CHAPTER II

REVIEW OF RELATED LITERATURE

Teenage pregnancy is a worldwide cause of concern, occurring in high-, middle-, and

low-income countries. However, adolescent pregnancies are more likely to occur in marginalized

communities, commonly driven by other issues such as poverty, lack of education, and

employment opportunities. According to the World Health Organization (2020), approximately

12 million girls aged 15-19 years give birth each year in developing regions, with at least 10

million of these cases unintentional pregnancies. At least 777,000 girls aged 15 years below give

birth each year, further raising concern about the aforementioned issue. Nowadays, low and

middle-income countries characterized by poor healthcare services house the vast majority of

teenage pregnancies (Kirchengast, 2016), resulting in complications during pregnancy and

childbirth, making it the leading cause of death for 15-19-year-old girls worldwide, with teenage

pregnancy being associated with higher fetal and neonatal mortality rate (World Health

Organization, 2020). Additionally, an estimated 3.9 million teenage mothers undergo unsafe

abortions, which may result in consecutive reproductive problems or even death. Further

contributing to maternal mortality, morbidity and lasting health problems (World Health

Organization, 2014). Not only that, teenage mothers in the age group of 10-19 years face higher

risks of eclampsia, puerperal endometritis and systemic infections than women aged 20 to 24

years, and babies of adolescent mothers have higher chances of having low birth weight, preterm

delivery and severe neonatal conditions. Teenage mothers are also likely to acquire pregnancy

induced hypertension, pre-eclamptic toxemia and have premature onset of labor, premature

delivery, and neonatal morbidities such as perinatal asphyxia, jaundice, and respiratory distress

syndrome (Kumar, Singh, Basu, et al., 2007).

 Several factors contribute to adolescent pregnancies and births. In many societies, girls

are put under pressure to marry and bear children earlier than they should. In least developed

countries, at least 39% of girls marry before they even reach the age of 18 and 12% before the

age of 15. In many places, girls choose to bear a child because they have limited educational and

employment prospects. In such societies, motherhood is often valued and marriage or union and

childbearing may be the best of the limited options available. Adolescents who are trying to

avoid pregnancies may not be able to do so because of knowledge gaps and misconceptions on

where to obtain contraceptive methods and how to properly use them. Adolescents face barriers

to accessing contraception such as restrictive laws and policies regarding the use of

contraception based on age and marital status, health worker bias and/or lack of willingness wo

acknowledge adolescents’ sexual health needs, and the teenagers’ inability to access

contraceptives because of knowledge, transportation and financial constraints. In addition,

adolescents may lack the agency to ensure the correct and consistent use of a contraceptive.

Sexual violence is also another cause for unintended pregnancy globally, with more than a third

of girls in some countries reporting that their first sexual encounter was coerced (WHO, 2020).

Social consequences for unmarried teenage mothers may include stigma, rejection or

violence of partners, parents and peers. Girls aged under 18 who become pregnant have higher

chances of experiencing violence within marriage or a partnership. Although efforts are

underway to enable them to return to school after child birth, adolescent childbearing often leads

them to drop out of school, and this may well jeopardize the girls’ future education and

employment opportunities (WHO, 2020).

Girls who had a family background of teen pregnancy were more likely to get pregnant at

an early age. According to Wall-Wieler, Roos and Nickel (2016), the possibility of girls aged 14-
19 who had at least one elder sister having a teenage pregnancy were 3.38 times higher than girls

whose elder sister(s) did not get pregnant during adolescence. Teenage daughters of mothers who

gave birth under the age of 20 had 1.57 times higher odds of pregnancy than those whose

mothers had their first child after 19 years of age. Educational achievement was adjusted in a

sub-population examining the odds of pregnancy between ages 16 and 19. The odds of teenage

pregnancy for teens with at least one elder sister who had a teenage pregnancy were reduced to

2.48 and the odds of pregnancy for teen daughters of teenage mothers were reduced to 1.39. The

study revealed that despite both being siginificant, the relationship shared between an older

sister’s teenage pregnancy and a younger sister’s teenage pregnancy is significantly stronger than

that between a mother’s teenage childbearing and a younger daughter’s teenage pregnancy.

