Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Seminar Proceedings
The Seminar on Adolescent Pregnancy and the First 1000 Days (the Philippine Situation) was held in Metro Ma-
nila on September 2013. The objectives were to: 1) describe the current nutrition and health status of Filipino ad-
olescent females, including those pregnant and lactating; 2) discuss existing programs that address their concerns;
and 3) identify gaps in existing knowledge and programs, and ways to address these gaps. Adolescent pregnancy
rates had increased from 8% in 2003 to 10% in 2008. In 2008, more than 35 percent of pregnant women below 20
years old were considered nutritionally-at-risk. Iodine deficiency and anaemia were major health problems in
both pregnant and lactating women of all ages. While government programs exist to address the needs of preg-
nant women, none were geared towards meeting the specific needs of pregnant adolescents. Conclusions: Studies
are needed to find ways to improve adolescent health and to effectively prevent and deal with unwanted pregnan-
cies among adolescents. Recommendations include 1) developing adolescent-friendly health centers, information
and education materials to increase reproductive and health awareness among youth and health workers, 2) exam-
ining the psychosocial and nutritional factors that determine birth outcomes and nutritional status of preg-
nant/non-pregnant adolescents, 3) examining adolescent growth patterns following delivery, 4) evaluating the im-
pact of current programs and interventions geared towards improving adolescent and maternal health, and more
importantly, 5) identifying the underlying reasons for the continued rise in adolescent pregnancy in the country.
Key Words: adolescent females, maternal nutrition, adolescent pregnancy, pregnant and lactating women, Philippines
Discuss existing programs that address the needs of In urban areas, fertility rate increased from 42 per 1000
these groups; women in 2008 to 52 per 1000 women in 2013. In rural
Identify gaps in existing knowledge and programs us- areas, fertility declined from 71 per 1000 women to 63
ing a continuum of care perspective; per 1000 women during the same period. Overall, adoles-
Examine possible ways (in terms of research, programs cent fertility increased from 54 per 1000 women to 57 per
and resources) to overcome/address the identified gaps. 1000 women during the period 2008 to 2013.12
Since the present report documents the results of a
seminar and workshop on adolescent pregnancy, ethical Pregnant and lactating adolescents
approval is not required. The 7th NNS defined nutritionally at-risk pregnant women
as those with BMI-for-age <P95.9 Based on this criteria,
DISCUSSION 35.1% of pregnant women below 20 years of age were
Nutrition and health status of Filipino adolescent fe- nutritionally at-risk (Table 4). Within the same age group,
males, including pregnant and lactating adolescents 12.9% of lactating women were underweight, while 6.7%
Female adolescents were overweight.
The 7th National Nutrition Survey (NNS)in 20089 showed Table 4 also shows that in 2008, vitamin A deficiency
that a total of 26.5% of female adolescents aged 11-19 (defined as serum retinol below 20 g/dL or 0.70 mol/L)
years were underweight and mildly underweight (Table 1), was identified as a mild public health problem among
while 4.4% were overweight. pregnant and lactating women (all ages). Iodine deficien-
Among Southeast Asian countries, the Philippines cy is also a public health problem among pregnant and
ranked third highest in terms of adolescent birth rate for lactating women, with 67.3% of pregnant and 59.5% of
the period 1991-2010 (Table 2). Adolescent pregnancy lactating women classified as having insufficient iodine
rates increased from 8% in 2003 to 10% in 2008.10 While status in 2008. Anaemia is considered a moderate public
the fertility rate in all women decreased over the years, health problem among pregnant women and a mild public
the rate among 15-19 year olds increased slightly over the health problem among lactating women, with prevalence
last three decades.10 of 25.2% and 16.6%, respectively, in 2013.
In 2008, 10% of women age 15-19 years were already Supplement intake. The nationally representa-
mothers or were pregnant with their first child.11 Table 3 tive2011Updatingof Nutritional Status of Filipino Chil-
shows trends in age-specific fertility rate among Filipino dren and Other Population Groups13 showed that most
females aged 15-19 years for the period 2008 and 2013. mothers (86.2%) have taken some form of supplements
Adolescent fertility is higher in rural than in urban areas. during their pregnancy. Types of supplements taken were
iron (82.2%), folic acid (4.7%), multivitamins with iron
(14.3%), and iron with folic acid (2.5%).
