TACLOBAN CITY, Leyte—Early childbearing is seen to become more prevalent anew in the Philippines, as it breeds an alarming new trend post-pandemic, when restrictive health protocols on social or physical distancing is no longer in effect, following the World Health Organization (WHO) and the Philippine government’s declaration of the end of Covid-19 being a health emergency here and abroad.

“Teenage pregnancy is a health and social economic issue in the Philippines and around the world, not only because pregnancy rates among teenagers remain significantly high, but also and most importantly, because of its implication on the growth, development and well-being of both a pregnant teenage mom and her child during the pregnancy and after childbirth,” said Vanessa G. Retuerma, director of Strategy Management, Impact and Learning Department of World Vision, during the Policy Forum on Teenage Pregnancy in Eastern Visayas held by Korea International Cooperation Agency (KOICA) and World Vision on September 6 in Tacloban City, Leyte.

According to Retuerma, the lifecycle of a child’s development lasts until the teenage years—a very crucial stage where children’s bodies grow and develop physically, discover their interests and talents, begin to dream and aspire, and learn how to navigate life through their education, experiences and relationship.

“So there are many factors that we need to consider for us to ensure that all children meet their needs to help them grow healthy, well nourished, be educated, be protected and, most importantly, be empowered,” she said.

By the numbers

ADOLESCENT birth rate, while a Sustainable Development Goals (SDG) indicator in itself, is also closely related with other SDGs, the closest of which are SDG 3 (Health), SDG 4 (Education), and SDG 5 (Gender Equality). All these seek a healthy life, well-being, inclusive and equitable education and environment for all, including children and women for a brighter future.

In June, the WHO reported that an estimated 21 million girls aged 15 to 19 years in developing regions, including the Philippines, become pregnant, and approximately 12 million of them give birth. Globally, adolescent birth rate (ABR) has gone down from 64.5 births per 1,000 women of the same age group in 2000 to 41.3 births for 1,000 women in 2023.

“Pregnancy among teenagers is more common among people with less education, or lower in socioeconomic level. Additionally, among these and other vulnerable populations, there is a lower success in adolescent first birth, which results in growing inequality,” noted United Nations Population Fund (UNFPA)-Philippines Project Coordinator Hanzel Luke P. Devera.

Such trend also holds true in Southeast Asia and the Pacific region, wherein 23 million adolescents aged 15 to 19 years old are currently married or in union, of which over 80 percent are girls. Majority or 15 million of them live in Southeast Asia. Across the region, 1 in 8 adolescent girls of the same age, and 1 in 50 boys are currently married or in union.

In Southeast Asia, 9 percent to 32 percent of adolescent pregnancies under 18 were conceived prior to marriage or cohabitation. This case is rather  high in the Philippines at 32.4 percent, followed by Vietnam, 32 percent; Indonesia, 26 percent; Laos, 24.4 percent; Timor Leste, 19.5 percent; and Cambodia, 9 percent.

“Premarital pregnancies often lead to circumstantial child marriage to avoid social sanctions associated with [it] and or sexual activity in a conservative setting,” Devera underscored.

Based on the 2022 Philippines National Demographic and Health Survey (NDHS), the adolescent birth rate seems to have been declining from 56 in 2020 to 25 per 1,000 girls aged 15 to 19. This trend follows even in regional levels like for Eastern Visayas, wherein it’s also the case for 245 respondents of the same age group of the female populace in the region, dropping to 4.7 percent last year from 6.9 percent recorded in 2017.

“Such statistics had quite gone down a little bit as we take into consideration the existence of the pandemic [during the time] that actually limited the interaction of our adolescents aged 15 to 19 with their respective peers. But based on the study, it is expected to rise again starting 2022 when the pandemic slackened and seems that we’re now in to face-to-face,” Commission on Population and Development (CPD) Region 8 Director Elnora R. Pulma told reporters in a briefing during the forum.

Impacts of early child bearing

DATA show that adult men older than 20 years old father a significant proportion, or 59.5 percent, of adolescent pregnancies. These could be attributed to various social determinants.

Devera cited them as lower educational attainment and economic status, poor access to contraception, challenges in the implementation of comprehensive sexuality education, and limited service delivery points providing adolescent and youth-friendly SRH services.

“So over the years, the evidence and progress of the adolescent pregnancy have expanded with this new trend, bringing in a richer set of policy and heightened a sense of urgency in tackling the issue. Today, we know that adolescent pregnancy takes a great toll on girls, their families and, of course, their future,” he said.

On education, the impact would be measured on the predicted high-school completion rate of 72 percent for those without early childbearing before the age of 18 as compared to 65 percent for those who get pregnant before reaching such legal age.

Economic-wise, the lifetime wage earnings foregone by a cohort of women 18 to 19 years old resulting from early childbearing is estimated to be around P33 billion.

“We are taking from young adult opportunities to earn this wage because of adolescent pregnancy,” Devera said, while citing birth by women below 19 years old have two times the risk of dying as compared to women not in the same risk category.

