Chapter 1

INTRODUCTION

Background of the Study

Pregnancy is the term used to describe the period in which a fetus develops inside a

woman's womb or uterus. Pregnancy usually lasts about 40 weeks, or just over 9 months, as

measured from the last menstrual period to delivery. (Office of Communications, 2017 It is a

state of carrying a developing embryo or fetus within the female body. This condition can be

indicated by positive results on an over-the-counter urine test, and confirmed through a blood

test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about nine

months, measured from the date of the woman's last menstrual period (LMP). It is

conventionally divided into three trimesters, each roughly three months long. Pregnancy ends

when the birth process begins. (Shiel, 2020)

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female

under the age of 20. Pregnancy can occur with sexual intercourse after the start of ovulation,

which can be before the first menstrual period (menarche) but usually occurs after the onset

of periods.

Teenage pregnancy has always been a worldwide issue, a lot of campaigns were made

in order to lessen its occurrence. The total number of this incident increases yearly. The

Philippines is one of the countries who faces this situation. Teenage pregnancy affects 5.99

percent of Filipino girls which is the second highest rate in Southeast Asia based on Save the

Children’s Global Childhood Report (2019). An estimated 538 babies are born to Filipino

teenage mothers every single day, according to Philippine Statistical Authority (2017). (Save

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the Children calls on the passage of Teenage Pregnancy Bill as the world celebrates

International Day of the Girl - Christelle Lei Tapang, 2019).

Therefore, the government in partnership with the different non government agencies

should exert efforts in resolving this issue. Teenage Pregnancies are often associated with

social development issues such as lack of sufficient education and poverty. This often results

in single parenthood which catalyzes conditions that renders the mothers to become

irresponsible. Hence, it conveys a social stigma in various countries and cultures. This study

would like to focus on exploring the lived experiences of Filipino teenage mothers in their

pre and post-natal stage on how they prepare and accept their new roles as mothers. The

gathered data from the methods were analyzed and interpreted according to qualitative

content analysis. As a result, this generated emergent themes which depicted the experiences

of the participants. (The Phenomenon of Teenage Pregnancy in the Philippines - Jordan

Tovera Salvador, et al., 2016).

About 140 million births take place every year and the proportion attended by skilled

health personnel has increased: from 58% in 1990 to 81% in 2019. This is mostly due to

larger numbers of births taking place at a health facility. Deaths from complications during

pregnancy, childbirth, and the postnatal period have declined by 38% in the last two decades,

but at an average reduction of just under 3% per year, this pace of progress is far too slow.

It also hides vast inequalities within and across countries. More than half of maternal

deaths occur in fragile and humanitarian settings. Sub-Saharan Africa and Southern Asia

share the greatest burden of maternal deaths, 86% of the global total in 2017.

The Sustainable Development Goals (SDGs) offers an opportunity for the

international community to work together and accelerate progress to improve maternal health

for all women, in all countries, under all circumstances. SDG targets for maternal health

include aiming for an average global ratio of less than 70 deaths per 100 000 births by 2030,

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and calling for the achievement of universal health coverage. These cannot be achieved

without reproductive, maternal, newborn and child health coverage for all. Maternal health

refers to the health of women during pregnancy, childbirth and the postnatal period.

Each stage should be a positive experience, ensuring women and their babies reach

their full potential for health and well-being. Although important progress has been made in

the last two decades, about 295 000 women died during and following pregnancy and

childbirth in 2017. This number is unacceptably high.

The most common direct causes of maternal injury and death are excessive blood loss,

infection, high blood pressure, unsafe abortion, and obstructed labour, as well as indirect

causes such as anemia, malaria, and heart disease. Most maternal deaths are preventable with

timely management by a skilled health professional working in a supportive environment.

Ending preventable maternal death must remain at the top of the global agenda. At the

same time, simply surviving pregnancy and childbirth can never be the marker of successful

maternal health care. It is critical to expand efforts reducing maternal injury and disability to

promote health and well-being.

Every pregnancy and birth is unique. Addressing inequalities that affect health

outcomes, especially sexual and reproductive health and rights and gender, is fundamental to

ensuring all women have access to respectful and high-quality maternity care. (WHO, 2020)

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 Figure 1.1 Teenage pregnancy Count during Covid-19 per Barangay in Mangaldan

Every year, an estimated 21 million girls aged 15–19 years in developing regions

become pregnant and approximately 12 million of them give birth.1 At least 777,000 births

occur to adolescent girls younger than 15 years in developing countries. The estimated global

adolescent-specific fertility rate has declined by 11.6% over the past 20 years. There are,

however, big differences in rates across the regions. The adolescent fertility rate in East Asia,

for example, is 7.1 whereas the corresponding rate in Central Africa is 129.

