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El embarazo de las adolescentes en la Zona de Monteverde: un examen preliminar.
Adolescent pregnancy and contraceptive use in the Monteverde Zone: a preliminary examination.
A preliminary assessment of contraceptive use and availability in the Monteverde Zone using qualitative field methods. Recommendations for improved contraceptive practices are included.
Una evaluacin preliminar de los usos y disponibilidad de los anticonceptivos en la Zona de Monteverde usando mtodos cualitativos del campo. Incluye recomendaciones para mejorar las practicas anticonceptivas.
The research team had been informed that adolescent pregnancy and various reproductive health issues are important problems that need to be addressed in the Monteverde area. To research the topic of adolescent pregnancy, qualitative field methods were used to gather data. Ten structured in-depth interviews on issues surrounding adolescent pregnancy were conducted with various community members in the Monteverde Zone. A number of informal conversations were also included in our qualitative data analysis. The authors conducted a preliminary assessment of contraceptive use and availability in the Monteverde Zone. Furthermore, the Globalization, Nutrition and Health field course conducted 19 reproductive histories in the San Luis area as part of a methodological exercise. This data was then analyzed and incorporated into the authors findings. Findings included that there are varying opinions with regards to adolescent pregnancy, and that lack of recreational resources contribute to adolescent pregnancy and to drug and alcohol abuse. Moreover, abortion is available in surrounding areas, if an individual is seeking one. There were varying opinions with regards to the sex education within the schools. However, many respondents called for even more education and information for adolescents. The major influences on adolescents sexual decision-making were first their friends, and then their family. Based on the information gathered from these interviews, various recommendations are presented for future research and methods to help alleviate the problem.
El equipo de investigacin fue informado de que el embarazo de las adolescentes y otros asuntos varios de la salud reproductiva son problemas importantes que necesitan ser atendidos en la Zona de Monteverde. Para investigar el tema del embarazo de las adolescentes, se utilizaron mtodos cualitativos de investigacin de campo para recoger la informacin. Se realizaron diez entrevistas estructuradas a fondo a residentes de varias comunidades en la Zona de Monteverde sobre temas que influyen el embarazo de las adolescentes. Tambin, se incluyeron en nuestro anlisis de datos cualitativos, varias conversaciones familiares. Las autoras condujeron una evaluacin preliminar sobre el uso de anticonceptivos y su disponibilidad en la Zona. Adems, el curso sobre la Globalizacin, Nutricin y la Salud condujo diecinueve historias reproductivas en el rea de San Luis como parte de un ejercicio metodolgico. Despus, estos datos fueron analizados e incorporados en los resultados que las autoras encontraron. Los resultados incluyeron que hay opiniones diferentes sobre el embarazo de las adolescentes, el abuso de drogas y alcohol por parte de los adolescentes, y tambin la falta de recursos recreativos contribuye al embarazo de los adolescentes. Por otra parte, el aborto esta disponible en reas cercanas, si un individual lo busca. Hubo varias opiniones sobre la educacin sexual dentro de las escuelas. Por un lado, muchos informantes exigieron que an ms educacin sexual e informacin sean ofrecidas a los y las adolescentes. Las mayores influencias en la toma de decisin sobre la conducta sexual de los adolescentes fueron, primero sus amigos, seguido por su familia. Basadas en la informacin recogida por estas entrevistas, se presentan varias recomendaciones para ser investigadas en el futuro y tambin mtodos para ayudar a eliminar el problema.