This is further supported by Samano, Martinez-Rojano, et al. (2017), where 29 teen

mothers had a family background of adolescent pregnancy. The girls disclosed feelings of

repression, indifference and loneliness towards their parents, leading them to unprotected sexual

relations with no fear of pregnancy whatsoever. However, after the pregnancy, the

communication between the girls and their parents had improved, but inversely, the relationship

between the teenage mother and her partner had degraded considerably. Consequently, the

teenagers returned to feeling as they did prior to becoming pregnant. They stated that they would

make their situation work for the sake of their child, and regretting dropping out of school and

getting pregnant at a young age. Almost all of the participants said that they were seeking love

outside the family, revealing a scenario of limited communication and unsatisfactory relations

within the family.

From a historical point of view, teenage pregnancies aren’t something new (Kirchengast,

2016). In fact, during the twentieth century in Europe, teenage pregnancies and adolescent
motherhood were considered as normal and often socially accepted. For much of human

evolution and history, first births that took place during adolescence were absolutely

common. During these times, married teenage girls would have been a common sight, giving

birth during the second decade of their life. This kind of reproductive behavior was socially

desired, and considered as normal (Santelli, Melnikas, 2010). One example of adolescent

childbirth was the matter concerning the teenage motherhood of Bristol Palin, the daughter of

Sarah Palin who served as the Governor of Alaska and ran as a Vice Presidential candidate of the

United States, in 2008. However, pregnancies during early adolescence (under the age of 15),

have always been rare. This was mainly due to the biological fact that menarche and

reproductive maturity were experienced much later in historical times compared to the present.

Moreover, sexual activity of girls and young women were mainly related to marriage until the

second half of the twentieth century (Bellis, Downing and Ashton, 2006). In this generation, the

first sexual activity is initiated at a much younger age, and the use rate of contraceptives among

this particular age group is rather low (Klein, 2005).

Teenage pregnancy is experienced worldwide, but this is especially true in Africa.

Globally, the rate of teenage pregnancy is 44 births out of 1,000 girls aged 15-19, however in

West and South Africa, this figure stood at 115 births, the highest regional rate worldwide.

Countries such as Central African Republic, Niger, Chad, Angola and Mali top the list of

countries with the highest adolescent birth rate, with figures above 178 (UNICEF, 2018).

In South Africa, specifically in the KwaZula Natal region, teenage mothers experienced

feelings of fear and sadness at the realization of pregnancy. Family reactions differ in that some

experienced anger, and disappointment about the situation. Participants often reported that they

were unaware of the pregnancy and had symptoms of teenage pregnancy. On the other hand,
some reported that the knowledge came from the partner before they realized they were

pregnant. The participants in the study were divided into two: those who continued to return to

school and those who didn’t. For those that did, some went back to school in an effort to get a

better job in the future to better care for their children, while others returned to school because of

the influence of their mothers who were teenage mothers themselves and returned to school.

There were also some who argued that their teachers played a role in their decision to continue

studying. For those that left school, they did so due to the lack of support from their family,

friends, and teachers, their attitudes towards them during and after the pregnancy, as well as

financial constraints and the absence of an individual with the role of taking care of the child

while the mother is at school (Dlamini, 2016)

According to Donkor and Lariba (2017), adults in the country of Ghana rarely discuss

sexual matters with the youth. Thus, the youth had little to no knowledge about the changes their

body experiences during the transition from youth to adulthood. For the vast majority of teenage

mothers, this has resulted in unplanned pregnancies which come with serious developmental and

socioeconomic complications. The findings of the study revealed that poor parenting, poverty

and peer influence were the major causes of teenage pregnancy in the study area. In addition, the

concealment of sex education and sex-knowledge from the youth made them more curious and

vulnerable. The study revealed the need for parents and schools to properly empower the youth

through sex education to equip them with knowledge in order to overcome the potentially corrupt

information through social media and friends.

