The United Nations Population Fund (UNFPA) says that humanity suffers from "demographic anxiety", especially women, from the pressure to have fewer children in the Global South and the opposite in more prosperous countries. In the case of the Dominican Republic, with a fertility rate of a rich country (2.2 children per woman), the concern is focused on the high proportion of teenage pregnancy and maternal mortality, closely related to early births. The latest data from the national statistics office (2019) reveal that 20.4% of women under 19 are mothers in the Caribbean country, above the 18% of Latin America and the Caribbean.
Yésica Prensa, a 26-year-old Dominican woman, has suffered many anxieties related to motherhood over the past decade. Her life exemplifies almost all the forms of suffering of women that UNFPA denounces in its latest annual report: she was a wife and teenage mother, unable to decide when and how many children, without correct information about contraceptives and in a country that prohibits the interruption of pregnancy in any case, she lost her first child two months after birth; She had three more, she dropped out of school, her partner left her. And today, lacking support for care, she cannot work.
Teens who become pregnant are more likely to suffer complications in pregnancy and childbirth, and babies are more likely to suffer health problems
Prensa was born in Mata los Indios, a batey – as rural communities of Haitian descent are called in the Dominican Republic, usually in the middle of sugar cane plantations – where about 200 people live, an hour and a half drive north of the capital; and far from the postcard paradisiacal beaches that attracted more than seven million tourists in 2022 alone. In this place from which Prensa has never left, of houses with wooden walls and tin roofs, dirt roads and few opportunities, the latest chapter of the violation of his rights has been an attempted rape in his own home, which he has reported to the police. "It was last night," he reveals.
"I married 16 and my husband wanted to have children," begins her personal account. A year later the first one was born. She says she knew about contraception, but shrugs her shoulders when asked why she became a mother sooner than she wanted. For too many Dominicans, choice is not an option: 23% are not free to make decisions about their own bodies when it comes to sex or contraceptive use, to which 46% do not have access. Sterilization was the most used method in the Dominican Republic, with 30.5% of women of reproductive age, married or united, according to the latest National Multipurpose Household Survey (2019). But not always by an informed choice: 25% of them were sterilized without knowing that it was an irreversible intervention. A percentage only behind Lesotho (28%), according to the United Nations.
"Men tell them that if they don't have sex with them, they will go with others. And in the end, faced with that psychological pressure, they agree. First, the girls have to know that they can say no and their partners will have to accept it," says Yaquelín Félix, project coordinator of the Foundation for the Development of Nursing (Fuden), who works in this area in bateyes such as Mata los Indios.
Yésica Prensa became pregnant with her last child, Dylan, without wanting to. I took the birth control pill, but wrongly, every other day. Miguel Lizana (AECID)
Felix's fight to reduce teenage pregnancy and associated maternal mortality is also against myths, taboos and misinformation around contraceptive methods: "Many do not tell their parents that they have sex and, therefore, cannot take the contraceptive pill home. The intradermal method [an implant in the arm] is the most appropriate in these cases, but some ask us to remove them after putting it on because, with the imbalances in menstruation, they think they are sick and that the blood will rise to their heads. "
The cost of early motherhood
Adolescent girls who become pregnant are more likely to suffer complications in pregnancy and childbirth which are, in fact, the leading causes of death among young women aged 15 to 19 worldwide, warns UNFPA. With 107 deaths per 100,000 live births, maternal mortality in the Dominican Republic is disproportionately high for an upper-middle-income country, and is above the rate of 88 in Latin America and the Caribbean, despite the fact that 98% of births were attended by qualified personnel. And their babies are more likely to suffer health problems and even die. In the case of Prensa, one of these fatal statistics came true. "He died a few weeks after birth. They sent me home and I saw something was wrong." She took the baby to the doctor, but there was nothing to do anymore. The doctor also told her that she could not have any more children. "He was wrong."
Tall, thin and with subtle gestures, Prensa alternates smiles with tears in the narration of her life, while her two youngest claim her attention. Sitting in the shade next to her modest two-room home, one for sleeping and the other with a ramshackle gas stove as her only equipment, she breaks down in tears as she immerses herself in thoughts of what could have been and was not. Nor does he think it will be. "I always said I would study law," he wipes his cheeks to continue.
Again, Prensa is the face behind the data on another consequence of teenage pregnancy: school dropout. 45.9% of young women who have become mothers between the ages of 15 and 19 attend school or university, compared to 89.8% of those who have never given birth. "This inequality has repercussions in fewer opportunities for their development," analyzes a study by Teresa María Guerrero, a researcher at the Dominican Institute for Evaluation and Research of Educational Quality.
