By Anastasia Moloney
SAN SALVADOR, May 2 (Thomson Reuters Foundation) - Rape at the hands of relatives and a lack of sex education are driving pregnancies among girls in El Salvador, which is struggling to stem one of the highest rates of teenage pregnancy in Latin America, according to a top health official.
More than a third of all pregnancies in the Central American nation are among girls aged 10 to 19, and girls as young as 9 have become pregnant, said Deputy Health Minister Eduardo Espinoza.
Rape and incest at the hands of grandfathers, fathers and other relatives is often the cause of pregnancies in girls aged 10 to 14, although there are no official figures, Espinoza told the Thomson Reuters Foundation in an interview.
"With adolescent pregnancies there's always a component of violence through either incest, or violence in the family, or domestic violence," he said.
Complications during pregnancy and childbirth are a leading cause of death among teenage girls worldwide, according to the World Health Organization (WHO).
In Latin America, the risk of maternal death is four times higher among girls under 16 compared to women in their early twenties, WHO says.
While non-governmental organizations and the ministry of education train some teachers about sex education, El Salvador has no formal curriculum on sex education, and schools are not required to provide it.
"Boys and girls come to have their first sexual relationship without having had any professional information. Generally the information they have comes from other children who are just as much as misinformed as they are," Espinoza said.
Initiatives to develop a nationwide curriculum on sex education have been opposed by the Roman Catholic Church and some evangelical groups.
In 2008, the church blocked a manual for teachers, created by the education ministry, from being used to teach sexual health in schools.
Opponents say sex education encourages children to engage in sex.
Sexual health experts, however, say a key way to curb teen pregnancies is to provide girls and boys with access to family planning information and services, including emergency contraception.
A 2015 World Bank study found that Salvadoran teenagers "were not educated enough" about sexual and reproductive health and had limited use of and access to contraceptives.
Espinoza said stepped-up efforts to stem teen pregnancies need to be taken by the ministry of education.
"We don't deal with teenage pregnancies until a teenager becomes pregnant," Espinoza said. "But the issue is before teenagers get pregnant and that's to do with school."
He defended the government's record, however, saying access to health services has been expanded nationwide since 2009, including free contraception.
El Salvador's waves of emigration also has played a role, the minister said.
Around three million Salvadorans live abroad, mainly in the United States, many of whom fled the country's 1980-92 civil war and more recently gang violence.
This has left broken families and untended children, Espinoza said.
"Fathers migrate, leaving mothers to be the sole breadwinner. Mothers find work in the garment factories and work all day so children are free, left alone," he said. "They are completely vulnerable." (Reporting by Anastasia Moloney, editing by Ros Russell. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights and climate change. Visit http://news.trust.org)