* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
High up in the Ecuadorian Andes, in the shadow of Mount Chimborazo, the highest point on earth, many adolescent girls keep their pregnancies a secret for as long as they can. Stigma and shame keep them silent.
In Chimborazo province, where most of the 500,000-strong population belong to the Quichua community and two-thirds live in poverty, the official rate of teen pregnancy is 15 porcent, but the true figure is probably far higher.
The secrecy means that by the time pregnancies come to light, it’s too late to provide the girls and unborn babies with the essential medical care they may need to save their lives.
When Jenny found out she was going to have a baby at the age of 16, she didn’t tell anyone.
“I knew I had to tell my parents but I didn’t trust them,” says Jenny, who is now 20 “We hadn’t talked much as I was growing up.”
The brightly-coloured fleece ponchos and intricately-patterned belts girls and women wear as protection against the chilling mountain winds make it easy for swelling bellies to go unnoticed.
When Jenny’s mother, Olga, eventually realised her daughter was pregnant three weeks before she had the baby, she cried. “I was shocked,” she says. “I hadn’t known she’d had a boyfriend.”
The clandestine nature of Jenny’s pregnancy meant she received no health checks at any point during the nine months and she gave birth with only her mother’s help, in the remote little bungalow where she has lived her whole life.
Thankfully, Jenny had a trouble-free birth and her son, Justin, has grown into a healthy ruddy-cheeked four-year-old who loves playing with the family’s collection of guinea pigs – an edible treat in the Andean highlands.
But not everyone is so lucky. Babies born to teenage mothers are 50 percent more likely to be stillborn or to die within their first weeks of life. In Chimborazo, where many families live many miles away from their nearest health facility and few own a car, the risk is even more acute.
Like Jenny, 19-year-old Lourdes had her first baby at 16. Within two weeks, the baby tragically died.
“I think he got the flu,” says Lourdes. “I was very sad. I cried a lot.”
Doctors stationed at a local hospital have long been worried that the secrecy around teen pregnancy in Chimborazo presents serious health risks to babies – and also their mothers.
Worldwide, pregnancy and childbirth complications are the leading cause of death among 15 to 19 year-old girls, with hypertension and abnormal bleeding the most frequent causes. Sixteen mothers died during or after giving birth in Chimborazo in 2017 and 12 the year before.
Lourdes’s mother-in-law, Rosa, is one of 47 midwives who for the past year has been receiving training from Plan International and Ecuador’s Ministry of Public Health to help tackle this problem.
Rosa has spent the past four decades using traditional indigenous birthing techniques to tend to pregnant mothers in her community. Plant medicine, prayer offerings to Mother Earth and vertical births have been the mainstay of her work.
Now she is working with local doctors to help them identify girls who are pregnant.
“The traditional midwives are completely embedded in the local communities and they occupy a position of trust, so having them alert us when they hear of teenage pregnancies is invaluable,” says Gabriela Cherrez, a local doctor.
In these unassuming households, Rosa relies on herbs to treat young mothers. Kalawalla, a type of fern native to South America is used to stop any bleeding, while cinnamon tea reduces the pain. She encourages girls to give birth kneeling up - holding on to a standing family member while having their hips massaged by Rosa - so that gravity can hasten the delivery.
Rosa still uses these techniques, but she has also received training to spot the warning signs that all is not well with mother or baby. She has also been encouraged to accompany girls to hospital to give birth because the sanitation in homes can be poor.
Lourdes gave birth to her second child two months ago. Accompanied by Rosa, she made sure this time to visit her local health centre for check-ups and vaccinations both during and after the pregnancy. Baby Jessica is a picture of health.
This year every one of the six teenage mothers identified in the local community received medical attention from Rosa or one of her peers, helping ensure they and their babies could go on to lead healthy lives.
The hope is that over time, the number of teenage mothers in the region will decline. In the meantime Rosa and her fellow midwives are determined girls and babies receive the healthcare they need to succeed in life.