WHEN Pope Francis visits Paraguay on July 10th, he will find a controversy that he might prefer to ignore. A ten-year-old Paraguayan girl is currently 26 weeks pregnant after having been raped by her stepfather. Some six weeks ago she was taken to a hospital by her mother, who asked that she be allowed an abortion. But the Paraguayan authorities, backed by the Catholic church, not only refused her plea; they also arrested the mother as an alleged accomplice in her daughter’s abuse, although she reported the crime last year.

This appalling case highlights several of Latin America’s abiding ills. The first is child abuse. While the plight of street children and child prostitutes has received a lot of attention, most abuse occurs in the home. Although there is little data, there is no reason to believe it is less prevalent than elsewhere in the world. It may be more so. Bolivia’s ombudsman reported that 34% of girls suffered sexual abuse before age 18. Studies suggest that up to 36% of Latin American adult women suffer domestic or sexual violence.

The second affliction is teen pregnancy, which is extraordinarily common given the region’s level of development. In Latin America 69 in every thousand girls aged 15-19 gave birth in 2012, according to the UN, a rate that is exceeded only in sub-Saharan Africa. The rate is higher than 80 per thousand in six countries in the region: Nicaragua, the Dominican Republic, Guatemala, Guyana, Honduras and Venezuela.

For very young girls the problem may be worsening. According to the UN Population Fund, over the past 15 years or so six of eleven countries in Latin America for which it has data saw a rise in pregnancies among girls aged 10-14. This is almost always the result of abuse. In Paraguay, whose population is 7m, there were 680 births to mothers under 15 last year.

Young mothers are four times likelier than those over 20 to die in pregnancy or childbirth, according to the World Health Organisation. If they live, they are more likely to drop out of school and to be poor than if they didn’t get pregnant. And their children are more prone to behavioural problems as adolescents, which means they are also more likely to stay poor.

The incidence of later-teenage pregnancy is falling (having risen in some countries in the 1980s and 1990s). But it is declining much more slowly than in other parts of the world, and more slowly than overall birth rates. Why? Pregnancies are far more common among poor, rural girls in families with low educational levels. They may partly be a consequence of lack of opportunity.

But they are also evidence of a policy failure. Only a fifth of adolescent pregnancies in Latin America are intentional, compared with 67% of those in Africa and 54% in Asia, according to Esteban Caballero of the UN Population Fund. In theory, most governments in the region provide contraceptives and sex education to young people. In practice, they are not reaching the most vulnerable groups. And families may resist the message, because of machismo and for religious reasons.

Child abuse and teen pregnancy intersect cruelly with Latin America’s rigid restrictions on abortion. Recent years have seen some timid liberalisation. Abortion is now legal in Uruguay and Mexico City. It is allowed in cases of rape, fetal malformation or threat to life in Colombia, in cases of rape in Argentina and in cases of rape and incest in Bolivia.

But not in Paraguay. There, the state has in effect “criminalised access to health care” for the pregnant girl, according to Mónica Arango, a Colombian lawyer at the Centre for Reproductive Rights, a New York-based group. There are similarly extreme bans on abortion in Central America. The consequence is that 4.2m Latin American women have clandestine and unsafe abortions every year; around a million of these are hospitalised as a result of complications, according to the Guttmacher Institute, another NGO. And many teenage girls commit suicide when they find out they are pregnant.

It is the still-pervasive influence of the Catholic church in forming views about women and reproduction in Latin America that is the main reason for the patchiness of contraception and the strictness of abortion bans, and thus for the prevalence of teenage pregnancies and illegal abortions. Catholics have a right to their private views on these matters. The 19th-century battle to stop them imposing these views on others was waged by the likes of Benito Juárez, a Mexican liberal. The clamorous silence of most Latin American politicians on issues of sexual and reproductive health shows that the fight is far from over.