Rural Vs. Urban Access to Health Services
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One of the first things I noticed when we got to Nicaragua was that everyone seemed very young. Seven out of ten of the people you pass on the street are under thirty, and most of them look like they are under 20. I’ve started researching this a bit more as background knowledge for a series of interviews I’m going to be conducting on the topic of Maternal Waiting homes in Nicaragua, and have discovered that my initial observation is correct. Adolescents (age 15-19) represent 26% of the population, and the percentage of women within that age bracket getting pregnant is the second highest in Central America. Not surprisingly, more than half of those pregnancies are unplanned.
The statistic is important not only because it’s high, but because unlike other health issues such as infant mortality, or HIV prevalence you can see the problem of adolescent pregnancy just by walking down the street. For example, a friend visiting from the US did not need a degree in medicine, or international development to make the semi-exaggerated statement “babies are having babies in Nicaragua.”
So how do we address it? Is it an isolated problem, or rather a symptom of a larger set of issues such as poverty, education, and access to services? A recent World Bank report “Las Casas Maternas en Nicaragua” states that 60% of adolescent women getting pregnant are from rural areas. What does that mean? Why would women in rural areas be more likely to conceive than women in urban areas?
Rural areas in Nicaragua have higher levels of unemployment and poverty, and lower levels of education. The national average of people without adequate education is 18% while in rural areas that number jumps to 25%. Women in rural areas also have less access to medical services and information on contraception, not to mention that they have fewer future opportunities to keep them from starting a family too soon. The result of these differences is that the average number of children per family in rural areas is 3.8 compared to 2.8 in urban areas.
Youth pregnancy is not the only problem stemming from the larger issues of rural versus urban access to education, health services, and employment. Levels of infant mortality and maternal mortality are also higher in rural areas than in urban areas, however you won’t be able to make that conclusion based on a walk through the campo. I'm hoping that the more obvious symptom of youth pregnancy will get other people to hone in on the underlying problems as well.
