Running Head: Privation of Contraception in Panama

The Privation of Teenage Contraception Use in Panama

Kayleigh Shelton
USF College of Nursing

Privation of Contraception in Panama

The Privation of Teenage Contraception Use in Panama

Spending time in the country of Panama, I have had an astounding opportunity to observe
the community health system in comparison with the United States. Panama City and Chitre are
more urban and populated, whereas other parts of Panama are much more rural and mountainous.
The cities are filled with stores and heavy traffic. There are lots of venders and pedestrians on the
street. In the more rural areas you will see a lot of open land with lots of wild horses, cows, and
dogs roaming around. There is a lot of trash disposed in the street and most of the streets are unkept dirt roads. The rural houses seem to consist of the poorer population where there is a lot of
health concerns such as: standing water, mosquitos, unsanitary conditions, disease carrying
animals, and lack of security.
Compared to the United States, Panama has a relatively smaller population. The
population in Panama is roughly 3.8 million (Chitre City Guide, n.d); whereas the
population in the United States is about 320 million (United States Census Bureau Population,
n.d). Panama itself is a little over 29,000 square miles (Chitre City Guide, n.d), and the
United States is much larger at 3.8 million square miles (United States Census Bureau
Population, n.d). The top three employers in Panama went from being the Panama Canal,
agriculture, and banking to the Panama Canal, tourism, and indoor malls (Panama, n.d).
Comparing the pros and cons of the factors that affect the healthcare system in Panama versus
the United States is very eye opening. Looking closely at these two countries exposes that both
countries can learn a lot from each other. Contraception among teens is a prevalent issue in
Panama; one that should be amended though patient teaching, health screenings in schools, and
amplified treatments through home visits.

Privation of Contraception in Panama

The health care system in Panama is similar to the United States with some important
differences. In the major cities, the hospitals are well ran with a lot of the same standards as in
the United States and Europe (Health Care, n.d). Many of the doctors in Panama were actually
trained in other places like the United States (Health Care, n.d). Healthcare is provided to all
Panamanians (whom have the option to have no health insurance) (The Health Care System,
n.d). Most citizens chose to pay for health insurance, because it is very cheap (Health Care,
n.d). Employees that are on salary are able to have social security, but employees paid
offhandedly have to pay out of pocket (Hospitals, clinics, n.d). At a public clinic in Chitre,
the people who did not have insurance pay $1 to be seen by a nurse (Health Care Service in
Panama, 2013). Public facilities dont accept appointments, so people come in and wait all

day without guarantee of being seen before the clinic closes (Health Care Service in Panama,
2013). The percent of families that are living beneath the poverty line in the United States is

about 14.5% as of last year (United States Census Bureau Economic, n.d). In Panama, the
percent of people living underneath the poverty line was about 26% (Panama Population,
n.d). In the United States the estimated amount of adults 25 years and older that received a
GED or high school diploma are about 62, 240 people, which comes out to about 90% (United
States Census Bureau Educational, n.d). In Panama the school system is divided into
primary and secondary schooling; whereas the first six years (from 6-12 years old) is primary
(Panama, 2014). Secondary schooling consists of two phases that are three years each (Panama,
2014). The first three years of secondary schooling is free, but then if continued on, fees may be
applied for things such as vocational or university education (Panama, 2014). That being said,
only a reported 63% of students eligible for their last 3 years of free education were enrolled

Privation of Contraception in Panama

(Panama, 2014). Panama is a Spanish speaking country (Panama Language, n.d).

