Conclusions

Abortion performed in inadequate conditions is a serious public health problem in Latin America and the Caribbean that particularly affects the youngest women in the region. Its high incidence among adolescents –much higher than that registered by official figures– reflects the gaps in reproductive health coverage that are still common in the majority of the region countries. Young people tend to have insufficient information on sexuality, and access to contraceptive methods is still fairly restricted. This is compounded by the fact that in many countries, young people tend to have sex at an increasingly younger age, often without being fully aware of the consequences this may have. This largely explains the increase in adolescent pregnancy in the region and the consequent increase in the number of very young women that interrupt their pregnancy. Usually, abortions are performed in secret and in conditions that entail a high risk for the health and even the lives of these young women.

Although women of many ages seek abortion, this resource often has greater consequences for adolescents. Young women are generally more vulnerable, often depending, both economically and emotionally, on their parents or other adults with whom they live. Therefore, when they face an unwanted pregnancy, they often lack the autonomy to be able to decide on whether or not to continue it. If they wish to terminate it, they lack the resources to have an abortion with qualified medical personnel in appropriate conditions. .Likewise, adolescents are commonly stigmatized for getting pregnant out of wedlock, which may lead them, in extreme cases, to interrupt their gestation by any means, even inducing an abortion themselves. At the same time, there is a social condemnation of abortion as an act which is repressed by justice, religion and society, and also because it reflects adolescent sexuality, which is socially frowned on. Thus, women often conceal their abortion from those closest to them and tend to describe abortions as miscarriages to avoid being stigmatized, particularly by the medical personnel dealing with them (Erviti, et al. 2004).

At the same time, the deeply rooted male domination of Latin American societies is reflected at the sphere of sexuality. A woman’s partner often refuses to use condoms or any other type of contraception, despite the risk of having an unwanted pregnancy which will eventually have to be interrupted. This inability of the woman to influence her partner to use protection tends to be greater if she is very young.

As explained earlier, adolescent abortion is the reflection of a problem that particularly affects this sector of the population in the region. To offset this, several authors propose a series of actions, including extending sex education programs to young people, not only at schools but also in other places they frequent. It is also important to offer them reproductive health services focusing particularly on them, in which they are given free or extremely low-cost care. These services also must preserve the confidentiality of the users in addition to being permanently available (GIRE, 2003; Ehrenfeld, 1999).

Another necessary action is to provide young people and adolescents who have begun their sex lives with modern contraceptive methods, which are much more effective than traditional ones. These methods, essential for preventing unwanted pregnancy, include emergency contraception, particularly useful in the event of rape or unprotected sex. Likewise, the authorities should guarantee young people access to quality medical services which provide abortions or deal with complications of abortions. This may also help the experience to be as painless as possible, since, as Almeyda Castro points out (2001), abortion in adolescents is a traumatic process from the biological, psychological, social and health points of view, in addition to being a significant cause of maternal morbidity and mortality among these young women. The consequences of abortion tend to be greater among those under sixteen; the group of women at the greatest psychological and physiological risks (Guzmán et al., 2001). As mentioned earlier, the vulnerability in which many adolescents and young women live exposes them to sexual violence, which may lead to unwanted pregnancies, or make them run the risk of contracting STD such as HIV or AIDS, the spread of which among Latin American and Caribbean youth is a cause for concern (Rede Nacional Feminista de Saúde e Direitos Reprodutivos, 1999).

Greater access for adolescents and young people to safe abortion services necessarily implies modifying laws on the issue. Although the vast majority of Latin American countries continue to have extremely restrictive abortion laws, so far these have not served to eradicate abortion, and they simply encourage its illegal practice. Likewise, it is important to respect the implementation of existing laws on abortion, in order to guarantee young people’s access to this practice when, for example, a woman wishes to interrupt a pregnancy that is a result of rape, as well as in other cases allowed by the legislation. Guaranteeing this access, in turn, means eliminating institutional barriers (like bureaucratic procedures) to obtaining authorization.

Another point that warrants particular attention is that sexual and reproductive rights should be actively promoted in order for young people to be able to exercise them (Díaz Sánchez, 2001). There has been some progress in the region in this respect. In Mexico, for example, the National Human Rights Commission and civil society organizations drew up a Charter of Sexual and Reproductive Rights for young people, which among other things, establishes that people’s sexuality should be respected, even in the case of those that are under age. It also states that they should be given sufficient information on the subject. Appropriate knowledge of their sexuality enables young people to exercise it more responsibly and thereby prevent unwanted pregnancies that tend to end in unsafe abortions.

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