Reproductive Views of Young Pregnant Teens

Caryl Vallejos, MD
Rico Reyes, MD, FPOGS*

Background: Teen age pregnancy is a very important issue for both the person and the pro-
vider of care as several factors like emotional, psychosocial, physiological, and familial im-
pact need to be addressed.
Objectives: To find out the perspective of the pregnant teen agers regarding reproductive
issues and formulate recommendations for an increased awareness on effective promotional
approach on pregnancy and family planning.
Methods: This is a prospective study using the descriptive approach with a researcher de-
signed questionnaire administered to the subjects consulting for their pre-natal check up. Set-
ting: OB-Gyne outpatient clinic of the Region 1 Medical Center conducted from June 1 to
Sept 30, 2013. Patients/Participants: The study involved teenage primigravid aging 13 to 19
years old who sought pre-natal check-up. Non-probability quota sampling was used of which
150 women qualified.
Results: Majority of the respondents were 19 years old, unmarried, high school graduate;
with partners usually older than them. Pregnancy was first learned through the usual pre-
sumptive and probable signs and symptoms of pregnancy. Aside from the partner and imme-
diate family member, friends play a major role in a teenager’s life. Notion about sex was
already known at an early age; hence first coitus was also experienced very early. In about
51.3 % of the respondents the idea of abortion was entertained due to the early and unwanted
pregnancy.
Conclusion: Most teen aged pregnancies are high school graduates with it occurring outside
of marriage with older partners. Sex and its practice is learned early at about aged16 ½ years
old with most families not discussing about it. Likely committing an abortion is high among
this population. Natural family planning such as withdrawal and calendar method is the most
preferred family planning method. Increased perception on the predisposing factors and ef-
fects of early pregnancy and family planning produce positive attitude on family planning.

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Keywords: teenage, pregnancy, contraception

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*Department of Obstetrics and Gynecology, Region 1 Medical Center