Table 1. BMI-for-age of female adolescents aged Use of health services. The use of professional assis-
11-19 years, Philippines 7th National Nutrition Sur-
tance during delivery is generally low in the Philippines.
vey 2008
The Updating Survey in 201113 showed that only sixty
BMI-for age Prevalence percent of women (all ages) who delivered in the last five
Classification years preceding the survey were assisted by a health pro-
cut-off (%)
<P5 Underweight 11.7 fessional during their most recent delivery. During the
P5 to <P15 Mild underweight 14.8 course of pregnancy, 94.3% of respondents received some
P15 to P85 Normal 69.0 form of prenatal care and 70% received postnatal care
>P85 Overweight 4.4
(Figure 1).
Based on WHO BMI-for-age percentiles for girls age 5-19
years; available from: http://www.who.int/growthref/cht_ Existing programs that address the needs of female and
bmifa _girls_perc_5_19years.pdf?ua=1. pregnant adolescents
Programs for adolescent females
Table 2. Adolescent birth rate in Southeast Asian The Philippine Obstetrical and Gynecological Society
countries (POGS) have led a number of programs to improve the
health of Filipino adolescents. These programs focused
Adolescent birth rate per 1000 women on the WHO Guidelines on Preventing Early Pregnancy
Country
aged 15-19,1991/2010 and Poor Reproductive Outcomes among Adolescents in
Lao PDR 110
Indonesia 66
Developing Countries, namely: 1) preventing early mar-
Philippines 53 riage; 2) preventing early pregnancy through sexuality
Cambodia 48 education;3) increasing education opportunities, econom-
Thailand 47 ic and social support programs; 4) increasing the use of
Vietnam 35 contraception; 5) reducing coerced sex; 6) preventing
Brunei 18 unsafe abortion; and 7) increasing the use of prenatal care
Myanmar 17
childbirth and postpartum care services.
Malaysia 14
Singapore 6 To achieve these objectives, the POGS carried out the
following research, information, education, and commu-
Taken from UNFPA State of the World Population 2012. nication activities:
Available from: http://www.unfpa.org/webdav/site/global/
shared/swp/2012/EN_SWOP2012_Report.pdf.
Conducted studies on the current situation of teenage
pregnancy in Metro Manila and Cebu, using the UN
Adolescent pregnancy in the Philippines 761
brochure entitled Giving Girls Today & Tomorrow: July 17, 2013. The Summit presented topics on Under-
Breaking the Cycle Of Adolescent Pregnancy as ref- standing Adolescent Behaviour, Sexual Health Impli-
erence; cations in the Adolescent, Complications of Teenage
Developed an educational module - Adolescent Health Pregnancy, Communicating Tools, and Talking to
Issues & Perspectives (AHIP) comprising four modules Adolescents. A panel discussion on Contraceptive
on adolescent health, myths and misconceptions, risk- Counselling and Services for the Adolescent was in-
taking behaviour, guidance and interventions; cluded;
Organized a Summit on Health Education in Reproduc- Published a resource book on gender-based violence
tion entitled The Young and the Restless: Demands entitled Breaking Barriers;
and Challenges in Adolescent Reproductive Health on Published and circulated the Clinical Practice Guide-
Table 3. Fertility rate per 1000 women aged 15-24 years, Philippines, 2008 and 2013
Table 4. Nutritional status of pregnant and lactating women based on results of Philippine National Nutrition Sur-
veys (2008 & 2013)
Figure 1. Percentage of mothers (all ages) who received pre-natal care and various health services during pregnancy with the youngest
child. Reprinted with permission from FNRI-DOST. Philippine Nutrition Facts and Figures 2012.
762 MV Capanzana, DV Aguila, CA Javier, TS Mendoza and VM Santos-Abalos
lines on Abortion the guidelines aim to prevent un- post-partum complications, micronutrient supplementa-
safe abortion and enable health practitioners to proper- tion, provision of breastfeeding support, provision of
ly respond to post abortive complications; family planning services and counselling on nutrition,
Conducted an intensive Training of Midwives from exclusive breastfeeding up to six months and neonatal
2010-2011 the goal is to increase the availability of care.
pre- and postnatal health services; Emergency maternal and newborn service package -
Conducted lectures on Good Prenatal Care and Proper refers to provision of facilities capable of managing
Nutrition during Pregnancy. complicated deliveries and newborn emergencies.
