Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the relevant literature and studies after the thorough and in-depth search
done by the researchers. Those that were included in this chapter are used to strengthen the
claim and importance of the study.

Background

According to the United Nations Population Fund (UNFPA) State of the World Population Report
of 2017, the Philippines has the third highest adolescent birth rate among 11 Southeast Asian
nations, trailing Laos and Thailand. The Philippine Statistics Authority (PSA) estimates that one
in every five persons is likely to be an adolescent between 10 to 19 years old and about half of
them are female. From 2000 to 2010, the number of babies born to teenage mothers increased
from 7.1 to 11.7 percent of total births. Consequently, the proportion of maternal deaths
among teenagers doubled from 5 to 10 percent for the same period.

The problem of high teen pregnancy rates is compounded by rapid repeat pregnancy, meaning
that teen moms tend to have another pregnancy soon after the index pregnancy. About one-
fourth of teenage mothers have a second child within 24 months of the first birth.

Early pregnancy and childbearing carries inherent risks for the mother and her infant. The
bodies of young mothers have not fully ready for the rigors of pregnancy and childbirth,
significantly raising the risks for complications. Children of young mothers are more likely to be
born prematurely and with low birth weight, making them prone to infant death and other
health issues like deafness and blindness. Early pregnancy and childbirth also carries social and
economic risks, such as reduced probability of school completion, and therefore, reduced
likelihood of gainful employment, perpetuating the cycle of poverty. According to the UNFPA
early childbearing could be costing the Philippines PhP33.0 billion annually, or one percent of
the country’s gross domestic product in foregone incomes. The Program for Young Parents
(PYP) is the United States Agency for International Development’s (USAID) response to the
problem of increasing teen pregnancies in the Philippines. The PYP seeks to expand access to
high-quality integrated MNCHN/FP services to help reduce unmet need for family planning,
especially among the poor and women below age 19.

The PYP is an adaptation and expansion of the Teen Moms Program of the University of the
Philippines – Philippine General Hospital (UP-PGH).
In compliance with the Department of Health (DOH) policy on high-risk pregnancy,
CEmONCcapable (Comprehensive Emergency Obstetric and Newborn Care) regional, provincial,
and district level hospitals with high numbers of deliveries among young women below 19 years
old are engaged for the PYP. The PYP emphasizes joint responsibility and involvement of male
partners in ensuring healthy pregnancy and safe delivery. It seeks to promote complete
antenatal consultations; facility-based deliveries, including availing of Philippine Health
Insurance Corporation (PhilHealth) benefits for the mother and infant; exclusive breastfeeding
for at least six months; and a gap of three to five years between births through the use of long-
acting reversible contraceptives. It is incumbent upon hospitals to serve clients, but adolescents
require special skills and empathy, in accordance with the DOH Administrative Order 2013-
0013, “National Policy and Strategic Framework on Adolescent Health and Development and
the National Standards and Implementation Guide for the Provision of Adolescent-Friendly
Health Services.” Engaged facilities constitute a PYP Team with members from the different
hospital departments and identify an area that they can transform into an adolescent-friendly
space. The PYP Team trains to deal with adolescent clients; drafts the hospital PYP protocol;
and operates the PYP Center. In addition to providing antenatal services, they conduct
educational sessions for teenage parents on recognition of danger signs and symptoms of
pregnancy, gender sensitization, life skills, healthy timing and spacing of pregnancies, and
exclusive breastfeeding. The PYP Team endorses clients who complete the health education
sessions to partners like the Department of Education (DepEd), Department of Social Welfare
and Development (DSWD), and Technical Education and Skills Development Authority (TESDA)
where they can access education and livelihood opportunities after delivery. The Schuyler
Center for Analysis & Advocacy (2008) states that it benefits society if mother and aby are
healthy; the mother is educated and able to care for her child; the child is prepared for school;
and the mother becomes economically independent. Further, the intervention must try to
reach out to the teen fathers, engage them to be part of the pregnancy and birth experience,
help them pursue education and employment to help them support their family, and counsels
them on relationships and parenting. These are precisely the outcomes that the PYP is seeking
to achieve.

An assessment conducted by the Health Policy Development Program in 2016 concluded that
the PYP meets most of the DOH’s Adolescent-Friendly Health Services standards - “The PYP
provides a clear link between demand generation strategies and service delivery. It supports
teenage mothers before, during and after delivery at different levels of the health system. The
hospital where the pregnant adolescent is compelled to deliver provides AYRH education,
prenatal, natal and postnatal care including birth-spacing and opportunities for a better future.
It also collaborates with an Inter-local Health Zone-SDN for demand generation and care for the
teenage mothers.”

Related Literature

I. Every year, approximately 12 million girls aged between 15 to 19 years, and at least 777,000
girls under 15 years, give birth in developing regions of the world.

