People across Honduras face many challenges accessing sexual and reproductive health services. Not only is there a limited supply of several kinds of contraceptives in the country, but there is also a gap in access to and education about sexual and reproductive health for adolescents. This contributes to the high rate of pregnancy among people under 18 years of age: in March 2022, the rate of teenage pregnancies in Honduras was 23 percent. Adolescent mothers face higher risk of complications from pregnancy, which is the leading cause of death for girls aged 15–19 globally. Adolescents in Honduras also face high rates of sexually transmitted infections (STIs), among other physical and mental health issues related to sexual and reproductive health.
Two decades ago, the Honduran Ministry of Health (known by its Spanish acronym SESAL) began working on a National Policy on Sexual and Reproductive Health that mandates the respect and protection of sexual and reproductive health and the provision of services to meet Hondurans’ needs. Despite this, widespread gaps in sexual and reproductive health services remain, including a lack of pre- and post-natal care and poor access to contraception in a context where there are high rates of sexual violence against women and girls.
“Given the magnitude of these needs, it is urgent that the country's authorities and other organizations increase their efforts and expand the supply of services for sexual and reproductive health issues in Honduras,” said Robert López, a psychologist and community educator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Choloma, in the country's northern Cortés department. “It is also important that health centers have access to medicines and quality training for health personnel, and [there is] the urgent approval of a protocol for comprehensive care for victims and survivors of sexual violence.”
Cortés department has the highest rates of sexual violence in the country. In Choloma, the need to expand access to this care is acute. “We go to places where there are no doctors or nurses and no education on sexual and reproductive health,” said López. “In some communities, there is not a person who...can guide on family planning issues or provide a pre-natal or gynecological consultation.”
MSF has worked in Choloma for several years, providing sexual and reproductive health care. Earlier this year, we launched medical and psychological care and community education on sexual and reproductive health issues in Choloma and nearby San Pedro Sula, the capital of Cortés. The team of doctors, nurses, psychologists, and community educators visit various communities to offer pre- and post-natal consultations, mental health care, contraception, community education, and health promotion. MSF’s teams see that the needs are highest in low-income communities, those with many pregnant women and adolescents, or those with high rates of sexual violence.
MSF’s health promotion team has also launched a program at health centers, schools and other educational centers, and through MSF’s mobile clinics to educate adolescents on sexual and reproductive health issues. Through this program, the team provides psychoeducation—a therapeutic intervention where psychologists provide education and information about mental health to those seeking or receiving services. They also hold group therapy sessions for adolescents to answer their questions about sexual and reproductive health issues and address mental health needs.
Women and girls face multiple vulnerabilities
“When I was 12 years old, my maternal grandfather abused me twice,” said María [patient name changed] during a visit to a health center in La Bueso, a village not far outside Choloma. “I decided to leave home at the age of 14. By 17, I had two children. I am currently 33 and I already have seven children.”
María came across MSF’s mobile clinic at the health center while trying to get registration documents for her five-month-old daughter. Last year, María became pregnant after being raped. “I didn't go to the doctor after the rape. I was surprised to find out I was pregnant. I had to give birth at home, with the help of a neighbor who is a nurse. Where I live there is no access to a health center, and I have no money to pay for transportation, much less go to a private clinic.”
María's experience is echoed in the stories of many other women who have suffered sexual abuse or rape from childhood. In the last 10 years, MSF teams in Honduras have treated 3,500 people who had experienced sexual and gender-based violence. Many survivors do not seek medical care; this is often due to stigma, not knowing what help can be provided, or not having access to health care.
Treatment for sexual violence is time sensitive. If rape victims seek care within 72 hours, they can be provided with medication to prevent STIs, including post-exposure prophylaxis to protect against HIV. Emergency contraception must also be administered within five days to be effective. Emergency contraception is illegal in Honduras and MSF is calling for this ban to be lifted. Early psychological care and social support is also important, however, mental health care and some other health services can be provided after the 72-hour window.
While María was waiting for her daughter’s registration papers, one of MSF’s educators from the community team approached her to tell her about the services MSF offers. Concerned about her economic needs and how challenging it can be to support a family, María decided to start contraception. “In the past, I had to go through a lot of things,” said María. “I had sex for money. Now I have many kids. Just the fact of being able to apply a family planning method for free gives me peace of mind.”
In the last 10 months, MSF’s team in Choloma has provided contraception to 690 people in 15 different communities.
During the conversation with the educator, María also recognized the emotional load that she brings from her childhood and how this is affecting her work and her relationship with her children. “I really need psychological help,” she said. “I don't have money to pay for a psychologist. With my current job, I earn 1,400 lempiras [about $58] and most of it goes to baby’s food. I am aware that I need this support because I have been dragging many things [with me] from the past.”
Since beginning the program, MSF has provided more than 739 mental health consultations. The main symptoms include depression, anxiety, grief, acute reaction to stress, chronic psychosis, epilepsy, bipolar disorder, post-traumatic stress, and behavioral problems in children.
The people MSF’s teams have interacted with are eager to learn more about sexual and reproductive health. In addition to talking about the importance of prevention, planning, and self-care, MSF’s community teams also prioritize de-stigmatizing sexual and reproductive health care and reducing prejudice against people who seek it.