Incidencias de la reforma procesal en la sentencia
V. La certeza moral para decidir y el especial aporte de las partes
Pregnancy is primarily affected by the age when sexual intercourse is initiated, the frequency of sex, and the use of contraception (Kirby & Lepore, 2007). Pregnant women in developed countries have a choice of continuing with the pregnancy or choosing to have a medically approved termination. As previously reported, a central focus amongst many nations is reducing the number of teenagers becoming pregnant (Superu, 2015a; World Health Organisation, 2014c). This policy is based on the evidence that early childbearing increases risks for both mothers and their newborns (Copland, et al., 2011; World Health Organisation, 2014c), and that
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pregnant adolescents are more likely than adults to have unsafe abortions (World Health Organisation, 2014c). Complications from pregnancy and childbirth are a major cause of death among girls aged 15–19 in low and middle-income countries (World Health Organisation, 2014c).
International studies reveal that despite progress in reducing the birth rate among adolescents, more than 15 million of the estimated 135 million live births worldwide are to girls aged 15 to 19 years (World Health Organisation, 2014c). In 1990 the birth rate among adolescent girls aged 15 to19 was 59 births per 1,000 girls, and in 2015, the birth rate decreased to 51 births per 1,000 girls. However, this rate does not show the wide variations amongst international countries (United Nations, 2015). In New Zealand, adolescent pregnancy rates are higher than in other developed countries (Paul, Fitzjohn, Eberhart-Phillips, et al., 2000; Psutkla, et al., 2012; Superu, 2015a). The United States has the highest teen pregnancy and birth rates, followed by New Zealand and the United Kingdom (Superu, 2015a). In 2013, New Zealand’s teenage birth rate (that is, births to 15-19 year olds) was 23.8 births per 1,000 women (National Institute of Demographic and Economic Analysis, 2014).
Although New Zealand’s teen birth rates are comparatively high, they have been declining (Superu, 2015b). In New Zealand teen births as a proportion of all births reached 5.9 percent in 2013, the lowest percentage ever recorded (National Institute of Demographic and Economic Analysis, 2014). Over 71 percent of all teen births in 2013 were to 18 and 19 year olds (Superu, 2015b). It is acknowledged that there are many factors that drive birth rates, and that the decline in New Zealand teen birth rates may be due to the delay in becoming sexually active among school-aged teenagers (National Institute of Demographic and Economic Analysis, 2014), and increased contraceptive use (Superu, 2015b). It is important to note that studies with New Zealand secondary school students over the past decade have shown that contraceptive patterns remain relatively unchanged (Clark, Fleming, Bullen, Crengle, et al., 2013).
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The Pacific population is one of the fastest growing subgroups in New Zealand, with the highest birth rate compared to other ethnicities (Gao, et al., 2008; Taha: Well Pacific Mother and Infant Service, 2015b). A report exploring trends for teenage births in New Zealand highlighted that current data by ethnicity of a birth mother was ‘unavailable as this information is presented by Statistics New Zealand based on the census data every five years‘ (National Institute of Demographic and Economic Analysis, 2014, p. 20). However, findings from a study undertaken by the New Zealand Child and Youth Epidemiology Service (NZCYES) showed that during 2002 to 2006 the teenage birth rates for Pacific women were significantly higher
than for European, Asian-ǡ¢Ǥ
This study explored a number of health indicators for Pacific children and young people in New Zealand, this included teenage birth rates amongst Pacific women in New Zealand using information from the birth registration dataset (New Zealand Child and Youth Epidemiology Service, 2008).
