HVMadamba2015

Teenage
Pregnancy
{
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
November 19, 2015
Philippine Pediatric Society Central Visayas Chapter Postgraduate Course 2015
Mariott Hotel, Cebu City
 HVMadamba2015
 In 2013, a total of 273,105 babies were born to
women aged 15–19 years, for a live birth rate of
26.5 per 1,000 women in this age group

Teenage Pregnancy
Martin, JA, Hamilton BE, Osterman MJK, Curtin SC, Mathews TJ. Births: Final data for 2013. Natl Vital Stat Rep. 2015;64(1)
at http://www.cdc.gov/teenpregnancy/about/index.htm
 HVMadamba2015

 Knowledge of sexual issues, HIV, other STDs,

and pregnancy (including methods of
prevention).
 Perception of HIV risk.

 Personal values about sex and abstinence.

 Attitudes toward condoms (pro and con).

 Perception of peer norms and sexual

behavior.
 Individual ability to refuse sex and to use

condoms.

Protective Factors
Kirby D, Laris BA, Rolleri L. The Impact of Sex and HIV Education Programs in Schools and Communities
on Sexual Behaviors Among Young Adults. Scotts Valley, CA: ETR Associates; 2006.
 HVMadamba2015

 Intent to abstain from sex or limit number of

partners.
 Communication with parents or other adults

about sex, condoms, and contraception.

 Individual ability to avoid HIV/STD risk and
risk behaviors.
 Avoidance of places and situations that might

lead to sex.
 Intent to use a condom.

Protective Factors
Kirby D, Laris BA, Rolleri L. The Impact of Sex and HIV Education Programs in Schools and Communities
on Sexual Behaviors Among Young Adults. Scotts Valley, CA: ETR Associates; 2006.
 HVMadamba2015

Christofides, N. J., Jewkes, R. K., Dunkle, K. L., Mccarty, F., Shai, N. J., Nduna, M., & Sterk, C. (2014). Risk
factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a
cohort of young South African women, 1(August), 1–9.
 HVMadamba2015

Unwanted or unplanned pregnancies:

 Beliefs about relationship control – not

associated
 Experiences of forced first sex or coerced
sex under the age of 15 – not associated
 Hormonal contraception - protective

 Condom use - not protective.

 Higher socioeconomic status - protective

174 pregnancies in South Africa

Christofides, N. J., Jewkes, R. K., Dunkle, K. L., Mccarty, F., Shai, N. J., Nduna, M., & Sterk, C. (2014). Risk factors for unplanned and
unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women, 1(August), 1–9.
 HVMadamba2015

Risk Factors for an unwanted pregnancy

 Physical abuse
 Having a pregnancy prior to baseline -

protective
 Believing that the teenage girl and her
boyfriend were mutual main partners
doubled the odds

174 pregnancies in South Africa

Christofides, N. J., Jewkes, R. K., Dunkle, K. L., Mccarty, F., Shai, N. J., Nduna, M., & Sterk, C. (2014). Risk factors for unplanned and
unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women, 1(August), 1–9.
 HVMadamba2015

 Gender power and socioeconomic status

 Interventions to prevent teenage
pregnancies need to be tailored by
socioeconomic status.
 Interventions that engage with

relationship dynamics of teenagers are

essential if unwanted and unplanned
pregnancies are to be prevented.

Conclusion
 HVMadamba2015

THE PHILIPPINE SCENARIO

https://psa.gov.ph/content/one-ten-young-filipino-women-age-15-19-already-mother-or-pregnant-first-child-final-results
 HVMadamba2015

Early pregnancy and motherhood

 HVMadamba2015

Early pregnancy and motherhood

 HVMadamba2015

Age at first marriage

 HVMadamba2015

 In Latin America, teen mothers

are seven times more likely
than older mothers to be poor.
 The poorer the country, the
higher the level of early
childbearing.

http://www.advocatesforyouth.org/publications/publications-a-z/432-the-impact-of-early-pregnancy-and-childbearing-on-
adolescent-mothers-and-their-children
 HVMadamba2015

 Fertility levels among the least

educated and the most educated
women in Peru differ by five
children.
 The fertility level of unschooled

women is twice their stated ideal

family sized.
 Teenagers with some secondary
education are roughly one-third as
likely to have had a child as those
who have less education

http://www.advocatesforyouth.org/publications/publications-a-z/432-the-impact-of-early-pregnancy-and-childbearing-on-
adolescent-mothers-and-their-children
 HVMadamba2015

 triple developmental crisis to

young women:
 that of adolescence,
 pregnancy, and

 establishing a relationship with a

member of the opposite sex.

