El embarazo no deseado: impacto sobre la salud y la sociedad en America Latin y el Caribe / Unwanted pregnancy: impact on health and society in Latin America and the Caribbean

Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100 percent effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occured. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the samr is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that healthcare be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy (AU)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

Evaluation of a sexuality education program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuallity education and pregnancy preventative programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and the use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact (AU)

Evaluation of a sexuality program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviours. Using a quasi-experimental design, the studies measured the effect of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on the use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive effect on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact. (AU)

A survey of HIV-related knowledge, attitudes, beliefs and practices among students on halls of residence on the Mona campus, University of the West Indies, Jamaica

Students at the Mona Campus of the University of the West Indies are in the most vulnerable age group (20-39 years) for contractig STIs including HIV/AIDS. This study sought to determine the HIV related knowledge, attitudes and practices among students living on halls of residence. Questionnaires were self-administered by approximately 10 percent (146) of the students on the halls of residence over a two week period and informal discussions were held with two small groups of students to gain greater insights into their understanding of the HIV/AIDS situation. The results showed deficiencies in the knowledge, attitudes and behaviours of students. Approximately 25 percent of students felt that HIV could be transmitted through blood donation and 29.5 percent said there was no link between STIs and contracting HIV. The students' attitude towards homosexuality was negative. The majority of students did not know the window period for HIV infection. Approximately 5 percent of students have had an STI and 15 percent of students who reported being sexually active were not using the condom. There was a significant association between the gender of students and condom use. The study concluded that the students are at risk of contracting and spreading HIV and other STIs. There is need for intense education on HIV/AIDS for students living on the halls and the placing of condom machines on the halls will give students easier access to condoms.(Au)

Knowledge, attitudes and practices of parents in a rural community with regard to the distribution of contraceptives to sexually active children under 16 years

Parents play a vital role in the lives of their children because they transmit and interpret acceptable cultural behaviour and help to mold the personality of their children. The study was designed to assess knowledge, attitude and practices of parents with regard to early sexual debut and distribution of contraceptive to sexually active children under 16 years. The study was designed to assess knowledge, attitude and practices of parents with regard to early sexual debut and distribution of contraceptives to sexually active children under 16 years. It was carried out on 75 parents in a rural district in Westmoreland. Two streets in the district were randomly selected and all parents with children aged 10-15 years were interviewed. Personal interviews were conducted by the researcher using pre-coded questionnaires. The results showed that while the majority of parents were knowledgeable about sexual activities in children, less that half knew about sexual activities in their children. They strongly disliked the practice of early sexual activities in children. Parental consent for contraceptive was not the preferred practice as the majority of parents expressed that they would not give consent for their children to access contraceptives but it must be made available so that children can access it when all else fail. Parents prefer to talk to and to counsel their sexually active children instead of offering contraceptives. The majority indicated that they are fulfilling their role as sexuality educators for their children (AU)

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St. Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9 percent) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75 percent. Among the high-risk group tested, being positive for HIV was associated with age (p=0.01) and ethnicity (p=0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p<0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p<0.001). These findings indicate that psychiatric patients are at greater average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.(AU)

Sexual Attitudes and Behaviour among young adolescents in Jamaica

Describes the attitudes and behaviour among low-income adolescents in Jamaica. Contributing factors to early sexual activity and pregnancy; Social pressure and encouragement among boys to be sexually active; Branding of young girls who become pregnant as having loose morals; Motivations for engaging in sex among girls and boys.(AU)

Contraceptive decision-making among adolescents in secondary schools in Kingston and St. Andrew, Jamaica

The study investigated the factors which influence contraception decision-making among Grade 9 or Form 3 students attending secondary schools within Kingston and St. Andrew (Corporate Area). A cross-sectional study which involved a random sample of 220 students drawn from six schools, (one all-female, one all-male and four co-educational) was carried out during the month of March 1997. The results showed that there was a significant difference between the number of females and males who were attending school. It was observed that the students did not have good knowledge on fertility but indicated that they were well aware of the condom and the pill. Closer examination to validate this knowledge, proved to be the corollary of what they had indicated, concerning the use of the pill. Generally, students had good attitude toward fertility and contraception but seemed to be unclear about the difference between abortion and contraception. Only a small percentage of them used a contraceptive, of which more males than females used a method, hence the condom was found to be used most popularly among this sub-group. The pharmacy remained the main source of providing teenagers with contraceptives, but students' preferences were the Doctor's Office and the Family Planning Clinic. The level of counselling was average and students main reason for their choice was related to health reasons. A significant number of males than females indicated that they had sufficient information to choose a method and 58 percent of them had been exposed to FLE, and 84 percent had good to fair knowledge on fertility and contraception. A fairly large percentage of students were dissatisfied with the FLE programme in their schools. Students suggested various sources from which they obtained information and cited the media (1st) and youth group as the most acceptable place where sex education information should be made available. A large majority of the respondents (96.7 percent) did not want to have a child now. The reasons for their choices were based on their perception of pre-disposing and enabling factors. The majority of students, least considered educational and future job benefits as part of their decision-making concerning contraception. The majority of the students did not want to enter into motherhood or. fatherhood, at this stage of their lives. But the result showed that they were lacking in several of the essential requirement necessary for decision-making.(Au)

