REVIEW OF RELATED LITERATURE

This section includes report findings, ideas, theories, facts, generalization and

discussion on the related literature and studies both international and local in the

previous years.

Adolescence, or puberty, is a period of great opportunity and hope. It is the

period between childhood and adulthood when young people undergo physical,

mental, and emotional changes. This period can be confusing for some adolescents

because most become sexually active without having the knowledge required to

manage their sexual behaviour (Mlyakado, 2013b), due to biological factors caused

by hormone changes (Walcott, Meyers, & Landau, 2008). When a growing person

enters puberty (adolescence) he or she becomes interested in sex, but is emotionally

immature and frequently ignorant. While others manage to make the transition to

adulthood without getting involved in risky sexual behaviours, others fail to overcome

the challenges of this critical stage and eventually miss the opportunity to realize their

full potential in life. The main reason is that most of them are sexual health illiterate.

Adolescents who fail to manage their biological changes are driven by emotions that

are associated with the increase of hormones during adolescence. Most of them are

susceptible to risky sexual behaviours, such as underage sexual intercourse, having

sexual intercourse with many partners, and participating in unprotected sexual

activities (Mlyakado, 2013a). These adversely affect their future health outcomes

through such things as increasing their chances of getting sexually transmitted

infections (STIs) including HIV/AIDS, and becoming school dropouts because of

pregnancy (Walcott et al., 2008). One of the most significant commitments a country

can make to its economic, social, and political progress, and to its stability, is to invest
in the growth and development needs of its adolescents, which includes educating

them about sexual health. Sexual health education programmes in many countries aim

to impart adolescents with the information they need to make informed decisions

related to sexual issues during adolescence (Mueller, Gavin, & Kulkarni, 2008).

Sexual health education is improving and is reducing cases associated with

irresponsible sexual behaviour within the adolescent age group. Adolescents who are

sexual health illiterate are more likely to participate in underage sexual intercourse,

unsafe sex, and sexual assault (Che, 2005; Peter, 2013; Shegesha, 2015). Cervical

cancer, unplanned pregnancies, and dropping out of school (Eggers et al., 2016;

Mathews et al., 2012; Sommer, Likindikoki, & Kaaya, 2015; Kirby, 2002; K.

Mkumbo et al., 2009; Smith & Harrison, 2013; Speizer et al., 2003) are more

common among those who have underage sexual intercourse. These adverse effects

may not only affect their childhood but could also prove detrimental to their adult life

—socially, culturally and economically (Shemsanga, 2013; Ubora wa Afya kwa

Familia Duniani, 2001). Sexual health education teaches adolescents how to make

right decisions about their sexual behaviour and improve their health status (Buston,

Wight, Hart, & Scott, 2002; Daniel Wight, Plummer, & Ross, 2012). These initiatives

have been jointly implemented by international and local organisations. Various

national and international movements support adolescents’ rights to sexual health-

related information. In order to determine the most effective approach to establishing

sexual health literacy, we conducted a literature review pertinent to the adolescent

sexual health education approaches currently being used globally, and in Africa and

Tanzania respectively.
Numbering nearly 1.8 billion, more adolescents populated the earth than at any

previous time in history [1]. In the World Health Organization (WHO) Western

Pacific Region, one in five people (235 million) are adolescents [2]. While maternal

and under-five mortality had decreased by around half, adolescent mortality has

remained stagnant. Globally, an estimated 1.3 million adolescents died in 2012 from

preventable causes such as road injuries, HIV/AIDS, suicide, lower respiratory

infections and interpersonal violence [2]. Thus, as countries focused on limiting

preventable deaths among women and children for the Millennium Development

Goals, Sustainable Development Goal 3.15 requires us to also focus on adolescents

[2]. Adolescence is a period of experimentation and maturation. It is a time of

physical, psychological, and social transitions from childhood to adulthood. Many

unhealthy habits driving the non-communicable disease epidemic begin in

adolescence. Thus, establishing healthy habits in adolescence is critical.

Today’s generation of adolescents faces a different world from what their parents and

grandparents had. New political, economic, educational, technological and religious

realities shape the world in which adolescents today live. They change the way

adolescents transition from childhood to adulthood [3]. Understanding how to best

support adolescents to have a healthy and smooth transition, we need to understand

both how the transitions occur and how the external forces interact with the

transitions.