In 2016, a United Nations Population Fund (UNFPA) report stated that the Philippines has the
highest number of teen pregnancies across Asia. Multiple partners and low condom use were
some of the factors cited for the increase in birth rates. Moreover, the UNFPA suggested that
one in 10 young Filipino women age 15 to 19 is already a mother.
According to the Commission on Population and Development (POPCOM), a Philippine
government agency, the number of pregnant children below 15 in the archipelago has doubled
in the past 10 years.

Juan Antonio Perez III, POPCOM’s Executive Director said pregnancies among children aged
between 10 to 14 years old went up to 2,200 in 2018, more than double the 1,000 recorded in
2007.

"We have roughly... 40 to 50, 10-year-old children giving birth every year," he explained.

Recently, the agency revealed that the country has recorded a seven percent increase in births
among girls aged 15 and below in 2019, up from the figure for teenage pregnancies in 2018.

Early pregnancy among adolescents results in major health consequences for young mothers
and their babies, according to the World Health Organization (WHO). The UN agency said that
pregnancy and childbirth complications are the leading causes of death among adolescent girls
globally, with low-and middle-income countries accounting for 99 percent of global maternal
deaths of females aged between 15 to 49 years old.

Other than that, the WHO also stated that teenage pregnancies have led to some 3.9 million
unsafe abortions among girls aged between 15 to 19 years old per year, contributing to
maternal mortality, morbidity, and lasting health problems.

II. Teenage Pregnancy and Motherhood

The issue of adolescent fertility is important for both health and social reasons. Children born
to very young mothers are at increased risk of sickness and death. Teenage mothers are more
likely to experience adverse pregnancy outcomes and to be constrained in their ability to
pursue educational opportunities than young women who delay childbearing. Table 7 shows
the percentage of women age 15-19 who have had a birth or were pregnant with their first
child at the time of the survey, according to background characteristics. Overall, 9 percent of
women age 15-19 have begun childbearing: 7 percent have had a live birth and 2 percent were
pregnant at the time of the interview. The proportion of teenagers who have begun
childbearing rises rapidly with age, from 1 percent at age 15 to 22 percent at age 19. Rural
teenagers start childbearing slightly earlier than urban teenagers (10% and 7% respectively).
Eighteen percent of teenagers in the Davao region and 15 percent each in Northern Mindanao
and SOCCSKSARGEN have begun childbearing. Teenagers in the highest two wealth quintiles (3-
5%) start childbearing later than those in other quintiles (10-15%).

Covid-19 Crisis
In the Philippines, teen pregnancy gets more problematic each year. The government there
labeled it a national social emergency in 2019. However, the issue has now worsened amid the
coronavirus pandemic.

At the time of writing, the Philippines has registered over 670,000 COVID-19 cases nationwide
with nearly 13,000 deaths to date. In recent days, the country has been reporting over 7,000
cases daily, hitting its highest daily tally yesterday when it reported 8,019 infections in 24
hours.

Like elsewhere around the world, the pandemic has affected livelihoods, businesses, and the
economy in the Philippines.

A report by Save the Children titled, “Global Girlhood 2020: COVID-19 and Progress in Peril”
showed that a dramatic surge in child marriages and adolescent pregnancies is expected during
the pandemic, due to the economic impacts of the health crisis.
“Early pregnancy robs teenage girls of their childhood and deprives them of their right to
survival, education, and a future. Children, especially girls, remain at the side line of the global
COVID-19 response, yet, they face the worst impact of the pandemic that threatens their lives
and destroys their future,” said Alberto Muyot, Chief Executive Officer of Save the Children
Philippines.

Back in November 2020, a Social Weather Stations (SWS) survey found that Filipinos think that
teenage pregnancy is the “most important problem of women today” in the Philippines. The
data showed that 59 percent believed that early adolescent pregnancy was the most important
problem, followed by physical violence at 11 percent and unexpected pregnancy at 11 percent.

According to POPCOM, at the end of 2020, more than 70,000 families were led by minors.
However, the agency warned that this number will dramatically rise to 133,265 by the end of
2021.

Health Consequences

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.3 Adolescent mothers aged 10–19 years
face higher risks of eclampsia, puerperal endometritis and systemic infections than women
aged 20–24 years. 4 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 and Economic Consequences

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 lead girls to drop out of school, although efforts are underway is
someplace to enable them to return to school after childbirth, this may well jeopardize girls’
future education and employment opportunities.

https://doh.gov.ph/sites/default/files/basic-page/Program%20for%20Young%20Parents
%20Implementing%20Guidelines.pdf

https://psa.gov.ph/sites/default/files/Philippines%20NDHS%20KIR.pdf

https://theaseanpost.com/article/philippines-teen-pregnancy-crisis

https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy