There is a silent crisis creeping up on us as a country that will have long term effects on our collective future. This is the slow but persistent level of teenage pregnancies. “Adolescent fertility rates have declined in the last two decades in all countries (in the region) with available data, with the exception of the Philippines where there has been little change,” reported the UNFPA, UNESCO and the WHO (2015).
In a webinar organized by the Philippine Center for Population and Development (PCPD) with the UP Population Institute, Dr. Maria Paz Marquez and Dr. Elma Laguna shared their research findings on teenage and adolescent pregnancies of girls aged 15 to 19 years with some findings on pregnancies of adolescent girls as young as 10 to 14 years. Teen pregnancies by definition include the number of pregnancies per 1000 teen girls aged 15-19 years old including live births, abortions and fetal losses (Fernandez-Alcantara, 2020).
A growing concern
Adolescent fertility in the Philippines is the second highest in ASEAN with only Lao PDR having a higher rate. In 2019, the country rate was 55 per 1000 live births, by teenage girls. This was in contract to Indonesia (46 per thousand live births), Thailand (44), Vietnam (27), Malaysia (14), Brunei Darussalam (9), and Singapore (3) (World Bank data).
In the past decade (2010 to 2019), the percentage of registered live births by teens grew slightly each year from 6.5% in 2010 to as much as 11.6% in 2018 before dropping to 10.7 per thousand in 2019 (National Demographic and Health Surveys [NDHS]).
Adolescent girls under 15 years of age saw their birth rate double from 0.07 percent of all live births to 0.14 percent over the same ten year time period. Teenage girls under 18 years of age saw an increase from 3.3 percent to 3.7 percent of all live births. (NDHS)
In the 2010 census, of 4.76 million women aged 15-19, 6.2% had children and of that number, 17.6% had more than 1 child.
One out of every 5 adolescent mothers had repeat pregnancies from 1993 to 2013 in all regions and all socio-economic classes (Maravilla, Betts and Alati, 2018). Based on the 2013 YAFS (Young Adults Fertility and Sexuality Survey), 17% of teenage mothers had repeat pregnancies – 16% having two pregnancies, 1% having two pregnancies (Marquez, 2019).
Mindanao had the highest rates of teenage pregnancies in the country with Davao (18%), Northern Mindanao (15%), and SOCCSKARGEN (15%) having the highest. The Cordilleras, Bicol, NCR, and the three Visayan regions had the lowest teen pregnancy rates from 4 to 7% (NDHS).
One of the most disturbing facts has to do with even younger girls getting pregnant. While it is acknowledged that overall pregnancies among teenage girls is dropping slightly, the pregnancy incidence among adolescents and teens younger than 15 years has been rising albeit from a small number. This phenomenon must reflect some reality we, as a country, should address.
Some other trends in the statistics
The number of adolescent mothers is substantial, but based on various data sources, the number and prevalence of adolescent childbearing has shown a downward trend in recent years. The number of births from 10-19 years old has been declining since 2014 – from 209,872 births to 180,916 in 2019.
The percentage of births from 15-19 years old among all births, however, has been unchanged from 2010-2019 (around 11-12 percent). Within this group, two-thirds (2/3) of births are 18-19 years old, which some may argue are already young adults. (By international definition, however, they are classified as teenagers.)
More worrisome is that since 2016, the number of births from 10-14 year old girls has been increasing, although, from a low number. The percentage of births from this age group is less than 1 percent of all births.
Why should teenage pregnancy be a national concern?
Teen pregnancies can have three effects on the girls involved and their families in terms of (a) Health effects, (b) socioeconomic effects or costs, and (c) intergenerational effects (Marquez, 2021).
The health effects are to both mother and child. For the teenage mothers, there is the increased risk of pre-term delivery, post-partum hemorrhaging, and other pregnancy complications that could lead to maternal death. The infants born tend to be below weight with a higher risk of early neonatal and infant mortality.
Socioeconomic effects include the disruption in schooling of the teenage mother and the added financial burden of raising a child while still being a child herself, not to mention the stigma and shame a teenage mother may feel. There, they may begin to see a limited future and less of a chance to realize their full potential.
Intergenerational effects are the long-term effects teenage mothers may have on their children as they grow up to be adults (and the next generation). Children of teenage mothers are more likely to also be teenage parents as well. They also tend to have low educational attainment. From experience, the pattern is more likely to continue.
There are impacts on education of the teenage others. Among women aged 15 to 49 years who have gone beyond High School, 8% became a mother under 20 years of age; 36% at age 20 or older (Castillo, 2014). In predicting the earning power of women over their earning years, women with high school diplomas can earn 36% more than women dropping out of school because of poverty and 7.4 times more than women who do not finish because of an early pregnancy AND poverty at age 20. The gap narrows as women grow older but the gap between women who finish a high school diploma and women who had to leave school because of a teen pregnancy is significant. Having a teen pregnancy and being from a poor household has a compounding effect (Herrin, 2016).