The Lancet Commission has recommended the development and practice of effective

evidence-based policies and interventions to reduce the burden of adolescent mortality

and morbidity worldwide [4]. As adolescents spend a large proportion of their time at

schools, they should be an important place to support adolescent health and

development. In 2013, the net enrollment rate of primary and secondary school in the

Western Pacific Region was 94.3% and 78.5% respectively [5]. Thus, schools have

the potential to reach a vast majority of adolescents and school health education has

the potential to positively impact a large proportion of youth who rarely visit health

facilities. In low-and middle-income countries, school health is additionally cost-

effective, and improves the effectiveness of their general education [6]. For these

reasons, school-based health interventions become a major area of focus for the

WHO.

Since its launch in 1995, the WHO's Global School Health Initiative has sought to

mobilize and strengthen school health programs globally. In effect, school health

programs should strive to formulate health policies and provide safe and healthy

environments, health education, and health services including screening for various

conditions and behaviours. However, existing evidence on the impact of school health

programs on adolescent health and development is limited. Currently, countries use

the global school-based student health survey (GSHS), a national level surveillance

project designed to help them measure and assess the behavioural risk and protective

factors in 10 key areas among young people aged 13 to 17 years. However, data on

school health service implementation and utilization is not well collected. A WHO

Cochrane review, which synthesized 67 cluster trials on school health-promoting

interventions, found little or no evidence of effectiveness in reducing obesity, fat

intake, alcohol use, drug use, mental health problems, violence or bullying.

Furthermore, 88% of the identified trials came from high-income countries [7].

Another review presented a global overview of school health service using data from

102 countries. However, 71.6% of interventions came from high-and upper-middle-

income countries, and no interventions were reported addressing important causes of

mortality and ill health in adolescents as listed above [8]. A scoping review of 30

school-based health interventions in developing countries found significant increase

in knowledge, beliefs and intentions, but no improvement in health behaviors and

outcome [9]. Shackleton et al conducted a systemic review of 22 reviews on school-

based health interventions and found 77% of them were conducted in the United

States. The authors found little evidence that interventions such as sexual-health

clinics, anti-smoking policies and other approaches targeting at-risk students were

effective [10]. None of the above mentioned literature focuses only on adolescents.

In 2015, The United Nations (UN) extended the existing Every Women, Every Child

agenda to include adolescents through the Global Strategy for Women’s, Children’s

and Adolescents’ Health. This strategy called for evidence-based interventions to

address the health and developmental needs of adolescents. Since nearly 90% of

adolescents live in low- and middle-income countries (LMICs)[1], it is therefor

critical to invest more in health to meet their needs. A recently published Lancet

article highlighted the need to focus on screening, counseling and treating adolescents

for common morbidities and risk behaviors that had long-term impact on well-being

[11]. Member states in the WHO Western Pacific Region have raised demands for

evidence-based interventions that can guide national actions. However, we found no

systematic reviews of school-based interventions for adolescents in the Region. We

conducted this review to describe the characteristics and identify effectiveness of

school-based intervention and facilitating factors for successful intervention to

promote adolescent health in low and middle income countries of WHO Western

Pacific Region.
Sexual risk behaviours among young adolescents appear to be on the

rise[1]. Meanwhile, the average age of the first sexual intercourse is declining. The

average age of first sexual intercourse in male and female students was 13.2 and 13.3

years old, respectively[2]. Globally, 1m of these girls being 15 years old or younger

give birth every year[3]. Correspondingly, in Thailand, the number of births among

extremely young adolescents age 10–14 is also increasing to twice the rate report ten

years ago[4].

Throughout the world, countries are taking steps to ensure that adolescents access

high-quality sexual health education and prevention services. A variety of sexual risk

prevention programmes based on the principles of nursing and public health have

been implemented to achieve reductions in teen pregnancy and other sexually

transmitted infections (STIs) including HIV[5]. A number of publications and

programmes have described several models for engaging adolescents in sexual health

through computer programme or social media[6, 7], or interactive activities[8]. Some

interventions explicitly involve parents[9], peers[10] and teachers[11] as an important

resource of influence on adolescents’ attitudes, norms, self-efficacy, and sexual

behaviours.