Teenage pregnancy--Costa Rica--Puntarenas--Monteverde Zone
Contraception--Costa Rica--Puntarenas--Monteverde Zone
Sex education--Costa Rica--Puntarenas--Monteverde Zone
Community Health 2001
Scanned by Monteverde Institute
t Community Health
Adolescent Pregnancy and Contraceptive Use in the Monteverde Zone: A Preliminary Examination Deepa Bhat Michelle Cockerham Amy Malliett Globalization, Nutrition and Health Monteverde Institute June 24th to July 21st, 2001
Abstract The research team had been informed that adolescent pregnancy and various reproductive health issues are important problems that need to be addressed in the Monteverde area. To research the topic of adolescent pregnancy, qualitative field methods were used to gather data. Ten structured in depth interviews on issues surrounding adolescent pregnancy were conducted with various community members in the Monteverde Zone. A number of informal conversations were also included in our qualitative data analysis. The authors conducted a preliminary assessment of contraceptive use and availability in the Monteverde Zone. Furthermore, the Globalization, Nutrition and Health field course conducted 19 reproductive histories in the San Luis area as part of a methodological exercise. This data was then analyzed and incorporated into the authors findings. Findings included that there are varying opinions with regards to adolescent pregnancy, and that lack of recreational resources contribute to adolescent pregnancy and to drug and alcohol abuse. Moreover, abortion is available in surrounding areas, if an individual is seeking one. There were varying opinions with regards to the sex education within the schools. However, many respondents called for even more education and information for adolescents. The major influences on adolescents sexual decision making were first their friends, and then their family. Based on the information gathered from these interviews, various recommendations are presented for future research and methods to help alleviate the problem. Personal Biography of the Team Our research team consisted of three members from various research backgrounds. Deepa Bhat is receiving a Masters in Public Health with a concentration in Epidemiology and a Masters in Nutrition with a concentration in World Hunger, Malnutrition, and Development at Tufts University in Boston, MA. Michelle Cockerham is presently completing the first year of her Masters in Public Health at the University of South Florida. Her area of concentration is Tropical Public Health and Communicable Disease. Amy Malliett is a Masters student in a dual degree program in Applied Anthropology and Public Health at the University of South Florida. Her area of research is in HIV/AIDS prevention, transmission and education in a cross cultural context. Each of the three authors was interested in themes that broadly revolved around reproductive health, so these themes were all compromised a bit to form this group. Malliett was interested in HIV, STDs, sexuality and/or womens issues. Bhat was interested in maternal nutrition and prenatal care issues. Cockerham wished to focus on womens health in a more general sense. Thus, it was difficult for the group members to compromise these topics in order to focus on adolescent pregnancy and contraception after talking with certain community members who informed them that this is considered a significant health issue in the Monteverde area. The Research Problem Once the group settled on this topic, the members began to realize how little they knew about the factors surrounding teen pregnancy in the Monteverde area. When fieldwork began, we discovered that, depending on whom we interviewed, different individuals had differing opinions on whether or not teen pregnancy is a rising problem, a problem at all, or if it is just a stigmatized norm. We wondered if maybe this is just the way it is for the younger generation of Tico/as. Also, who was it that actually considered teen pregnancy a problem also into our thought processes? We knew that some people perceived it as a problem, but who, and specifically, why? In any case, we were told informally that twenty of the previous years eighty local births
were to adolescent moms. If accurate, the rate of 25 percent is quite significant, so it is a phenomenon, whether or not it is considered a problem. However, one fear we had was that we might be biasing our answers by assuming it is a problem. Thus, the group spent some time brainstorming in order to attempt to get a conceptual grasp on this issue in the local context. Nat Scrimshaw, Director of the Monteverde Institute (MVI), organized a community forum to discuss the research topics of the Globalization, Nutrition and Health class. The community forum held at Monteverde Institute to discuss our group topics was very helpful in that some community members suggested many related topics. In this forum, certain community members informed us that incest is very common in this area. Moreover, according to another community member at that forum, gender relations also cause depression among women, but people do not like to talk about it because of machismo. We were also reminded that the problem of adolescent pregnancy is present at the national level, not just locally in Monteverde. Some community members also stated that sex education in local schools is a good idea for teenagers because parents do not normally talk about it. In addition, other community members also mentioned that the Catholic church is a huge barrier to family planning, given its views on contraception. Further complicating the issue, there are very few recreational activities in the area; one community member claimed that teens spend most of their time with other teens, watching T.V. or on the internet. The Historical and Social Context In 1951, a group of Quakers from Alabama came to what is now the Monteverde area. This area is now comprised of three relatively densely populated