TEENAGE PREGNANCY AS A PUBLIC HEALTH ISSUE

Community Research Paper

BY
EVELYN R. PAJARON

January 21, 2015

TABLE OF CONTENTS

Introduction

. 2

Epidemiology of Teenage Pregnancy

. 3

Etiology of Teenage Pregnancy

. 6

Implications and Effects of Teenage Pregnancy

. 10

Health Issues

. 10

Psycho-emotional Issues

. 11

Socio-economic Issues

. 12

Moral/Spiritual Issues

. 13

Intervention Strategies on Teenage Pregnancy

Sex Education

. 14

. 17

Access to Health Care and Services

. 18

Deal with the Twin Problem of Poverty

and Lack of Education

. 19

Family Interventions

. 22

Address the Spiritual/Moral

Development of the Youth . 23
Conclusion

. 25

Bibliography

. 27

INTRODUCTION

Teenage years are exciting years when many changes take place internally (hormonal
levels, onset of menstruation, brain development) and externally (body shape and
development of secondary sex characteristics, height). It is also a time when critical
transitions take place from childhood to adulthood, from dependence to independence when
teenagers begin to try out things on their own. The Philippines has a fairly young population
(35.4% aged 0-17), and population projection shows that they will continue to comprise the
bigger share of the population.1 Needless to say, what happens with this segment of society
affects the present and the future of our nation. Public health is trying to address the most
vulnerable sector of children under five, but there is also a trend among the youth that merits
attention from a public health point of view. The UN considers adolescents to include
persons aged 10-19 years and youth as those between 15- 24 years for statistical purposes
Together, adolescents and youth are referred to as young people, encompassing the ages of
10-24 years.2 In 2013, there were 19.2 million youths in the country, 10.2 million were aged
15-19, and 9 million were aged 20-24.3 National surveys done the last two years on the
youths show a considerable increase in premarital sex and teen pregnancies, of kids having
kids. Fig. 1 shows the increase that is raising alarm among public health practitioners and
concerned citizens in the country thatisworthlookingintoandfindinginterventionsfor.

1 Figure deduced from data provided in Philippines in Figures 2014, National Statistics
Office, 25: http://web0.psa.gov.ph/sites/default/files/2014%20PIF.pdf (accessed October 1,
2014).
2 Adolescent and Youth Demographics: A Brief Overview, UNFPA:
https://www.unfpa.org/webdav/site/global/shared/factsheets/One%20pager%20on%20youth
%20demographics%20GF.pdf (accessed October 6, 2014).
3 Josefina N. Natividad, The 2013 Young Adult Fertility and Sexuality Study (YAFS 4),
Results presented on February 6, 2014 at GT-Toyota Asian Center, UP Diliman, 4:
http://www.drdf.org.ph/sites/default/files/PinoyYouthToday%20-%20(1)%20About
%20YAFS.pdf (accessed October 1, 2014).
2

EPIDEMIOLOGY OF TEENAGE PREGNANCY

The National Statistics Office (NSO) conducts every five years a National Demographic and
Fig. 1

Health Survey (NDHS) which covers important population and health indicators useful for
monitoring, evaluating, and designing population and health policies and programs of the
Government, as well as for monitoring the countrys Millenium Development Goals
(MDGs) . . . 4 The NDHS, conducted from August 12 to October 16, 2013, was made on a
nationally representative sample of 14,804 households, which yielded completed interviews
of 16,155 women age 15-49 in all selected households.5 Twenty percent were aged 15-19,
totaling 3,261.6 One of its findings showed that 8% are already mothers (261) and another 2%
(65) are pregnant with their first child.7 The incidence of sexual activity before age 18 is more
common among teens
Fig.with
1 less education (over 40% with some elementary education
compared with 7% with college education) and those in poorer households (36% compared to
10% in richer ones).8 More teens (22 %) reported first intimate sexual act before age 18 in the
rural areas as against 17% in urban areas.9
In 2012, the University of the Philippines (U.P.) Population Institute and the
Demographic Research and Development Foundation, Inc. (DRDF) also conducted the

4 Carmelita N. Ericta, Foreword to 2013 NDHS National Demographic and Health Survey
Preliminary Report, Philippine Statistics Authority (February 2014):
http://dhsprogram.com/pubs/pdf/PR47/PR47.pdf (accessed September 9, 2014).
5 Philippine Statistics Authority, 2013 NDHS National Demographic and Health Survey
Preliminary Report, 1.
6 Philippine Statistics Authority, 6.
7 Romeo S. Recide, One in Ten Young Filipino Women Age 15 to 19 is Already a Mother or
Pregnant with First Child (Final Results from the 2013 National Demographic and Health
Survey), Philippine Statistics Authority (August 28, 2014): http://www.census.gov.ph
(accessed September 9, 2014).
8 Recide, One in Ten Young Filipino Women, (accessed September 29, 2014).
9 Recide , One in Ten Young Filipino Women, (accessed September 29, 2014).
3