A school fight against AIDS in the Caribbean

The English-speaking Caribbean consists of some fifteen countries, with a population of just over 6 million. The countries including Suriname are united under CARICOM, (the Caribbean Economic Community) and share a common education system. The area is characterised by low infant mortality rates (averaging less than 20/1000 live births) and high literacy rates (above 85 percent for many years). (AU)

Knowledge, attitudes and practices regarding syphilis and gonorrhea among fourth form secondary school students in Kingston, Jamaica

The study was conducted among 195 fourth form students between the ages 13 and 17 years old in four secondary schools, one all girls, one all boys and two coed, in Kingston. The study was designed to investigate the differences in knowledge, sexual attitudes and practises between two groups of fourth form high school students, one of which had acquired specific formal haealth education and the other which had not done so and also based on their socialization in schools coed vs. segregated schools. Regarding syphilis 7.2 percent of the participants had never heard about the disease and 4.1 percent had never heard about gonorrhea. Based on health education status, regarding knowledge there was no significant difference between the two groups (t=1.72, p < 0.087, df=192). Regarding attitudes, t-test was statistically significant (t=3.47, p=0.000646, df=192). Attitudes of students based on their socialization in schools, coed vs single sex, t-test was statistically significant (t=2.92, p=0.003889, df=192). Regarding sex, of 189 respondents, 51.9 percent had had sex, 38.8 percent said they always used condoms, 43.9 percent used condoms sometimes and 17.3 percent had never used a condom. Regarding safe sexual practices, there was a significant statistical difference between the two groups of students based on health eduaction status and based on socialization in school. Sexual practices of respondents based on health education status, chi-squared was significant (chi-squared + 60.43, p < 0.0000001, df=2), based on socilization in schools chi-squared was significant, (chi-squared=90.997, p < 0.0000001, df=6). There was a strong statistically significant association betwen health education, socialization in schools and safe sexual practices. (AU)

Lessons from an STD/HIV preventive education project among Jamaican teenagers - abstract

Between August 1993 and June 1994, a project in teenage peer-to-peer education for HIV/AIDS and STD prevention was run in 20 school-based Red Cross clubs in Jamaica. First, 23 teenagers (21 girls and 2 boys) were trained to do small group teaching using lectures, story;-telling, games, and role-play. They in turn, taught approximately 100 learners from eleven (11) "intervention" clubs. Approximately 100 teenagers from nine other schools served as controls. The syllabus encompassed information about HIV/AIDS and STDs, options for prevention, reinforcement of social skills including decision-making, and practice in placing condoms on an artificial penis. Adults designed the curriculum and trained the peer educators but only participated in the peer-to-peer sessions for brief periods at the teenagers' request. Evaluation of the project was done by direct observation of some sessions, key informant interviews, focus group discussion and pre-and post-education questionnaires. The training programme helped to improve knowledge concerning the link between other STDs and HIV infection and the increased risk of contracting STDs when under the influence of alcohol or cocaine. Some teenagers confessed shyness to handle condoms even after learning. Participants reported that they (a) were challenged to improve their attitudes toward persosns with HIV/AIDS and (b) saw more clearly the relevance of practising safer sex and the need to actually adopt safer sex benefit from the project. This peer-to-peer approach was judged to be effective enough to be offered outside of Red Cross clubs (AU)

Sex education in schools: GPA reviews studies on its effect on the sexual behavior of adolescents

Sex education, particularly at the primary school level (5-11+ in the Caribbean), remains a controversial subject yet to be resolved between certain influential sectors of society-the State, church as well as among some teachers and parents who have direct day-to-day responsibility for nurturing the minds of the young. Wherever sex education is taught in regional schools, it is done within the context of their family life education programmes which attempt to deal with broad issues of human sexuality. It is a matter of concern to all since sexual activity begins at a very early age in many parts of the Caribbean and related diseases continue to rise (AU)