Panamanians older than five years old that do not speak English amount to about 86%
(Panama Language, n.d). In the United States, approximately only 12.9% of Americans
spoke Spanish at home in 2011 (US is 5th, 2013).
Three strengths in the health of Panama are: the utilization of healthcare services, the
healthy lifestyle that decreases incidents of obesity, and the importance placed on mental health
teaching in the schools at a young age. Initially, Panamanian culture is very resourceful and
makes a lot of what they have. This being said, research shows that, even with less resources and
availability than the United states, Panamanians utilize their healthcare services almost as much
as the United States (WHO, 2011). The WHO measures this by percentages of women who give
birth in the presence of a qualified healthcare professional, people who have received the
measles vaccination, and successful tuberculosis treatments (WHO, 2011). In all three categories
Panama comes very close to the same percentages as the United States, except for the measles
vaccinations where Panama ranks higher (WHO, 2011). Furthermore, incidents of obesity in
Panama are lower than in the United States (WHO, 2011). The percentage of obese Panamanian
men 20 years and older rate at about 19.4%; whereas obese men 20 years and older in the U.S.A
rank at about 30.2% (WHO, 2011). Female adults in the United States also rank slightly higher
than in Panama (WHO, 2011). Lastly, the emphasis Panamas community health nurses put on
the importance of mental health teaching has significantly decreased bullying in schools.
Bullying has become a more and more prevalent issue here in the United States, where at least
77% of students are bullied (School Bullying, n.d). In Panama, the percentage of bullied children
in schools dropped down closer to 50% (Bullying in Panama, n.d).

Privation of Contraception in Panama

Three health issues in Panama that are most concerning when compared with the United
States are the commonness of diabetes, the lack of use of contraceptives, and hygiene such as
water safety. Diabetes in the USA causes 2.7% of deaths (WHO United States, 2011). In Panama
diabetes causes double the amount of deaths than the United States (WHO Panama, 2011). In
the United States, contraceptive use is about 76% (WHO United States, 2011). In Panama only
52% of Panamanians use contraceptives (WHO Panama, 2011). Lastly, Panamas hygiene and
water cleanliness is concerning. In the USA, the population using improved water and
sanitation is 100% (WHO United States, 2011). In Panama only 70% use improved sanitation
facilities and 90% use improved drinking water (WHO Panama, 2011).
One of the most precedent health issues in Panama right now is teenagers lack of use of
contraceptives. This issue is very important because it has multifactorial effects on the teenager
and the family. Statistics place HIV and AIDS on the top ten causes of death in Panama (WHO
Panama, 2011). Not only does the lack of contraceptive use put the teen at health risks for STDs
and mental health issues; but it can also cause pregnancies that affect the family financially.
When inquired about this issue with a Panamanian superior nurse, she stated that the schools do
have sex education and condoms are free; but the real problem is the gender roles in Panamanian
culture. The nurse continued to explain that Panamanian women have little to no say in the use of
contraception, and are stigmatized for any sign of interest in contraception.
The community health model combines several general categories to determine the health
of the population or individual; such as, policymaking, social factors, health services, individual
behavior, biology, and genetics (Determinants of Health, n.d). This information is used by the
community health nurse to make, prioritize, and implement a health plan (Determinants of
Health, n.d).

Privation of Contraception in Panama

There are several factors that influence the use of contraception: proper education,
resources, gender roles, culture, religion, and laws. Proper education is essential to compliance,
because most adolescence get their information from their peers (which is typically
misinformation) (Morrison,n.d). Proper affordable resources are needed to accommodate those
who cannot afford birth control or condoms, which is why most clinics and Universities provide
free condoms to clients and students (Morrison, n.d). Gender role is a factor in every culture, but
more prevalent in undeveloped and less progressive countries (Morrison, n.d). Females often feel
as if they have no say in the use of contraception, or are simply scared of speaking up (Morrison,
n.d.). Most cultures and religions look down upon premarital sex, therefore this discourages
young adults from asking for help or obtaining contraceptives (Morrison, n.d).
The population diagnosis is: Panamanian female teenagers decisional conflict related to
social stigma as evidence by expressed cultural views. The primary intervention would be
directed toward the community; such as home visits, schools, and other public places to set up
teaching. We should use health promotion to promote the use of condoms in homes and explain
the importance of their use primarily to the males (who are claimed to be the decision makers).
We need to emphasize to the females ways to avoid situations where they feel they dont have a
say in the use of contraception. We need to approach the males in a way that they would agree to
use condoms; and to approach the females with ways they can avoid situations that make them
feel helpless. The role of the community health nurse for this intervention would be doing the
actual teachings when he or she does home visits. The goal for the community health nurse
would be to really try to comprehend the teenagers concerns when it comes to sex, and to
approach the females and males appropriately to promote safe sex. Evidence of our intervention