Young Adult Fertility Survey (YAFS 4), geared specifically to respondents aged 15 24 to
track well-being, risk and non-risk behaviors of youth.10 What provided impetus for the
survey was the current realities found in Philippine society: the rapid technological change
especially in communications technology, the changing landscape of Philippine labor,
emergent issues in reproductive health such as the rising prevalence in HIV infection,
premarital sex, teenage pregnancy and sexually transmitted infections among todays
youth.11 The YAFS 4 surveyed 19,178 respondents in 18,547 households, 51.2% of whom
were male, 48.8% (9,359) were female; 59.8 % (11,468) were aged 15-19.12
The survey results released in 2013 showed that 13.6% (769) of girls aged 15-19
years old have become mothers.13 The graph (Fig. 2) shows the increased fertility of
teenagers in the past decade.14 It reflects a steady increase of 60% in the period 2000 to 2010
making the country the 3rd highest in ASEAN countries with teenage pregnancies.15 The
survey also showed that one in three youths have engaged in pre-marital sex (PMS).16 There
is an increasing prevalence of PMS from 17.8% in 1994, 23.2% in 2002, and 32% in 2013.17
10 Young Adults Fertility Study 4: http://www.ovcrd.upd.edu.ph/wpcontent/uploads/2013/02/Ppt-UPPI.pdf (accessed September 10, 2014).
11 2013 Young Adult Fertility and Sexuality Study, Demographic Research and
Development Foundation, Inc. (Quezon City, Phils.): http://www.drdf.org.ph/yafs4
(Accessed February 12, 2014).
12 Elizabeth Angsioco, Sexing Dangerously, Manila Standard Today (February 8, 2014):
http://manilastandardtoday.com/mobile/2014/02/08/sexing-dangerously/ (accessed September
29, 2014).
13 Amanda Fernandez, Kids having kids: Number of Pinay teen mothers doubled in last
decade, GMA Newsonline (February 6, 2014):
http://www.gmanetwork.com/news/story/347319/lifestyle/healthandwellness/kids-havingkids-number-of-pinay-teen-mothers-doubled-in-last-decade (accessed September 30, 2014).
14 Ma. Paz N. Marquez, Sexy Time: Sexual Behavior of Pinoy Young Adults, UP
Population Institute, 9. http://www.drdf.org.ph/sites/default/files/y4-presentations/POPCOM
%20Mar%205%20dissemination%20-%20Sexual%20behavior.pdf (accessed October 1,
2014).
15Ime Morales, Number of Pinay teenagers giving birth up by more than 60% in 10 years,
3rd highest in ASEAN GMA News (July 9, 2013):
http://www.gmanetwork.com/news/story/316613/lifestyle/healthandwellness/number-ofpinay-teenagers-giving-birth-up-by-more-than-60-percent-in-10-years-3rd-highest-in-asean
(accessed September 9, 2014).
16 Fernandez, Kids having kids.
17 Marquez, Sexy Time, 9.
4

The highest PMS prevalence was found in the National Capital Region (NCR) with 40.9%,
Central Luzon with 39.1%, and Davao City with 38.4% while the lowest at 7.7%
was in the Autonomous Region of Muslim Mindanao.18 The percentage of those who have
begun childbearing has tripled at age 15,
and increased at every age, as shown in
Fig. 3.19 The highest percentage (18.4) are
in the Cordillera Autonomous Region
(CAR), followed by 18.1% in Region 2.20
In absolute terms with the present youth

Fig. 3

population, it means 6.2 million youths

have engaged in PMS, 1.4 million of them have engaged in casual sex experience, and
700,000 teenage females have begun childbearing.21
Globally, the World Health Organization (WHO) lists in their key facts that about 16
million girls aged 15 to 19 and some 1 million girls under 15 give birth every year most in
low- and middle-income countries.22 Dr. Balbalunde Osotimehin, United Nations Population
Fund (UNFPA) executive director, says that adolescent pregnancy is not just a health issue,
it is a developmental issue.23 UNFPA, the lead agency of the U.N. for delivering a world
where every pregnancy is wanted, every birth is safe, and every young persons potential is
fulfilled launched their 2013 report focusing on adolescent pregnancy.24 Indeed, why would
18 Marquez, Sexy Time, 11.
19 Josefina N. Natividad, Childbearing in the teenage years: Findings from the 2013 Young
Adult Fertility and Sexuality Study (YAFS 4), Presented at the 2014 Teenage Pregnancy
Summit (Subic International Hotel, April 22-24, 2014), 7.
http://www.drdf.org.ph/sites/default/files/y4-presentations/Teen%20pregnancy%20summit
%20presentation%20Apr%2022.pdf (accessed October 9, 2014).
20 Natividad, Childbearing in the teenage years, 8.
21 Marquez, Sexy Time, 17.
22 Adolescent Pregnancy, World Health Organization (September 2014):
http://www.who.int/mediacentre/factsheets/fs364/en/ (accessed September 29, 2014).
23 Morales, Number of Pinay teenagers (accessed September 9, 2014).
24 About UNFPA, United Nations Population Fund:
http://www.unfpa.org/public/home/about (accessed October 6, 2014).
5

the rise in teen pregnancies be a global and national issue and a public health concern? What
are the root causes, and the results and implications of children having children? What would
be the long-term impact on society? What are the ways this could be addressed? How would
this research impact the public, practitioners and policies? These are just some of the
questions that beg answers that this paper wants to address.
ETIOLOGY OF TEEN PREGNANCY
There are several factors cited that contribute to the increase in incidence rate and prevalence
of teen pregnancy. It is important to look at the root causes before we can propose solutions
on how to deal with this public health issue. Usually, just as the roots of a tree are in a sense
interconnected, this is also true for the factors causing the increase in PMS and teen
pregnancies among the youth. As we shall see, there are certain main ones that lead to others.
A panel discussion on teen pregnancy moderated by Boy Abunda as UNFPA Goodwill
ambassador at Rizal High School in July 2014 concluded that Its root causes are poverty,
gender inequality, violence, power imbalances between adolescent girls and their male
partners, lack of education and the failure of systems and institutions to protect their rights.25
What he said echoed the words of UNFPAs Osotimehin, with the added feature of child and
forced marriage that is true in other cultures.26 The U.P. Population Institute cited the
following reasons for becoming pregnant among teenagers, which are based on current
realities in Philippine society: unplanned sexual encounters (getting caught up in the
moment) and peer pressure; lack of information on safe sex; breakdown of family life and
lack of good female role models in the family; and absence of accessible, adolescent-friendly
clinics.27 It is good to examine the causes cited to determine in what ways they are
25 Boy Abunda, The root causes of adolescent pregnancy, The Philippine Star (September
26, 2013): http://www.philstar.com/entertainment/2013/09/26/1238116/root-causesadolescent-pregnancy (accessed October 1, 2014).
26 Cited in Morales, Number of Pinay teenagers giving birth up by more than 60% in 10
years, (accessed October 2, 2014).
27 Carin Van der Hor, Teenage pregnancy among todays Filipino youth Philippine Daily
Inquirer (May 15, 2014): http://opinion.inquirer.net/74517/teenage-pregnancy-among-todays6

contributing to the increase in teen pregnancies in the Philippines.

