Teen pregnancy rates higher among Amerindians, the poor -situation analysis
A recently-concluded Situation Analysis of Children and Women in Guyana found that one in every five Amerindian girls between ages 15 and 19 was a mother as was one in every four girls who lived in poor houses.
The analysis, carried out in 2015/2016, on the whole found that around 15% of girls between ages 15 and 19 had begun child bearing and prevalence is dependent on the area the girl lives, her ethnicity, and her poverty status.
On the latter point, it said while one in every four girls who lived in poor houses in Guyana had started childbearing, the number was one in every 10 for girls living in richer households.
On average, 5% of the women had their first sexual relationship before the age of 15, it added.
The analysis was the result of a collaboration between the Government of Guyana and the United Nations Children’s Fund (UNICEF), with the main objective being to support the new government in the development and implementation of the national strategic development plans and programmes to advance development of the rights of Guyanese children with a strong equity focus on the most vulnerable children and their families.
While the analysis concluded that Guyana has improved some of its socioeconomic conditions over the past decades, it said inequity is a major factor as boys and girls do not have access to the same quality of education, health and child protection due to the structural problems.
“The country’s averages… create different vulnerable groups that demand special attention. Vulnerability is connected to the risk of deprivation, losing assets, being physically or psychologically hurt, or losing life due to different threats in the environment that surrounds the child and his/her family.”
The vulnerable groups identified in the analysis include persons who live in the hinterland, Amerindians, children with disabilities and special needs, children living in single-parents households, especially those headed by women, and those who are poverty-stricken.
The report was handed over to Minister of Social Protection Volda Lawrence late last week.
Birth registration
The report said 11.3% of the births in Guyana are not registered and the number is three times higher in Region One than the average in the rest of the country. As a result, it concluded that there is “still room for improvement” when addressing the issue of birth registration.
In addition to the high number of unregistered births in Region One, the report from the analysis stated that a child living in the interior has twice the chance of not having a birth certificate in comparison to a child living in the urban areas (19% and 9.5%, respectively).
“Two other factors that increase the chances of a child not having a birth certificate are poverty and ethnicity. Areas with high incidence of babies delivered at home also present an elevated number of babies not being registered,” the report indicated.
Speaking to the factors that influence the low level of birth registration for some groups and some regions, the report pointed out that while the knowledge of the importance of having the children registered is key, parents and caregivers have to have the means to do so. Poverty, social norms and regional disparities are identified as structural causes for the low registration of some populations.
Meanwhile, the analysis revealed that maternal mortality estimates for 2015 stand at 229/100,000 live births, which does not reflect any significant progress since the year 2000 (210/100,000).
It added that child mortality numbers had indicated small reductions since the year 2000, but also does not indicate major changes in the situation. “Neonatal mortality continues to be the major component of under-5 mortality in the country,” it stated.
As to the causes of maternal and child mortalities, the report said they are shared and include congenital factors, including elevated obstetric risks reinforced by low levels of prenatal care, delivery and postnatal care; the incidence of diseases and infections such as respiratory infections, malaria and diarrhoea; and poor nutritional status of mothers–high incidence of anaemia–and children–high incidence of stunting. The listed causes are influenced by inadequate health care; lack of full immunisation; the unhealthy situation of household environment in relation to water and sanitation; and by household food insecurity.
“Poverty, social norms, regional disparities and gender norms were identified as the structural causes. All of these causes are exacerbated for some specific populations such as mothers-to-be and children under the age of 5 living in the hinterland, in the rural areas, living in poor families, and from Amerindian families,” the report added.
It was noted that the children in rural areas do not have access to good quality health services, and, consequently, have higher chances of mortality or in the development of cognitive and/or physical impairment.
Further, it found that a series of bottlenecks and barriers support the listed causes and therefore there are opportunities for the country to improve the coordination among the different actors involved in the health of mothers and children. Issues related to the management of the system include lack of communication among the health facilities in the regions and the central management in the capital. Also the availability of essential commodities and the access to adequately staffed services are both identified as contributing factors to the current situation as information shows that not all the regions have the adequate number of trained health workers and community health workers.
Guyana’s geography was also listed as a direct factor to hinder access and this negatively impacts in the propensity of families to search for help and also prevents health and education professionals from working in the most remote areas.
And despite health care being free, the report said difficulty of access creates some “implicit financial barriers” to some groups. It added that there are also social and cultural practices and beliefs that influence the personal decision of some mothers to access the obstetric services provided by the government.
“In some areas of the country, cultural barriers are considered as some of the major obstacles impeding women from getting adequate and timely care. Cultural practices also influence the use of home remedies, and some elevated number of home-births that happen in the interior of the country,” the analysis pointed out.
HIV-pregnant mothers
On the issue of HIV pregnant mothers, the report said that the prevalence of the virus among pregnant women in 2014 was 1.9%, the same as in 2013, which consolidated to an upward trend since 2010. It was noted that the HIV Prevention of Mother-to-child Transmission (PMTCT) programme is available countrywide. In 2014, 94.4% of the pregnant women accessed PMTCT services and were tested for HIV. Among those identified as HIV positive, 97% of them had received AntiRetroviral Treatment (ARV) in 2014, while there were 37 new cases of HIV reported among children (ages 0 to 19) in 2014, which represents a reduction when compared to 2010 but an increase when compared to 2013 (32 new cases).
Most of the new cases among children are found between 15 and 19-year olds.
It was pointed out that the fact that almost 25% of the new cases of HIV in the child population in 2014 had happened between the ages of 1 year and 14 years demands extra attention on prenatal procedures, delivery and postnatal care of mothers and children.
“These cases represent the failures of the system, i.e., the cases that were not identified, monitored and/or properly
treated during pregnancy, delivery and the initial months of life of the child,” the report stated. And it noted too that the efficiency of the PMTCT programme is affected by the same bottlenecks related to maternal and child health, including shortage of essential commodities, difficulty of access to health facilities, and financial constraints. Further, deficiencies in the prenatal care, delivery and postnatal care affect not only the detection of the virus in mothers and babies, but also in the follow-up that identified patients should have, it said.
It was noted that interviewees mentioned that it is known that some pregnant women would undergo rapid testing for HIV and even with a positive result would not return for further testing, to get advice and/or to collect their ARV medication.
It was also pointed out that knowledge of mother-to-child transmission is also low in the country (53% among women and 35% among men), increasing the risk of HIV transmission among those babies born from women who did not have proper prenatal care.
School enrolment
As it relates to enrolment of adolescents in school, the analysis said that there are 82,000 boys and girls enrolled in public and private schools but as it is with the primary education, an official secondary net enrolment rate is not available, jeopardizing any analysis of the efficiency of the system.
While children might be enrolled at school, it noted that their attendance is not guaranteed and the quality of education that students receive is not homogeneous.
It said too that boys and girls continue to drop of school or are not attending due to the country’s economic situation, which pushes some of them to start working without the necessary qualification and in low skill–and consequently low pay–jobs. It said some also do not see the benefits of continuing their academic studies, while some girls drop out due to teenage pregnancy.