Dagupan City, Pangasinan

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
INTRODUCTION
Pregnancy is a major life crisis for most
women. Although, it generally reflects good news
for a new life will soon come into being, it creates
different effects to the woman. For a married cou-
ple, who have been long waiting for a child, it will
probably be one of the best moments of their lives.
However, for some relationships that having a
baby is not a priority, it causes physical, emotional
and psychological stress. This is common among
women who get pregnant for the first time, and the
effect is even worse among women in the teen
ages.
Statistics from the United Nations Chil-
dren’s Fund (UNICEF) show that countries such as
the United States, United Kingdom and New Zea-
land have teenage birth rate (women aged below
20) per 1,000 women aged 15 to 19 occurring at
52.1%, 30.8% and 29.8%, respectively.1 Based on
the pregnancy info.net website2, around 750,000
teen pregnancies are recorded yearly in the United
States as of 2010 to 2011 report. This represents a
serious problem for the country. In the United
States, the 18 - 19 year-old age group has the high-
est rate of pregnancy followed by the 15 - 17 year-
old age group. However, 15 – 17 year-old preg-
nancy rates dropped by as much as 23% between
1992 and 2000, while the rate for 18 to 19 year-
olds only dropped by 11%.
In the Philippines, the 2002 Young Adult
Fertility and Sexuality Study by the University of
the Philippines Population Institute and the Demo-
graphic Research and Development Foundation,
show that 26 percent of our Filipino youth nation-
wide from ages 15 to 25 admitted to having a pre-
marital sex experience. Even worse is that 38 per-
cent of our youth are already in a live-in arrange-
ment. Meanwhile, the 1998 National Demographic
and Health Survey (NDHS) reveal that 3.6 million
of teenagers got pregnant. In 92 percent of these
teens, the pregnancy was unplanned, and the ma-
jority, 78 percent, did not even use contraceptives
the first time they had sex. Many of the youth are
clueless that even on a single intercourse; they
could wind up pregnant.3
In an article by Domini Torrevialla on
(Philippine Star, 3/14/2013) she stated, “Teenage
pregnancies cost taxpayers 9.1 billion each year.
26
MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
More than 2/3 of all teenagers who have a baby
will not graduate from high school, billions of dol-
lars are spent taking care of teenage mothers and
their children and they are more likely to be in the
poverty bracket. Only 1.5 % of teen mothers have
a college degree by age 30 and children of teenage
mothers have lower birth weight, hence, more
likely to perform poorly in school and are at
greater risk of abuse and neglect. Sons of teen
mothers are 13 % more likely to end up in prison
and daughters of teen mothers are 22% more likely
to become teen mothers themselves. Lastly, nearly
80 % of unmarried teen mothers end up on welfare.
Statement of the Problem
This study aims to determine the percep-
tions on pregnancy and family planning of teenage
primigravid seen in the OB Clinic of the Outpa-
tient Department of Region 1 Medical Center. Spe-
cifically, it seeks to find out the following:
1. What is the profile of the teenage pregnant
women in terms of the following:
A. Socio-demographics
i. age
ii. civil status (upon pregnancy)
iii. highest educational attainment
iv. age of partner
B. Responses to selected sexual issues
i. how the pregnancy was first learned
ii. the first person the pregnancy was told
about
iii. age learned about sex
iv. age of first coitus
v. talking about sex in the household
vi. desired family planning method
2. What is the perception of the teenage pregnant
women on:
a. Pregnancy
1. Predisposing and risk factors to and of
early pregnancy
2. Effects of early pregnancy
b. Family Planning
3. What is the attitude of the teen age primigravid
towards family planning?
 Hypothesis
There is no significance between the level of
perception about pregnancy and family plan-
ning and their attitudes towards family plan-
ning
Significance of the Study
The study sought to determine the status of
teen pregnancy among primigravid women who seek
prenatal check-up in the OB Clinic of a government
tertiary training hospital. The result of the study will
enable OB practitioners to recognize the actual num-
ber of younger women experiencing pregnancy. This
will also allow them to enhance their health educa-
tion using the patients’ level of perception on preg-
nancy itself and the means to plan their families.
This will also benefit the teenage women who are in
their current pregnancy to learn more about the sig-
nificant aspects of childbearing, childbirth and child
spacing. Thus, this study included the advocacy on
family planning through recommendations made af-
ter results were finalized.
Definition of Terms
The following terms are used in this study:
Contraception. Intentional prevention of conception
through the use of various devices such as use of ar-
tificial methods or natural methods to prevent preg-
nancy as a consequence of sexual intercourse.
Family Planning. This refers a program to regulate
the number and spacing of children in a family
through the practice of contraception or other meth-
ods of birth control.
Teen- This refers to women within the ages of 13 to
19 years old
Review of Literature and Related Studies
The situation on teenage pregnancy is a
worldwide concern. That even according to the Phil-
star.com (2012)4, United Nations Population Fund
found that Philippines ranked
MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
first with the highest pregnancy rate of 53 in every
1000 women aged 15 to 19 among South East
Asia’s six major economies. Furthermore, Govern-
ment statistics on female adolescent pregnancies
indicate that the total number of annual births
changed little over the preceding 10 years, but the
number of teenage pregnancies rose 70 percent,
from 114,205 in 1999 to 195,662 in 2009
(Philippine News Agency, 2012).5
Weber’s dissertation(2009)6 on “Young
pregnant teens' perceptions of themselves and their
relationships with their families and male partners
among ten pregnant teens” showed that many of
the teens' relationships with their male partners
were tense before the pregnancies occurred; several
of the male partners had problems with alcohol,
violence, and the law; and there was a variety of
family support available for the teens. Meanwhile,
all of the subjects had information about sex and
birth control.
Teenage pregnancy creates effects physi-
cally, socially and emotionally to the teenager in-
volved. Thus according to Rominez (2012)7, aside
from the physical changes brought by child bearing
