(Photographs by Jennifer Gonzalez)
While contraceptives are fairly available to teenagers in the Dominican Republic, pregnancy prevention is seldom practiced, at least before an adolescent's first child.
In this Caribbean country—where one in 10 teenage girls became pregnant in 2013, according to the United Nations Population Fund—prevention is taught after a teenager's first pregnancy, not before.
"If there was a first pregnancy, [we] avoid a second one," said Lilian Guerrero, 39, who has been a gynecologist for seven years at Maternidad Nuestra Señora la Altagracia in Santo Domingo, the country's capital. "That's what we do here."
In Guerrero's waiting room, 34 pregnant teenagers—one with a spouse, five with their mothers—sit and watch as a nurse wearing a blue collared shirt prays, claps and dances to make the soon-to-be mothers comfortable. Diagrams of what and what not to eat are taped on the walls, and after being weighed and attending an HIV lecture, the girls are tested for syphilis, Guerrero said.
Then they are called into a doctor's office.
"Cinco rosado," a nurse yells into the room now full of singing, and some smiling, adolescents. The number indicates what doctor they will see, and the color indicates if they have been to the hospital before.
Sixteen-year-old Gabriella Javier, who is seven months pregnant with her first child, jumps out of her chair and follows the nurse. Her 38-year-old mother, who became pregnant with her first of five children at the age of 14, remains seated in the waiting room.
Elisa Doñe Frias, 43, who has been a nurse at Clinica Rural el Jamey in the mountainous region of San Cristobal known as Jamey for four years, said teenagers do not get contraceptives until they are already pregnant because talking about sex is taboo in most homes, even though teenage pregnancy is a generational issue.
"Prevention lessons are about not having a second child," said Frias, whose clinic offers four types of contraceptives. "You can teach the kids, but the family needs to learn too because teens aren't allowed to have contraceptives in the home."
This is largely because the Dominican Republic is predominantly Roman Catholic, which, according to Pope Paul VI's 1968 Humanae Vitae, states, "any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation, [is intrinsically wrong.]"
Pablo Wagner, 54, who has been the sub-director at Materno Infantil San Lorenzo de Los Minos in Santo Domingo for 10 years, said church teaching could contribute to the high numbers of pregnant teenagers.
"[Churches] are opposing to allow young teenagers [to use] planification [contraception] methods," said Wagner, who had 64 pregnant teens ages 11 to 15 in his hospital in 2013. "The church says [contraceptives are] a way to encourage them to have sex."
Guerrero, who has a 15-year-old patient with three children, said because the church does not agree with contraceptives, doctors are often left in a predicament.
"Churches have their own opinions, but we as doctors have our own," she said. "[Neither Catholics or Protestants] agree with oral contraceptives, so that's a dilemma, but as doctors we think about health first."
Frias said teenage girls also do not get contraceptives because they fear people will think they participate in sex work, which is legal in the country.
"If a guy comes [to get contraceptives] it is considered good, but if a girl comes she may be a prostitute, which is viewed negatively," said Frias, who thinks parents should educate children about sex at the age of 9. "One 16-year-old girl is afraid to come here because she is fearful people are going to talk about her having sex."
Eighteen-year-old Yudeiqui Brito Guzman, who goes by Ariza, said she understands the 16-year-old's distress. She is the mother of 3-year-old Aleini and 4-month-old Yobel.
"The most difficult part of being a teenage mother is other people gossiping and their opinions," said Ariza, whose partner Yosandi, 19, visits Saturday through Monday when he is not counting oranges at the market for work. "Also going to school feeling all the pregnancy symptoms, nausea, vomiting."
Guerrero, whose youngest patient is 11 years old, said the country should create a prevention campaign to better promote contraceptives and open dialogue about using them.
"[There is] no education, no prevention lectures," said Guerrero, whose teenage-specific maternity ward assists about 80 patients each day. "They do not [know] about planification and start very young to have sex."
Eudhy Estevez, 24, who has completed six months of a yearlong internship at the Jamey clinic, said the high rate of pregnant teenagers can be attributed to the insufficient knowledge and discipline of contraceptive use.
"They don't use the pills as they are supposed to," Estevez said. "For example, they take [birth control] three hours after the time frame or they want to take them all together after [they have] forgotten. We keep giving them planification pills but they do not use them. They are kids having babies."