Hilary Zetlen, MPH, MDc


Nominated From: University of Washington

Research Site: Peru

Research Area: Maternal and Child Health

Primary Mentor: Dr. Magaly Blas, MD, MPH, PhD

Research Project

Early pregnancy among adolescent girls in the rural Peruvian Amazon: identifying and addressing educational determinants

Lack of educational attainment among young women in rural and underprivileged communities in Peru is an area of significant social and public health concern. In the remote and sparsely populated Loreto region, which encompasses most of the Peruvian Amazon, only 35% of women complete secondary school, while less than 2% continue on to university education. Loreto also has some of Peru’s poorest maternal and child health outcomes, with high rates of adolescent pregnancy and limited family planning services. Lack of female educational attainment in the Peruvian Amazon and the region’s reproductive health issues are likely interrelated– lower levels of educational attainment are associated with increased rates of adolescent pregnancy, which is in turn associated with increased maternal and perinatal morbidity and mortality. Addressing these educational disparities is a national priority in Peru. In 2011, the Peruvian government established the Beca 18 scholarship program to encourage youth from underprivileged communities to enroll in higher education. However, Beca 18 enrollment in Loreto continues to be dominated by male students. In order to design an effective intervention to address educational and reproductive health disparities, there is a need for improved understanding of why young Amazonian women do not complete school and how this affects gender equity and maternal and child health outcomes in the Amazon region.

Specific Aims:
1. Identify and characterize determinants of and barriers to educational attainment and family planning among young women age 10­-17.

2. Assess attitudes and knowledge related to female education and adolescent reproductive health among parents and community leaders.

3. Develop recommendations for a health promotion intervention to increase educational attainment and delay age of first pregnancy among young Amazonian women.

4. Collaborate with Beca 18 and the Ministry of Education to integrate scholarship outreach efforts into project design and implementation.

Research Significance

In Loreto, women give birth at a younger age and have more children than in other regions of Peru. Decreasing age among Latin American mothers is associated with substantially increased risk for maternal and perinatal morbidity and mortality, a pattern observed in Loreto, where maternal and infant mortality rates are considerably higher than Peru’s national average. Additionally, 71% of women in Loreto reported having an unwanted pregnancy at some point in the last year, demonstrating significant gaps in reproductive health knowledge and family planning services in the Peruvian Amazon. The educational inequities experienced by young Amazonian women are clearly associated with the poor maternal and child health outcomes seen in these communities. Women who are educated are more likely to access family planning services, use effective contraceptive methods, seek out prenatal care, and have skilled birth attendants. Targeting interventions to address the lack of educational attainment among young women in Loreto is vital to improving the health of women and children in the region.

There has been very little research on the gaps in women’s education in the Amazon region and how they relate to reproductive health outcomes. Our study aims to characterize the social context and community structure and identify the primary barriers to educational attainment and family planning for young Amazonian women, with the ultimate goal of improving the educational situation and health status of adolescent women in Loreto. Beca 18 hopes to improve its outreach to these underrepresented women, and has expressed their support and belief in the meaningfulness of this proposed project. Beca 18 leadership will collaborate with us on the design and implementation of the study and its resulting recommendations.