Numerous research studies here and abroad show that teen pregnancy is both caused
by and results in poverty that is, the same complicated set of socio-economic factors that
put teenagers at risk of childbearing also contributes to the reality that teen parents continue
to live in poverty.28 The YAFS 4 results show PMS and pregnancy are higher among those in
the rural areas and with lower education and poorer households. Result of studies in Latin
America and the Caribbean suggests, that those teens with more education, living in urban
areas and belonging to higher income families have a lower probability of getting
pregnant.29 More recent research in the US qualifies poverty as a cause particularly among
those coming from poor families who dont see any way out of their poverty, not just from
poverty per se. Researchers Kearney and Levine reported: "They choose non-marital
motherhood at a young age instead of investing in their own economic progress because they
feel they have little chance of advancement."30 Locally, poverty could be considered one of
the main root causes that branches to other causes, such as, lack of education, lack of access
to reproductive health resources, and gender inequality.
Gender inequality exists in many forms in many cultures in Asia that especially prefers sons
than daughters. Gender inequality contributes in the sense that male strength and dominance
take advantage of the young girls weakness, using lines as if you love me, you will let
me for sexual advances and favors. But it is exacerbated in teenage pregnancy in that the
girl is usually left with the responsibility of carrying, giving birth and raising the child if the
filipino-youth (accessed October 2, 2014).
28 Teenage Births: Outcomes for Young Parents and Their Children, Schuyler Center for
Analysis and Advocacy (Albany, NY: December 2008), 10.
http://www.scaany.org/documents/teen_pregnancy_dec08.pdf (accessed October 4, 2014).
29 LAC: Poverty, Poor Education and Lack of Opportunities Increase Risk of Teenage
Pregnancy, The World Bank, (December 12, 2013):
http://www.worldbank.org/en/news/press-release/2013/12/12/lac-poverty-education-teenagepregnancy (accessed October 3, 2014).
30 Susan Reimer, Case closed: Teen pregnancy is povertys offspring (April 16, 2012):
http://articles.baltimoresun.com/2012-04-16/news/bs-ed-reimer-0416-20120416_1_teenpregnancy-american-teens-teen-mom-reality (accessed October 2, 2014).
7

father refuses to own responsibility, which is often the case. The girls are even forced to go
for abortion by their male partners, and are the ones who suffer from sexually transmitted
diseases. This power imbalance between adolescent girls and their partners also leads to
violence as another root cause. A study of related literature shows that 61% of pregnant
teenagers have had an unwanted sexual experience with 23% getting pregnant by their
perpetrator (Gershenson et. al., 1989); 62% of pregnant teens and teen mothers had
experienced contact molestation, attempted rape, or rape prior to their first pregnancy and of
these, 11% and 20% got pregnant as a direct result of rape (Boyer & Fine, 1993).31 Thus, poor
teenage girls who become pregnant and get saddled with responsibilities beyond their years,
unable to work, and have slimmer chances to pursue education because of a child, stay poor.
Lack of education is a branched root of the poverty issue. A lecture on YAFS findings
presented by Grace T. Cruz of U.P. Population Institute showed positive correlation between
fertility and education, with more of the less educated ending up with teenage pregnancy
(Fig. 4).32 YAFS 4 shows that 35.7% have not finished high school, 36.8% have finished high
school or are in vocational school, and 9.8% are in college.33 Getting pregnant means lesser
chances of continuing education if they are still going to school. For those who were not able
to go to school, it meant lots of idle time where the mind was not engaged to think about
cause and effect, to think of possibilities and ways to better ones future. Because of lack of
education, there is also ignorance of information on safe sex or where to access resources in
order to prevent pregnancy. The YAFS 4 shows that 41% have no source of information about

31 Cited in Teen Pregnancy and Sexual Assault, Connecticut Sexual Assault Crisis
Services, Inc., www.crisiscenter.org/pdfs/Teen_Pregnancy_and_SA_doc.pdf (accessed
October 4, 2014).
32 Grace T. Cruz, Lecture on: Population and Development YAFS Findings, U.P.
Population Institute (Fersal Hotel, Quezon City: May 12, 2014):
http://www.drdf.org.ph/sites/default/files/y4-presentations/Probe%20Media%20Foundation
%20Lecture%20Population%20Development%20May%2012.pdf (accessed October 2,
2014).
33 Natividad, Childbearing in the teenage years, 9.
8

sex,34 and that 78% of the first PMS did not use any form of protection.35 And so those
unplanned sexual encounters (getting caught up in the moment) when teens give in to peer
pressure with no knowledge of consequences, create a situation where pregnancy could occur.
Another major root cause mentioned is the breakdown of the family. The parents, who
shoulder the responsibility
Fig. 4 to raise, provide for, train and teach their children to become
Fig. 4

responsible adults, have either abdicated or unable to do so. The personal, societal and
systemic cycle of poverty in poor communities could cause parents to be chronically stressed
with daily living that they fail to bond with
and guide their children. I also wonder if the
OFW phenomenon has contributed in a way
because of absentee parents. YAFS4 survey
results showed that the most popular sources
of information of the YAFS respondents on
sex came from television (20.3%), books
(17.6%), and internet (16.2%). The ones they will most likely consult for questions about sex
are friends (37.5%), with mothers only coming in next (27.4%) and 21.5% said they would
not consult anyone.36 The surveys reflected the lack of parental involvement in discussing sex
with their children. Filipino families are usually uncomfortable and shy to discuss sex, as
shown by our euphemistic words for private parts, and many parents would not know how to
go about teaching their children about sex. And so without parental guidance and modeling,
misinformation, wrong information, and peer pressure could come into play among the teens
in their discussion of and experimentation with sex.
Another cause mentioned is the failure of institutions such as the local governments to protect
the rights of the teenagers through education for the poorest of the poor and easily accessible
34 Cruz, Lecture on: Population and Development YAFS Findings, 16.
35 Marquez, Sexy Time, 10.
36 Cruz, Lecture on: Population and Development YAFS Findings, 16.
9

reproductive health resources. Corruption among elected officials has been hogging the
headlines for so many years now, and we are saddled with those who enrich themselves
instead of truly serving their constituents. The present government has tried to help through
conditional cash transfers to those who would send their children to school, but this is not
enough for the long term, and many still get overlooked in the system.
Thus far, we have seen that poverty is indeed one of the major causes that contributes
to teenage pregnancies. Poverty renders the parents unavailable and incapable of guiding
their children as they eke out a living to make ends meet. It also renders teenagers from
pursuing and finishing education that will give them a greater chance to find employment that
will get them out of poverty. The present government is trying to address some issues but
there is a need for a more comprehensive plan for the long term to address the needs of the
poor. This leads us to the effects of teen pregnancies that make it imperative for government,
health practitioners, and different stakeholders, to devise effective interventions to resolve
this issue.
IMPLICATIONS AND EFFECTS OF TEENAGE PREGNANCIES
Early pregnancy and childbirth particularly for teens involve a number of risks and
consequences both for the mother and the child and, if allowed to continue and to balloon,
will have adverse effects on our society as well. These can be categorized under health issues,
psycho-emotional issues, socio-economic issues, and moral/spiritual issues.
Health Issues
Pregnant teens, duetotheiryoungage,andwith many coming from the poor sector,
face a number of health risks, for them and their baby. Here is a list from a medical point of
view.
As expected, teen mothers have low rates of age-related chronic disease
(diabetes or hypertension) that might affect the outcomes of a pregnancy. They

