Pregnant Teens in Latin America Need Psychiatric Care



BOGOTÁ, COLOMBIA – Adolescent girls who become pregnant and carry to term experience high morbidity, including psychiatric outcomes, numerous studies have established. And, in Latin America, teenage pregnancy rates are rising, and legal abortion is rarely an option.

Learning how to prevent postpartum depression and psychosis among these girls is something "gleaned over years of clinical practice," says Dr. Roberto Chaskel, who has treated such girls for nearly 3 decades. "No one tells you how."

At the fourth International Congress of Medicine and Women’s Mental Health, Dr. Chaskel presented video of an 11-year-old who had just given birth days earlier by cesarean section and was experiencing psychosis. The girl had been referred for psychiatric care only after the birth.

Adolescent pregnancies have risen in many Latin American countries in recent decades, despite declining fertility trends overall, according to a 2007 United Nations Report. One Latin American study of 854,377 girls aged 15 years and younger found pregnancy associated with a fourfold higher risk of a host of adverse pregnancy outcomes, including maternal death, early neonatal death, and anemia, compared with women aged 20 years or older (Am. J. Obstet. Gynecol. 2005;192:342-9).

(Meanwhile, the Centers for Disease Control and Prevention reported recently that teenage pregnancy rates in the United States declined 9% from 2009 to 2010, which means that the rate is at an historic low of 34.3 births/1,000 adolescents aged 15-19 years. The decline was seen across all ethnicities.)

In most Latin American countries, including Colombia – where access to abortion is highly restricted, pregnancies among girls aged 15 years and younger often result in birth. Only three Caribbean or Latin American states permit abortion without regard to reason, according to a 2012 report by the Guttmacher Institute. Illegal procedures are estimated to represent 95% of all abortions performed in the region, according to the same report.

In 2006, in Bogotá there were 22,228 pregnancies reported among teenage girls between 10 and 19 years of age (170/100,000), placing Bogotá’s teenage pregnancy rates nearly on nearly on par with those of Uganda and Sierra Leone, according to a 2010 study by researchers at the Universidad Nacional de Colombia. A tenth of the reported pregnancies were to women aged 14 years and younger.

It is possible to prevent psychotic and depressive episodes related to pregnancy and birth and "offer teenagers and adolescents, and the babies of these girls, the best possible quality of life" through a family practice that seeks to mitigate some of the traumas associated with early sex, pregnancy, and birth, and also to guide the early attachment process between mothers and children, said Dr. Chaskel of the department of psychiatry at the Universidad El Bosque and coordinator of child psychiatry at the Fundación Santa Fe, both in Bogotá, Colombia,.

In a separate presentation at the congress, Dr. Marta B. Rondón, a psychiatrist affiliated with the Universidad Peruana Cayetano Heredia in Lima, Peru, discussed the difficulty of achieving an evidence-based understanding of the mental health impact of abortion and unwanted pregnancy in nations where access is restricted and "generally speaking, a woman cannot choose just to terminate a nondesired pregnancy."

In a restricted legal environment, "the condition of secrecy means the woman has to go a very hard road – this could have negative consequences for her mental health – but we don’t have the numbers," Dr. Rondón said, adding that discussing how to conduct research on abortion and mental health in Latin America would be a priority of next year’s international congress on women’s mental health, which will be held in Lima.

Any attempt to get a perspective on the mental health impact of abortion and unwanted pregnancy means using studies conducted in the United States and Europe – different cultural environments that could produce different results. "We need prospective research with randomized samples in Latin America, which may become possible as abortion is gradually decriminalized," Dr. Rondón said.

Currently, Peru and Colombia allow legal abortion only in the event of a threat to the life or physical health of the woman. In addition, Colombia allows terminations in cases of rape or to preserve a woman’s mental health.

Dr. Chaskel said in an interview that the 11-year-old patient in his video would have been a candidate for legal abortion under Colombian law and that he would have referred her had she presented to him early. However, he said, her obstetrician had judged her ineligible.

Their options might be limited in terms of a choice to terminate, but pregnant adolescents in Latin America do have the benefit of strong family ties, and Dr. Chaskel’s practice taps into the high level of familial support available to most. "You bring grandma and grandpa, and the new uncles and aunts into clinical practice – right into the office," he said in an interview. A pregnancy in adolescence "generates confusion not only for the girl but also on the whole family group: In Latin America, this usually means three generations confused as to how to approach this situation."

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