When she took her 10-year-old daughter to hospital suffering stomach cramps and vomiting, Rosana had little idea of the ordeal ahead.

Several clinics had prescribed medicine for stomach parasites. One diagnosed a tumour. But a scan showed that the girl was several months pregnant.

Within days, Rosana’s partner was on the run, later convicted of raping his stepdaughter. Police dragged Rosana away from her daughter’s hospital bed on suspicion of allowing the abuse.

Meanwhile, the girl – who became known as Mainumby – became the focusof an international media storm over Paraguay’s high rates of child pregnancy and its draconian abortion laws.

Paraguay forbids abortion unless a risk to the mother’s health can be proven – an exception that is rarely applied. In 2016, 24 women died from unsafe clandestine abortions, according to official statistics.

And despite the recommendation of local doctors and global health authorities, Mainumby was made to give birth a few months after her 11^th birthday.

“It’s like they were pushing her to the limit – even if it cost her life,” said Rosana, whose name has been changed. “She made it. But with how much suffering?”

Mainumby’s case is far from unique in Paraguay. According to official data obtained by Amnesty International, 634 children between 10 and 14 gave birth in 2016. This was down from 699 in 2014, but the real number is likely to be more.

Paraguay’s rate of child pregnancy is one of the highest in Latin America, according to Cladem, a regional NGO. At least three girls died in childbirth between 2010 and 16, rising to 74 aged 15-19.

This March alone, three more girls died, aged 10, 14, and 16. Two of them died in childbirth.

Mainumby, now 14, suffers chronic pain in her hips and waist, the result of her pregnancy drawing calcium and vitamins from her growing body.

More painful still are the psychological scars. Her daughter, now nearly four, is a constant reminder of the traumatic end to her own childhood. Mainumby regularly self-harms, said Rosana.

“She’s taking medication, her anti-depressants, pills to help her sleep,” said Rosana. “She has panic attacks … several times, she’s wanted to commit suicide.”

Rosana told the family’s side of the story – often through tears – in an interview at a friend’s house on the outskirts of the capital, Asunción.

At the time of the abuse, she left the home at 4am daily to work as a school caterer, returning after 7pm. She tried several times to report her suspicions to a local clinic but was brushed off, she said.

When the case hit headlines, Rosana was detained for nearly two months. In prison, inmates assaulted her and doused her with scalding water. “It’s like I was a criminal,” she said. She was later released and all charges were eventually dropped.

Meanwhile, Mainumby was kept in a local Red Cross shelter with nine underage mothers. Here, they were made to clean and taught with a doll how to change their babies.

After the birth, “they even made her breastfeed,” she added. “Imagine how much it hurts us adults when we breastfeed for the first time. You can’t explain the pain. And for her?”

“This left a mark on her … She won’t be able to grow normally,” Rosana said. “They destroyed the girl that she was.”

Child motherhood is strikingly normalised in Paraguay.

On a visit to the Rosa María shelter – one of Paraguay’s four homes for young mothers – Oscar Ávila, an elderly manager, praised the “maternal ability” of the younger girls in his care.

“The nine-year old girl we once had here was extraordinary in how she cared for her baby,” he added. “The 10-year-old … and 11-year-old as well.”

The volunteers are well-meaning, offering support to girls who are usually from poor, rural families, often emotionally broken, and sometimes addicted to drugs.

But they rely on collection-plate donations and coffee mornings for funding, said Cilsa Rosa, another volunteer. “We’re not specialists,” she admitted.

The walls are bare, the rooms empty and echoing. Girls attend religious service seven days a week. They are not allowed to go to school for fear of further drug or sexual abuse; teachers and psychologists come to them.

“We feel genuinely comforted that 213 babies saved from abortion have passed through here,” said Rosa.

But there is a growing sense that Paraguay’s high rates of child pregnancy – and the underlying factor of rampant child abuse – can no longer be ignored.

A string of abuse scandals emerged in March during the country’s presidential election campaign, including the case of a 14-year-old girl who died giving birth, the victim of abuse by a 37-year-old man.

Government data show that reported cases of child sexual abuse have risen, from 2,196 in 2015 to 2,461 in 2017.

Some of the underlying reasons are cultural. Women in Paraguay are sexualised at an early age, said Milda Rivarola, a sociologist and historian.

“In the countryside, they say as soon as girl weighs 50kg, she’s ready to be a lover. It’s a mentality of child abuse,” she added.

The practice of criadazgo – whereby poor families send their young children away to work as live-in help in return for their upkeep – also plays a role. “They’re abused by the boss and his sons,” said Rivarola. “They’re not servants, but slaves.”

Men often abandon their families, meaning that working single mothers are forced to leave children in the care of relations or neighbours. Officials suggest that 70% of cases of minor abuse take place within the home.

Yet many argue that the poor quality of sex education in Paraguay is to blame.

“This is proven at a global level with study after study,” said Norma Duarte, the director ofCalle Escuela, an organisation that supports child workers. “The more a child knows and understands, the harder it is for them to fall victim to abuse.”

But sex education is restricted to rudimentary anatomy lessons, said Tatiana Monge, 16, a domestic helper.

“If you know and talk about more than they tell you, they look at you and treat you badly, like it’s a sin,” she added.

Last November, amid a moral panic over the alleged spread of “gender ideology”, education minister Enrique Riera banned all scholastic materials referring to gender and sexuality.

Legislation to help prevent sexual abuse was brought before congress this July – although conservative senators blocked the clauses referring to sexual education.

Officials point to some progress in protecting young women. Birth rates among 15- to 19-year-olds have fallen by 10% since 2010, and the government has increased the number of drop-in teenage health centres from eight to 21.

New legal reforms mean stealing a cow no longer carries more jail time (12 years) than raping a child (formerly three years; now a maximum of 20 years).

In May, the secretariat for children and adolescents launched a 15-day media campaign under the slogan “niñas, no madres” (girls, not mothers).

But their budget is limited, acknowledged Eduardo Sosa, an official with the secretariat for children and adolescents. As for abortion, “as long as it’s not permitted by the constitution, we’re not allowed to discuss it,” he added.

There are fears that women’s rights could be further rolled back under the conservative incoming president, Mario Abdo Benítez, who takes office in August.

In a campaign debate, Abdo Benítez vowed to open more shelters, but said Paraguay would always have child mothers.

“The girls they force to be mothers are poor,” concluded Duarte. “Middle- and upper-class teenagers that get pregnant can easily get abortions … It’s clearly a question of class.”

Óscar González, the vicar-general of Asunción, attributed child pregnancy to rural-urban migration and the breakdown of traditional families.

“Abortion comes from a lack of care of the person … we need greater care in the family,” he said.

But Rosana has little patience for the bishops, priests and pastors who regularly come knocking.

“They say that women are for giving birth – that everything that comes from God is meant to be so,” said Rosana. “They say, the baby is fine. Her mother is fine. They look fine. But on the inside? They don’t think about that. These people from the church are terrible.”

Rosana is determined to speak out for other child mothers. “If I have to shout it in the streets, I will. Because this has to stop.”

At the Rosa María shelter, a small room was filled with the sound of hairdryers and chatter. A visiting beautician – herself a former resident – offers weekly classes to the girls.

An 11-year-old girl sat quietly as her hair was curled. A crucifix rested atop her stomach, which showed the signs of a three-month pregnancy.

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Laurence Blair and Santi Carneri

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