neighboring communities Santa Elena, Cerro Plano, and Monteverde and twenty four outlying villages that are economically tied to these communities. The community today, includes scientists, artisans, researchers, tourists, Quakers, Ticos and a colorful mix of anything and everything in between. In the eighty years since the areas earliest agricultural settlement, there have been drastic changes in the area. Globalization, in a plethora of ways, has changed social relations, lifestyles, culture, norms and personal goals and aspirations. However, the view that, in the past, sexual relations were restricted to marriage; divorce and desertion were almost unheard of and unified families of three generations formed the moral base of the society is no more accurate than the gloomy picture of current family breakdown (Biesanz 167). In fact, as of 1996, female headed households, mostly single mothers and their unmarried children and often their daughters children as well accounted for 20 percent of all households (Biesanz 172) in Costa Rica. Moreover, trends towards earlier initiation into sexual activity and toward later marriage increased the incidence of out of wedlock births from 14 percent of all births in 1970 to 47 percent in 1995. Such births are especially prevalent in rural areas and in coastal provinces. Public attention has focused on adolescent mothers, but most new single mothers are twenty or older (Biesanz 173). For such reasons, since the 1970s, the government has promoted family planning. It offers contraceptive services at social security clinics. It uses TV spots and billboards to encourage smaller families and the use of condoms, although describing the latter primarily as a safeguard against AIDS. Many priests now offer tacit support for family planning (Biesanz 172). However, the issue of adolescent pregnancy still seems to persist, at both the national and local levels. Globalization, of course, has wrought changes on the national level, but also in Monteverde. The Costa Rican governmental infrastructure has been hurried to keep up with the changes, and this is true in regards to
adolescent pregnancy as well. In fact, the CCSS or Caja has created the Program of Integral Attention to the Adolescent (PAIA). The PAIA publishes a pamphlet regarding adolescent pregnancy and manages a hotline called Cuenta Conmigo for teenagers who have questions about sexuality. According to PAIA, Costa Rican teenagers are having children because of factors including the lack of adequate sex education, resources and available avenues when seeking advice. Also, they do not realize the serious consequences of having a baby. Or worse, they view it as an attractive option. The belief that pregnancy will strengthen their relationship with their partner and the role women have historically played in society as mothers and housewives are also influences (PAIA 99 04, Seguro Social de Costa Rica). Moreover, from the methodological point of view, adolescents, nor of dysfunctional families, nor the lack of information about contraceptive methods, but it is a product of multiple interrelationships, of these and other factors (Rivas 1). These claims seem to be corroborated by our fieldwork in the Monteverde Zone (discussed later). At the local level, contraceptive methods are available to adolescents through the Caja health care system. Moreover, according to the Ficha data from 2000 in the Monteverde Zone, among 15 to 19 year olds, birth control pills were the most common form of contraceptive used followed by condoms. However, data collected through in depth interviews (discussed later) suggest that the Ficha data seem to overestimate the rate of contraceptive use within this age group. The types of contraception the Ficha data suggest as being used also seem contradictory in comparison to the information we gathered. Whats more, in Costa Rica, in general, abortion is easily available at private clinics for those who can afford it or from less skilled, less hygienic practitioners for a smaller fee. Complications following amateur abortions are now the main cause of maternal mortality (Biesanz 173). This issue was also frequently raised locally in the Monteverde Zone. Besides contraceptive issues, in recent years, the AIDS epidemic and the coincidental rise in teenage pregnancies have increased the demand for sex education (Biesanz 181). While sex education is available in the Monteverde Zone, interview data indicates that it depends on which school is attended, and its quality seems debatable. Nationwide, studies have found that 40 percent of girls in a 1993 study were bewildered by their first menses. Other studies have found that most young Ticos use no contraception during their first intercourse, which now usually occurs, for both sexes, long before marriage typically at about age fifteen for boys and sixteen for girls (Biesanz 182). Thus, the data on this issue definitely suggest little more than the fact that these issues need to be researched more extensively. Corroborating the reference to incest at the community forum, studies show that since 1997, when more detailed records have begun to be kept, sexual abuse and incest are growing alarmingly these statistics do not take into account the hundreds of cases that remain anonymous in families that cover up the problem to avoid denouncing the offenders (Mendez 171). Moreover, in the local context, the issue of sexual abuse of children and incest was mentioned in a number of our interviews. Thus, this is an issue that demands serious further research. In the case of information about sexuality available to adolescents in the Monteverde Zone, we have heard from a number of people in the community that every home has Satellite TV, and that adolescents and children watch a lot of T.V. and learn a lot about sex from what they watch. Of course, this is the case of television around the world, but it still may be a strong factor that influences adolescents perceptions on sex and sexuality. Some members of the Monteverde communities have mentioned that children begin watching soap operas (Mexican soap operas that mostly have sex and amorous relationships as a theme) at a very