¢ teenage years than any other ethnicity in New Zealand (Ingham & Partridge, 2004; Taha: Well Pacific Mother and Infant Service, 2015b). Some authors attribute the high Pacific birth rates to low utilization of contraception and a cultural preference for large families (Anae, et al., 2000; Gao, et al., 2008), while others comment that cultural heritage and economic deprivation may contribute to the patterns of teenage pregnancies (Ingham & Partridge, 2004). Authors have commented on the
need to explore the role of access to health care for sexually experienced ¢and
Pacific students, as they are the ethnic groups shown to be at greatest risk of teenage pregnancy in New Zealand (Copland, et al., 2011). A study by Copland, et al., (2011) explored self-reported pregnancy and access to primary health care among sexually experienced New Zealand high school students. The study
analysed the ǯͶͽ survey findings and found that 10.6 percent of sexually
experienced high school students self-reported that they had been pregnant
(11.6%) or caused a pregnancy (9.9%). The figures were higher for ¢ (15.3%)
and Pacific (14.1%) students, and higher among female (11.6%) than male (9.9%) students. Self-reported pregnancy was lowest among New Zealand European
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(7.5%) and Asian students (7.9%) (Copland, et al., 2011). The researchers in this study acknowledge that similar ethnic trends have been recognized in New Zealand and international studies and are reflective of structural disparities, that include colonization, marginalisation, poverty, and discrimination (Copland, et al., 2011).
The discussion at this point has highlighted teenage pregnancy and birth rates. Unplanned pregnancy is an important issue that requires brief consideration. The rates of unplanned pregnancy for the general New Zealand population vary in the
literature. The reported that 40
percent of pregnancies in New Zealand are unplanned (Growing Up in New Zealand, 2015); other estimates suggest that 60 percent of pregnancies are unplanned (Health Committee, 2013). In an earlier discussion, some 60 percent of Pacific mothers had not planned their pregnancy (Paterson, et al., 2004). The rates for New Zealand teenagers are even higher. A report by Superu (2015a) states that approximately 88 percent of teenage pregnancies are unplanned. These findings show that a large proportion of births are unplanned has widespread implications on the health of the birth mother, unborn child and wider family unit.
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The transmission of sexually transmitted infections is primarily affected by the age when sexual intercourse is initiated, the frequency of sex, the number of sexual partners, and the use of condoms (Kirby & Lepore, 2007). The associated complications of STIs include chronic pain, infertility, neonatal morbidity and genital tract cancer (Ministry of Health, 2014f).
International evidence suggests that 498 million people aged 15 to 49 are infected each year with chlamydia, gonorrhea, syphilis, or trichomoniasis (World Health Organisation, 2012b). Approximately 2.2 million adolescents are living with HIV and more than half of them are females (Ahmad, et al., 2014). In 2012, an estimated 2.3 million people were newly infected with HIV, this is a significant decline (33%) compared with the 3.4 million new infections estimated for 2001.
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People living in sub-Saharan Africa accounted for 70 percent of all new infections. In 2012, an estimated 35.3 million people were living with HIV. Globally, an estimated 1.6 million people died of HIV and AIDS in 2012, down from the peak of 2.3 million in 2005 (World Health Organisation, 2014c).
Sexually transmitted infections (STIs) are common in New Zealand (Ministry of Health, 2014f) with New Zealand having a high prevalence of chlamydia (Psutkla, et al., 2012). In 2013, chlamydia was the most commonly reported STI in New
Zealand, ¢ STIs compared to other
ethnic groups (The Institute of Environmental Science and Research Ltd, 2014). A disproportionate burden of STIs are also common amongst those aged under 25 years (Ministry of Health, 2014f). The chlamydia rate had been stable between 2009 and 2011 and then decreased in 2012.
The importance of documenting and monitoring ethnic STI information,
particularly for ¢ and Pacific groups, is recognised (The Institute of
Environmental Science and Research Ltd, 2014). When compared with other international countries, New Zealand has one of the lowest HIV prevalence rates in the world (NZ AIDS Foundation, 2015). Figures show that from 1985 to 2011, 3608 New Zealanders were tested positive for HIV (Ministry of Health, 2014e). Recent 2014 figures show that currently 2900 New Zealanders are living with HIV. Gay and bisexual men are the most at risk population group of contracting an HIV. In 2014, 136 of the 217 diagnoses were amongst gay, bisexual and other men who have sex with men (MSM). Of all the 136 MSM individuals that were found to be infected, seven were of Pacific ethnicity (5%). Of the 45 individuals that were infected with HIV through heterosexual sex, four were of Pacific ethnicity (9%) (AIDS Epidemiology Group, 2015; NZ AIDS Foundation, 2015).
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