A need for reviewing the literature specific to types of characteristics, content and

study designs is required to examine the literature regarding young adolescents in

particular. A very few studies have evaluated sexual health interventions specifically

designed for the early adolescent with age between 10 and 13 years[2]. Moreover,

specific support on what features or variables influence the effects of these

programmes is unclear, especially in the early adolescent. Thus, this is an opportune

time to offer developmentally appropriate, evidence-based sexual health

programmes[3].

During the past decade, research has been conducted to examine the effects of a

sexual promoting intervention. However, the methodological and substantive features

of these existing studies have never been reviewed in Thailand to identify gaps in the

studies that, in turn, will affect the effectiveness of the sexual health interventions to

delay the initiation of sexual intercourse and prevent other sexual risk behaviours

particularly early adolescents.

School-based comprehensive sexuality education (CSE) constitutes a public health

intervention, promoted globally, to improve young people’s sexual and reproductive

health and well-being. CSE, described by UNESCO as ‘a curriculum-based process of

teaching and learning about the cognitive, emotional, physical and social aspects of

sexuality’ (UNESCO, 2018a, p. 16), seeks to equip children and young people with a

set of skills, attitudes, and scientifically accurate knowledge to nourish respectful

social and sexual relationships (UNESCO, 2018a). It commonly incorporates a

positive notion of sexuality, a holistic understanding of sexual health, and emphasises

the sexual rights of young people as a human right (Berglas, 2016; Haberland &

Rogow, 2015; UNFPA, 2015). CSE is therefore increasingly considered best practice

in sexuality education (Vanwesenbeeck, 2020).Footnote1

CSE is recognised to impact positively on a range of adolescent sexual and

reproductive health (SRH) outcomes, including but not limited to the following:

knowledge of SRH and human rights, communication skills, sexual and emotional

well-being, and attitudes supporting gender equity (Goldfarb & Lieberman, 2021;

Ketting et al., 2016; UNFPA, 2015). Systematic reviews have demonstrated that CSE

programmes also tend to have positive impacts on knowledge, attitudes, and skills

although they often demonstrate weak or inconsistent effects on behavioural outcomes

such as sexual risk-taking, number of partners, age at initiation of sex, and condom

use (Denford et al., 2017; Kirby, Laris, & Rolleri, 2007; UNESCO, 2018b).

CSE is also considered an important tool in efforts to promote gender equality, reduce

gender-based violence (GBV) (Miller, 2018; UNESCO, 2018a), including intimate

partner violence (Kantor et al., 2021; Makleff et al., 2019), and in achieving the

Sustainable Development Goals (Starrs et al., 2018). These efforts are rooted in an

understanding that gender inequality, gender norms, and SRH are closely intertwined,

with gender inequality and restrictive gender norms contributing substantially to

adverse health outcomes, including in the area of SRH (Heise et al., 2019).

Conceptualising gender as a hierarchical social system differentiating between women

and men and commonly ascribing higher power, resources, and status to men and

things masculine, Heise et al. argue that gender norms uphold this social system via

unwritten rules that define acceptable behaviour for women, men, and gender

minorities (Heise et al., 2019). These norms act as a powerful determinant of

adolescent SRH (Pulerwitz et al., 2019). Gender inequality places girls and women at

higher risk of gender-based violence, STIs, biological, social and behavioural

vulnerability to HIV, and unintended pregnancy (Dellar et al., 2015; Heise et

al., 2019; Park et al., 2018; Wingood & DiClemente, 2000). Traditional gender norms

place adolescents at higher risk of unsafe sex as it affects their ability to negotiate safe

sex (Wood et al., 2015), whilst masculinity norms can drive risky sexual behaviour in

men, including avoiding condom use and contraception (Heise et al., 2019).

As adolescence is considered a key developmental phase during which gender norms

and attitudes intensify, this period presents a window of opportunity for intervention

(Amin et al., 2018; Buller & Schulte, 2018; Kågesten et al., 2016). Therefore, schools

and school-based CSE have been argued to constitute key sites to promote healthier

gender norms and gender equality at scale (Jamal et al., 2015). Whilst the focus of our

work is on adolescents, it is increasingly recognised that school-based interventions

geared towards younger children and continued through the school trajectory may be

very effective in addressing gender norms and roles (Goldfarb & Lieberman, 2021).
A systematic review of randomised controlled trials of sexuality education

programmes that were not abstinence-only and focused on the prevention of HIV,

other STIs, and unintended pregnancies as primary outcomes showed that

interventions were more likely to have a positive effect on these three biological