young age. Moreover, even the teen magazines in the local businesses exude images, articles and references that revolve around sex. One magazine, 15 to 20, shows photographs of young women in suggestive clothing, suggestive poses and contains a number of articles about sex, romance and topics usually considered of an adult nature. The very fact that the magazine targets fifteen year olds to twenty year olds, which spans varying levels of maturity, suggests that teens in Costa Rica are being targeted as being part of an adult cohort, as well. Research Methods Thus, given all of this complicated and potentially contradictory data, and the information that arose out of the groups initial inquiries, the authors decided that local opinions were vital to an understanding of factors surrounding adolescent pregnancy in the Monteverde Zone. Moreover, given the sensitive, often clandestine nature of these issues, gathering quantitative data would be almost impossible, given our limitations. Thus, our fieldwork revolved around collecting qualitative data would be almost impossible, given our limitations. Thus, our fieldwork revolved around collecting qualitative data from the local community. As mentioned, when we first settled on our general group topic, we began to brainstorm about issues relating to reproductive health in the Monteverde area. We had a number of questions we needed to have answered before we felt confident to begin our actual field work. First, we needed to know how to locate local teenagers and community members to interview. Thus, we began asking people such as Angie Houge at MVI and others about potential contacts, and then networked through the recommendations from there. The community forum held at MVI was very helpful in guiding the direction our research would take, and focusing our brainstorming into research questions. We had wondered about the legal age of marriage, as we all were unfamiliar with Costa Rican domestic laws. Further, we wanted to know what the more common forms of birth control are and if they are readily available to teenagers. Our group also brainstormed about possible influences on sexual decision making such as the concepts of safe sex, gender relations such as machismo, gender roles and religion. Furthermore, although we knew that abortion is illegal, we questioned its availability throughout unofficial channels, like in so many other countries. To begin answering some of these questions, we began our fieldwork in the local communities. Informal and structured interviews were conducted with a number of community members, including women who delivered babies when they were teenagers, to collect qualitative data concerning this health issue. We were interested in opinions and local conceptions of the issues related to adolescent pregnancy, such as contraception, the life and responsibilities of adolescent parents, factors influencing sexual decision making, etc. The most feasible way to obtain opinions is trough the use of in depth interviews. Some of these interviews were impromptu, taking place when we happened upon them. Others were scheduled interview appointments. In all cases, guarantees of confidentiality were stressed. In addition, in the San Luis area, GNH class members conducted nineteen reproductive histories, for purposes of instruction and experience. The authors then analyzed this data, as it was relevant to our project, and incorporated it into our research. The course format did provide some challenges to our fieldwork and data collection. For instance, the amount of time we spent in lecture and class activities drastically limited the time available to work on our project. Also, since all students and staff at MVI share the use of only two vehicles, and our course had a large number of students (20), logistical problems with transportation were common. Thus, we had to arrange our own
transportation, in some cases, or limit our fieldwork to an area we could reach by foot. Moreover, some of the individuals we wanted to contact spoke only Spanish. In addition, our results and our presentation had to be available in bilingual format, which was time consuming since only some of our group members were fluent in Spanish. In other cases, there were conflicts in scheduling interviews or informants declined to be interviewed. Finally, it quickly became apparent to our group that, in order to be done comprehensively and effectively, a study of this nature would take much more time than the three week time frame the course allowed us. One of our biggest concerns was the sensitivity of this topic. Therefore, one problematic issue we faced was asking community members personal questions relating to contraception use and prevalence of abortion in the community, especially as non members of this community, much less the country. Certain individuals did not welcome our inquiries. In addition, we were concerned about presenting the information we gathered to the community, especially our analysis of the reproductive histories. Due to the interpersonal familiarity of the community we had to be extra careful to not include identifying information about any individuals in our writings or presentations, nor any controversial, problematic data. Discussion of Findings During the reproductive histories conducted in San Luis, a number of questions were asked of the respondents. Information on age at first pregnancy, age at first marriage, age at first period, contraception use, along with their actual reproductive history were some of the topics included in these reproductive history interviews. From this data and from other background research, a limited amount of demographic information was available to the group. The most salient finding of the