The Society was instrumental in the signing of Presi-
dential Proclamation No.569 in 2004, declaring March 10 Issues and gaps in existing knowledge and ways to ad-
as Arawng mgaBuntis (Pregnant Womens Day), in dress these gaps
coordination with the Department of Health. The bill de- The following needs and knowledge gaps regarding ado-
clared that all pregnant women, by virtue of their bringing lescent pregnancy in the Philippines were identified.
another life into the world, are heroes in their own right.
The need to find effective ways of dealing with un-
Programs and policies for pregnant/lactating women planned and unwanted pregnancies
(all ages) Early studies showed that most teenage pregnancies (65%)
The rate of decline in maternal and newborn mortality has in the Philippines were unplanned and that one out of five
decelerated in the past decades to a point where Philip- teenage pregnancies was unwanted, leading to
pine commitments to the Millennium Development Goals abortion.14,15 In 2008 and 2012, it was estimated that
(MDGs) may not be achieved. 560,000 and 610,000 cases, respectively, of induced abor-
In response, the Department of Health issued Adminis- tions occurred across all ages.16 According to the Depart-
trative Order 2008-00295 Implementing Health Reforms ment of Health, approximately12% of maternal deaths are
for Rapid Reduction of Maternal and Neonatal Mortality. due to unsafe abortions.17 Hence, there is a need to find
This law mandates the provision of a package of maternal effective ways of preventing adolescent pregnancies and
and newborn, child health and nutrition (MNCHN) ser- dealing with these pregnancies once they occur.
vices in each locality.
The program is based on the following principles: 1) The need to plan interventions based on knowledge of
every pregnancy is wanted, planned and supported; 2) Filipino adolescent behaviour
every pregnancy is adequately managed throughout its The Cebu Longitudinal Health and Nutrition Survey
course; 3) every delivery is facility-based and managed (CLHNS) is the longest running birth cohort study in
by skilled birth attendants or skilled health professionals; Southeast Asia.18 It was initially designed to examine the
and 4) every mother and newborn pair secures proper determinants and consequences of pregnancy outcomes,
post-partum and newborn care with smooth transitions to particularly low birth weight. The study included relevant
the womens health care package for the mother and child issues in the life course of the cohort participants, such as
survival package for the newborn. A Core Service Pack- sexual and reproductive health. Table 5 shows a profile of
age using a life cycle approach and consisting of the fol- pregnant teenagers in Cebu City, derived from index chil-
lowing services is made available to all women: dren of first-generation study participants. Using
Pre-pregnancy package-includes micronutrient sup- knowledge obtained from this study (as well as other lo-
plementation particularly iron with folic acid, tetanus cal studies), interventions can be planned to effectively
toxoid immunization, fertility awareness, especially mold adolescent behaviour towards sexual abstinence and
among adolescents, birth spacing and family planning pregnancy prevention, and for those already pregnant, to
counselling, nutrition and healthy lifestyle, oral health, ensure good birth outcomes.
counselling and services on STD/HIV/AIDS, manage- Other issues affecting adolescents and pregnant women,
ment of lifestyle-related diseases, and adolescent health. in general, include:
Prenatal package - consists of monitoring height and The need for psychosocial adaptation to the condition
weight, blood pressure determination and monitoring, of pregnancy (including physical changes and stress
pregnancy test, urinalysis, complete blood count (CBC), within the family) which, accompanied by changes due
blood typing and sexually-transmitted infections (STI) to puberty, make adolescent pregnancy a dual devel-
screening, pap smear and acetic acid wash, blood sugar opmental crisis.
determination, micronutrient supplementation, tetanus The health status of the teenager, her requirements for
toxoid, malaria prophylaxis, oral health and birth spac- growth and those of her baby can only be met through
ing. In addition, assessment of fetal growth and well- sound dietary patterns and eating habits. This may be
being, counselling on healthy lifestyle, prevention and difficult to achieve given the existing commercial, cul-
management of bleeding in early pregnancy, early de- tural and psychosocial environment in which teenagers
tection and management of danger signs and complica- live.
tions of pregnancy, prevention and management of In order to address these gaps, the following recom-
other diseases and counselling on breastfeeding and mendations were given:
family planning methods are also part of the prenatal 1) Develop a clear understanding of the psyche of Filipi-
package. no adolescents. It is important to understand the ado-
Post-partum Service Package - include physical exam- lescents frame of mind in order to understand her be-
ination, identification of early signs and symptoms of haviour. We need to be able to evaluate the
Adolescent pregnancy in the Philippines 763
Table 5. Profile of pregnant adolescents in the Cebu Longitudinal Health and Nutrition Survey
adolescents responses and ideas to help her weigh pregnancy and prevention of consequences, and effec-
decisions or options, assist her to see the consequenc- tive communication of teens with healthcare profes-
es of her actions, develop alternatives, and identify ar- sionals and parents.