10

also have lower rates of twin pregnancies than older women. They tolerate
childbirth well with few operative interventions. However, as compared with 2039 yr old mothers, teens have higher incidences of low birth weight infants,
preterm infants, neonatal deaths, passage of moderate to heavy fetal meconium
during parturition, and infant deaths within 1 yr after birth. The highest rates of
these poor outcomes occur in the youngest and most economically deprived
mothers. Gastroschisis, though very rare, has a markedly higher incidence in
infants of teen mothers for reasons that are not yet clear. Teen mothers also have
higher rates of anemia, pregnancy-associated hypertension, and eclampsia, with
the youngest teens having rates of pregnancy-associated hypertension 40%
higher than the rates of women in their 20s and 30s. The youngest teens also
have a higher incidence of poor weight gain (16 lb) during their pregnancy.
This correlates with a decrease in the birth weights of their infants. Poor
maternal weight gain also correlates strongly with teens late entrance into
prenatal care and with inadequate utilization of prenatal care. Sexually active
teens have higher rates of STIs than older sexually active women.37
For teens with an unplanned and unwanted pregnancy, theyarealsomostlikelyto
seekabortion,whichisillegalinthecountry,butistakingplacebythehundreds.Intheyear
2000alone,therewere473,000inducedabortionsreportedbasedonhospitalreports.38This
didnotcountunsafepracticesresortedtowithuntrainedhilotswithquestionablesterility
proceduresorfrombuyingabortiondrugsfromthestallssurroundingQuiapochurch.39In
2008,anestimated560,000inducedabortiontookplace,90,000soughtmedicalhelpfor
complications,and1,000died.40WHOalsoreportedsome3millionunsafeabortionsamong
girlsaged15to19takeplaceeachyear,contributingtomaternaldeathsandtolastinghealth

37 Dianne S. Elfenbein and Marianne E. Felice, Chapter 112: Adolescent Pregnancy, in

Robert M. Kliegman, et al, Nelson Textbook of Pediatrics, 19th ed. (Philadelphia, PA:
Elsevier, Inc., 2011), 701.
38 Susheela Singh, et al, Unintended Pregnancy and Induced Abortion in the Philippines:
Causes and Consequences, Guttmacher Institute, 10-11:
http://www.slideshare.net/HarveyDiaz/likhaan-study (accessed October 3, 2014).
39 Carlos H. Conde, Philippines abortion crisis, The New York Times (May 16, 2005):
http://www.nytimes.com/2005/05/15/world/asia/15iht-phils.html?pagewanted=all&_r=0
(accessed on October 3, 2014).
40 Center for Reproductive Rights, Forsaken Lives: The Harmful Effect of the Philippine
Criminal Abortion Ban (New York, NY: 2010), 10:
http://reproductiverights.org/sites/crr.civicactions.net/files/documents/phil_report_Spreads.pd
f (accessed October 3, 2014).
11

problems.41Thesearecompellingreasonsforteenagepregnancytobeaddressedasapublic
healthissue.Butthereismorethatisinvolvedthanjustphysicalhealth.
Psycho-emotional Issues
Teenage years are already a time of emotional upheaval and mood swings for many. This
condition is made worse with getting pregnant as feelings of guilt, shame, fear of parents
reactions, abandonment by the partner, fear of the future, insecurity as to how to take care of
and be responsible for a child, and possibly depression may overwhelm pregnant teens prior
to and after giving birth. They may have to deal with stigmatization and discrimination from
relatives, friends or the community. They may have ambivalent feelings towards the child,
and if the pregnancy is caused by rape or is unwanted, they may feel anger or hate towards
their unborn child. Pregnancy and the responsibility attached with having a baby will also
mean putting their social life on hold, and bleaker opportunity to get back to school, unless
they have a supportive family to help with childcare.
Teens who cannot handle the psycho-emotional challenges connected with teen
pregnancy may be driven to self-induced abortion. The guilt and remorse or hard-heartedness
resulting from abortion compounds the emotional turmoil and stress of teens. Dr. Philip Ney,
a practicing psychiatrist and psychologist who has done such an extensive research on
women and families who have had abortion, says: statistically speaking women who have
had abortions are less likely to bond to their children, and therefore these children are more
likely to be abused and neglected. Also, women who were abused and neglected as children
are more likely to have abortions.42 He also says that siblings of the aborted child know
instinctively that an abortion has taken place and they experience a post-abortion survivor

41 Adolescent Pregnancy, World Health Organization, (accessed October 3, 2014).

42 Interview with Dr. Philip Ney, Priests for Life:
http://www.priestsforlife.org/media/interviewney.htm (accessed October 7, 2014).
12

syndrome that is characterized by very deep conflicts similar to those of Holocaust

survivors.43 There is just so much at stake with teen pregnancy that is why interventions are a
must.
Socio-economic Issues
As noted earlier, studies have shown that women who became mothers in their teens
were less likely to finish their education and thus have fewer skills to offer and lesser
opportunities for earning a decent living. Children born to teen parents are also more likely to
face negative health, cognitive and behavioral outcomes due to maternal malnutrition and
inadequate prenatal care and psycho-emotional issues. The cycle of poverty continues and
deepens. Teenage pregnancy also contributes to a high population growth rate especially of
the young, and a high percentage of young people needing more resources on health,
education and food. Instead of growing to be responsible contributors to society, they and
their children become a focus of concern for our already burdened institutions that need to
look after their care.
Moral/Spiritual Issues
The data from YAFS 4 tell us a number of things about the youth today. There is an
increasing trend in living in conditions of those surveyed: 44.9% in 1994, 57.1 in 2002, and
65.3% in 2013, with over one in 10% teenage moms are never married.44 Also, in 2002, 31.2
% young males and 16% of young females were engaged in pre-marital sex, but it increased
to 35.5% for male and 28.7% for females in 2013.45 The increase in pre-marital sex and in
teenage pregnancy show that more and more of our young people are choosing to live
outside the bounds of what was considered the moral values of a Catholic country: are living
in without the benefit of marriage, they are becoming sexually active at a young age; they are

