Miko L. Balisi

TEENAGE PREGNANCY: YOUNG, PREGNANT, AND POOR EXECUTIVE SUMMARY There are 19,884,964 adolescent population between 10 to 19 years living in the Philippines accounting for almost a quarter of the population in the country. The female population in the Philippines ages from 10 to 19 accounts to 9,716,452. These young people live in diverse socio-cultural and economic contexts, yet they share important challenges and opportunities related to their sexual and reproductive health. In the Philippines, the changing context of socio-cultural landscape contributes to the changing sexual values, norms and behaviors of young people, often in conflict with the traditional, conservative sociocultural attitudes towards premarital sex and gender norms. These factors contribute to significant barriers that limit young people’s access to information and services that they need to make a healthy transition into adulthood. A significant proportion of young people in the Philippines according to the Young Adult Fertility Survey (YAFS 4) are sexually active (1 in 3 young adult), and while for many the onset of sexual activity is associated with before marriage is also increasing in number. Although there is a limited data, basing on the available information indicates that most young people are ill-prepared for this transition due to lack of knowledge and life-skills to negotiate safe and consensual relationships and facing considerable barriers to accessing services and commodities needed to avoid unsafe sex and its consequences. Additionally, a significant proportion of adolescent girls and young women report coerced sex and up to half have experienced sexual violence. Rates of violence are also high among young female sex workers, men who have sex with men, and young transgender people. As a result, young people are at risk of having poor health outcome, especially reproductive health outcomes such as unintended pregnancy, unsafe abortion, sexually transmitted infections, and HIV. Poor sexual and reproductive health not only impacts on the health and well-being of young people, but also has significant socioeconomic implications, impacting on education, economic participation and poverty. These negative consequences extend to young people’s families and future generations, and can perpetuate a cycle of poor health and disadvantage. Thus, it is vital that this population will be given focus due to the possible opportunities that these young will miss and in return an unending cycle of economically disadvantage individual. INTRODUCTION Adolescent is a stage of considerable change; it is the phase where physical and emotional changes in life of a teenager happens. It is a phase where teenagers are more engage with peers rather than their family. Further, teenage years is the stage where peer pressure is more common due more time spent with their peers and the thinking of “Fitting in”. One of the issues that teenagers may encounter at this stage of their life is early pregnancy which causes different consequences. It may affect different areas of their life such as social, economics, health, education, among others. For instance, teenage pregnancy may result to drop outs among female secondary students(1). Given all the possible outcome of early pregnancy, it is important that this will be looked as a major issue in the society. There’s an early onset of teenage pregnancy in the Philippines. According to the Philippine Statistics Authority (PSA) one in ten young Filipino women age 15-19 has begun childbearing. 8 percent are already mothers and another 2 percent are pregnant with their first child according to the results of the 2013 National Demographic and Health Survey(2). There is a rising trend of teenage pregnancy in the Philippines compare to its neighbors in Asia. Even though Philippines' total fertility rate was 3 births per woman as of 2013, falling at a slow pace of 1.6 percent per year from 7 births per woman in 1960. But the poorest quintile of the population has a higher fertility rate of 5.2 births per woman as of 2013(3). Young women, most especially those who are poor and uneducated are more vulnerable as they are not prepared physically and mentally in motherhood. This reflects that young women have in adequate information about pregnancy. According to Grant and Hallman(4), the competing risk of adolescent who drop- out of school for other reason than teenage pregnancy. Their study provided evidence that low economic status strongly associate with school drop outs and teenage pregnancy. Adolescent who have high aspirations in terms of education are less likely to engage in behaviors that will lead to pregnancy while enrolled in school(5). This is due to high motivation they are getting from their studies and they have more motivation to continue studying and pursue college. In contrast those with low self-esteem and exhibit poor school performance and have pregnancy serves as their path to economic independence and adult status(6). Known factors that are associated with influences adolescents to engage in early pregnancy are unsafe sex, deprivation, substance misuse, school drop outs, bad school performance in school, and having low family income. Many researchers viewed that teenage mothers future will be depressing and some challenges will be experienced(7). After pregnancy teenage mother lacks qualifications which mean they have low paid and often unsatisfying jobs, or cannot qualify for jobs. Although but some young mothers worked out of necessity because they had no choice. A big challenge for a teenage mother is how to give a bright future for the child. However, as well as the money, there were additional, wider benefits. Working also gave women a sense of accomplishment, confidence and some much needed social contact(8) Teenage pregnancy became an intricate and complex problem of the requiring multisector approach and different government institution working together. These agencies promote programs which is useful in the prevention