CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction

Teenage Pregnancy is considered as a major contributor to maternal and child mortality

and to the cycle of ill-health poverty where globally, average birthrate among 15-19 years old is

49 per 1000 girls (World Health Statistics 2014). In the regions of Southeast Asia, the

Philippines has the highest rate of teenage pregnancies and is the only country where the rate is

increasing (United Nations Population Fund, 2014) . In addition, every hour, 24 babies are

delivered by teenage mothers in the Philippines (The Philippine Statistical Authority (PSA)

2014). These statistical data echo the need for healthcare practitioners to address the issue on

teenage pregnancy as the latter can be considered as a health and social issue as it affects not

only the teenage mothers but also the community as a whole. According to Arai (2009), there are

two reasons why teenage pregnancy is relevant in the promotion of holistic health, one is the

alleged immaturity of teenagers (which has a biological, emotional and social dimension and

impacts on sexual and parenting behaviors and reproductive outcomes); and teenagers’ economic

dependency on others. The problem on teen pregnancy encompasses not only the physical well-

being of the teenage mothers but also includes their ability to handle and cope with the stresses

of childbearing and its consequences which will greatly influence their health outcome.

In the Philippines, a woman’s reproductive health is given great importance hence the

creation of the Reproductive Health Law. Section 4 Definition of terms of the said law, states

that one of the elements of Reproductive Health care is to have an adolescent and youth

reproductive health guidance and counseling (2012). As a nursing advocate with constant direct
immersion in the different communities, teenage pregnancy is one of the emerging trends and yet

no structured program was made to address the issue, both in local and national level. Teenage

pregnancy is attributed to numerous factors. Some of the reasons for pregnancy among

teenagers includes unplanned sexual encounters, peer pressure, lack of information on safe sex,

lack of female role model and absence of accessible, adolescent-friendly clinics ( Van de Hor,

2014). The researchers acknowledge the need for information dissemination and counseling

amongst pregnant teenagers and an organized institution should be readily available for them.

Moreover, the mother's risk for postpartum depression is heightened (Bierne, 2015). The

risk involved in the emotional aspect of teenage pregnancy demands that special care should be

given to clients and that includes providing them the necessary support to achieve optimum

health. Ingram (2014) indicated that pregnant teens with a strong support group raise healthier

babies, continue their education and go on to live better and more productive lives.

This research focuses on the social support received by pregnant teenagers. Glanz et al.

(2008) specified that social support is commonly categorized into four types of behaviors:

emotional, instrumental, informational and appraisal. The researchers have chosen the two types

of supportive behavior which are emotional and informational support. The emotional support

aspect is used to examine the level of social support because of the high risk of depression

among mothers (Bierne, 2015). Moreover, the informational support aspect of social support is

utilized in this study because of the need to develop information and education materials to

increase reproductive and health awareness among youth and health workers ( Capanzana et. al,

2013). In addition, this research will determine the level of support recieved by teenage mothers

in the selected barangays of Tubod, Lanao del Norte and will identify the extent of support the

local healthcare professionals have offered the pregnant teenagers in their area. Furthermore, this
research will aid in planning and creating guidance and counseling scheme addressing the Youth

and Adolescents Reproductive health concerns. . It will be the source of information and support

for pregnant teenagers including all teenagers in the community.

Theoretical Framework

This research on social support for teen pregnancy is grounded on two types of theories

namely Social Support Theory and Measurement by Lakey & Cohen (2000) and Social

Cognitive Theory by Albert Bandura (1989).

I. Emotional Support

The Social Support Theory and Measurement by Lakey & Cohen (2000) will highlight

the importance of emotional support received by teenager throughout her pregnancy. Their

approach is to present brief overviews of three important theoretical perspectives on social

support research: (1) the stress and coping, (2) the social constructionist perspective, and (3) the

relationship. For the purpose of this research, the stress and coping perspective will be used.

Stress and Coping Perspective

The stress and coping perspective stipulates that emotional support is vital to health by

shielding people from harmful effects of stress. Being pregnant for the first time while studying

or being a father at a young age will be stressful for teenagers and parents. The stress of

pregnancy, revelation of pregnancy to parents, and moving on despite the shame and worry can

be nerve-racking (Nuble, C. 2016). One of the social supports that help teenager to cope with

their stress is Emotional support. However, the Emotional Support they need are different

compared to other teenagers because they are suddenly thrust into the adult world and

shouldering responsibilities often beyond their understanding. Pregnant teenagers really need a
steady and calm support system to balance out the wide range of emotions they feel