Privation of Contraception in Panama

being successful would include positive feedback and number of people that were actually
reached out to and taught.
The secondary level of prevention would include more health screenings in the schools.
This should be a system wide intervention, where every school has free STD and STI screenings
for students at least twice a year. This screening should include anonymous diagnosing and
reporting; as well as confidential treatments. This type of intervention would require the
compliance of the community, public officials, healthcare providers, fundraised money, money
provided for healthcare services, and legislators for the confidentiality aspect. The community
health nurse could assist with the school screenings and follow ups.
The tertiary level of interventions purpose is to restore the health of teenagers who have
acquired a pregnancy, STD, or STI. We want to make sure the mothers are getting adequate
information and resources to stay healthy during their pregnancy and their mental health is being
evaluated. We also want to provide confidential treatment for teenagers with STDs and STIs.
We will monitor compliance, treatment effects, and deal with the consequences by making
frequent home visits. To prevent the spread of STDs, education is the key. Although education
is being implemented already, the goal is to change the approach to appeal to the real concerns of
the teenagers. This intervention will involve the teenagers in the community, health care
providers, public health nurses doing home visits, and funding sources; such as insurance,
fundraised money, and money provided for healthcare services. The role of the community
health nurse would be the home visits, and tracking the progress of the patients.
Public policy is instrumental for patient advocacy. Public policy is used by nurses, and
other health care employees, to make changes to improve the health of a community or
population. In regards to the nursing diagnosis of: Panamanian female teenagers decisional

Privation of Contraception in Panama

conflict related to social stigma as evidence by expressed cultural views, the primary intervention
would be the most effective. The expected impact of the health policy is to decrease the
incidence of teen pregnancy, overpopulation of families, and occurrence of STDs. The primary
invention is really taking the sex education given in schools and individualizing it to appeal to
the male and female students. Instead of just giving the students facts, we need to evaluate their
own personal concerns and really appeal to those apprehensions. We need to be harsher with the
males, who seem to be the official decision makers when it comes to using contraception. We
need to really alarm the males with the consequences of not using contraception, and guide them
out of the invincible mentality. For the females we need to focus more on ways for them to avoid
situations where they may feel compelled to have unprotected sex. With a more personalized
type of teaching, hopefully together the male and female teenagers can make more beneficial
decisions that will lower the incidence of unplanned pregnancies and STDs. Health care
providers, nurses, and community members(such as parents, teachers, and authority figures) will
help implement this plan. We would require the support of community members, who these
children look up to, such as: teachers, male figures, parents, guardians, and healthcare providers.
Some people of opposition may include religious figures or men who are already raised to
display their masculinity. To initiate this plan we would have to start in the schools, by
approaching the principles or head of the school department. Success with this intervention
would decrease illness in the community, by decreasing the spread of STDs and STIs. It would
also decrease the amount of unplanned pregnancies that negatively effect families financially and
emotionally.
All together, Panama is a strong country that thrives on its community relationships and
resourcefulness. Although, the country is struggling with the consequences of the lack of teen

Privation of Contraception in Panama

contraceptive use, it can be significantly improved beginning with a little reframing of their
sexual education.
References
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Chitre City Guide (Information about Chitre).(n.d)

Retrieved from: http://www.mapsofworld.com/panama/cities/chitre.html
Determinants of Health (Determinants of Health). (n.d)
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Health Care in Panama (Health Care in Panama). (n.d)
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Hospitals, Clinics and Pharmacies in Panama (Hospitals, Clinics and Pharmacies in Panama)

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(n.d). Retrieved from: http://panama.angloinfo.com/healthcare/health-system/hospitalspharmacies/

Morrison, D. (n.d.). Adolescent Contraceptive Use. PsycEXTRADataset.

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Privation of Contraception in Panama

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