More than half of the adolescents who become pregnant in the Dominican Republic drop out of school and, when they get a job, earn an average of 20% more than those who have been mothers in adulthood. Miguel Lizana (AECID)
"I didn't finish high school, now I'm paying the consequences. I would have had a profession," Prensa is excited. "I would like to work. Whatever, but work," he repeats with tears in his eyes. And go back to school? "I can't either," and he shakes in his lap Dylan, the youngest of his children, about to turn two. "I have no one to take care of them." Even with care support, financially she could not afford to resume her studies: it would mean paying, in addition to tuition, daily trips to the city of Monte Plata, where adult training is provided. A fortune of six euros a day that he does not have.
"Her story is no exception," stresses Micaela Parras, head of programs at the Spanish Agency for International Development Cooperation (AECID) in the Dominican Republic, which supports projects of local organizations so that there are fewer and fewer cases like the Press that "show the inequality of women through denial, in all possible ways, of their rights".
Cases like that of Yésica Prensa "show the inequality of women through the denial, in every possible way, of their rights"
Micaela Parras, AECID Dominican Republic
The reality of Prensa is so common and persistent that the results of a 2018 UNFPA study indicated that the cost of teenage pregnancy and early motherhood in the Dominican Republic amounted to more than 222 million euros that year (0.29% of GDP). A figure resulting from the sum of health care expenses and the cost of less education and the difficult or no labor insertion of young mothers who, when they get a job, earn on average 20.4% less than those who were mothers in adulthood.
Trapped in a cycle of poverty and with no hint of an opportunity to get out of it, knowing firsthand the cost of early motherhood and school dropout, Prensa talks to the young women of her community so that they postpone motherhood and do not abandon their training. "They tell me who am I to give them advice, that I stopped studying and have dedicated myself to giving birth to children without a future." But she does imagine a prosperous future for her little ones: "I want them to study, to be someone in life, so they don't have to go through what I've been through."
Free contraceptives, little information
With no more family support than that of his grandfather – pastor of Mata los Indios – after the death of his mother and his father left, Prensa sent the eldest of his children, now seven, to live with uncles. Then came Keisa who, at the age of three, runs around her mother on a toy motorcycle with which she stumbles through the earth. He already had his desired girl, whose initial he wears hanging on a thin chain around his neck. And I didn't want any more. She opted for the contraceptive pill, which is provided free of charge at the Monte Plata health center. But very soon she became pregnant again. Instead of taking the pill daily, she did it every other day, only when her partner slept at home. "I thought it was going to work out, but no."
Without family support for the care of her children, aged two and three, Yésica Prensa cannot resume her studies or work. In the picture, he chats with his grandfather, his only close relative, who is the pastor of the community of Mata los Indios.Miguel Lizana (AECID)
Today, the lump of the contraceptive implant is stroked in her left arm. "It was recommended by the gynecologist and my mother-in-law told me it was safe." This method is effective for three years and will not give you the option to make mistakes. "When it's over, I'll wear another one," she says determinedly. "I wanted to prepare." That's tubal ligation, but he was (and is) too young for such a drastic operation.
In search of the "cascade effect"
Despite declaring a great concern for the unexceptional reality of Prensa, the Government of the Dominican Republic, in line with the postulates of the religious and conservative sectors of the country, repealed at the end of 2022 the 2019 norm (never implemented) that introduced training in gender equality and sexual and reproductive health issues in the pre-university school curriculum. "Many schools demand that we go to give talks on the subject because the girls get pregnant," says Felix, from Fuden. According to the local press, which cites data from the Ministry of Education from May 2023, "at least 1,154 students are pregnant this school year, of which 112 have been victims of rape and 28 of incest."
Yohanni Beras Pérez is the other side of the coin. Witnessing the abuse suffered by her older sisters, who married as teenagers, she decided that she did not want that life for herself and continued her studies until she graduated in nursing. "It wasn't easy, sometimes, in college I was hungry," she says. Today, she is the community leader of Mata los Indios.Miguel Lizana (AECID)
For Micaela Parras, of the AECID in the Dominican Republic ―which has logistically contributed to the realization of this report―, "it is fundamental" to support health personnel and organizations that work in rural communities, "invisible and excluded", where the statistics of early unions and adolescent fertility are most primed. In this line, Spanish Cooperation will allocate 3.2 million euros to the fight against this scourge between 2019 and 2024. Of that amount, Fuden will receive 181,000 euros over two years to train nurses who in turn will give workshops to community health promoters. They will disseminate adequate information on family planning to the population, especially the youngest. Also in Mata los Indios. "The country is communities and, by intervening in them, we will achieve a cascade effect to change the country," reasons Félix, who coordinates this project.
"At school, the teacher explained something to us, but if it had been for my mother, I wouldn't know anything," says Yohanni Beras Pérez, leader of the residents of Mata los Indios. She has had a very different life from her friend Prensa. Witnessing the mistreatment suffered by her older sisters, married at an early age, she decided that she did not want that life and focused her efforts on studying. With effort and "going hungry", she managed to finish nursing and works in the emergency department of a hospital. She has become a reference in her community, but here, she is an exception.
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