43 Interview with Dr. Philip Ney, (accessed October 7, 2014).

44 Natividad, Childbearing in the teenage years, 8.
45 Marquez, Sexy Time, 10.
13

into risky sexual activities . . . Our young people are sexing dangerously.46 With higher
exposure to pornography through the internet and mass media and without proper guidance
and input on how to process and handle those information, teens are engaging in more risky
sexual behaviors as shown by the YAFS 4. These include the following: 7.3% engaged in
casual sex, 3.5% have had regular sex without emotional attachment, 5.3% of men
experienced sex with another man, and 3.1% of married/living-in young adults have had
extramarital sex experience.47 These data are telling of the increasing promiscuity of our
youth and reflect the moral/spiritual condition they are in.
We have noted that just as teenage pregnancies and motherhood have intertwined
roots that cause it, the effects and implications are multi-faceted as well. Unless teen
pregnancy is addressed, the increase in incidence and prevalence will continue to negatively
affect six of the eight Millenium Development Goals namely, eradicate extreme poverty,
achieve universal primary education, promote gender equality, reduce child mortality,
improve maternal health, combat HIV/AIDS. Achieving these development goals will
continue to be an uphill battle unless the issue of teenage pregnancy is addressed and
interventions for prevention are actively pursued.
INTERVENTION STRATEGIES ON TEEN PREGNANCY
The causes and effects of teenage pregnancy are multi-faceted and therefore require multilevel and multi-faceted approaches to interventions for the issue to be properly addressed.
There is a need to minimize the effects or issues commonly encountered by pregnant
teenagers and teenage moms. There is also a need to address the prevention of teenage
pregnancy as a public health issue and the specific interventions that would address the
problem. I will take a sample community in Manila to show how they are addressing the
issue and the needs of pregnant teenagers in their community. I will briefly touch on
46 Angsioco, Sexing Dangerously, Manila Standard Today.
47 Marquez, Sexy Time, 13.
14

intervention strategies being done by concerned agencies locally regarding the issue, and
what has been the feedback or result of studies where other countries have done similar
interventions. Understandingly there is difference in culture and characteristics of a people
but we could also learn from other nations experience and research until we find better
solutions that will address teenage pregnancy in the country. I will also suggest interventions
that may still not be in place but deal with root causes discussed earlier in the paper.
The city of Mandaluyong has a Batang Ina-Ang Munting Anghel sa Mandaluyong
Fig.the
5 citys increasing number of teenage pregnancies. Fig. 5 shows the
project that addresses
plan they have for both the prevention of and assistance to pregnant teenagers. As the figure
shows, it will take a strong partnership and cooperation of the government agencies, the
community, the family and the teenager to ensure that the teenage mom can get the support
she needs. The city provides
adolescents education and support
programs, teen parent and child care
information and services and safe,
youth-friendly homes for homeless

pregnant adolescents in the city.48 If

this could be replicated in every city and barangay in the country, then it will lessen the
negative impact of teen pregnancy among those affected.
The concerned government agencies are also doing something to address the problem of
teenage pregnancy. I came across a well-developed and researched plan on behavior change
communication to prevent teenage pregnancy that aims to delay sexual initiation, protected
48 Jigs Nepomuceno, DOH-NCR, Mandaluyong launched the Batang Ina Task Force Zambotimes
(December 21, 2012): http://www.zambotimes.com/archives/news/58247-Metro-News-DOH-NCR,Mandaluyong-launched-the-Batang-Ina-Task-Force.html (accessed January 16, 2015).

15

sex or use of contraceptives, avoid multiple sex partners and avoid commercial sex through
the Department of Health website.49 It is helpful to understand the study to see how they
perceive the problem based on their research and the ways they want to address the issue.
Figure 6 will show the analysis chart and figure 7 will show the stakeholders who need to
participate in order for the intervention to work. Both are gotten from the same source.

Fig. 6. Source:
Development of
Behavioral Change
Communication (BCC)
Strategies for Preventing
Adolescent Pregnancy:
Final Project Report,
Demographic Research and
Development Foundation,
Inc. (March, 2012):

http://www.doh.gov.ph/sites/default/files/FinalReportDevelopmentBCCStrategiesAdolescentPregnancy.pdf (accessed
January 18, 2015).

49 Development of Behavioral Change Communication (BCC) Strategies for Preventing

Adolescent Pregnancy: Final Project Report, Demographic Research and Development
Foundation, Inc. (March, 2012): 25.
http://www.doh.gov.ph/sites/default/files/FinalReportDevelopmentBCCStrategiesAdolescent
Pregnancy.pdf (accessed January 18, 2015).
16

Fig.7, p. 27

I agree that it will take all the stakeholders mentioned for the interventions to succeed. I will
touch on some of the interventions mentioned and learn from other studies regarding those
interventions.
Sex Education
A recurring intervention that is proposed is that of giving age-appropriate sexual
education in schools to educate the youth on reproductive health. Indeed, former DOH
Secretary Dr. Esperanza Cabral mentioned that human sexuality education was introduced
and being pilot-tested in both public and private secondary schools under her term.50 There
might be a need to do more research and evaluate the effectiveness of the sex education
curriculum that was introduced several years back and how much of the plan has really been
implemented, since the incidence continues to increase in the recent years. The National
Youth Commission (NYC) Commissioner Perci Cendana also advocates for adolescent
50 STATEMENT by Hon. Esperanza Cabral, M.D. Secretary of the Department of Health of the Republic of
the Philippines at the 43rd Session of the Commission on Population and Development (New York, NY: United
Nations) 13 April 2010, 5.
http://www.un.org/en/development/desa/population/pdf/commission/2010/country/philippines.pdf (accessed

January 14, 2014).

