood and speaks with young women about the importance of delaying motherhood and continuing with their education. Her aim is for her children to study hard and have ambition, escaping the cycle of poverty which has enveloped her life. Prensa acknowledges that her reality is not uncommon and shares her story to prevent others from being caught in a similar cycle of poverty. She urges women to take charge of their reproductive health and refuse to be pressured into having children by their partners, emphasising the importance of independent decision-making.
