Time to talk about sex? Why Honduras is starting to tackle 'taboo' topic.

Honduras has the second highest rate of teen pregnancy in Latin America – a problem with long term social and economic consequences. 

Irene is curled up at the end of a yellow, plastic mattress, tapping her hand lightly on the cooing baby by her side. The 14-year-old new mother is so petite, she barely takes up the top half of the bed. At her feet lies another wrinkly, day-old infant that belongs to her 19-year-old roommate.

“I think having her will make my life joyful,” Irene says of her first child, Genesis.

The stiflingly hot fourth floor of this decaying wing of Hospital Mario Catarino Rivas, the largest public hospital in San Pedro Sula, isn’t a teen maternity ward. But there’s at least one girl under the age of 19 in each of the four-person rooms here. 

They're among the 66,000 teens giving birth in Honduras each year, according to USAID. Some 24 percent of all pregnant women in Honduras are between the ages of 15 and 19, a rate that's been rising and has given the country the second highest teen pregnancy rate in Latin America. Nicaragua is number one, and neighboring nations like El Salvador and Guatemala aren't far behind.

The consequences are serious, especially for Honduras, which already faces high rates of poverty, unemployment, and emigration. Giving birth before the age of 20 can have long-term health as well as social effects. Teen moms are more likely to drop out of school and less likely to be employed as adults, and babies are more likely to be underweight or to die in the first few months after birth.

Awareness about the importance of sexual education in the country is growing: Not only are tens of thousands of teens having babies here every year, but about half of those pregnancies are due to sexual assault, many times taking place within the family.

Educating about sex is more than teaching about STDs and condoms – though that’s vital, specialists say. Things like consent, and how to identify and report unwanted sexual advances is a part of the education that’s lacking and often times avoided due to cultural taboos here. National initiatives are popping up across the country, from training teachers – who may never have had sexual education themselves – on how to talk about sex in the classroom to setting up a hotline to address teen health concerns. Just last year the president and first lady launched a national program that aims to cut teen pregnancy by about 25 percent by 2018, largely through education initiatives in schools but also for government officials and within families.

“There’s more awareness that if we don’t educate about sex, we are working against the wellbeing of this country,” says Ana Raquel Gómez de Ordoñez, who heads up the department of adolescent pregnancies at the Hospital Escuela in Tegucigalpa. Dr. Gómez's team is running a pilot program that includes giving psychological care in addition to medical attention for teen mothers, in an effort to help them stay in school and avoid another birth in their teens.

A number to call

In a tiny office off a main hospital corridor on a recent afternoon, psychologist Alicia Benitez picks up her clunky orange phone on the first ring, asking in a sweet, high-pitched voice how she can help.

The hotline caller has questions about contraceptives: How old do you have to be to get them? What options are out there?

Ms. Benitez gives her a brief rundown on what is available – condoms, birth control pills, injections – and after determining that the caller lives nearby, suggests she come by the adolescent health department to learn more.

The LLAMHA call center, which uses the tagline, “call and clear up your doubts about sexual and reproductive health,” launched in late June, with backing from the Ministry of Health and World Vision Honduras. Volunteer doctors and medical students staff the phone line five days a week from 8 a.m. to 3:30 p.m., answering questions about sex and other concerns, like abuse or thoughts of suicide.

The pilot project is the result of a 3-1/2-year push by nurse Zayda Cáceres, who coordinates the hospital’s family and youth services. Over the years, Ms. Cáceres saw thousands of misinformed – or simply uninformed – teens arriving here pregnant, with sexually transmitted diseases, or facing other adolescent health challenges.

The hospital currently delivers between 150 and 170 babies each month to mothers between the ages of 12 and 15. Worried by these high rates – which increased by 25 percent over the previous year, according to the Ministry of Health – Cáceres began giving out her cellphone number to patients and parents.

“They’d call, they’d message, there were always so many questions,” she says. She realized for some teens, calling her was the only way to talk to an adult about sex. 

“I don’t think there’s a single teen in this country without at least one cell phone and at least one question about sex,” Cáceres says.

'Taboo'

A few hours south in the capital of Tegucigalpa, 15-year-old Tamariz climbs onto an exam table at the city’s largest hospital for her first ultrasound.

About three months pregnant, Tamariz stumbles over the word “sex” when she says that “of course” there was sex education at her school. Her class had chats about “AIDS and other illnesses,” she says. But when asked if there was any mention about birth control or the process of deciding whether or not to have sex, she looks down and laughs uncomfortably. “No, no, no. Nothing like that,” she says.   

In theory, sexual education is part of the national public school curriculum – but that hasn’t been the reality. Discussing sex is considered off limits to many in Honduras, a conservative and devoutly Christian nation.

“Talking sex is taboo,” says Julio Zuniga, country director for PASMO, an NGO that works on sexual and reproductive health. “Many see it as a sin, so the topic is rushed over or it’s sanitized.”

The phenomenon cuts across social classes, he adds. “A parent might have a master’s degree, but still, they won’t talk sex.”

Some teachers skip the sex ed curriculum by choice, or under pressure from parents who don’t want their children exposed to it. All this translates to, “13- and 14-year-olds that go to their friends to learn about sex and end up with inadequate information,” Mr. Zuniga says.

Training educators is a central part of the call center project, says Cáceres, who has so far worked with teachers from six schools in San Pedro Sula and is in the process of scheduling trainings with eight more.

But sex education shouldn’t be only about teaching teens how babies are made, says Hugo González, the United Nations Population Fund representative in Honduras who has worked closely with the government’s recent initiative on teen pregnancy. There’s also a need to inform girls and boys about consent and to teach personal responsibility.

The public prosecutors office estimates that 50 percent of teen pregnancies here are a result of sexual assault. These cases are severely underreported officials say, and part of the importance of sharing information about sex at school and within families is teaching about the vital role of consent.

“We can lower the teen pregnancy rate here,” says Gómez from the Hospital Escuela. “But it requires a team effort,” including parents, schools, churches, and the government, she says. “We have a lot of work ahead of us. [Pregnant] girls keep arriving.”

– Whitney Eulich reported from Honduras as a fellow with the International Reporting Project.