17

sexual reproductive health (ASRH) and stresses the urgent need for scientific, accurate, ageappropriate and culturally-sensitive ASRH education to complement values education and
encourage more responsible behavior among youth.51 The YAFS 4 finding that 78% of
young peoples first sexual encounter was unprotected (84% for women and 73% for men)52
may have triggered this response of sex education to make the youth be aware of the need for
protection and prevention of pregnancy in case they engage in pre-marital sex.
However, looking into some findings of countries implementing sex education in
schools show that sexual health knowledge does not necessarily correlate with safer
behavior.53 A study of university students in the UK which has a very high incidence of
teenage pregnancy despite the sex education in the schools found that despite knowing about
the transmission and consequences of STDS, many students continued engaging in risk
behaviour.54 Likewise, a 2009 study conducted among 823 adolescent students in Central
Taiwan published in the International Journal of Nursing Studies found, No significant
correlation between sexual knowledge and safe sex behaviour of adolescents.55
There is no question that sex education of the youth need to be taking place but it has

51 National Youth Commission, NYC: Results of Youth Sex Study Very Alarming
Calls for Urgent Interventions, (Feb 10, 2014): http://www.nyc.gov.ph/whats-new-atnational-youth-commission/nyc-updates/81-youth/848-nyc-results-of-youth-sex-study-veryalarming-calls-for-urgent-interventions (accessed October 10, 2014).
52 Angsioco, Sexing Dangerously, Manila Standard Today.

53 Peter Jon Mitchell, The stark limitations of sex education classes, eReview Vol 14, No.
19 (October 8, 2014), 1.
http://www.imfcanada.org/sites/default/files/eReview_Oct_8_14_0.pdf (accessed October 10,
2014).
54 Jones, N.R. & Haynes, R., The association between young peoples knowledge of
sexually transmitted diseases and their behaviour: A mixed methods study, Health, Risk and
Society Vol. 8, issue 3 (September, 2006), 293-304, cited in Peter Jon Mitchell, The stark
limitations of sex education classes, 2.
55 Jiunn-Horng Lou & Sheng-Hwang Chen, Relationships among sexual knowledge, sexual attitudes, and safe
sex behaviour among adolescents: A structural equation model International Journal of Nursing Studies, 46,
(2009), 1600. http://www.sciencedirect.com/science/article/pii/S002074890900176X (accessed January 15,
2015).

18

to be done not just by the school but should also be taking place in the home by the parents
from the early years, as will be discussed in family interventions. It should also be taking
place in the community where out-of-school youths hang around through the barangay youth
centers and community health centers actively reaching out to those at-risk youth, which are
related to the next intervention. Stronger control of the proliferation of pornographic
materials, websites, movies, and others, are also important as exposure to these wrong
sources of sex education for the curious teenagers could contribute to risky behavior of teens.
Access to Adolescent Health Care and Services
Another commonly proposed intervention is that of making health care and services more
accessible to youth in the community so they can get needed information and help. Even
during the time of Dr. Cabral as DOH secretary, she acknowledged that,
. . . several sectors in the country are implementing integrated programs and
initiatives on adolescent and youth health and development, in integrated and
complementary manner. The Adolescent Health and Youth Development
Program (AHYDP) under the population management program is accelerating
effort to provide necessary information and skills among youth and adolescents
on matters related to their sexuality, health and development. Modular training
packages on parenting adolescents have been developed and rolled-out at the
community level to train parents and guardians on educating and guiding their
adolescent on responsible sexuality and health.56
This is well and good if it is being implemented and funded well to ensure its success. The
roll out of these programs and success of implementation may also be dependent on the
advocacies and priorities and funding available in different local government units, thereby
affecting the increase in teenage pregnancy despite these programs.
The succeeding interventions are strong suggestions that need working on as they deal
with the root issues of the problem.
Deal with the Twin Problem of Poverty and Lack of Education
Research conducted on US teen pregnancy by professors Melissa Kearney and Phillip
56 STATEMENT by Hon. Esperanza Cabral, M.D. Secretary of the Department of Health of the Republic
of the Philippines at the 43rd Session of the Commission on Population and Development, 5.

19

Levine showed that being on a low income trajectory in life leads many teenage girls to have
children while they are young ... It reflects a decision among a set of girls to choose nonmarital motherhood at a young age instead of investing in their own economic progress
because they feel they have little chance of advancement.57 Their conclusion is worth noting:
This conclusion has important implications for public policies. We do not
believe that policies targeted directly at teen pregnancy prevention sex
education, improved access to contraception, abstinence counseling, and the
like are likely to improve outcomes much for disadvantaged young women.
Instead, we believe that with improved economic opportunities, reduced
poverty, and improved prospects for other adult outcomes, teen pregnancy
would also decline.58
Another writer says basically the same thing:
Theupshotisthatteenmotherhoodismuchmoreaconsequenceofintense
povertythanitscause.Preachinggoodbehaviorwontdoanythingtoreduceits
incidence,andevenhandingoutfreebirthcontrolwontcontributemeaningfully
tosolvingeconomicproblems.Instead,familylifeseemstofollowrealeconomic
opportunities.Wherepoorpeoplecanseethathardworkandplayingbythe
ruleswillrewardthem,theyreprettylikelytodojustthat.Wherethesystem
looksstackedagainstthem,theyremorelikelytoabandonmainstreamnorms.
Thosewhodosobybecomingsingleteenmomsendupfairingpoorlyinlife,but
thosebadoutcomesseemtobearesultofbleakunderlyingcircumstancesrather
thanpoorchoices.59
Thus, one of the ways to minimize teen pregnancy is to address the lack of economic
opportunity among families especially for those children and youths at risk. We must
recognize the need to support poor families and their communities holistically in poverty
reduction through food security, cessation of conflict and peace-building strategies, micro-

57 Melissa S. Kearney and Phillip B. Levine, Why is the Teen Birth Rate in the United
States So High and Why Does It Matter? Journal of Economic Perspectives Vol. 26, No. 2
(Spring 2012), 142: http://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.26.2.141 (accessed
January 15, 2015).
58 Kearney and Levine, Why is the Teen Birth Rate in the United States So High and Why Does It
Matter? 163.