‘Baby face’ of the problem

WHILE the number of adolescent birth is declining, the number of births by mothers aged 10 to 14 years old has shown a slight increase over the years, with 1,903 in 2016 and 2,113 in 2020.

“We need to look at the new faces of teenage pregnancy, which have not yet been unveiled. Who are they? The 10 to 14 years old that are [usually] victims of gender-based violence. And those data are essential that we need to get from DSWD (Department of Social Welfare and Development) and DILG (Department of the Interior and Local Government) so that we can address the problem,” said Dr. Miel Filomeno S. Nora, technical advisor for adolescent health at the Department of Health (DOH) Central Office.

There are existing laws meant to address the problem of childbearing among teeners: Republic Act (RA) 11596 or An Act Prohibiting the Practice of Child Marriage; RA 11648, or an act providing for stronger protection against rape and sexual exploitation and abuse by raising the age of sexual consent from 12 to 16 years; and the  Responsible Parenthood and Reproductive Health Act in 2012.

Despite these, there are certain gaps in terms of their implementation, per Retuerma. She said: “That’s also the jumping board of the recommendations moving forward for different policies. To fill in that gap in terms of implementing that law, specifically from the national and most importantly down to the local level, because that’s where usually the challenge is how to implement a national law. We’re trying to thresh out through the study what are the factors that really contribute to the prevalence of teenage pregnancy, especially in Region 8.”

Moving forward, she added that their organization is advocating passage of the Teenage Pregnancy Prevention Act, which was approved on final reading at the lower house on Tuesday, and will be submitted to the Senate in the next few weeks.

“This bill is actually in a way intended to address some of the existing gaps in the policies and programs of the national government to address this emergency issue around teenage pregnancy,” she said.

Government efforts

AT the local level, the DILG is promoting the Child-Friendly Local Governance Audit (CFLGA), where it assesses the compliance of local government units (LGUs) with health service mandates not just for children but also their parents.

“We are happy to say that more than 50 percent of the local government units—36 municipalities and the other cities—were able to pass well from 2021 to 2022. Currently, we are also finalizing the results of the CFLGA,” cited Geselle P. Endriano, local government operating officer/assistant division chief at DILG-Region 8.

“[As regards] the Seal of Good Local Governance, we are soon to have the national validation and there are certain indicators there where we can say or we can mention specific LGUs who passed the social protection governance area,” she added.

To a certain extent, most LGUs have somehow made some interventions as far as adolescent health is concerned, or teenage pregnancy for that matter, such as the cities of Tacloban and Ormoc in Leyte, as well as Borongan in Eastern Samar and other municipalities in Eastern Visayas region.

According to Pulma, the former is “very adamant as far as implementing interventions in addressing teenage pregnancy in the city being an urban area [is concerned],” and even came up with a mechanism to provide services, particularly the information service delivery network that serves as a referral pathway to certain services that were made available for adolescents, like counseling and other productive health services.

Majority or six of the provinces in Region 8 are already implementing The KADA Network, a strategy of the DOH that focuses on establishing adolescent-friendly health facilities and hospitals, as well as learning institutions. Currently, the regional office of the health agency conducts a province-wide implementation of this initiative in Biliran.

“Then maybe this year, once the funding is already transferred to local government units, the rest will follow, which include Samar, Leyte, Southern Leyte, Eastern Samar, Northern Samar, Tacloban City and Ormoc City,” said Hermart C. Severino, Nurse V, DOH-Eastern Visayas Center for Health Development.

Samar has a lot of strategies, including the establishment of Sirak Kabataan, a provincial youth development program under the National Youth Commission that focuses on mental health and adolescent pregnancy, he added.

Shared responsibilities

FOR their part, World Vision and KOICA are now implementing Phase 1 of the KOICA Maternal Newborn and Child Health (MNCH) Project in the Eastern Visayas Region, covering 16 municipalities in the provinces of Leyte, Eastern Samar, Samar, and Northern Samar.

This Mid-Term Strategy for Health 2021-2025 of KOICA involves various activities, such as capacity-building for the barangay health workers who are doing home visitation.

“In a way, this holistic approach is not only addressing pregnancy or maternal health, but it’s general. So if we will look at it, there are lots of interventions, but still problems exist. One of them is from behavioral change,” shared Romil Jeffrey R. Juson, KOICA MNCH Project and World Vision Philippines project manager.

To equip them well, KOICA and World Vision provide medical tools, medicines or consumables to increase the readiness and availability for the health service in the community. Both parties, likewise, work with other partners to improve and upgrade policies related to maternal health.

“For the next year, we are looking to get also a partner to upgrade our referral system. This is because during our discussion with the communities and municipal workers, we found out there are still many pregnant women who are struggling to be referred to the highest level hospital,” revealed Jihwan Jeon, project director of KOICA MNCH Project and World Vision Korea.

“Once we finish this first phase of the program, we can invest in another research for another five years. So that is our plan.”

Image credits: Ocusfocus | Dreamstime.com