reproductive histories was that there was a clear correlation between age and contraceptive use. It seems that, as age decreases, the likelihood of using some form of family planning increases. This is in stark contrast to some of the older women in the sample (over 55 70) who had never used any form of contraception in their reproductive life. The in depth qualitative interviews were more involved and comprehensive. There were a number of varying groups of people the group wished to contact. For example, teenagers, both with children and without, both male and female, would obviously have very relevant opinions on the issues discussed here. Further, certain community leaders such as doctors, teachers, business owners, and long term community members would all also be able to provide invaluable information for our research. At first, the research team discussed possibly creating a separate interview guide for each cohort of individuals. However, this would not have been feasible given our time limits and course format constraints, and would have created too much data to analyze. Thus, the authors created two interview guides; one was targeted at teenagers with or without children, the other at adult community members and/or leaders. These interview instruments were comprised of open ended questions relating to adolescents and their reproductive health. Information gathered covered a number of thematic areas. Most of our respondents have lived in Monteverde for a number of years, if not their entire lives. When we inquired about what local adolescents do for recreation, all respondents mentioned that there was little more for teens to do other than the bars La Cascada and La Taverna. Moreover, use and abuse of alcohol and drugs were mentioned as the most frequent pastimes, other than dancing at these bars. Most respondents felt this was also a serious problem in the local community. When the conversations turned to adolescent pregnancy, most respondents said that they did think adolescent pregnancy is a problem in the Monteverde area. On the other hand, one respondent said
that it was not necessarily a problem, but that it simply draws more attention because of the small size of the community. In any case, our findings suggest that the life of a teenager changes dramatically after becoming a parent. Some respondents said that, in most cases, young women drop out of school after having a baby. Most find employment and begin to work in order to support the child. Furthermore, a number of respondents noted that the fathers of the children of adolescents do not generally take responsibility for the child. Thus, many young mothers bear the weight of parenthood alone, or only with the help and support of her own family. In some cases, the mother of the adolescent will simply raise the child, rather than the teenager being responsible for it. Moreover, as one informant said, her life will change dramatically, but teen women dont think they have any other opportunities anyway, so they dont see their own potential. This sentiment of fatalism with regards to their own reproduction was mentioned as a characteristic of adolescent women in a number of interviews. In most cases, respondents noted that adolescents are not prepared for the responsibilities that parenthood brings upon them. Most respondents said that sex education is available in the local schools. However, there were various other themes about sex education that emerged. Moreover, some respondents felt that there is a lack of communication about sex and reproduction in the home. They noted that parents should discuss these issues with their teenagers, in the home even though they may learn about it at school. Others mentioned that the sex education in schools should begin at younger ages than it currently does and that it should contain more information and in more detail. The authors were told that the sex education in the covers included basic physiological information and the biology of reproduction. Some stated that contraceptive information is also covered in the schools, but there was also the opinion that it was not covered adequately. However, when adolescents have a question about reproduction and/or sexuality, most respondents felt that they would turn to their friends and/or their family, rather than any other source. In fact, one respondent saliently commented that, Sometimes its the family, others its the friends, not a whole lot the school. Many figure it out by themselves which is lonely and sad. Respondents were also asked about factors that might influence the sexual decision making of local adolescents. An individuals friends, as an influence on behavior, was the most common factor discussed. Wanting to do what everyone else is doing, influences adolescents decision making with regards to sex, just as with the cases of smoking and alcohol use. Moreover, the fact that the major recreation is local dance clubs/bars also influences behavior. Some respondents mentioned that teenagers mainly go to these establishments with their boyfriends or girlfriends, or with the intention of meeting someone. Furthermore, others mentioned that the cultural norm of women as mothers also influences female adolescents behavior. Interestingly, religion was not mentioned unless it was deliberately explored through probing from the interviewer. The authors found that knowledge about contraceptive use is limited among adolescents. After one respondent suggested evaluating the availability and cost of condoms in the area, the authors visited three supermarkets and department stores in Santa Elena and Monteverde to conduct a very small scale study. It should be mentioned that these are the only 4 businesses in the zone that we found to sell condoms. In each business, we had to openly request to purchase the condoms. The costs of the condoms ranged from 125 colones to 625 colones for a pack of three. Because in most cases the condoms are placed behind the counter it may not be conducive for teenagers to feel comfortable to buy them without others passing judgement. The