59 Matthew Yglesias, Why Are Teen Moms Poor?

http://www.slate.com/articles/business/moneybox/2012/05/teen_moms_how_poverty_and_in
equality_cause_teens_to_have_babies_not_the_other_way_around_.html (accessed October
2, 2014).
20

credit and enterprise, shelter, literacy, and education to name but a few.60
The government is addressing somewhat the issue through the Pantawid Pamilya or
Conditional Cash Transfer (CCT) program that encourages parents in poor families to keep
their children in school in exchange of cash assistance. The World Bank reports that the
program is indeed working as the 2012 Review shows the following:
In Pantawid barangays, 75.3 percent of preschoolers are enrolled in daycare,
compared to 65 percent in non-Pantawid barangays;
Among school children at age 6-11, 97.5 percent of children in Pantawid
barangays are enrolled in school, as against 93 percent in non-Pantawid
barangays.61
The weakness of the program though is that the teens and youth are not included in the age
bracket of those being given assistance probably due to higher education costs. The
recommendation says,
The program as currently designed does not improve school enrollment of
older children (age 12 and above), which is key to sustaining the benefits
reaped from investments made in human capital and breaking the intergenerational poverty trap. To address barriers that older children face in staying
in school, many CCT programs such as the Female Secondary School Stipend
Program (FSSP) in Bangladesh, Opportunidades in Mexico, Familias en
Accion in Colombia, the Social Risk Mitigation Project (SRMP) in Turkey, and
Jamaicas Program of Advancement through Health and Education (PATH)
provide larger benefit amounts for children in secondary school than for
elementary school children, recognizing that older children have higher
opportunity costs and higher costs of schooling.62
Partnership of the government and private sector, churches and businesses is needed to
address the needs of the at-risk youths. The Kariton Classroom spearheaded by CNNs
2009 Hero of the Year Efren Penaflorida could also be multiplied to help reach out-of-school
or street children. His Dynamic Teen Company (DTC) has been reaching out to out-of-school
60 Stephen Tollestrup, Children are a Promise of Hope, in Douglas McConnell, Jennifer
Orona, and Paul Stockley, eds., Understanding Gods Heart for Children: Toward a Biblical
Framework (Colorado Springs, CO: Authentic Publishing, 2007), 194-195.
61 Nazmul Chaudhury, Jed Friedman, and Junko Onishi, The World Bank (January 22, 2013), 20:
http://www.dswd.gov.ph/download/Research/Philippines%20Conditional%20Cash%20Transfer%20Program,
%20Impact%20Evaluation%202012.pdf (accessed January 20, 2015).

62 Chaudhury, et al, Philippines Conditional Cash Transfer Program Impact Evaluation

2012, 32.
21

youths by bringing the classroom to where they are in the streets.63 They have seen youths
transformed youths who used to be drug pushers, petty thieves, scavengers, street kids,
drop-outs and out-of-school youth are now DTC volunteers and have returned to mainstream
education.64 The DSWD and DepEd took the idea and, in partnership with DTC, launched
the K4 or Kariton, Klasrum, Klinik, Kantin, in order to address basic needs of street
children who are unable to go to schools for formal education.65 They are rolling this out in
Malabon, Caloocan, Quezon City and Pasig and have pans to expand to other areas. Older
out-of-school youths could be motivated and talked into taking advantage of the Alternative
Learning system (ALS) program to pursue and finish their education. The ALS Non-formal
Education happens outside the classroom, community-based, usually conducted at
community learning centers, barangay multi-purpose hall, libraries or at home, managed by
ALS learning facilitators, such as mobile teachers, district ALS Coordinators, instructional
managers at an agreed schedule and venue between the learners and facilitators.66 They
should also be assisted with acquiring vocational skills that could help them earn and be
employed.
Family Interventions
I personally believe that parents are still one of the best persons to tap for deterring
sexual experimentation of teens and should be equipped to teach their kids about sex. Some
studies attest to this. More than two decades of research on parental influence on adolescents
risk of becoming pregnant show that parent/child closeness or connectedness, parental
supervision or regulation of childrens activities, and parents values against teen intercourse
63 Dynamic Teen Company History: http://www.dtc.org.ph/?page_id=174 (accessed January
20, 2015).
64 Dynamic Teen Company History (accessed January 20, 2015).
65 Atom Araullo, DSWD, Dep Ed launch kariton classrooms, ABSCBN News (April 18,
2013): http://www.abs-cbnnews.com/focus/04/18/13/dswd-deped-launch-kariton-classrooms
(accessed January 20, 2015).
66 Alternative Learning System, Department of Education: http://www.deped.gov.ph/als (accessed
January 20, 2015).

22

(or unprotected intercourse) decrease the risk of adolescent pregnancy.67 Data from a
national longitudinal study of children and youth in Canada (NLSCY) covering the first year
of life to 19 years of age were culled and compared. The study found a number of factors that
deter kids from having sex as teens: close family relationships, having two biological parents,
low levels of tobacco and alcohol use.68 Mitchell, the research analyst, gave the following top
recommendations: (1) Parents should be the prime sex educator. Parents are the most
influential force in a teens life. (2) Parents should work to create a healthy, stable home
characterized by warmth, open communication and clear expectations. (3) Parents should
model a healthy lifestyle and positive choices. (4) Sex education should engage parents and
recognize their role as the primary sex educators. (5) Sex education should acknowledge that
girls face unique risks compared to boys when it comes to early sexual engagement.69
Helping equip parents on how to raise their children from birth through adulthood is a much
needed intervention as it deals with a major root cause of teen pregnancy. This is where
churches and organizations that teach godly family values and principles can be mobilized
especially for targeted at-risk communities. Our ministry, FamilyLife Philippines, conducts
such seminars in different provinces of the country and have trained local people in several
provinces to reach out to communities and barangays in their areas. But we recognize that
much still needs to be done.
Address the Spiritual/Moral Development of the Youth
This is an area that has been alluded to but not really given much attention to in terms
of intervention, but it certainly deals with the root cause. Research and studies made in
67 Brent C. Miller, Brad Benson and Kevin A. Galbraith, Family Relationships and
Adolescent Pregnancy Risk: A Research Synthesis, Developmental Review 21 (2001): 1,
(accessed January 19, 2015).
68 Peter Jon Mitchell, Rated PG: How Parental Influence Impacts Teen Sexual Activity,
Institute of Marriage and Family Canada (October 2009): 2,
http://www.imfcanada.org/sites/default/files/Rated_PG_Part_1.pdf (accessed January 19,
2015).
69 Mitchell, Rated PG, 1.
23