(Havenwood Academy, 2016

According to Teen Pregnancy Statistics (2006), Depression is common among pregnant

teens, and a pregnant teen may feel left out by her friends or may not know how to talk to her

parents and friends. Pregnant teen and parent support group offers a place where they can talk to

other girls who are going through the same thing and make new friends who understand their

concerns. Unfortunately in the Philippines, these practices have not been developed and

recognized as an important aspect to address stress issues related to teenage pregnancy). A

strong support system is beneficial to the pregnant teenager especially in dealing with the stress

of pregnancy. According to Lakey & Cohen (2000), supportive actions are thought to enhance

coping performance (figure 1.1). Figure 1.1. The supportive

action approach predicts
that received support,
Receive enhances coping, which
Support
buffers the relation between
stress and health outcomes.
COPING

STRESS HEALTH

II. Informational Support

The Social Cognitive Theory by Albert Bandura (1989) was utilized as a framework to

examine the informational support received by the respondents. There are 3 variables to consider

in this theory:

 behavioral factors

 environmental factors (extrinsic)

  personal factors (intrinsic)

These 3 variables in Social Cognitive Theory are said to be interrelated with each other, causing

learning to occur. An individual’s personal experience can converge with the behavioral

determinants and the environmental factors.

BEHAVIOUR

PERSONAL ENVIRONMENTAL
FACTORS FACTORS

Figure 1.2 Social Cognitive Theory

According to Pajares (2000), the reciprocal nature of the determinants of human

functioning in social cognitive theory makes it possible for therapeutic and counseling efforts to

be directed at personal, environmental, or behavioral factors. Strategies for increasing well-being

can be aimed at improving emotional, cognitive, or motivational processes, increasing behavioral

competencies, or altering the social conditions under which people live and work. Applying the

social cognitive theory as a framework of teenage pregnancy, health professionals can share

information about the risk involve during pregnancy and encourage them to attend prenatal care

(personal factor), promoting healthy lifestyle by eating nutritious diet, taking prescribed vitamins

and iron supplements (behavioral factor), and conducting a separate schedule or make yourself

available for counselling to tackle their health issues and concern about pregnancy

(environmental factor).

In the person-environment interaction, human beliefs, ideas and cognitive competencies

are modified by external factors such as a supportive parent, stressful environment or a hot
climate. In the person-behavior interaction, the cognitive processes of a person affect his

behavior; likewise, performance of such behavior can modify the way a person thinks.

Lastly, the environment-behavior interaction, external factors can alter the way you

display the behavior. Also, your behavior can affect and modify your environment. This model

clearly implies that for effective and positive learning to occur an individual should have positive

personal characteristics, exhibit appropriate behavior and stay in a supportive environment.

In addition, Social Cognitive Theory states that new experiences are to be evaluated by

the learner by means of analyzing his past experiences with the same determinants. Learning,

therefore, is a result of a thorough evaluation of the present experience versus the past.

Conceptual Framework

This study aimed to determine the level of social support received among pregnant

teenagers. Social support is a very important factor in determining the status of physical health,

mental health and immune system functioning for everyone (Clark, 2005). As shown in the

diagram, social support specifically the informational and emotional support from family, friends

and peers, partner/husband, healthcare professionals and schools influence the pregnant

teenagers’ health status. Emotional Support manifests as expression of empathy, love, trust and

care which contributes to the pregnant teenager’s self worth. Informational Support includes the

provision of advice, suggestions and information about teenage pregnancy. Family is the primary

source of social support through verbal and nonverbal communication throughout pregnant

teenager’s childhood and adolescence stage. Husbands or partners are also important sources of

social support for they are the pillars of strength and courage the pregnant teenagers need to

overcome the changes brought by pregnancy. Friends and peers are other important sources of
social support through exchange of information about attitudes and expectations regarding

teenage pregnancy. Healthcare Professionals act as advocates, educators and counselors, creating

healthy, supportive communities for pregnant teenagers in the childbearing phases of their lives.

Lastly, schools can be a direct source of social support through school curricula containing

comprehensive reproductive health education that can shape attitudes and behaviors towards

teenage pregnancy.

Figure 1.3. Schematic Diagram of Variables

Family, Friends and

peers, partner/husband,
Healthcare
professionals, School

Emotional Informational
Support Support

Pregnant
Teenager

Study Objectives

Study Objectives

This study looked into the level of social support among pregnant teenagers in selected

barangays of Tubod, Lanao del Norte. The study specifically aims to:

1. Determine the level of emotional and informational support among pregnant teenagers;

2. Determine the sources of social support during teenage pregnancy;

Statement of the Problem

This study will determine the level of social support among pregnant teenagers in

selected barangays of Tubod, Lanao del Norte.

