Baseline Assessment of Adolescent Reproductive and Sexual Health in Yantaló, San Martin, Peru
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BACKGROUND: The term “adolescent fertility rate” refers to the number of births per 1000 in girls ages 15-19. In July 2013, the adolescent fertility rate in rural Yantaló, Peru, was nearly 10%, almost double the national rate of 5.2% in 2012 (World Bank). Adolescent pregnancy remains a major contributor to maternal and child mortality and to the cycle of ill-health and poverty world-wide (WHO). In Yantaló, many young mothers are forced to terminate their schooling in order to care for their children, giving them fewer opportunities for financial independence in a society with a strong machismo culture. OBJECTIVE: To gain a better understanding of the adolescent sexual and reproductive health education and practice in Yantaló and the potential interventions that could be made to decrease the adolescent fertility rate. METHODS: This study involved numerous methods of data collection that were then evaluated and presented to the local community. We started by conducting oral interviews with 19 local authorities, who played different roles in the community, to gain a deeper understanding of the issues surrounding adolescent sexual and reproductive health in the region. We then conducted 218 written surveys with high school students ages 11-19 to investigate their baseline reproductive health knowledge, religious values, family life, and their preferences regarding avenues of receiving sexual health information and sexual health classes. We also evaluated the proposed national curriculum on sexual health. All of this data was then used to create suggestions regarding interventions to improve the adolescent fertility rate in Yantaló, and this information was presented to local authorities. RESULTS: Analysis of the study revealed that there were many components that contributed to the high adolescent fertility rate in Yantaló and many potential areas for intervention were made apparent. Data from oral interviews pointed to a strong machismo culture, rampant misconceptions regarding sexual health and contraceptive methods, insufficient outreach programs, and a general lack of coordination between local entities as reasons for the high number of adolescent pregnancies. The surveys of the adolescents revealed that they lacked basic reproductive health knowledge but were eager to learn more, especially from local clinicians and their mothers and fathers, despite admitting having difficulty communicating openly about sexual health with their parents. Although the proposed national curriculum was analyzed, the school in Yantaló admitted that it only followed the guidelines loosely, which made it an ineffective tool to evaluate sexual health education in the region. CONCLUSION: Yantaló is similar to many other rural communities in South and Central America in that it has a strong traditional, machismo culture that influences much of the adolescent sexual health practices. Like much of Peru, Yantaló also has access to trained healthcare providers and free contraceptive care, but misconceptions and a lack of education regarding sexual health limits access. This research emphasized the importance collaboration within the community to utilize the existing infrastructure of the village to increase education of adolescents and encourage communication between providers, parents, and adolescents to improve adolescent sexual health and reduce the burden of unwanted teenage pregnancy. This practice could be easily translatable to numerous other communities that struggle with the same inefficiencies.