A/HRC/44/48/Add.1 39. The Special Rapporteur was also concerned to learn about the high suicide rates, particularly among adolescents. While he was informed by the Ministry of Health about efforts to develop an intersectoral plan to prevent suicides, he recalls that the prevention of suicide should be addressed as an issue of societal cohesion and public health. The protection and promotion of all human rights are important to suicide prevention, as are the care and support for persons who are affected by depression and other mental health conditions. IV. Key populations and groups 40. The Special Rapporteur observed that certain key populations and specific groups faced serious challenges in realizing their right to health, including women and girls, children and adolescents, lesbian, gay, bisexual and transgender persons, persons with disabilities, people living with HIV/AIDS and people on the move. Such challenges disproportionately affect indigenous populations and persons of African descent, who have worse health indicators than the rest of the population. The situation is aggravated by the limited number of services and human resources available for the rural and impoverished populations. A. Women and girls Maternal mortality and gender-based violence 41. The maternal mortality rate was reported to be 41.1 per 100,000 births. 17 There were 221 maternal deaths, of which over half concerned adolescents and youth and 3 concerned girls under the age of 14. Inequalities persist among poorer women, adolescents and youth, and in rural areas. The Special Rapporteur was concerned to see the increase in late maternal deaths, which rose from 21 cases in 2016 to 84 cases in 2018. 18 He recommends that the monitoring and evaluation system for maternal deaths, including late maternal deaths, be strengthened and efforts to implement maternal mortality reduction plans increased. 42. Sexual abuse and other forms of gender-based violence are widespread. According to official data, 1 in 10 women has been sexually abused as a child or teenager and 6 out of 10 women have experienced gender-based violence. 19 Accordingly, every day, 7 girls below the age of 14 and 158 girls between 15 and 19 years of age become mothers. It has been reported that 8 out of 10 adolescent pregnancies result from sexual violence.20 Three per cent of women with disabilities reported having their first child before the age of 14. 21 According to information provided by the Ministry of Education during the visit, there were over 8,700 cases of sexual violence in schools between 2014 and 2019, of which 37 per cent were committed by persons within the education system. 43. Such alarming data, as well as the information collected, allow the Special Rapporteur to conclude that violence against women and girls is endemic, leads to high numbers of forced pregnancies and motherhoods and affects communities in the most marginalized situations. Sexual violence, paired with minimal access to sexual and reproductive rights, means that women and girls are frequently forced to carry unwanted pregnancies to term. 44. Particularly worrying is the high number of teenage pregnancies, which, according to information received by the Special Rapporteur, are often the result of sexual violence. The high rate of early pregnancies, which is one of the highest in the region, reflects a serious protection gap in children’s rights, including their right to physical and mental health and integrity, their right to be free from all forms of violence and their right to 17 18 19 20 21 10 See www.salud.gob.ec/wp-content/uploads/2019/09/Gaceta-del-2018-de-MM.pdf. Ibid. See www.ecuadorencifras.gob.ec/documentos/web-inec/Estadisticas_Sociales/sitio_violencia/ presentacion.pdf. See https://ecuador.unfpa.org/sites/default/files/pub-pdf/Politica_Interseccional%20%282%29.pdf. See www.ecuadorencifras.gob.ec/estadisticas/.