such as increase in body weight and figure, the
adolescent experiences confusion on what to do,
frustration on the earliness of the pregnancy and
fear on how to tell the parents about it. Some ado-
lescents may even result to abortion and suicide
due to depression. On the other hand, teenage preg-
nancy according to Maholo (2008)8 in her thesis
emphasized the inevitable interruption in education
where some temporarily drop out and many do not
resume schooling. Maholo further cited that the
dual responsibility of parenting and schoolwork
often results in poor scholastic performance, which
adds to the burden of a limited education and em-
ployment opportunities.
The study of Kanku and Mash (2010)9 in
Taung, South Africa found that teenage pregnancy
is influenced by socioeconomic factors such as
poverty, substance abuse, particularly alcohol, lack
of alternative entertainment. Social infrastructure
made shebeens (local bars) a normal part of teen-
age social life. Other factors include peer pressure
from boyfriends and the broader social network,
the right to motherhood before becoming HIV posi-
tive, poor sexual negotiation skills, the need to
prove one’s fertility, sexual coercion and low self-
esteem.
27
Furthermore the study pointed out that most teenag-
ers perceived falling pregnant as a negative event
with consequences such as unemployment, loss of a
boyfriend, blame from friends and family members,
feeling guilty, difficulty at school, complications
during pregnancy or delivery, risk of HIV, secon-
dary infertility if an abortion is done and not being
prepared for motherhood. But how do we combat
the increasing number of teenage pregnancy? Sev-
eral studies such as the work of Skinner et al. (2009)
10
highlighted the importance of attitudes toward
contraception, pregnancy and parenthood in shaping
teenagers’ motivation to use contraception. They
concluded that continues education on the preven-
tion of teenage pregnancy must address the spectrum
of attitudes underlying teenagers’ contraceptive and
reproductive decisions in order to alter pathways to
teenage pregnancy and early parenting.
Based on the facts given by the World Health
Organization (WHO, 2012)11, an estimated 222 mil-
lion women in developing countries would like to
delay or stop childbearing but are not using any
method of contraception. Family planning allows
people to attain their desired number of children and
determine the spacing of pregnancies. Basically, it
is achieved through use of contraceptive methods
and the treatment of infertility. Moreover, the WHO
(2012) listed some of the benefits of family planning
such as preventing pregnancy-related health risks in
women, reducing infant mortality, helping to prevent
HIV/AIDS, empowering people and enhancing edu-
cation, reducing adolescent pregnancies and slowing
population growth.
Family planning provides a lot of benefits
not only to the mother but to the children, father and
the family as a whole. Aside from enough time for
regaining health after delivery, the mother can pro-
vide adequate time for own personal advancement
and attention to each members of the family. The
father on the other hand, will be lightened with the
financial support to the family, thus adequate provi-
sion of basic needs such as food, shelter and educa-
tion will be met. Healthy children are likely to result
if mothers are healthy (Department of Health,
2012).12
Although, in the study of Ryan et al. (2004)
13
, they presented that in 750 adolescents, 67% of the
partners always use the same type of contraceptive.
The study also reported males having higher levels
of perceived condom use knowledge than females
while females perceived higher levels of contracep-
28
MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
tive self efficacy than males. When it comes to the
motivation to use of birth control, females are sig-
nificantly more motivated than males.
Based on the study done by Almirante et al14
entitled Adolescent Pregnancy from the Pediatric
and Adolescent Gynecologist’s Perspective: a 3-
year experience results revealed 73 pregnant adoles-
cents January 2007-December 2009. Thirty-sex per-
cent were in the middle adolescent age group and 35
% in late adolescent age group. Primigravids were
at 88% and 12% were segundis and they were still
living with their parents from first pregnancy. No
form of contraception was noted in 89 % of them
and 67% had pregnancy interval <1 year. Based on
their education, 57 % were high school undergradu-
ate and 62 % expressed interest in continuing their
education. Risk taking behaviours include: alcohol
intake with 73 % of them and 78% smoking. Age
onset of sexual initiation is at 14-16 year old, 45 %.
Seventy-six percent of them had their first sexual
experience occurring in the partner’s house; 88%
unprotected, while 12% used contraception (56%
condom and 44% withdrawal method). Five percent
reported history of sexual abuse (2% resulted in cur-
rent pregnancy and 1 already pregnant when the
abuse occurred). After counseling, 40 % were still
undecided with what contraceptive method to use
post-partum. Thirty –three percent opted for secon-
dary abstinence, 12 % used Depomedroxy progester-
one acetate and10% were on oral contraceptive pills.
Research Design
METHODS
For this prospective study, the descriptive
method as described by Hale 15 was used. A survey
was used with a validated questionnaire designed by
the researcher. Descriptive statistics were used like
means, frequencies were used.
Research Locale and Sample Respondents
The study involved teenage primigravid aged
13 to 19 years old who sought pre-natal check-up
from June 1 to September 30, 2013 at the Outpatient
Department Obstetrics and Gynecology Clinic of
Region 1 Medical Center. A non-probability sam-
pling method of quota sampling was utilized with a
total sample of 150 primigravids.
Data Gathering Instrument and Procedure Point Values Mean Range Descriptive
Rating
Items from the questionnaire were taken 5 4.21 – 5.00 Highly Agree
from literatures and studies reviewed by the re- 4 3.41 – 4.20 Agree
searcher. Primarily they were based from data culled 3 2.61 – 3.40 Moderately
from the World Health Organization (2012), Depart- Agree
ment of Health (2012), article of Rominez (2012), 2 1.81 – 2.60 Disagree
and the study of Kanku and Mash (2010).
1 1.00 – 1.80 Highly Dis-
The level of perception of the teenage primi-
agree
gravid women on pregnancy and family planning
and attitude were determined through frequency and
percentage together with the computation of the av- RESULTS
erage weighted mean (AWM). The AWM is inter- For the profile on socio-demographics and
preted as follows using the 5-point Likert type of sexual issues the results of the study showed the fol-
scale. lowing:

Profile Variable Frequency Percentage

Age (in years)
13 2 1.3
14 13 8.7
15 5 3.3
16 10 6.7
17 19 12.7
18 31 20.7
19 70 46.7
Civil Status
Single 95 63.3
Married 13 8.7
Cohabitation 42 28.0
Highest Educational Attainment
Elementary Graduate 22 14.7
High School Level 19 12.7
High School
63 42.0
Graduate
College Level 46 30.7
Age of Partner (in years)
15-19 60 40.0
20-30 90 60.0
Table 1. Socio-Demographic Profile

From Table 1, most respondents are 19 years old comprising 46.7% of the sample population, indi-
cating that the majority of the pregnant teenagers were in their late pubertal age. Similarly, from table 1,
more than one-half of the teenage pregnant women are single at 63.3%. Although, the remaining has part-
ners, most of them cohabit with 28% and only 8.7% are married. The result suggests that most of the teen-
age pregnancy occurred outside the context of marriage. Most of the respondents were mostly high school
graduates (42%) and college level (30.7%). Most (60 %) have partners aged 20 to 30 years old indicating
having older male partners.

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
 Profile Variable Frequency Percentage
How the pregnancy first learned
- Recognition of initial signs and
104 69.3
symptoms of pregnancy
- Over-the-counter pregnancy test kit 40 26.7
- Consultation with a doctor 6 4.0
First person the pregnancy was told about
- Partner 94 62.7
- Mother 16 10.7
- Grandmother 20 13.3
- Friend 20 13.3
Age Learned About Sex (in years)
13 8 5.3
14 18 12.0
15 20 13.3
16 69 46.0
17 35 23.3
Age of First Coitus (in years)
11 5 3.3
12 4 2.7
13 9 6.0
14 25 16.7
15 22 14.7
16 52 34.7
17 32 20.3
Talk About Sex
Yes 72 48.0
No 78 52.0
Abortion
Yes 77 51.3
No 73 48.7
Desired Family Planning
natural 82 54.7
withdrawal 60 73.2
calendar method 22 26.8
artificial 68 45.3
Contraceptive pills 55 80.9
Injectable 13 19.1
TOTAL SUBJECTS (N) 150 100 %
Table 2.Responses to selected sexual ssues
From Table 2, we find that 69.3 %, or more Almost 50 % first learned about sex at the age of 16
than 2/3 recognized the possibility of pregnancy years with 5 % learning about it at the age of 13
through its signs and symptoms indicating high years old. More than half (55 %) have their first coi-
awareness of this event. This pregnancy is first di- tus at age 16 and 17 years old with 6 % (9/150) hav-
vulged t their partners (62.7 %). Other significant ing it at ages 11 and 12 years old. This is disturbing
people like mothers, grandma, and friends have for such young age for these people to have carnal
similar frequencies. knowledge.