stigma attached to unmarried girls asking for contraception inhibits many girls from utilizing them. At the CAJA health center, injections of Depo Provera, two types of birth control pills, and condoms are available to anyone that requests them. I was informed by practitioner at a CAJA clinic that these methods are provided for no additional cost, other than the monthly SS payment every Costa Rican adult makes. One informant said, Pills and condoms are available, but young, young girls never use condoms. They will not use the pill, they are too ashamed, embarrassed. Yes, some teens use condoms, but if they all did all the time, there wouldnt be unplanned pregnancies, so all are not using them obviously. They do not protect themselves from STDs; they are getting pregnant, so they definitely arent protecting themselves enough. Although abortion is illegal, there are illegal practitioners. From our data, it may be more common than some may perceive. Plus, it is very dangerous when not regulated, and a major deterrent is the fear of having to go to the clinic if something goes wrong, in which case they would be asked to report what happened. Respondents suggested that Puntarenas and San Jose are places where abortion services are readily available. Most people knew of at least one or two girls who had received abortions. In addition, two respondents mentioned that the abortion pill (RU486) is also available here. The problem is that if someone wants one, they go find it, have it done, come back and just go about their life and ya, no one may know it. So, I dont know how often they happen. Another respondent mentioned that, They thought that it was the right choice, but they felt like they lost something inside, so they wanted to have another baby, but too young. Thus, abortion may be an important aspect of the reproductive health of local adolescents. Recommendations Out of the data we gathered, and the conversations we had within the community, many recommendations have emerged from the opinions of community members themselves. One of these involves methods of contraception, especially condoms and birth control pills. The authors findings suggest that these contraceptives should be made more easily available to teenagers. Our assessment of contraception availability showed that adolescents would have to make an obvious and often public request in order to receive most contraceptive methods. Moreover, in order to use condoms for contraceptive or safe sex purposes, adolescents have to purchase them; there is no place they can receive them at no cost and, more importantly, in a discreet manner. This was mentioned as a barrier to their being used. Moreover, some community members mentioned that there is a need to find more ways to promote safe sex and contraception among adolescents. Teenagers need a way to learn to protect themselves both from sexually transmitted diseases and from getting pregnant. Moreover, they should be reminded that protection only works if they use it every time they have intercourse; it only takes one time to get pregnant or to contract an STD. Some community members suggested that this could be achieved through some form of peer education. In conjunction with more availability of and promotion for contraceptive use and safer sex, increasing the amount of sex education and presenting it in various formats is key. For instance, there is a need for more sex education to be given to the young women who are not in school, since the classroom based programs are not reaching these individuals. Other informants feel that the programs that do take place in the schools should start younger than the age at which they received it (eleventh grade).
Another recommendation suggested by informants is to improve communication skills between sexual partners and between a young woman and her parents, especially her mother. In the case of all women, skills such as decision making and interpersonal communication should be emphasized. This would enable women, of all ages, to take more control over their own sexuality. Further, having open lines of communication with regards to reproductive health issues will be conducive to advice seeking and confident decision making. Most importantly, sexually active teenagers would be able to become more informed in their choices and this would then assist them in making thought out decisions. Many respondents stated that adolescents want more information with regards to sexuality as well as sexual and reproductive health. Some respondents mentioned that local organizations should coordinate and/or sponsor lectures and workshops about gender, sexuality and pregnancy. Workshops for men, for women, and for both together were all suggested. Forums for discussion among teenagers, themselves, were seen as key to this method. Moreover, these lectures and workshops would be even more effective if they were able to incorporate a system of peer education in which adolescent parents could relate their experiences to other teenagers. One respondent even stated, excitedly, that she would be willing to give lectures about her personal experiences. Another proposal by one of our informants was organizing similar workshops and lectures that consist of a panel of professionals. The panelists would also include teenagers with children, but in conjunction with obstetricians, gynecologists, and pediatricians. The same informant mentioned in the previous paragraph also offered to speak at this type of workshop. These could be held at the high schools, at the Monteverde Institute in conjunction with their Vida Familiar program, or maybe at the church. Some community members brought it to our attention that Priest Rafael is very open about this kind of thing and he holds activities for teenagers. Most community members conveyed the sense that the community needs