Nigerian teenage mothers, as previous studies have shown, especially those in the Niger

Delta, drop out of schools completely and may never go back again. Instead, they become low-

level laborers, or miscreants to the society (Salami, 2015). The results of the analysis revealed
that teenage pregnancy is on the rise in the Niger Delta. Furthermore, sex education is not given

a place of priority in the Education National Policy, with teachers shying away from teaching it

in schools and parents lack of support for the matter. Nevertheless, there is an urgent need to

incorporate it into the Biology curricuclum.

A study conducted in Northeast Ethiopia showed that teenage pregnancy had a high

prevalence in the area. Utilizing a community-based cross-sectional study among 514 teenagers

in Wogedi, Northeast Ethiopia, factors that were found to have a statistically significant

association were age, residence, contraceptive nonuse, and parental divorce. It is strongly

recommended to strengthen contraceptive use by giving special attention to rural dwellers and

showing the consequences of divorce to the community (Habitu, Yalew and Bisetegn, 2018).

Aside from Africa, Vietnam has also experienced occurrences of teenage pregnancies.

Nguyen, Shiu and Farber (2016) utilized two Vietnam Survey Assessment of Vietnamese Youth

that were conducted in 2003 and 2008 to answer two research questions: (1) what is the

prevalence of teen pregnancy in contemporary Vietnam; and (2) what selected social, family, and

individual factors are associated with teen pregnancy in Vietnam? The questions were answered

within the context of fast political, economic, and social change in the nation in the last two

decades. Results of the study showed that the prevalence of pregnancy among Vietnamese

teenagers in the surveys was stable at 4%, or 40 pregnancies per 1000 teenage girls aged 14-19.

Some factors that were positively correlated with higher odds of teenage pregnancy in both

survey cohorts are age, experience of domestic violence, and early sexual debut. However, only

the 2008 cohort showed that educational attainment, sexual education at school, Internet use, and

depressive symptoms were significantly related to teenage pregnancy because of it being an

ethnic minority.
 The presence of adolescent childbearing in America proves that even developed nations

cannot prevent the phenomenon from happening. According to Domenico and Jones (2007),

while the rate has been slightly decreasing in recent years, adolescent pregnancy remains

prevalent in the United States, with nearly one million teenage females becoming pregnant each

year (Meade and Ickovics, 2005; National Campaign to Prevent Teenage Pregnancy, 2004). In

fact, the country’s teenage pregnancy rate continues to hold the record for the highest among

western industrialized nations, with 4 of every 10 pregnancies occurring in females younger than

20 years old (Dangal, 2006; Farber, 2003; SmithBattle, 2003; Spear, 2004). Despite a 21%

decline in the rate of pregnancy among older adolescents between the ages 15 to 19, nearly

12,000 adolescent females who are under the age of 12 become pregnant each year (National

Campaign to Prevent Teen Pregnancy, 2003; Rothenberg and Weissman, 2002; Sexuality

Information and Education Council of the United States, 2002).

Aside from ranking at the top for the highest rate for teenage pregnancies, the United

States of America also holds the record among developed nations for the highest rate of sexually

transmitted diseases (Stanger-Hall, and Hall, 2011). In an effort to reduce these rates, abstinence-

only sex education programs were funded by the U.S. Government. Using national data collected

in 2005 from all the states with information on sex education laws or policies, it shows that

increasing emphasis on abstinence education is positively correlated with teenage pregnancy and

birth rates. The trend remains significant after accounting factors such as socioeconomic status,

teenage educational attainment, ethnic composition of the adolescent population, and availability

of Medicaid waivers for family planning services in each state. These data show clearly that

abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and

instead may actually be contributing to the high teenage pregnancy rates in the United States.
The integration of comprehensive sex and STD education into the biology curriculum in middle

and high school science classes and a parallel social studies curriculum that addresses risk-

aversion behaviors and planning for the future is proposed as a solution in alignment with the

evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process

Model advocated by the National Institutes of Health (Stanger-Hall and Hall, 2011).