eas of potential conflict. The following areas for future research and action were
2) Prioritize the development of adolescent-friendly suggested:
health centers integrating nutrition screening as part of 1) Examine birth outcomes among adolescents and their
holistic approach to health care. The government growth patterns after giving birth;
should also focus on improving the knowledge and 2) Examine psychosocial factors that determine health
skills of health providers in assessment and manage- and nutrition among adolescents, particularly pregnant
ment of nutrition problems, improving education of adolescents;
in-school and out-of-school youth to debunk nutrition 3) Determine the impact of interventions (national, local,
myths and address socio-cultural differences. school- and home-based programs) on rates of preg-
3) Three approaches for public health intervention for nancy and identify the reasons underlying the contin-
adolescent health and birth outcomes were recom- ued increase in teenage pregnancy;
mended. First is for national government, community- 4) Develop the following information and education ma-
based, health, youth-serving non-government organi- terials:
zations to provide evidence-based sex education in- Intervention programs using social media target-
formation, support the nutritional needs of teens ing young girls;
throughout their development, provide sexually-active Curriculum revisions that extend nutrition and
teens access with effective and affordable contracep- physical activity from the school into the com-
tives, and improve access to home, worksite or school munity;
income-generating activities (IGA). Second is to have Direct campaigns targeting the youth which fo-
a youth-friendly individualized comprehensive nutri- cus on birth control and contraception, reproduc-
tion counseling within the life cycle and adapted to tive education, healthy diet and lifestyle;
socio-cultural perspectives, taking into consideration Campaigns discouraging moralistic attitudes of
the food-based and micronutrient supplementation, health workers regarding teenage pregnancy, and
focus on weight gain and growth patterns for optimal promoting greater helpfulness and understanding
birth outcomes, and healthy eating habits, lifestyle to deal with this issue.
changes, and self-esteem strengthening. The third is to
have teen-friendly clinics that will conduct screening Issues that go beyond adolescence and the first 1000
and risk prevention, growth and development assess- days
ment, discuss birth control options towards healthy In the Philippines, adolescent pregnancy is an issue close-
764 MV Capanzana, DV Aguila, CA Javier, TS Mendoza and VM Santos-Abalos
ly associated with poverty. Data from the 2008 Demo- cent health and behaviour, as well as adolescent-friendly
graphic and Health Survey20 showed that adolescent birth interventions and programs targeting their needs, are
rate per 1000 women aged 15-19 years was highest needed to address the escalating issue of teenage preg-
among those with no education, in the poorest income nancy.
group, and who lived in rural areas (Table 6).
Studies from other countries indicate that unintended
ACKNOWLEDGMENTS
(or unwanted) pregnancies taken to term may have detri- Acknowledgement is given to the following seminar speakers
mental effects on both mother and child.21 Unintended and workshop participants: Dr Jossie M Rogacion (University
pregnancy has been associated with maternal depression of the Philippines Manila), Dr Rosa Maria Hipolito-Nancho
and anxiety.21 Among adolescents, pregnancy prevents (Philippine Childrens Medical Center), Dr Emily G Flores
achievement of a better life by inhibiting educational op- (University of the Philippines Manila), Dr Iris Dando (Universi-
portunities and increasing dependence as well as the ty of the Philippines Manila, Philippine General Hospital), Dr
probability of domestic violence.21 On the other hand, Ditas Cristina D Decena (University of Santo Tomas, Philip-
unwanted children are more likely to experience symp- pines), Dr Juanita A Basilio (Department of Health), Dr Grace
toms of illness, have lower nutritional status, and have V Agrasada (University of the Philippines Manila), Dr Judith
Rafaelita B Borja (University of San Carlos, Cebu City), Ma.