to be realistic and open about issues relating to reproductive health and sexuality. In addition, once the baby is born it is important that teenagers are informed and confident enough to lead healthy lifestyles, for themselves, and for their children. Parenting classes are a way to provide discussion and instruction to teenagers on how to provide for the baby and take care of themselves too. Again, the concept of peer education is key here. In this context, adolescent parents could be incorporated into the program to convey the lessons they have already learned to the new parents. Moreover, as one informant said, education is the most important, but it takes more than that alone. Many informants said that education of this sort should start at the family level. Families here, they dont talk about things they need to talk about. The family is the base of our society, so we have to start there. Also, certain informants claimed that, there are many problems with the families here, as well. So, it follows that some kind of family counseling and/or, family support system would be very valuable here, including a focus on interfamilial communication skills and methods for parents to discuss sex and sexuality with their adolescents. Others called for more values being taught within the family, Since the family sets the example for behavior. Thus, the community should promote the discussion of sex in the home; parents have to talk to their teens about it. They need to know really how it is, but thats never enough. In any case, as another informant has said, things are improving a little bit, slowly, but a little bit. It used to be that people couldnt even say the word contraception. With the changes in norms with regards to these sensitive issues, changes in behavior
and information dissemination should follow as well. With increased funding and resources, the Vida Familiar program at the Monteverde Institute was seen as a vital asset to these recommendations. Moreover, as most of the informants interviewed for this project, adults and teenagers alike, mentioned that there are little or no recreational resources for adolescents in the Monteverde Zone, the local community should look for methods to remedy this situation. The lack of healthy and productive pastimes leads to much drug and alcohol abuse among adolescents, as well as providing much free time to engage in amorous and physical relationships with other teenagers. Providing options for teenagers other than drug use, consumption of alcohol, and sexual relations, will significantly improve the health and well being of local adolescents. Finally, one of the most salient conclusions the research team arrived at was that much more research is needed on this and similar issues. As with any research project, our findings brought up various other topics that should be further addressed to contribute to a comprehensive understanding of sexuality and reproductive health in the area; how do local couples negotiate family planning; how do local men perceive issues related to reproductive health, sex and sexuality; how do local women perceive issues related to reproductive health, sex and sexuality; how do these perceptions influence the behavior of teenagers; what is the cultural conception of parenthood; what are the roles men and women are supposed to play within the family and as parents; what are the major barriers to adolescents using contraceptive and safe sex methods; what is the rate of incest and sexual abuse of minors in the Monteverde Zone; how do local children and adolescent recover and deal with these abuses; how do ramifications of these abuses affect an individuals sexual decision making in adulthood; what is the rate of depression and suicide among local adolescents; what factors influence the level of self esteem young local women have; what would be feasible methods to help increase the self esteem of these young women? Furthermore, a more comprehensive study of the issues addressed in this group project is needed. Obviously, there is quite a lot of room for further research in these subject areas. Moreover, the authors would fervently recommend these topics for upcoming studies, as many of them are of an important, urgent nature. The quality of life of the local youth is closely intertwined with many of these issues. Conclusion Through formative research, one can clearly see that adolescent pregnancy is influenced by a complex interplay of factors. These factors are relevant worldwide; whats more, many nations in the world are dealing with identical reproductive health issues. However, alleviation of this issue requires a close examination of cultural factors and norms specific to an area. At a local level, adolescent pregnancy is an emerging issue in the Monteverde community. This deduction is based upon discussions with various community members. However, in conclusion, as one respondent so eloquently phrased it, All parents can do is teach and explain, ultimately the decision is yours. Above all, teenagers need to have the ability to make informed and confident decisions with regards to their own reproductive health.
References Biesanz, Mavis Hiltunen, Richard Biesanz and Karen Zuleris Biesanz, 1999. The Ticos: Culture and Social Change in Costa Rica Boulder, CO: Lynne Rienner Publishers. Leitinger, Ilse Abshagen, ed., 1997. The Costa Rican Womens Movement: A Reader : Pittsburgh, PA: University of Pittsburgh Press. Mendez, Gioconda Batres, 1997. Father Daughter Incest: Case Studies in Costa Rica , as printed in Leitinger, ed., The Costa Rican Womens Movement: a Reader Pittsburgh, PA: University of Pittsburgh Press. Programa Atencin Integral de la Adolescencia (PAIA). Document number PAIA 99 04. San Jos, Costa Rica: Seguro Social de Costa Rica. Rivas, Hilda Nez and Ana Rojas Chavarra, 1999. Prevencin y Atencin del Embarazo en la Adolescencia en Costa Rica, con nfasis en Comunidades Urbanas Pobres , Rev. Costarric. Salud Pub. 8(14).