There are also enormous variations within regions. In 2018, the overall adolescent

fertility rate in South-East Asia was 33. Rates, however, ranged from 0.3 in Democratic

People’s Republic of Korea to 83 in Bangladesh. And even within countries there are

enormous variations. In Ethiopia, for example the total fertility rate ranges from 1.8 in Addis

Ababa to 7.2 in the Somali region with the percentage of women aged 15-19 who have begun

childbearing ranging from 3% in Addis Ababa to 23% in the Affar region.

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 While the estimated global adolescent fertility rate has declined, the actual number of

child births to adolescents has not, due to the large – and in some parts of the world, growing

– population of young women in the 15–19 age group. The largest number of births occur in

Eastern Asia (95,153) and Western Africa (70,423). Approximately 12 million girls aged 15–

19 years and at least 777,000 girls under 15 years give birth each year in developing regions.

At least 10 million unintended pregnancies occur each year among adolescent girls aged 15–

19 years in the developing world.

Complications during pregnancy and childbirth are the leading cause of death for 15–

19-year-old girls globally. Of the estimated 5.6 million abortions that occur each year among

adolescent girls aged 15–19 years, 3.9 million are unsafe, contributing to maternal mortality,

morbidity and lasting health problems.

Adolescent mothers (ages 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 face higher risks of low birth weight, preterm delivery and severe

neonatal conditions.

The estimated global adolescent-specific fertility rate has declined by 11.6% over the

past 20 years.5 There are, however, big differences in rates across the regions. The adolescent

fertility rate in East Asia, for example, is 7.1 whereas the corresponding rate in Central Africa

is 129.

There are also enormous variations within regions. In 2018, the overall adolescent

fertility rate in South-East Asia was 33.6 Rates, however, ranged from 0.3 in Democratic

People’s Republic of Korea to 83 in Bangladesh. And even within countries there are

enormous variations. In Ethiopia, for example the total fertility rate ranges from 1.8 in Addis

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Ababa to 7.2 in the Somali region with the percentage of women aged 15-19 who have begun

childbearing ranging from 3% in Addis Ababa to 23% in the Affar region.

Adolescent pregnancies are a global problem occurring in high-, middle-, and low-

income countries. Around the world, however, adolescent pregnancies are more likely to

occur in marginalized communities, commonly driven by poverty and lack of education and

employment opportunities.

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

girls are under pressure to marry and bear children early. In least developed countries, at least

39% of girls marry before they are 18 years of age and 12% before the age of 15. In many

places girls choose to become pregnant because they have limited educational and

employment prospects. Often, in such societies, motherhood is valued and marriage or union

and childbearing may be the best of the limited options available.

Adolescents who may want to avoid pregnancies may not be able to do so due to

knowledge gaps and misconceptions on where to obtain contraceptive methods and how to

use them. Adolescents face barriers to accessing contraception including restrictive laws and

policies regarding provision of contraceptive based on age or marital status, health worker

bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and

adolescents’ own inability to access contraceptives because of knowledge, transportation, and

financial constraints. Additionally, adolescents may lack the agency or autonomy to ensure

the correct and consistent use of a contraceptive method. At least 10 million unintended

pregnancies occur each year among adolescent girls aged 15-19 years in developing regions.

An additional cause of unintended pregnancy is sexual violence, which is widespread

with more than a third of girls in some countries reporting that their first sexual encounter

was coerced.

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 Early pregnancies among adolescents have major health consequences for adolescent

mothers and their babies. Pregnancy and childbirth complications are the leading cause of

death among girls aged 15–19 years globally, with low- and middle-income countries

accounting for 99% of global maternal deaths of women aged 15–49 years. Adolescent

mothers aged 10–19 years face higher risks of eclampsia, puerperal endometritis and

systemic infections than women aged 20–24 years. Additionally, some 3.9 million unsafe

abortions among girls aged 15–19 years occur each year, contributing to maternal mortality,

morbidity and lasting health problems.

Early childbearing can increase risks for newborns as well as young mothers. Babies

born to mothers under 20 years of age face higher risks of low birth weight, preterm delivery

and severe neonatal conditions. In some settings, rapid repeat pregnancy is a concern for

young mothers, as it presents further health risks for both the mother and the child.

Social consequences for unmarried pregnant adolescents may include stigma,

rejection or violence by partners, parents and peers. Girls who become pregnant before the

age of 18 years are more likely to experience violence within a marriage or

partnership.Adolescent pregnancy and childbearing often leads girls to drop out of school,

although efforts are underway is some place to enable them to return to school after child

birth, this may well jeopardize girls’ future education and employment opportunities.

