Ahead of her 15th birthday, Diana Zalazar’s body had gotten so big she could no longer squeeze into the dress she bought for her quinceañera to celebrate her passage into womanhood in Paraguay.

Her mother sought help from a doctor, who suspected that growing inside of the 14-year-old Catholic choir girl could be a giant tumor. Next thing Zalazar knew, a gynecologist was wiping down the probe she’d applied to her belly and informing her that she was in her sixth month of pregnancy.

It made no sense to Zalazar, who had recently had sex for the first time without realizing it could make her pregnant.

In Catholic Paraguay, which has the highest rate of teenage pregnancy in South America, many young mothers explained their teen pregnancies to The Associated Press as the result of growing up in a country where parents avoid the birds and the bees talk at all costs and national sex education is indistinguishable from a hygiene lesson.

“I didn’t decide to become a mother,” Zalazar said. “I didn’t have a chance to choose because I didn’t have the knowledge.”