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
 An almost equal percentage (52% vs 48 %)
of the respondents declared that sex education is not
discussed with the family during the reproductive
age while the other side claimed sex education is
openly discusses in the family. As an offshoot of this
pregnancy 51.3% thought of committing abortion
when the pregnancy was first learned and 48.7%
says otherwise.
Among the 150 respondents, 82 opted for
natural family planning method while 68 opted for
artificial method comprising 54.7% and 45.3 % of
the population respectively. Among the natural fam-
ily planning methods, withdrawal is most desired
(54.7 %), and the artificial method, us of contracep-
tive pills (80.9 %) is most desired.
For the perception of the subjects on pregnancy the
following are noted.

A.1. Predisposing factors (Reasons) of early pregnancy AWM DE

1. Lack of education about reproductive health predisposes a young girl 3.21 MA
to fall into pregnancy.

2. Poverty leads to most teenagers unable to afford going to school, 4.31 HA

thus more at risk of being pregnant.

3. Poverty leads to early age prostitution, thus leads to early pregnancy. 3.80 A

4. Friends may influence the desire to engage in early sexual activity. 4.31 HA

5. Teenagers who engage in alcohol drinking and illegal drugs are 3.21 MA
highly at risk of getting pregnant.

6. Pregnancy may result from sexual activity to please boyfriend/ 3.80 A

partner.

7. Pregnancy may result from need to prove one’s fertility (manhood or 3.21 MA
womanhood).

8. Pregnancy may result from coerced sexual activity (ex. rape). 4.31 HA

9. Pregnancy may result from manipulation of older partner. 3.80 A

10. Pregnancy may result from desire to have financial support from the 3.80 A
partner.

Summated Mean 3.77 A

Table 3. Level of perception of the teenage pregnant women About Pregnancy

From table 3 we know that teen age primigravid believed that friends and poverty are the best
predictors to early pregnancy. They also highly agree that coercion like rape is a significant factor as
well. As a whole, they AGREE on all the parameters set in the questionnaire.

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
 A.2. Effects of Early Pregnancy
1. Younger woman is more at risk of pregnancy and delivery complica- 4.31 HA
tions (ex. bleeding, ectopic pregnancy)
2. Early engagement in sexual activity causes high risk for acquiring 3.80 A
sexually transmitted infections.
3. The issue of acceptance of the family, partner, friends and the society 3.21 MA
as a whole about the early pregnancy creates emotional effect and guilt
to the teenager.
4. The desire to choose abortion is high among teenage pregnant 4.31 HA
women.
5. The plan to commit suicide becomes an option. 3.80 A
6. Early pregnancy causes the teenager difficulty in the school or even 3.53 A
to quit schooling.
7. Early pregnancy leads to consequences such as early unplanned mar- 3.21 MA
riage or break-up with the partner (father of the baby).

8. Early pregnancy creates financial problems. 3.68 A

Summated Mean 3.73 A
Overall Mean 3.75 A
Table 4. Perception on the effects of early pregnancy
In table 4, the subjects highly agree that the desire to commit abortion and increased in delivery
complications arise during teenage pregnancy (WM=4.31). Respondents “agreed” (WM: 3.80) that early
pregnancy may also end up to acquiring sexually transmitted infections, financial problems, suicidal plan
and difficulty in school or quitting school at most. The overall mean of 3.75 shows that they “agree” on
the predisposing factors and effects of pregnancy that occurs at younger age

Family Planning WM DE
1. Family planning reinforces people’s rights to determine the num- 3.53 A
ber and spacing of their children.
2. Family planning reduces the need for unsafe abortion. 4.31 HA
3. Some family planning methods help prevent the transmission of 3.21 MA
HIV and other sexually transmitted infections.
4. Family planning enables the woman regain her health after deliv- 3.75 A
ery.
5. Family planning enables provision of adequate basic needs to 3.80 A
children (ex. food, shelter, education)
6. Family planning gives enough time for the woman to take care of 3.68 A
her family members and her own personal advancement.
7. Proper spacing of birth reduces complications of pregnancy. 3.53 A
Summated Mean 3.68 A
Table 5. Perception of the teenage pregnant women About Family Planning
From table 5, the subjects all agree that family planning is better for the health of the woman. They
all AGREE especially that it causes reduction in unsafe abortion, enables provision of adequate basic needs
of the children and enabling regaining of the health of the pregnant.

