Beyond Borders: A Multi-Country Comparative Look at Approaches to Sexual & Reproductive Health

A young Ecuadorian woman walked into clinic in Quito for a women’s health visit—she looked strong, slightly nervous, but holding her emotions well. This eighteen-year-old woman presented because she’d had no period for six weeks. When asked about contraception, she mentioned she and her boyfriend use the pull-out method. After speaking with the physician, the patient went for vaginal ultrasound, where she was noted to be five weeks pregnant. The attending physician reviewed the results, then scheduled her for further prenatal visits. Eighteen…and unexpectedly pregnant. Her boyfriend lives two continents away. She has dreams and aspirations… she wants to become a veterinarian, and her first semester starts in the next few weeks. Options counseling is not practiced, as abortion is illegal in Ecuador. Within moments, her life course is markedly changed.

Centro Médico de Orientación y Planificación Familiar (CEMOPLAF), the national foundation I worked with in Quito, Ecuador for my fourth year rural primary care selective rotation (through Quillen College of Medicine), offers family planning services and seeks to promote sexual and reproductive health education. As part of my rotation, I had the opportunity to work with Ecuadorian physicians in family planning clinics, providing contraceptive services and prenatal care. I also traveled with sexual health educators to primary and secondary schools in Quito to deliver comprehensive sexual education curriculum, participated in adolescent sexual health curricular events at CEMOPLAF clinics, and attended national conferences for sexual health educators in Ecuador. CEMOPLAF addresses a significant public health concern. The adolescent fertility rate in Ecuador is 76 births/1,000 women ages 15-19. Similarly, adolescent fertility rates in the United States are as high as 119 births/1,000 women ages 15-19, in some regions, Appalachia included. Ecuador and the United States have made strides to decrease adolescent pregnancy rates, yet there is still much work to be done.

Adolescent pregnancy comes with social and economic costs. Adolescent mothers are less likely to finish high school and more likely than their peers to lead impoverished lives. Children of adolescent mothers are more likely to experience health problems and developmental delays and are more frequently neglected and/or abused. Furthermore, adolescent pregnancy is estimated to cost the United States $10.9 billion annually in lost tax revenues, public assistance programs, healthcare expenses, foster care, and criminal justice system involvement. Of my community service experiences, including with public school education, and medical school rotations in Appalachia, I have seen firsthand the socioeconomic costs of adolescent pregnancy time and time again.

Comprehensive sexual education is recognized by researchers and public health professionals as a primary tool to prevent adolescent pregnancy. The Netherlands integrates sexual education into all grade levels, starting in kindergarten; not surprisingly, the Netherlands has one of the lowest adolescent pregnancy rates in the world, 5.1 births/1,000 women ages 15-19, which is six times less than the average adolescent pregnancy rate in the United States. Similarly, the adolescent abortion rate in the Netherlands is approximately two and a half times less than that in the United States, and the HIV prevalence rate is approximately three and a half times less. Analogous statistics apply for Germany and France.

Furthermore, geographic and financial access to contraception is absolutely key to reducing adolescent pregnancy and adolescent abortion. Survey of Family Growth, a primary source of US federal government data for sexual and reproductive health, found that improved access to contraception is a major contributor to reduction of adolescent pregnancy and abortion.

Sexual health education and access to contraception are imperative for adolescent pregnancy prevention. I’m fortunate to have had the opportunity to be involved with and learn from the family planning services and sexual health education provided at CEMOPLAF in Ecuador. May we continue to learn from organizations such as this as we seek to address this public health concern in our local, national, and international communities.