In Guatemala, most pregnancies among girls under 14 are the result of rape at the hands of fathers or other relatives, but often it is the girl who is forced to leave the family home, and few perpetrators are punished, said a leading rights campaigner.
Nearly a quarter of all births in Guatemala are among teenage mothers - one of the highest rates of teen pregnancy in Latin America.
"In the majority of cases of sexual violence against girls, some as young as 10, most are committed by family members, mainly by the girl's father or stepfather," said Mirna Montenegro, the head of Guatemala's Sexual and Reproductive Health Observatory (OSAR).
In 2012, nearly 90 percent of all pregnancies among Guatemalan girls under 14 involved relatives, including cousins and uncles, of which 30 percent were the result of rape by fathers, according to Guatemala's human rights ombudsman.
Despite new laws passed in Guatemala to better protect against sexual violence, few who commit rape against girls are punished.
"Getting justice for girls who report crimes of sexual violence is still a big challenge for us. Often it's the pregnant girl who is removed from her home and placed in a refuge and not the perpetrator of the crime," Montenegro told the Thomson Reuters Foundation in a telephone interview.
According to a 2009 law, sex with a child under 14 is defined as rape, but of the 2,000 reported cases of under-14s getting pregnant in 2012, only eight resulted in convictions, Montenegro said.
Guatemala's children's prosecutor, Harold Flores, said the country's high teen pregnancy rate was a "scourge", and there were few convictions for rape carried out on girls under 14.
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"We want girls, who have been victims of sexual violence, to remain in their home or be under the care of a relative. In some cases in the past girls were placed in government care and the aggressor wasn't arrested," he said from Guatemala City.
"It's deplorable that many of these cases are a result of sexual violence within the nuclear family: stepfathers, uncles, fathers, and grandfathers. We're reaching more and more girls as soon as we hear about a case and we have expanded our presence across Guatemala and rural areas," Flores said.
High levels of sexual violence against women and girls stem from the low status of women, especially indigenous Mayan women, in Guatemala's patriarchal and macho society.
"Machismo is about men believing a woman is their property and possession. We've heard fathers say 'She's my daughter and my property so I will do what I want with her," said Montenegro,
She said gender violence is also a legacy of Guatemala's 1960-1996 civil war when rape was used as a weapon of war.
Complications during pregnancy and childbirth are the second highest cause of death for 15 to 19 year-old girls globally, and babies born to adolescent mothers face a 'substantially higher risk' of dying than those born to women in their early 20s, according to the World Health Organization.
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In Guatemala, teenage pregnancy is most common among uneducated indigenous girls, especially in poor rural areas.
"Girls in rural areas don't have or know other options in life. Their lives are limited to finding a partner, having children and looking after the home," Montenegro said.
Guatemala's high prevalence of child marriage, where girls can marry at 14 with their parent's consent, also fuels adolescent pregnancy, Montenegro said.
Guatemala's congress is considering a bill that would raise the minimum legal age for marriage to 16 for girls and 18 for boys, with the issue a debating point ahead of the country's presidential election run-off on Oct. 25.
"For this first time we've seen the issue of child marriage come up during the election campaign. The majority of presidential candidates have said they are in favour of raising the minimum age for marriage," said Montenegro, whose organisation is an alliance of universities, non-governmental organisations and lawmakers.
Last year, 5,100 girls under 14 became pregnant in the Central American country, up from 4,354 in 2013, according to OSAR.
One reason for the increase is because hospitals and health providers have to report pregnancies among girls under 14 under a law passed in 2012.