Specifically, it will answer the following questions:

1. What is the respondent’s socio-demographic profile in terms of:

1.1. Age

1.2. Religion

1.3. Educational Attainment

2. What are the respondent’s sources of social support?

3. What is the availability of emotional support towards the respondents’ sources of

social support in terms of:

3.1 Family

3.1 Husband/Partner

3.2 Friends/Peers

3.3 Local Healthcare Professionals

3.4 Schools

4. What is the availability of informational support towards the respondents’ sources of

social support in terms of:

4.1 Family

4.1 Husband/Partner

4.2 Friends/Peers

4.3 Local Healthcare Professionals

 4.4 Schools

Scope and Limitation

This study was conducted among pregnant teenagers (14-19 years old) who sought

prenatal check-ups in selected Barangay Health Station of Tubod, Lanao del Norte. This study

focused mainly in identifying the level of emotional and informational support among pregnant

teenagers. It determined the relationship of pregnant teenager’s age, religion and educational

attainment towards the level of emotional and informational support.

This study was limited to the collection of information and data gathered from the

researcher-made questionnaire that was given to the respondents. The validity of the data

gathered depends with the respondent’s truthfulness and honesty in answering the questions. The

researcher agreed to conduct the study in selected Barangay Health Station of Tubod, Lanao del

Norte within 1 week of duration, thus making the study more accessible and affordable. The said

respondents were composed of 31 pregnant teenagers chosen depending on their availability for

this study during the data gathering last August 2016.

Significance of the Study

This research study is focused on determining the level of social support among pregnant

teenagers because social support is to affect the women’s health during pregnancy, labor and

delivery and the postpartum period. The outcome of this study will be beneficial to the healthcare

practitioners because it will give a better knowledge and understanding on the pregnant

teenagers’ need of social support. This study could also provide them information on social

support that can be incorporated in health teachings during mothers’ class and prenatal check-

ups. The results will also benefit the pregnant teenagers for it will raise awareness on the

importance of social support to maternal health and fetal well being. This study shall also give
ideas and framework to the government in creating a range of holistic interventions to strengthen

the level of social support among pregnant teenagers. The study may also serve as a basis for

future researches regarding the social support among pregnant teenagers.

Definition of Terms

The following terms which are useful in the study are defined operationally.

Level of Social Support- is one of the dependent variable in the study which referred to the

perception and actuality that pregnant teenager is cared for, has assistance available from other

people, and that pregnant teenagers is part of a supportive social system.

Educational Attainment is one of the independent variable in the study under the socio-

demographic profile of pregnant teenagers in selected barangays of Tubod, Lanao del Norte

which referred to the status of their education. Low educational attainment individuals are most

likely to engage in sex at an early stage, not use contraception consistently and become pregnant

or cause a teenage pregnancy.

Emotional Support is one of the independent variable in the study that teen mothers explains

less emotional support received than older mothers because pregnant teen may feel left out by

her friends or may not know how to talk to her parents and friends.

Informational Support is one of the independent variable in the study to identify the

informational support of teen mothers received throughout their pregnancy. It is referring to their

mothering role that is needed in order to ready their selves to dig into reality about the abrupt

change of their life more than they could have imagined.

Tubod, Lanao del Norte is one of the independent variable in the study where the study is

conducted specifically in selected barangays only.

Family is an independent variable including parents, brothers, sisters, grandparents, aunts,

uncles, cousins, nephews, nieces, and/or siblings-in-law as one of the sources of social support of

the subject that defines the level of their emotional and informational support given to the subject

during her unwanted teenage pregnancy.

Husband/Partner is a male in a marital relationship. It is under in the independent variable that

is also one sources of social support of the subject that is actually named as the primary provider

and assists with childrearing of his partner. Nevertheless, today many different arrangements are

common that is mostly the utmost concern especially in teenage pregnancy.

Friends & Peers is one of the independent variable of the study that knows and whom has a

bond of mutual affection and who offers their selves as one of the sources of social support of the

subject out of wedlock.

Local Healthcare Professionals is one of the independent variable of the study includes the

Doctor, Nurse and Midwife who provide care and maintain or improve the health of Pregnant

teenagers in selected barangay of Tubod, Lanao del Norte during their prenatal check-ups as well

as imparting health education effectively.

School is one of the independent variable of the study including the teachers and classmates that

is also one of the sources of social support of the subject whom contributes help and defines the

level of emotional and informational support during her school days when unwanted pregnancy

happens.