During the early part of the Millennium Development Goals era, prevention of

adolescent pregnancy and related mortality and morbidity and prevention of HIV and HIV

related mortality in adolescents and young people were not given sufficient attention due to

competing priorities. During this period, WHO worked with partners to advocate for attention

to adolescents, to build the evidence and epidemiologic base for action such as “WHO’s

Guidelines for preventing early pregnancy and poor reproductive outcomes in adolescents in

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developing countries",to develop and test programme support tools, to build capacity, and to

pilot initiatives in the small but growing number of countries that recognised the need to

address adolescent health. As the world has transitioned to the Sustainable Development

Goals era, adolescents have moved to the centre of the global health and development

agenda.

While WHO continues its work on advocacy, evidence generation, tool development

and capacity building, the focus has shifted to strengthening country-level action. WHO

works closely with partners within and outside the United Nations system to contribute to the

global effort to prevent children becoming wives and mothers. WHO works to strengthen the

evidence base for action, and to support the application of the evidence through well-

designed and well-executed national and subnational programmes. For example, WHO works

closely with the UNICEF, UNFPA and UNWomen on a global programme to accelerate

action to end child marriage. It also collaborates with Family Planning 2020 ─ a global

partnership working to enable 120 million more women and girls access contraceptives by

2020.

Nongovernmental organizations have been at the forefront of efforts to prevent

adolescent pregnancy in many countries through bold and innovative projects. There is now a

small but growing number of successful government-led national programmes e.g. in Chile,

Ethiopia and the United Kingdom. These countries show what can be achieved with the

application of good science combined with strong leadership, management, and perseverance.

They challenge and inspire other countries to do what is doable and what urgently needs to be

done – now. (WHO, 2020)

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Conceptual Framework of the Study

The conceptual framework of the study is based on an act introduced by Senator Ana

Theresia “Risa” Hontiveros - Baranquel.

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 AN ACT
PROVIDIN
G FOR A
NATIONAL
POLICY IN
PREVENTI Input Process Output
Basis
NG
TEENAGE
Profile respondent in terms of :
PREGNAN A. Gender
CIES, B. Age Status of teenage
INSTITUTI C. Civil status pregnancy in Brgy.
D. Religious affiliation
ONALIZIN E. Income Descripti Guilig,
G SOCIAL F. Health problems ve Mangaldan,
PROTECTI G. Educational attainments Qualitativ Pangasinan
ON FOR Assists the awareness of learners about e-
TEENAGE the prevention of teenage pregnancy in Quantitati
PARENTS, terms of : ve
A. Readiness of the teenagers
AND B. Availability of resources research
PROVIDIN C. Financial stability design.
G FUNDS Proposed action
The teenage mothers living in brgy.
THEREFOR Guilig, Mangaldan experienced problems Data is plan of Brgy.
during quarantine in terms of: analyzed Officials in Brgy.
Introduced A. Economic and Guilig,
B. Peer pressure
by Senator C. Experimenting and risk taking interprete Mangaldan,
Ana behaviour of adolescents d based Pangasinan
Theresia “ D. Social issues on the
E. Physical abuse
Risa” data
Hontiveros - Maternal adolescent reasons for gathered
Baraquel childbearing. through:
Parenting challenges at young ages.
May 30, Strategies in decreasing teenage
2017 pregnancy in Brgy. Guilig Mangaldan. FEEDBACK
Question
Brgy. Guilig Mangaldan Officials: Steps naire
in avoiding teen pregnancy
Data
Analysis
Figure 1.2 Research Paradigm

With the above concept the conceptual paradigm of the study in figure 1 in

accordance with input process, output model (IPO model) The input, process and output

model presents the basic idea that inputs lead to processes that in turn lead to outcomes.

The input paradigm represents the profile of respondents in terms of gender, age ,

civil status, religions affiliation, income, health problem and educational attainments.

Moreover the researcher will determine the teenage pregnancy of barangay Guilig.

Process variables include the use of descriptive qualitative and quantitative research

design. The process is composed of disseminating surveys and questionnaires in barangay

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Guilig. The objective of this paradigm is to collect information necessary for the research

study.

The incidence of teenage pregnancy during Covid-19 pandemic in barangay Guilig,

Mangaldan, Pangasinan. In order to prevent teenage pregnancy, teenagers need to have a

comprehensive understanding of abstinence, contraceptive techniques and consequences. And

to prevent girls becoming pregnant the only one that is absolutely effective is sexual

abstinence.