of teenage pregnancy (1).According to Duncan (2007), special programs on family life and reproductive health reduces the number of teenage pregnancy, alcohol and drug abuse. Outcomes Associated to Teenage Mothers  Greater rates of postpartum depression  Less likely to breastfeed  have children who frequently experience health and developmental problems  Less likely to complete education  More likely to live in poverty  Factors Associated to Teenage Pregnancy       Born from teenage parents Lack of parental Guidance Adolescent Sexual Behavior Inadequate knowledge about safe sex Exploitation by oldermen Socio-economic factors TEENAGE PREGNANCY Outcomes Associated to Child of Teenage Mother  More likely to be Born Pre term  Low birth weight  Higher neonatal mortality INTERGENERATIONAL TEENAGE PREGNANCY Figure 1. Conceptual model shows the factors associated with Teenage Pregnancy, and the result of teenage pregnancy. Further, the framework also illustrate the likelihood of intergenerational teenage pregnancy(9). Adolescent Pregnancy: Implication, Paradigm, and Construct Teenage pregnancy is not like any other issue there in the whole world although it seems to be a common concern, it does not seem to bother people that much. Not until they are personally affected by the issue or until they finally realized that it had been increasing in number of affected people that it slowly reached an abnormal stage or the point that it affected too many lives already and too many aspects of living. Teenage pregnancy is mostly unplanned, and as a result, people react to the experience differently. The teenager has to come to terms with the unexpected demands of being an adult, and in some cases, she may also have to deal with disapproval and dissatisfaction shown by significant others like parents and relatives(10).Teenage pregnancy is associated with different outcomes encompasses behavioral, social, and biological. The long- term effects of pregnancies are far reaching and teenage mothers face difficulties such as dropping out of school. Other problems that they may encountered can be physical, psychological, social, academic and emotional. One of the major setback among teenage mothers, will be there schooling, most will not be in a position to go back to school after delivery as they are forced to look after their children(11). In some cases, these young mothers’ physical health conditions do not make it conducive for them to go back to school. Lack of educational achievement is a risk factor not only because of limited career and educational opportunities but also because of its correlation with a lack of motivation and ambition Young people uncertain of a purpose in life or a career objective identify parenting as a future role(12). Another construct affected by early pregnancy is mental health; depression is seen to be one of the emerging problems among teenage mothers. Cultural factors refer to culture as the way of life of the members of a society, or of groups within a society. It includes how people dress, their marriage customs and family life, their patterns of work, religious ceremonies and leisure pursuits. Socialization is also a factor. He defines socialization as the process by which humans learn the culture of their society and become adult members of that society in which they live. Socialization teaches humans to live in society and what is regarded as appropriate behavior in different situations. A study on psychosocial impact of teenage pregnancy found out that low educational aspirations were more likely to become teenage mothers than were their high-achieving peers(13). On the other hand, he also stated some of the causes of teenage pregnancy such as lack of parental guidance, adolescent sexual behavior, inadequate knowledge about safe sex, exploitation by older men and socio-economic factors. Social construct greatly affects teenage mothers. One of the factors associated with teenage pregnancy is the lack of parental guidance: Most people evade their children from talking about sex. In some cases, they provide false information regarding sex and discourage their children to participate in any informative discussion about sex. Adolescent sexual behavior: Among the adolescents, peer pressure is a major factor that encourages the teenage boys and girls to indulge in sexual activities. Early dating, as early as 12 years of age, is another factor that contributes to teen pregnancy. In the Philippines, there’s social acceptance about sex education is highly discourage resulting to inadequate knowledge about safe sex: Most adolescents are unaware of safe sex. They probably have no access to the traditional methods of preventing pregnancy. And the main reason behind is that they are either too embarrassed or fear to seek information about it. Adolescents generally encounter different problems during pregnancy and child birth than older women. Being pregnant at an early age (≤19 years) is associated with an increased risk of preterm birth and intrauterine growth restriction, infant mortality, and child undernutrition(14, 15). Dlamini (2002:178) stated in his study the problems that might affect the pregnant adolescents’ psychologically, emotionally and also the social relations with the people around them, including the support from individuals. And also there are some challenges that they encountered such as: the father of the child were not willing to support or even denied for being a father and non-acceptance of pregnancy by the adolescents’ parents. Adolescent pregnancy and child birth impose difficult long-term outcomes and have adverse effects not only on the young mother, but also on her child. A study of Darisi (2007) stated that a negative perspective on teen pregnancy leads to a negative view of pregnant teens. The young woman who becomes pregnant sets in motion a series of events that ultimately leads to the disaster of a teen birth. The pregnant teen becomes a statistic and assumptions are made about her character, intelligence