Pregnant at 10 and abortion's not an option
Earlier this year, a 10-year-old girl in Paraguay made headlines when she arrived at a hospital 20 weeks pregnant. But this was not a one-off case. Last year, more than 700 girls aged 14 and younger gave birth in this South American nation of seven million people.
At the Casa Rosa Maria in Paraguay's capital, Asuncion, the kitchen is full of chattering girls preparing food to celebrate the 13th birthday of a new resident - a girl who is five months pregnant. Nine of them live at this spacious mother-and-baby home run by the local Catholic Church. It's a joyful place that echoes with the sound of teenage laughter, scampering toddlers and gurgling babies.
In the kitchen in a stripy jumper and jeans, rocking her hefty-looking one-year-old son on a hip that's hardly there, is Perla. She is 12. Perla was raped by her brother when she was 10, and became a mother at 11.
Perla's one of 200 girls who have passed through the doors of the Casa Rosa Maria, some as young as nine.
"When they are so young and they are plucked from ordinary family life and brought here, it can be very hard for them," says Cilsa Vera, who is in charge. "But we give them good health care, clothing and food, and they adapt very quickly."
That was certainly the case with Mercedes. Now 17, she became pregnant at 12 after being raped by her stepfather. Arriving at the Casa Rosa Maria was a huge relief.
"When I lived in the country at home, my life was terrible," she says. "Everything was so much better when I got here to Asuncion. Now I want to study cookery, finish my schooling and go to university. I want the best for my daughter, and I never want her to experience what I went through."
At the Casa Rosa Maria all the girls are encouraged to study so they can get a job to support their children.
According to Paraguay's Ministry of Health, 704 girls aged 14 and younger gave birth last year - about two each day. But the real figure could be higher - data collection is unreliable, especially in far-flung communities, some of them many hours by road from Asuncion, the capital.
"The numbers are increasing year on year, so this is a problem that's getting worse," says Mirtha Rivarola from the UNFPA, the UN's Population Fund. "It's an alarming situation. For a 10-year-old who becomes a mother, her life trajectory is going to be limited. We're losing too many precious lives for the future."
In England and Wales, with a population of 57 million, eight times greater than Paraguay's, there were 1,378 conceptions by girls aged 14 and younger in 2013. Abortion is legal in the UK, so the majority of these pregnancies ended in termination. In Paraguay however, abortion is only allowed if a mother's life is deemed to be in danger.
Ten-year-old Mainumby became front-page news in April. She first complained of stomach ache in January. Her mother took her to various clinics, but the pain continued. Three months later, a hospital doctor had the presence of mind to give the child a scan, and she was found to be 20 weeks pregnant.
The alleged abuser, Mainumby's stepfather, was taken into custody while the courts await the results of a DNA test that will prove paternity. Media interest in the case ratcheted up when her mother was arrested as an accessory to the abuse, imprisoned for two months and not allowed to see her daughter.
Amnesty International campaigned for Mainumby to be allowed to have an abortion, and a group of United Nations human rights experts criticised Paraguay. But the authorities were unmoved.
"The psychological evaluations Mainumby underwent showed she was a happy girl - a girl without any problems," says Paraguay's Health Minister, Dr Antonio Barrios. "And the only option left open to us, because the girl's life was not in danger, was to continue with the pregnancy."
Mainumby has since given birth to a baby girl. But some Paraguayans think the government gambled with her health - pregnancy is much riskier for a girl or teenager than it is for an adult woman.
"There's a very strong religious fundamentalist influence here," says Elba Nunez, the co-ordinator of a feminist network, Cladem. "In the end they need to demonstrate that a 10-year-old girl can be a mother in Paraguay… Sexual abuse is a problem, but forced child pregnancy is also a problem, and it's a human rights issue."
Abortion is available illicitly though - if a girl's family can pay. But there are no reliable figures, nor are there numbers for the women who die as a result of a termination that goes wrong. Nunez talked to children in Concepcion, north of Asuncion, who knew all about cases like this.
"The poor kids said, 'Yes, it happens here… Girls have a fever, they gasp for breath and then they die.'"
The wealthier children knew exactly which clinics provided abortions and how much they cost.
"They call abortion 'appendicitis with little feet'. The girl doesn't come to school for a couple of weeks and all the kids know she has appendicitis with little feet."
Often, behind the stories of child pregnancy lie stories of sexual violence - some 600 cases of sexual abuse of children under 14 reach the attorney general's office every year, though the perpetrators frequently escape punishment.
"What we see isn't the full picture of abuse in Paraguay," says specialist prosecutor Teresa Martinez Acosta. "And there is impunity - we manage a conviction in only 30% of cases. Also sentences are short, so usually after three or five years the perpetrator can walk free and continue to abuse."
But she says there has been one big positive change.
"Now we're receiving more cases - until a few years ago nobody would report anything, but now neighbours and teachers are beginning to come forward with information."
That willingness to report abuse has also been noticed at the national helpline that responds to the ill-treatment of children. In the month after Mainumby's pregnancy hit the headlines, the number of calls jumped from 750 to more than 950.
Those who blow the whistle on abusers often want to remain anonymous - a hangover perhaps from Paraguay's dictatorship years, when thousands were imprisoned and tortured, and staying safe meant keeping your head down.
In the past this meant many cases didn't make it to court, but now the transcripts of these phone conversations are being accepted as evidence.
With years of experience in social work, the co-ordinator of the helpline, Licia Martinez, is still surprised by some of the cases that are reported - and by the attitude of perpetrators.
"Sometimes they don't understand that it's wrong. They have no empathy, or feelings of guilt. And they don't see that, not only could this lead to jail, but it's hurting another human-being. It's bordering on the behaviour of a sociopath," she says.
In Paraguay there is little state support for young mothers. Most help is provided by charities and the Catholic Church.
At one church-run family centre in Banados Sur, Mil Solidarios, a dozen teenage mothers are attending an afternoon class - some with their babies. Some of the girls have partners, others are single parents. In return for coming here twice a week, and for attending night school to finish their secondary education, they receive a small grant.
"We're trying to make them see they have a future," says Soraya Bello, the co-ordinator.
Banados Sur is one of the most marginalised and populous neighbourhoods of Asuncion. It was built on swampland between the banks of the River Paraguay and the edge of the city, next to a huge rubbish dump. There are no paved roads and flooding is common.
"Girls here don't go out and have fun - childhood is very short," says Bello. "There's a lack of opportunity and education. And if both parents are working, the oldest girl will assume the role of mother to look after her brothers and sisters. After that, it's usually not long till she's pregnant herself."
In one of the classrooms, Maria is writing her group's feedback for the afternoon's session on a large piece of paper.
"People say a lot of things about us because we're from Banados Sur - that we're all criminals, and that we're dirty because of the conditions we live in.
"They say, 'How can you have a kid already, what were you thinking? You're a tart!' And even in the hospital they tell us off. So what are we going to do? It's not the baby's fault. And there's nothing to be done once you're pregnant."
At the Casa Rosa Maria, that realisation has already dawned on the newest resident at the mother-and-baby home. She stands with her hands in her jacket pocket, a child who is five months pregnant.
As the others prepare her birthday tea, she is the only one not chatting, laughing, or chasing after a toddler. When the girls sing happy birthday, her face is a picture of bewilderment and despair. But then how many children would choose to spend their 13th birthday this way?
The names of some young mothers have been changed for this article
Subscribe to the BBC News Magazine's email newsletter to get articles sent to your inbox.