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
 From table 5, the subjects all agree that family planning is better for the health of the woman. They
all AGREE especially that it causes reduction in unsafe abortion, enables provision of adequate basic needs
of the children and enabling regaining of the health of the pregnant.

Qualifying Statements WM DE
1. Family planning should be continually included in the health 3.21 MA
education of pregnant women during clinic visits.
2. I will practice my choice of family planning method. 4.31 HA
3. I will continue to practice family planning method even my hus- 3.80 A
band or other family members disapproves it.
4. I will encourage other women to practice family planning meth- 4.31 HA
ods.
5. I will support studies that will improve family planning activi- 4.31 HA
ties.
6. I will support laws that will advocate family planning. 3.80 A
Summated Mean 3.95 A
Table 6. Level of Attitude Towards Family Planning

From table 6, the respondents “agreed” on the use and support for family planning as seen on the
summated mean. Specifically, they “highly agreed” on the practice of own choice of family planning
method, encouragement of other women to practice family planning and support to the studies that will im-
prove the family planning activities

SUMMARY
The following are the summary of the find- The teenage women generally “agreed’ on
ings of this study: the predisposing factors and effects of early preg-
nancy. But it is noted that lack of education about
The profile of the primigravid teenaged is reproductive health, engaging in alcohol and drugs
that of 17-18 years of age, single, high school and proving of one’s fertility can lead to pregnancy
graduates with older sex partners who learned about at early age garnered the least perception from the
their pregnancy through signs and symptoms. They respondents. Meanwhile, there is high perception
told their pregnancy first to their partners, learning towards family planning given with its uses and ad-
about sex at age 17 and as early as 13 years old. vantages. They also generally “agreed” on the use
and support of family planning especially practicing
Topics about sex were not openly talk about their own choice of method, encouraging other
and discussed within the respondent’s family. This women and supporting studies that will improve the
only signifies that for some Filipino family, talking family planning activities.
about sex education is still taboo in the society.
When asked on the committing abortion upon the There is significant relationship between the
knowledge of pregnancy, more than one-half admit- level of perception of the teenage pregnant women
ted the thought. Finally, natural family planning in about pregnancy and family planning and their atti-
the form of withdrawal and calendar method is more tude towards family planning.
appealing among the young women but artificial is
also a choice with contraceptive pills as most pre-
ferred.

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MEDICAL INSIGHTS—Jul-Dec 2013 Volume No. 1 Issue No. 2
Recommendations
The researcher recommends the following:
1. Pursue the integration of sex education especially as early as secondary level of education to in
crease the knowledge and ill effects of early engagement in sexual activities.
2. Create linkages to schools and provide seminars about early pregnancy to be conducted by a well
knowledgeable health care provider.
3. For out of school youth, create linkages to the community that will design programs or strength
en current programs on pregnancy and family planning.
4. Continuously include health education during consultations and follow-up check up especially on
outpatient OB clinics to enhance their knowledge about pregnancy and the different options
of family planning.

Corresponding Author: Dr. Caryl Vallejos

Department of Pediatrics, Region 1 Medical Center, Dagupan city
Email: rylcamed2@yahoo.com
* The Complete Questionnaire is available upon request
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11. World Health Organization (2012). Family planning Fact sheet N°351 . available At http://www.who.int/mediacentre/factsheets/fs351/
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are-benefits-using-family- planning

13. Ryan, S., Franzetta, K. And Manlove, J. (2004). Knowledge, Perceptions, and Motivations for Contraception: Influence on Teens’ Con-
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14. Almirante, et al _____________________________________

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