and maturity. Young mothers are often well-aware of these assumptions. Lack of accurate information on sex education is one of the reasons for the increasing number of unwanted pregnancies among teenagers(16). However, Watson (2003) stated that a strategy can be successful only when a multi-agency tasked group is formed with representatives that provide services and work closely with children and young people. Teenage pregnancy as previously stated is a multi-sectoral and multifaceted complex reality that needed to have integrated approach. One of the major pressing issues in early pregnancy is the economic implications. In the study of Sheree et al (17) their findings suggested that early motherhood was associated with several indicators of economic disadvantage at age 30, including working fewer hours, welfare dependence, lower personal incomes, and exposure to economic hardship(18-20). These findings suggest that having a child before age 20 leads to long-term economic disadvantage that persists for at least a decade(18, 21). One economic explanation suggests that early motherhood is a cause of poverty and states that becoming a mother at an early age disrupts life course development and leads to later economic difficulties. To examine this possibility, it is necessary to control the differences in family background and other factors between early mothers and other women. One approach used in previous papers has been to compare early mothers to a group of women who were not early mothers, but are in other ways similar to the women who became early mothers, such as women who became pregnant early but had a miscarriage, or sisters of the women who became early mothers. However, these approaches tend to underestimate the effects of early motherhood on economic outcomes, as there remain important prepregnancy differences between early mothers and these comparison groups (22). A better way to address this issue is to compare early mothers with other women while controlling for a wide range of individual level prepregnancy factors that are associated with early motherhood. Several studies using this approach have reported that, even after extensive control for prepregnancy factors, early pregnancy and motherhood remain significantly associated with later economic disadvantage(19, 21). For instance, reported that when teenage mothers and other women are matched on a range of background characteristics, including demographics, parental background, childhood family factors, personality, religiosity and cognitive ability, teenage motherhood remained a significant predictor of poor economic outcomes. Adolescent Pregnancy in the Philippines and ZFF Areas Summary Statistics on Adolescent Pregnancy in Philippines 1 in 10 Filipino women age 15-19 has begun childbearing Among young adult, 43% are already mothers and 4% are pregnant 209,872 out 1,748,857 or estimated 12% of total registered births are from teenage mothers Early pregnancy is more common among young adult with less education (44% elementary level) Higher proportion of young adult begun childbearing classified as from poor household (37% lowest wealth quintiles. The WHO reports that about 16 million adolescent girls aged 15-19 give birth each year, roughly 11% of all births worldwide. Almost 95% of these births occur in developing countries. The adolescent fertility rate worldwide was estimated to be 55.3 per thousand for the- period, meaning that on average about 5.5% of adolescents give birth each year. In the Philippines, one in ten young Filipino women age 15-19 has begun childbearing: 8 percent are already mothers and another 2 percent are pregnant with their first child according to the results of the 2013 National Demographic and Health Survey (NDHS). Among young adult women age 20 to 24, 43 percent are already mothers and 4 percent are pregnant with their first child. According to the Philippine Vital Statistics Report by the Philippine Statistics Authority (PSA), in 2014 a total 1,748,857 births were registered; of these 209, 872 were born to teenage mothers. Total registered births by teenage mothers in 2014 is lower by 1% from the previous year’s 209,582 births. Assuming the same level of underreporting for teenage births as for total births, a comparison of the percent increase of total births and births to teenage mothers suggests that fertility has a faster pace in the youngest reproductive ages. Early pregnancy is more common among young adult women age 15 to 24 with less education (44% elementary) compare to their counterpart who have higher education (21%). The proportion of young adult women who have begun childbearing is higher among those classified as belonging to poor households than those in wealthier households (37 percent for young women in the lowest wealth quintile versus 13 percent for women in the highest wealth quintile). NDHS also reveals that one in five (19 percent) young adult Filipino women age 18 to 24 years had initiated their sexual activity before age 18. Some of them would have had their first intimate sexual act before marriage. The survey reveals that 15 percent of young adult women age 20 to 24 had their first marriage or began living with their first spouse or partner by age 18. This proportion is lower than the proportion (19 percent) earlier cited regarding initiation by young women of an intimate sexual activity. Age at first marriage hardly changed over the years. A slightly higher proportion (17 percent) of older cohort of women (age group 40-49) had their first marriage at age 18. Initiation of sexual activity before age 18 is more common among young adult women with less education and those in poorer households. Over 40 percent of young adult women with some elementary education, compared with only 7 percent of those with college education, reported having their first intimate sexual act at age 18. Similarly, 36 percent of young adult women in the lowest wealth quintile, compared with only 10 percent of those in the highest wealth quintile, had