Investigating the Effects of Adolescent Pregnancies on Maternal Health and Child Development Among At-Risk Patients in Bolivia

Project: Bolivia

Adviser: Dominic Vachon

Final Report:

This past summer, I had the opportunity to conduct research on adolescent pregnancy and its effects on maternal health and child development in La Paz, Bolivia. La Paz is the highest national capital in the world and is connected by a cable car system called the Teleférico due to its many hills. The bustling city has two Level 3 hospitals, which are the hospitals with the highest level of care, drawing in patients with more extreme cases than Level 1 and 2 hospitals. I was able to conduct my investigation in both El Hospital de la Mujer and El Hospital del Niño (the women’s hospital and the children’s hospital) during my four weeks in Bolivia. I also spent one day in El Hospital Materno de Los Andes, a maternal hospital. Since these hospitals have the best care in the area, patients sometimes travel hours to receive care. This lack of access to healthcare was a central part of what I learned during my time in the hospitals. For my research, I was particularly interested in learning about obstacles that adolescent females face and understanding the circumstances that led them to the pregnancy. By gaining a better appreciation of the demographic and the cultural influences that are present, I could target my interview questions toward those topics and gain a holistic understanding of the issue of adolescent pregnancy. In addition to the focus on the mother, I spent time with doctors in the neonatal intensive care unit (NICU) and the newborn unit to learn more about the impacts of adolescent pregnancy on the development of the child. Overall, I was interested in learning about barriers to pregnant adolescents in La Paz, the effects the pregnancy has on the mother and the baby, and strategies to improve healthcare for these women and their children.

In order to thoroughly investigate the topic of adolescent pregnancy in La Paz, I worked with the organization Child Family Health International (CFHI). Their global health program provided me with access to health professionals in the hospital to learn from and observe. They partner with El Hospital de la Mujer and El Hospital del Niño as well as a few other locations outside of the city. My research was primarily conducted in the Women’s Hospital, El Hospital de la Mujer, but I also conducted interviews in the Children’s Hospital, El Hospital del Niño, and El Hospital Materno de Los Andes, a maternal hospital in El Alto, the neighboring city. In the Women’s Hospital, I spent most days in the high-risk obstetrics unit, which mainly consisted of women with complications in pregnancy, such as preeclampsia or an infection. However, in Bolivia they also consider adolescent pregnancies high risk, so this is where I was able to observe doctor-patient interactions with pregnant adolescents. Apart from my observations during rounds in the morning, I was able to interview three physicians and a group of four medical students who were in their fifth year of medical school. I was also able to observe a Cesarean section in the operating room, which gave me the opportunity to learn about this procedure firsthand. In the Children’s Hospital, I shadowed in the NICU and was able to interview three physicians and one medical student about their experiences with adolescent pregnancies and the children in the NICU who are a result of an adolescent pregnancy. In the Maternal Hospital in El Alto, I conducted interviews with two physicians and was able to observe postpartum care in depth. Every interview was conducted in Spanish, which caused some communication challenges, but I was able to learn more and more as I continued my investigation and developed relationships with the doctors.

All of the physicians and medical students mentioned the lack of access to adequate healthcare, especially in rural areas. Although I was in the city, I was able to observe this firsthand because women had traveled from rural areas of the country to receive care. These women were primarily in the high-risk unit because they had waited so long to receive care that it caused them to be at a point in their pregnancy where their lack of prenatal care had caused serious issues in the pregnancy. This lack of access to healthcare was prevalent for most patients and caused severe issues like anemia, postpartum depression, abuse, malnutrition, and problems with breastfeeding. Without healthcare access, education about healthcare was also scarce. This caused the pregnant woman to be uninformed about the importance of prenatal and postnatal care, putting themselves and their babies at risk.

In addition to inadequate healthcare and healthcare education, there is also a lack of sex education. Something that I was surprised to learn during my interviews is that all contraception methods in Bolivia are free. However, the percentage of Bolivian people who use contraceptives is very low. The lack of sex education in the country prevents adolescents from learning the importance of contraception and the various consequences that may follow with a lack of proper contraception. The physicians that I interviewed called sex education and contraception “taboo” topics in Bolivia. This being an avoided topic in the education and healthcare system causes more women to become pregnant, especially younger, uneducated women. Not only are sex education and contraception taboo in Bolivia, but mental health is too. Mental health is especially important regarding adolescent pregnancy due to the risk of postpartum depression as well as the possibility of abuse between the adolescent and her partner. The avoidance of cornerstone topics in the epidemic of adolescent pregnancy only increases the rate of these pregnancies. After speaking with the healthcare professionals in my interviews, I was able to understand that there is so much to do before pregnancy even happens. If young women are kept in school, given concrete goals for their futures, mental health resources, education on contraception and all of what is required of you during and after pregnancy, less young women may become pregnant. Young women need a system of support from their family, friends, healthcare provider, and education system to avoid an adolescent pregnancy or to maintain a safe pregnancy. The physicians emphasized the importance of individualized care and raising awareness to help these girls in the most optimal way possible.

In regard to the development of children who resulted from an adolescent pregnancy, I learned from the physicians that the cycle continues. The children are often either neglected, abused, or a combination of the two. This trauma in early life significantly affects brain development and causes these children to have developmental issues that lead them away from prolonged education and towards an early pregnancy, or the cause of an early pregnancy. Adolescent brains are already not fully developed and not capable of making such a life changing decision such as pregnancy. When children are negatively affected in early childhood by their unprepared adolescent parents, they are even further behind in development than other adolescents. In addition to brain development issues, a problem that children face due to adolescent pregnancy is a lack of prenatal care. I learned through my interviews that not only do adolescent mothers lack education about prenatal care, but they also do not have the ability to access that care whether that is due to their location, money, or an abusive relationship. A fetus that does not receive proper prenatal care can end up being born prematurely, which results in a Cesarean section. Many adolescents need to have a Cesarean section simply because their bodies are not grown enough to have the capabilities to give birth. Whether it is due to a lack of prenatal care or the age of the mother, a Cesarean section causes trauma to the body of that adolescent and also has been shown to affect the development of the child. In addition, it is shown that you should not have more than three Cesarean sections. This means that an adolescent pregnant is likely to dictate the number of children that woman can have in the remainder of her life.

My time spent studying adolescent pregnancy and its effects on child development in La Paz was incredibly eye opening and informative. I learned so much in just four short weeks and got to experience a sector of Bolivian healthcare in depth, furthering my knowledge of the culture and of the healthcare system overall. My interactions with members of the community in Bolivia taught me more than I could ever have imagined, and I am extremely grateful for the doctors and patients that provided me with this opportunity. There is so much to learn in the complicated realm of adolescent pregnancy, but I know that my experience has made me more cognizant of the hardships that adolescent pregnant women endure. This experience has deepened my passion for advocating for young mothers, and I look forward to learning more about adolescent maternal health to create a positive change in the future.