childrens spirituality reveal that children and youth are very much interested in their spiritual
lives and that it positively affects other areas of their lives, including engaging in risky
behaviors as PMS. A longitudinal College Students Beliefs and Values (CSBV) Survey
conducted from 2004-07 with 14,527 students attending 136 US colleges and universities
nationwide showed a powerful argument in support of the proposition that higher education
should attend more purposefully to students spiritual development.70 The Search Institute
also surveyed 6,500 young people with ages ranging from 12 to 25 living in 17 countries, and
results showed that a sizeable portion of the youth is interested in and is committed to their
spiritual development.71 The same group studied 370 young people in the U.S. who described
spirituality as important and participated in religious community over a period of three years.
The results showed that these young people are better off on a variety of risk and thriving
indicators such as delaying sexual intercourse, preventing school problems and resisting
getting into dangerous situations.72 Another extensive scientific research that assessed the
behavioral and academic effect of Bible literacy on students showed that those with high
levels of Bible knowledge exhibited higher academic achievements and positive behavior
patterns.73 These studies have contributed to the growing acceptance of The Bible Literacy
Projects textbook, The Bible and Its Influence, which is now being used in 580 public
schools in 43 states.74 A survey of 39 professors from top 34 U.S. schools including Harvard,
70 Jennifer A. Lindholm et al., A Guidebook of Promising Practices: Facilitating College
Students Spiritual Development, University of California in Los Angeles (2011):
http://spirituality.ucla.edu/docs/promising-practices/Promising_Practices_web.pdf (accessed
July 18, 2013), v.
71 Eugene C. Roehlkepartain, et al, With Their Own Voices: A Global Exploration of How
Todays Young People Experience and Think About Spiritual Development, Search Institute:
The Center for Spiritual Development in Childhood and Adolescence (2008), 5-7.
72 Peter C. Scales. Early Spirituality and Religious participation Linked to Later Adolescent WellBeing, Search Institute: Minneapolis, MN (2007), 1-2.

73 William Jeynes, Results of Three Scientific Studies Boost Rationale for Introducing Bible
as Literature Courses in Public Schools, Religious News Service,
http://www.bibleliteracy.org/site/News/bibl_newsRNS070424.htm (accessed July 18, 2013).
74 David Van Biema, The Case for Teaching the Bible Time Magazine: March 22, 2007,
http://www.time.com/time/magazine/article/0,9171,1601845-1,00.html (accessed July 18,
24

Yale, Princeton and Stanford, showed that professors agree to the idea that knowledge of the
Bible is important to a good education.75
These studies affirm the fact that children and youth value their spiritual lives and that
attention given to it and the Bibles central role in their lives bring about positive results.
There is growing evidence that the spiritual dimension/development is seen as vital to the
childrens developmental journey. A 2008 report on development issues and trends of Filipino
children included the Moral, Spiritual or Transcendent Framework as often missing but is
perhaps the most important backbone of development as it provides the compass for the
other development aspects.76 UNICEF, in its global study on child poverty,
differentiated it from adult poverty and proposed a child poverty model that includes not just
material deprivation but also considers the emotional and spiritual aspects of the child.77
George Barnas company conducted a lot of research on parents, children and church and he
wrote a number of books on the implications of the results of the surveys. He said that,
most parents see spiritual development of children as a value-added proposition rather than
the single most-important aspect of childrens development more important than
intellectual, physical and emotional development.78 He considered spiritual health most
important because every dimension of a persons experience hinges on his or her moral and
spiritual condition.79 The editors of a handbook on the spiritual development of children and
2013).
75 Good Education Includes Bible Knowledge Newsday: June 3, 2006,
http://www.bibleliteracy.org/site/News/bibl_newsNewsday060603.htm (accessed July 18,
2013).
76 Florangel Rosario-Braid, Ramon R. Tuazon and Ann Lourdes C. Lopez, eds., The Future
of Filipino Children: Development Issues and Trends Asian Institute of Journalism and
Communication (2011): xiv http://www.aijc.com.ph/Megatrend%20final%20complete.pdf
(accessed January 19, 2015).
77 Jenny D. Balboa and Josef T. Yap, Children and Development, in Global Study on Child Poverty
and Disparities: The Case of the Philippines, Philippine Institute for Development Studies Discussion paper
Series No 2009-27, (September 2009), 2-3.

78 George Barna, Transforming Children into Spiritual Champions: Why Children Should Be
your Churchs #1 Priority (Ventura, CA: Regal, 2003), 19.
79 Barna, Transforming Children into Spiritual Champions, 33.
25

adolescence hypothesized,
spiritual development is a dimension of human life and experience as
significant as cognitive development, emotional development, or social
development. All of these dimensions of development are interrelated. It is the
spiritual dimension that is most involved in a persons effort to integrate the
many aspects of development. As a core process of development involving the
creation of a life narrative (in which the self is connected to larger constructs of
values, tradition, space and/or time), spiritual development cannot be reduced to
merely human need or desire.80
Indeed, there is a wider consensus that having a vital spiritual life can help todays
youth face the challenges they have to contend with in a globalized, technologically wired,
urbanized society where families themselves have a harder time navigating. Different
Christian organizations and churches working among the youths testify to changed lives for
the better, changed motivation for living, power to do what is right even in difficult situations
and in the midst of peer pressure. They could be tapped as a partner to reach out and address
the issue through biblical teaching and compassionate models for the young to give control to
God who empowers them to resist to live lower than what God intended for them.
CONCLUSION
Just as the root causes of teenage pregnancy spring from poverty socio-economic,
educational, and spiritual/moral poverty the interventions need to address these root causes
in order for us to see significant reduction of the problem instead of its increasing prevalence.
The data I have presented have pointed out that it will take the cooperation, concerted efforts
of different stakeholders government agencies, parents, businesses, churches, communities,
schools, NGOs to see success in dealing with teenage pregnancy as a public health issue. I
have cited some programs that are working well and bring encouragement. I have shown that
much still needs to be done to make a difference. This paper simply presents a general picture
of the causes, effects, and possible interventions to deal with the problem. A more thorough
80 Eugene C. Roehkepartain, Pamela Ebstyne King, Linda Wagener and Peter L. Benson,
eds., The Handbook of Spiritual Development in Childhood and Adolescence (Thousand
Oaks, CA: Sage Publications, 2006), 9.
26

and well-researched study needs to be made to document gains and workable solutions so that
our youth and the young will not fall into the statistics and difficult situation of kids having
kids.

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