In impoverished communities in Mexico, most adolescent mothers do not attend school,

but typically; they become pregnant after dropping out (Atienzo, Campero, et al., 2017). The

findings of the study reveal that out of 68 women and 44 men, 39% and 57% of the numbers

respectively had their first sexual intercourse at the age of 15, with the females getting pregnant

at age 16; 39% of men and 57% of women were already parents to a child; 54% and 19%

respectively were working and studying simultaneously. 41% of women and 14% of men were

reported to have dropped out because of either a pregnancy or a marriage. The support of family

and teachers is crucial to stay in school, but the institution remains indifferent to their plight,

with their immediate needs easily defeating their aspirations. In order to design focused

strategies promoting their success in adult life, it is fundamental to acknowledge and notice the

experiences of these vulnerable young people.

The phenomenon of teenage pregnancy is also present in the Philippines. According to

the results of the 2013 National Demographic and Health Survey, one in ten young Filipino

women in the age group of 15-19 years had begun childbearing: 8 percent were already mothers

and 2 percent were pregnant with their first child. Furthermore, the number of women who have

begun childbearing rose from 8% in 2003 to 10% in 2013 (National Demographic and Health

Survey; Young Adult Fertility and Sexuality Study, 2013). The survey also reveals that one in

five young adult Filipino women in the age group of 18 to 24 years had initiated their sexual
activity before they reached the age of 18, meaning that some of them would have had their first

intimate sexual act before marriage. Aside from that, it is also shown that 15 percent of young

adult women aged 20 to 24 had their first marriage or began living together with her spouse or

partner by the time she reached 18. The proportion of female teenagers or young adult females

who have begun childbearing is higher among those classified as belonging to financially

challenged households (37%) than those in wealthier households (13%). Early childbearing is

more common in Caraga and Cagayan Valley, reaching 38% and 37% respectively.

Teenage pregnancies in the country are often associated with social development

problems such as lack of sufficient education and poverty. This often results to single parenthood

which creates conditions that makes the mothers irresponsible (Salvador, Sauce, et al., 2016).

Aside from that, pregnancy is more common among women aged 13 to 24 with less education

than those with higher education (44% for women with elementary education versus 21% for

women with college education) according to the 2013 National Demographic and Health Survey.

Hence, it conveys a social stigma in various countries and cultures. The results of the study

showed that this serves as an ‘eye opener’ for people to involve themselves in the public

awareness, planning, implementation, and evaluation of the programs that would build

sustainable development. As early as possible, sex education should be incorporated in the

curriculum of the intermediate and secondary schools to properly teach teenagers the effects and

disadvantages of teenage pregnancy (Salvador, Sauce, et al., 2016).

According to the World Health Organization (2020), the estimated global adolescent-

specific fertility rate has declined by 11.6% over the past 20 years. However, there are significant

differences in rates across regions. For instance, the teenage fertility rate of East Asia is 7.1,

whereas the corresponding rate in Central Africa is 129.5. Within regions, enormous variations
are also observed. In 2018, the overall teenage fertility rate in Southeast Asia was 33. However,

rates ranged from Bangladesh’s 83 to the Democratic People’s Republic of Korea’s 0.3. And

even within countries, enormous variations were common. For instance, in Ethiopia, the total

fertility rate ranges from 1.8 in Addis Ababa to 7.2 in the region of Somali with the percentage of

women in the age group of 15-19 years old who have begun childbearing ranging from 3% in

Addis Ababa to 23% in the Affar region.hile the estimated global teenage fertility rate has

declined over the years, the actual number of child births to teenagers has not, due to the large –

and in some parts of the globe, increasing – population of young women in the 15-19 age group.

The largest number of births occur in Eastern Asia and Western Africa, with 95,153 and 70,423

respectively.