fewer educational and development opportunities.21 An
Lourdes Y Sevilla (Plan International, Philippines), Dr Anthony
analysis of Demographic and Health Survey data from
P Calibo (Department of Health), Ms Veronica F Balintona
five developing countries, including the Philippines, (Centro Escolar University), Ms Michelle B Bangui (St. Paul
found rising levels of unwantedness with increasing birth University), Ms Rhea B De Leon (University of the Philippines
order.22 Filipino women whose pregnancy was unwanted Diliman), Dr Irish Rowena I Bernardo (Polytechnic University
had independently elevated odds of having received inad- of the Philippines), Ms Ana B Castaeda (BIDANI Network
equate prenatal care, and unsupervised delivery was asso- Program), Mr Alex Castro (Infant and Pediatric Nutrition Asso-
ciated with higher birth order, lower maternal education, ciation of the Philippines), Mr Richard S Dandan (DSM Nutri-
lower household wealth, and rural residence.22 These tional Products Philippines Inc.), Ms Lourdes F De Mesa (De-
findings indicate that providing contraceptive family partment of Social Welfare and Development), MsRacky D
planning education and services targeting both adult Doctor (Long Live Pharma), Dr Mary Anne L Ilao (Fabella
Hospital), Dr Adela J Ruiz (Polytechnic University of the Phil-
women and adolescents in impoverished areas will con-
ippines), Dr Jing Hua (DSM Nutritional Products Asia Pacif-
tribute significantly to the nations poverty alleviation ic), Ms Ma. Ruth Estrellieta Marayag (Council for the Welfare
efforts. of Children), Ms Estrella E Matibag (Makati Health Depart-
ment), Mr Timothy Moises C Mendoza (Food and Drug Admin-
Conclusions istration), Dr Maria Carolina M Mirano (Fabella Hospital), Mr
Studies have shown that delaying adolescent births could Joey Montalvo (Infant and Pediatric Nutrition Association of the
significantly lower population growth rates, potentially Philippines), Ms Ethel May F Onas (Centro Escolar University),
create broad economic and social benefits, in addition to Ms Melissa M Ortono (UST Pediatrics Hospital), Dr Emaluz Z
improving the health of adolescents. Since 1999, adoles- Parian (Nutrition Center of the Philippines), Dr Ma. Regina A
cent birth rates have been increasing in the Philippines. Pedro (Mead Johnson Nutrition), Ms Maria Fatima R REARIO
At the same time, the decline in maternal and newborn (Helen Keller International), Ms Rhoda L Reyes (St. Paul Uni-
versity Manila), Mr Eric V Reynoso (International Rice Re-
mortality has decelerated to the point that the country is
search Institute), Mr Daniel G Salunga, Dr Marian April G Sal-
unable to meet its millennium development goals. Major vador (Fabella Hospital), Dr Florentino A Solon (Nutrition Cen-
underlying causes for maternal deaths and low birth ter of the Philippines), Ms Evelyn F Valencia (Department of
weight infants include unintended pregnancy and mater- Social Welfare and Development), Dr Portia L Vitug (St. Paul
nal undernutrition, conditions highly relevant to adoles- University), MsDewi P Wardhani (Adventist International Insti-
cent pregnancy. Studies on the factors influencing adoles- tute of Advanced Studies), Ms Cathleen R Yandug (Business
Team Nutrition Management Solutions), Ms Elizabeth T Yu
Table 6. Adolescent birth rate (ABR) per 1000 women (AJINOMOTO Philippines, Corporation), Dr Rolando T Yu
aged 15-19 years, by background (Philippines DHS (Polytechnic University of the Philippines), Dr Marie T Bugas
2008) (FNRI-DOST), Ms Marietta M Bumanglag (FNRI-DOST),
MsJulieta B Dorado (FNRI-DOST), Ms Mildred G Udarbe
Background Adolescent birth rate (FNRI-DOST), Ms Consuelo L Orense (FNRI-DOST).
(per 1000 women aged 15-19 yrs)
Area of residence AUTHOR DISCLOSURES
Urban 42.4 The authors declare no conflict of interest. Funding for the sem-
Rural 70.8 inar was provided by ILSI SEA.
Education
No education 144 REFERENCES
Primary 109 1. United Nations Children's Fund (UNICEF). Committing to
Secondary or higher 51.1 child survival: a promise renewed. Progress report 2013.
Income quintile 2013 [cited 2013/10/1]; Available from: http://www. scribd.
Poorest 114 com/UNICEF.
Second 80.6 2. The World Bank. Data. Low birth weight babies (% of
Middle 51.8 births). 2013 [cited 2013/10/1]; Available from: http://data.
Fourth 42.9 worldbank.org/indicator/SH.STA.BRTW.ZS?order=wbapi_
Richest 20.9
Adolescent pregnancy in the Philippines 765
Seminar Proceedings
1000
1000 2013 9
1
2 3
2003 8% 2008
10%2008 20 35%
1
2/
3 4
5