their first intimate sexual act before age 18. Across regions, the proportion ranges from 11 percent in Cordillera Administrative Region to 27 percent in Davao. The proportion of young adult women reporting first intimate sexual act before age 18 is 22 percent for rural areas and 17 percent for urban areas. Among young women age 15 to 24, 2 percent reported initiating their sexual activity before turning 15. The ZFF Way The Zuellig Family Foundation with its mission in improving the local health systems with emphasis on ensuring that the poorest of the poor will benefit to change their health outcomes. Thus, one of the strategies made in view of these issues is the Community Health Partnership Program (CHPP), with the objective of partnering with local chief executives, municipal health officers and community leaders in designing and implementing interventions aimed at addressing health inequities. The CHPP further expand its operation by introducing the Adolescent Sexual and Reproductive Health (ASRH) Initiative. The ongoing ZFF programs for cohort municipalities focus largely on the attainment of then development goals by adapting the primary health care approach. The ZFF strategies includes innovations in terms of leadership and governance, health financing schemes for pregnant mothers, ensuring access to appropriate commodities, master listing of pregnant women, and improved service delivery through strengthened health facilities delivering mother and neonatal care. ZFF ASRH Initiative started in 2014 when the technical working group was founded in the cohort 4 of CHPP. In order to strengthen the initiative, a theory of change specific to reduction of adolescent birth rate (ABR) was formulated in 2015. Given the high number of teenage pregnancy in the municipalities where ZFF presence is established, it is timely that the initiative was instituted. Municipality 2015 Cohort 1 Municipality 2015 Motiong, Samar 44 Dingalan, Aurora No data UMAK 2 Padre Burgos, Quezon 38 Santol, La Union 23 Dao, Capiz 88 Kayapa, Nueva Vizcaya 34 Bacolod, Lanao del Norte 43 Goa, Camarines Sur 184 Milagros, Masbate 140 San Jacinto, Masbate 13 Cohort 2 Magdiwang, Romblon 22 Pilar, Sorsogon 60 Limasawa, Southern Leyte Lapuyan, Zamboanga del Sur 100 Cohort 4 San Pablo, Zamboanga del Sur 47 San Fernando, Camarines Sur 123 Tungawan, Zamboanga Sibugay 155 Tinambac, Camarines Sur 172 Cataingan, Masbate 107 UMAK 1 22 Cervantes, Ilocos Sur 63 Mandaon, Masbate No data Looc, Romblon 96 Del Carmen, Surigao del Norte 42 Ragay, Camarines Sur 114 Hinatuan, Surigao del Sur 171 Ivisan, Capiz 39 Magsaysay, Palawan No data Source: CHPP ASRH Data, 2015 In June 2016, to formalize the institutionalization of ASRH, a roadmap vetting and baseline data was gathered. Further, the Theory of Change for ASRH was revised and further honed to answer the needs of the municipalities engage in the program. The two intermediate outcome of the theory of change for ASRH are to Increase number of adolescent with delay of 2nd pregnancy and to delay sexual initiation of adolescent, thus, in return will decrease the incidence of Adolescent Birth Rate. Conclusion Overall, this discussion paper put forward the findings teenage pregnancy is the Philippines based on available literature corroborates that there’s an increasing trend of teenagers that are getting pregnant compared to earlier cohorts. A confluence of factors have come together to make this happen: a trend toward younger age at menarche, changing norms and practices with regard premarital sexual activity among the youth and increasing acceptance of premarital sex coupled with less societal pressure to legitimize out-of-wedlock pregnancies. Although there are differences amongst groups, the increasing prevalence of early childbearing is observed in all socioeconomic classes, all levels of education and in both urban and rural settings. It is pivotal that the organization focus on the lobbying of policies and initiatives aimed at mitigating or reducing economic disadvantage should include some component aimed at deferral of pregnancy. Indeed, it has been suggested that comprehensive social programs aimed at reducing economic inequality should be accompanied by the widespread provision of relationship skills and life skills training that teaches and encourages young women to be able to avoid early pregnancy, rather than the basic provision of information regarding birth control. Recommendation The recommendation from this discussion paper is drawn on the available literature and evidences that has been reviewed.     Parental relationship have pivotal role on their teenage children by having an increased and open communication lines, talking to their children about relationship and proper parental guidance Schools through DepEd should be encouraged to have programs addressing reproductive health. An important arm should be a cultural sensitive reproductive education that focuses on empowerment rather than provision of basic information with regards to birth control. Involving the teens in activities that encourages education and high aspiration in life such as community and religious services can also lessen the risk taking behavior of teenagers especially on vices like smoking, alcoholism, drugs, etc. There should be some branches in the government, health and education services that will work together to create programs for better support for teenage mothers including help to teenage mothers in returning to education, improving contraceptive, proper nutrition during pregnancy and advice services for young people. BIBLIOGRAPHY 1. Brindis C, Philliber S. Improving services for pregnant and parenting teens. Prevention Researcher. 2003;10(3):9-13. 2. Bersales L. Philippines National Demographic and Health Survey 2013. Phillipines National Demographic and Health Survey-. UNFPA U, and WHO. Sexual and Reproductive Health of Young People in Asia and the Pacific: A review of Issues, Policies, and Programmes. 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