Usando un marco conceptual de Usando un marco conceptual de derechos humanos para la derechos humanos para la

prevencion del VIH en jovenes en prevencion del VIH en jovenes en America Central y el CaribeAmerica Central y el Caribe

Avances, lecciones aprendidas y desafios del Avances, lecciones aprendidas y desafios del 20122012

Belize

Indicadores de salud del adolescente

Avances

Lecciones aprendidas

Desafios

Contenido

Maternal, under five and neonatal mortality rate Belize 1964-2012

Hypertensive disorders during pregnancyHypertensive disorders during pregnancy

Eclampsia/Thyroid Storm, Violence, Sepsis IUFD

Female group is getting twice as many tests done as is the male group (ratio of 1.93:1 F:M);

There was a marked increase in the total number of new infections (approximately 10%) when compared to 2010 data

Casos de VIH. Belize. 1986 - 2012

GSHS 2011

Total Boys Girls

• Adolescents need more access to preventive SRH services• More participation from non traditional providers, schools and NGO,s, CBO’s• FHS females, more than 90% approved SRH should be thought in schools

Education C. Quintiles Ethnicity

Males

Young adolescent (10-14) 0.0 1.1 0.0 0.0 0.0 0.0 298

Adolescent (15-19) 3.8 2.9 12.1 2.6 0.0 4.2 362 Older adolescent (20-24) 35.1 34.1 16.7 26.9 42.1 28.6 249

Development stage Creole Garifuna Hispanic Maya Mestizo Other N Females Young adolescent (10-14) 0.7 1.4 0.0 0.0 2.4 4.0 476

Adolescent (15-19) 19.1 16.0 32.1 20.2 14.3 11.1 1,035 Older adolescent (20-24) 61.1 61.7 80.2 68.6 75.0 59.7 1,026

Percent of respondents of the 2011 Belize Coverage Exercise who have at least one child, by sex, development stage and ethnicity

Intergenerational??? Unintended pregnancies???

Fertility Rate 2006 2007 2008 2009 2010 2011 Reduction

Total fertility rate 3 2.9 2.7 2.8 2.6 2.6 0.4

<20 fertility rate 0.084 0.081 0.077 0.078 0.08 0.08 0.004

6.5

2.8

Number of children per woman

Adolescent birth rate 15-19Lowest Belize district 51/1,000Highest Stann Creek and Toledo 84 and 81 / 1000

Urban 39/1000Rural 85/1000

Total Fertility Rate

Mother’s educationNone 6.0Primary 3.3Secondary + 2.0

Poorest 4.2Richest 1.7

EthnicityMaya 3.8Garifuna 3.1Mestizo 2.8Creole 1.4

It is estimated that approximately 15% of total pregnancies are loss spontaneously (miscarriage). In Belize 2011, the percentage of abortions from total pregnancies is below the estimated standard [9.2%].

Morale and

values?

Correct

information?

Timely

information?

Gender based

violence?

No girl or woman should undergo abortion

Indicadores de salud del adolescente

Avances

Lecciones aprendidas

Desafios

Contenido

- Politica de SSR aprobada en 2002

- ONG atencion a madres adolescentes – 1/6 distritos

- Pasantias hospitalarias adolescentes embarazadas – 1/6 distritos

- Desarrollo de normativas AIA – FNUAP –

- MICS y otros estudios

- Encuesta de nutricion MER 15-49 y nino[as] 6-59 meses – CDC y UNICEF

Avan

ce

s

- Estudio costo efectividad – Vacuna HPV

- MINSA promueve cobertura universal

- Seguro nacional de salud en 3/6 distritos

- Brigadas medicas moviles a todas las comunidades

- EU-PAHO 1 strengthening critical maternal and neonatal care

- VIH tamizaje en ferias y otros eventos publicos

- ARV gratuito, Option B+, PTMI actualizada

Avan

ce

s

Insumos anticoncepcion incremento de 50,000 a 160,000 USD con fondo de gobierno

Unintended pregnancies

among adolescents

reduced

Estrategias

-Help line – scaling up

-Informacion y acceso a anticonceptivos

-Sensibilizar e identificar adolescentes en riesgo de embarazo no planificado

-Prevencion del segundo embarazo en adolescentes

-Anticoncepcion Emergencia

-Fortalecer el sistema de referencia y contrarreferencia

2. Censo, tamizaje, referencia, intervencion, seguimiento con consentimiento firmado por padres y adolescentes

A Guide for Youth-Friendly Health Workers and Community Health Workers

First Edition September, 2013

Indicadores de salud del adolescente

Avances

Lecciones aprendidas

Desafios

Contenido

Determinantes sociales de salud

Determinates sociales - salud sexual y reproductiva

Determinantes sociales - salud del adolescente

Enfoque multisectorial

Indicadores de salud del adolescente

Avances

Lecciones aprendidas

Desafios

Contenido

Comision nacional de SSR vs.

Comision nacional VIH

Desarrollo de habilidades en atencion integral al adolescente en atencion primaria y secundaria

Notificacion obligatoria de adolescentes sexualmente activa y embarazo en < 16 anosDesafi

os

Desafios

Compromisos, leyes y politicas no alineados

FNUAP-MINSA barreras legales para el accesso a informacion y servicios de SR para el adolescente

FNUAP-MINSA Modelo de ley de accesso a SR del adolescente

Exceptos al acesso a servicios de salud sin aprobacion de padres:

Abuso sexual

Embarazada o infectada con STI

Casada a los 16

Emancipated child

Common law exception: Gillick v Gillick.

•Lord Fraser: Doctor could provide contraceptives if:

the young person will understand the professional's advice;

the young person cannot be persuaded to inform their parents;

the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;

unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer ;

the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent

Where the young person refuses treatment, parents can override the young person’s consent.

Desafios

Ministerio de la Familia:

Cambios en Codigo Penal- incluir abuso sexual en ninos

Actualizacion de la politica de Genero – orientacion sexual

Organizacion LGBT demandando al Gobierno para la no penalizacion de HSH

Ministerio Educacion: Retiro curricula educ SR

APS0.3 / 1,000

Enfermeras / poblacion