Effect of Pregnancy on
Adolescent Health
Leppert PC. The effect of pregnancy on adolescent growth and development. Women Health. 1984 Summer-Fall;9(2-3):65-79
at http://www.ncbi.nlm.nih.gov/pubmed/6464482.
 HVMadamba2015

 Physiological adjustments of
pregnancy and adolescence
 Psychological and intellectual
development
 Poor contraceptive knowledge

Effect of Pregnancy on
Adolescent Health
Leppert PC. The effect of pregnancy on adolescent growth and development. Women Health. 1984 Summer-Fall;9(2-3):65-79
at http://www.ncbi.nlm.nih.gov/pubmed/6464482.
 HVMadamba2015

Situationer on Teenage Pregnancy

Navarro J 2012.
A Retrospective Study on
the Maternal and Fetal
Outcome of Teenage
Pregnancy in Vicente Sotto
Memorial Medical Center
(January - December 2011)
 HVMadamba2015

Teenage Pregnancies in 2011

Deliveries No. of cases Percent

Deliveries ≥ 20 yo 5139 88%
Teenage Pregnancy 698 12%
Total 5837 100%

Navarro 2012
 HVMadamba2015

Age (years) No. of Cases Percent

15 37 5%
16 79 11%
17 135 19%
18 214 31%
19 233 33%
total 698 100%

Include 19yo pregnant patients:

• 66% are ≤ 18 yo
• 33% are 19 yo

Navarro 2012
 HVMadamba2015

The main high risk complication is preterm labor

(18%) and severe preeclampsia, occurring in 6% of
teenage pregnancies.

Total No. Teenage

Type of Hypertension of Cases Percent Pregnancy Percent p-value
Antepartum Eclampsia: 121 2% 19 3%
Severe Preeclampsia: 979 19% 42 6%
Gestational hypertension: 284 6% 31 4%
Mild preeclampsia: 654 13% 26 4% 0.000
Fetal Outcome
Preterm: 702 14% 129 18%
Fullterm: 4421 86% 561 80%
Posterm: 16 0% 8 1% 0.000

Navarro 2012
 HVMadamba2015

PROGRAM FOR
YOUNG PARENTS
VICENTE SOTTO MEMORIAL MEDICAL CENTER
 HVMadamba2015

 Hospital Executive Committee

 Department of Pediatrics
 Department of Obstetrics and Gynecology
 Women and Child Protection Center
 Nursing Services
 Department of Internal Medicine
 HACT (HIV and AIDS Core Team)
 Department of Mental Health Services and
Behavioural Sciences
 Hospital Training Division
 Medical Social Services
 Support Services (Dietary Section, Dental Services
Pharmacy, Security etc.)
 Peer support groups

PROPONENTS
 HVMadamba2015

PROGRAM FOR YOUNG PARENTS

Planning Workshop for the PYP Feb 1, 2014 at Be Resort, Mactan
 HVMadamba2015

INAUGURATION OF THE PYP CLINIC

March 4, 2014 at the Outpatient Department, VSMMC
 HVMadamba2015

Best Practices in
Preventing Teenage
Pregnancy
HVMadamba2015
 HVMadamba2015

 Sixty-six focus group discussions

were conducted with 341 male and
female adolescents aged 15-19
years from rural and urban
communities on two islands of
Vanuatu.
 sexually transmitted infections and
HIV.
 prevention of pregnancy, condom use

 puberty, sexuality and relationships.

 HVMadamba2015

 Parents were not a common source

but were preferred, particularly by
girls, despite considerable socio-
cultural barriers.
 Schools were an important but
underutilised source of
information, as were a range of
media sources.

Source of information
 HVMadamba2015

Denver, Colorado

Devine, S., Ph, D., Bull, S., Ph, D., H, M. P., Dreisbach, S., … H, M. P. (2014). Enhancing a Teen Pregnancy Prevention Program With Text
Messaging : Engaging Minority Youth to Develop TOP Ò Plus Text. Journal of Adolescent Health, 54(3), S78–S83.
http://doi.org/10.1016/j.jadohealth.2013.12.005
HVMadamba2015
 HVMadamba2015

 month-long version of TOP Plus Text with 96

teens at four sites
 computer-based survey
 teens’ values, social support, self-efficacy, and
behaviors relating to school performance, trouble
with the law, and sexual activity.
 three weekly sessions then collected
satisfaction measures.
 exit interviews with twelve purposively
selected pilot participants

Teen Outreach Program + Text

Devine, S., Ph, D., Bull, S., Ph, D., H, M. P., Dreisbach, S., … H, M. P. (2014). Enhancing a Teen Pregnancy Prevention Program With Text
Messaging : Engaging Minority Youth to Develop TOP Ò Plus Text. Journal of Adolescent Health, 54(3), S78–S83.
http://doi.org/10.1016/j.jadohealth.2013.12.005
 HVMadamba2015

http://pdf.usaid.gov/pdf_docs/PA00K7KQ.pdf
 HVMadamba2015

Teenage
Pregnancy
{
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
November 19, 2015
Philippine Pediatric Society Central Visayas Chapter Postgraduate Course 2015
Mariott Hotel, Cebu City