Statements of the Problem

In this analysis, the goal is to determine what could be the reason why brgy. Guilig,

Mangaldan has the highest rate of pregnancy during the Covid-19 pandemic. And this will

also seek to find the coping strategy to decrease the numbers of teens getting pregnant.

From this problem statement the following question were derived;

1. Do the teenage mothers living in barangay Guilig, Mangaldan experienced problems

during quarantine in terms of:

a. Economic

b. Peer pressure

c. Experimenting and risk taking behaviour of adolescents

d. Social issues

e. Physical abuse

2. What made them decide to have a child at a young age?

3. What were some of the challenges that they faced being a new parent at a young age?

4. Do teenage pregnancies commonly occur in their community?

5. Which support system would help to decrease teenage pregnancy in the community of

barangay Guilig, Mangaldan?

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6. What recommendations or action can be made by the brgy. officials of barangay Guilig,

Mangaldan to prevent teenage pregnancy?

Scope and Limitation of the Study

This study is limited to those who have been pregnant at the age of 13-19 and are

currently living in barangay Guilig, Mangaldan, Pangasinan and this will limit the

generalization of the findings to teens from other barangay of the said municipality. The

period of the study covered the month of April to November year 2020.

This study focuses on reasons and factors affecting teenagers engaging in teenage

pregnancy during this Covid-19 Pandemic and in order to see through the real problem and

be able to help formulate a solution or prevention for the said problem. Pregnant teenagers

will be part of the study as the respondents/respondents.

Significance of the Study

This part of the study would talk about the importance on how to appropriately

educate teenagers, providing correct information discimmination and proper role

identification of participants involving teens to decrease the number of unprepared

pregnancies and help society especially during the Covid-19 pandemic.

Results of this study will be helpful to the following:

Nursing Education. The result of this study will help nursing students to gradually

understand the concepts as to which contributes to an increased number of unprepared

pregnancy. This will also help them choose the right choice and to value education more.

This study, with the statistics and data gathered, will provide the real circumstance of

increased teenage pregnancy during this pandemic, its effects on the society and how it

affects the individual's life, physically, mentally, emotionally and financially. The researchers

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think that the study will be a jolt to broaden students' minds and increase their awareness. As

student nurses and soon will venture out to the community, they will be equipped with

knowledge on how to deal with this kind of scenario during home visits or community clinic

set-ups.

Nursing Practice. The outcome of the study will help nursing practitioners whether

they may be in the hospital setting or educational sector to improve their roles in decreasing

unprepared pregnancies in the country by providing additional factual insights and imparting

them to their students, clients, patients, community and or society. The research conclusion

would also diminish anxiety in imparting knowledge to those who need it. Nursing practice

involves actual contact with unprepared mothers or troubled teens in the field. This research

would help as a baseline as to why teens made those decisions and would make them

understand the certain situations young girls experience which would make their analytical

and judgement more clearer.

Nursing Research. The researchers believe that due to the rising case of unprepared

pregnancies not just only this pandemic, the country is already alarmed. By conducting this

study it will help and improve the rational aspect of proper education to teens which could be

imparted to the community where it is gravely needed. The data given out on this research

can also be used as a reference documentation in managing a new related outcome. It may be

used as a note that will give them a framework or a run-through of the increasing number of

teenage pregnancies especially during the Covid-19 pandemic.

Definition of Terms

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 The following are terms defined theoretically and operationally such that readers can

completely understand the context of this study:

Covid-19 Pandemic - a state of quarantine time imposed by the Philippine government to

lessen the movement of individuals that may carry and spread the disease.

Teenage Pregnancy - a young girl not fully a woman, aged 13-19 who becomes pregnant.

Incidence - the increase in number of teenagers getting pregnant at a young age.

Peer pressure - is the direct influence of peers to an individual that makes them change their

attitudes and encourages them to follow the flow of their group.

Support System - a group of people who provide support, care and respect to teenage girls

who had an unexpected pregnancy.

Educational attainment - refers to the highest level of education that an individual has

completed.

Physical abuse - physical abuse can include hitting, slapping, kicking, choking, pushing and

any form of physical harm.

Teenage Pregnancy Rate- is a calculated data from rural health units or may also be from

hospital records by taking the ratio of all live births.

Local Government- the one who implements and facilitates projects concerning the rate of

teenage pregnancy issues.

Social issues - a broad problem facing teens nowadays.

Risk Taking Behaviour of Adolescent- teenagers engagement in risky and impulsive

behaviors.

Economic - the state in which your financial stability accounts for.

Recommendations - the added suggestions that you want people to follow in a community to

reduce unintended pregnancy.

Goal - a desired action to reduce teenage pregnancy in a community.

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Coping Strategies - a more effective strategy used as a solution with teenage pregnancy

problems.

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