What are the risk factors?
What risk factors make it more likely for adolescent or teenage girls to engage in sex and risk getting pregnant? Dr. Marquez cites five risk factors:
- Early marriage or a living-in situation where frequent sex is practiced;
- Low education attainment of one or both partners where there is a higher correlation with low knowledge of family planning and women’s health concerns;
- The teenage mother raised by single parent where there might be less parental guidance;
- Early exposure to sex in the immediate community environment; and,
- No modern contraception knowledge, use or access.
By quintile, the three poorest quintiles were from 2 to 5 times more likely to have teenage pregnancies than the two richest quintiles. In the 2017 NDHS, 14.8 of the poorest quintile was a teenage mother versus 3.2 of the richest quintile (NDHS).
How prepared are teenage girls for pregnancy?
In focused group discussions (FGDs) with teen mothers in 2017, with teenagers in 2020, analysis of YouTube vlogs in 2021, and a research report in 2020, Dr. Laguna concluded that the first pregnancy was something that was not planned. In fact, more than one teenage mother revealed that they had sex only once before getting pregnant. Most did not use contraception nor talked to their partner about it.
After getting pregnant, many teenage mothers feared parental reaction. Most worried about their future, especially not being able to finish their education. A number were not sure about their relationship with the father and whether there would be a continuing one at all. Many felt there would be a stigma being a teen, unwed mother. At least one or two were shocked but happy. A few thought about how to end the pregnancy.
In the 2013 Young Adult Fertility and Sexuality Survey (YAFSS), of all teen pregnancies in the country, 26.6% were unwanted, 23.3% were mistimed, and 50.1% were intended. That so many girls of such a young age intended to get pregnant deserves more disaggregated study. Where in the country is this more prevalent, in what social class or demographic group, and why?
Of those aged 15 to 19 years who terminated their pregnancies, 15.7% were never married; 11.1% were living in; 10.4 were married; and 11.5% were separated. This was in contrast to 11.3% all women of all age groups who pre-terminated their pregnancies (YAFWS, 2013).
How did teenage girls prepare for birthing?
The majority of teenage respondents in Dr. Laguna’s research studies availed of prenatal services from barangay health workers (BHS) in their first or second trimester. Being underage and not yet a member of PhilHealth, many used their parent’s membership to avail of PhilHealth coverage.
All the respondents had a low knowledge of contraception. A number had misconceptions about contraception.
How did they feel about their future? Uncertain.
For not a few of them, the fathers were not longtime partners nor did they have plans to marry. Most wanted to finish schooling after giving birth though they may not have thought through how this would be done. A number of the teenage mothers said they did not want another child.
Prof Laguna was more positive about the outcomes. She concluded in her presentation, “Teenage motherhood, though far from ideal, does not necessarily spell doom on young people’s future. With a supportive family, and social environment, young mothers can still achieve their dreams and aspirations.”
What about teenage fathers?
Of all fathers nationwide, 2.4% were teenage fathers. Of this number, 0.7 were never married, 49.8% were married, and 4.2% impregnated a woman other than their spouse (YAFSS, 2013).
In the last decade, just like teenage mothers, the number of births involving teenage fathers rose from 2.6 of live births in 2010 to 3.2 in 2019.
Where do we go from here?
The Philippine Center for Population and Development is an organization approaching its 50th year in supporting and advocating proper population management and the balanced use of resources for development. What PCPD supports and advocates is recognizing and fulfilling women’s needs and rights as the core of all population strategies. This means providing them opportunities to access better health care, education, and family planning methods of their choice, among others.
While the Foundation is led by professionals with expertise in women’s health and population, the majority of the membership, myself included as the current chair, are advocates and not necessarily experts.
This issue of teenage pregnancy is a complex social concern that needs to be addressed. From the research work done on the subject, this is clearly an unplanned phenomena of very young people without proper guidance or information engaging in sexual behavior that can lead to unplanned pregnancies. In such a setting, young lives and plans get disrupted and the intergenerational effects can have long-term effects not just on individual lives but also on the country. That women bear an unequal responsibility for this is also unfair and unjust. In a society that thinks that the macho man is king, it is actually women who bear the brunt of such unequal responsibility.
Teenage pregnancy should be a national concern. For too long it has not been paid attention to. The country and society should take a serious look at this situation. We owe this to our young people, especially young women.
The author thanks Elena Masilungan of PCPD for fact-checking the numbers. Any mistake or error, however, are the author’s doing.