outcomes if they explicitly addressed ‘gender and power’ in relationships as

compared to interventions that did not include this

componentFootnote2 (Haberland, 2015). In the review, the gender and power content

constituted ‘at least one explicit lesson, topic or activity covering an aspect of gender

or power in sexual relationships, for example, how harmful notions of masculinity and

femininity affect behaviors, are perpetuated and can be transformed; rights and

coercion; gender inequality in society; unequal power in intimate relationships;

fostering young women’s empowerment; or gender and power dynamics of condom

use’ (Haberland, 2015, p. 3). In addition to demonstrating the effectiveness of the

programmes with gender and power content, Haberland identified four common

characteristics of effective programmes: ‘Fostering critical thinking’, ‘explicit

attention to gender or power in relationships’, ‘fostering personal reflection’, and

‘valuing oneself and recognising one’s own power’ (ibid, pages 6–7).

As a result of the work of Haberland and others, explicit attention to gender and

gender-related power has been incorporated into many CSE programmes, e.g. by

incorporating gender norms and power dynamics into the theory of change in CSE

programmes (Berglas, 2016). Such ‘gender-transformative’ programming considers

the roots of gender-based health inequities, incorporates strategies to address these,

and ultimately seeks to shift gender relations and norms that contribute to these

inequities (Ruane-McAteer et al., 2019; World Health Organization, 2011). However,

whilst there is both a strong rationale and great emphasis on incorporating gender and
power content in CSE (UNESCO, 2018a) and evaluating gender- and power-related

outcomes (Haberland & Rogow, 2015; UNFPA, 2015), these programmes’ pathways

of change remain under-researched (Ketting et al., 2016; Kippax & Stephenson, 2005;

Ruane-McAteer et al., 2019). In complex public health interventions such as CSE,

gender and power components are likely to interact with context and impact on

intervention effects in a non-linear manner (Petticrew et al., 2013; Rutter et al., 2017).

Evaluation studies exploring these processes can therefore contribute to understanding

how interventions work by elucidating mechanisms of impact, effective

implementation strategies, and contextual factors shaping programme outcomes

(MRC, 2015).

Building on Haberland’s work, we undertook a systematic review of process

evaluations of school-based CSE and other sex education programmes with gender

and power components targeting adolescents. By sex education, we mean

interventions which seek to promote healthy sexual and relationship behaviours,

excluding abstinence-only interventions. We sought to gain an in-depth understanding

of how inclusion of gender and power content shapes programme implementation and

outcomes with the ultimate goal of informing CSE programming by delineating

effective implementation strategies and programme characteristics, as well as

mechanisms of impact. We synthesised evidence on (i) implementation, (ii)

programme characteristics, and (iii) mechanisms of impact.

Adolescence is recognized as a critical time of life. Because, at this stage, adolescence

becomes independent, develops new relationships, learns new social skills and

behaviors to become competent in their adult life. Sexuality and reproductive health

are considered taboo and are not open for discussion in most of South Asia. Despite a

significant proportion of young people being sexually active irrespective of their

marital status, data on adolescent reproductive and sexual health in South Asia is

limited (UNFPA 2015), for developing planned and targeted intervention programs

for adolescents. Increasing access to social media, urbanization, globalization,

migration, changing social structure and values are affecting the sexual norms and

behaviors of adolescents. Access to information from diverse sources comes in

conflict with the traditional conservative socio-cultural attitudes towards sexual

behavior and gender norms. Yet, most adolescents are ill-prepared for their transition

into adulthood. They often lack adequate knowledge and life skills to negotiate safe

and consensual relationships and access reproductive health services and commodities

needed to avoid unsafe sex and its consequences. A large proportion of adolescent

girls also report coerced sex and sexual violence (UNFPA 2015).

Adolescent pregnancy is a significant risk for the reproductive health of adolescent

girls. It is a considerable contributor to pregnancy and childbirth-related health

complications, which is a leading cause of death among adolescent girls worldwide

and more so in South Asian Countries. Survey results suggest that in the developing

regions around the world, approximately 16 million women aged between 15 and 19

years become mothers. The causes range from forced early marriage at the age of

puberty, lack of education, poverty, and social pressure to become a mother. Research

suggests that adolescent motherhood may lead to gynecological and other

complications at a later stage. Adolescent mothers are more likely to die during
childbirth than nonadolescent mothers (Stover et al. 2016). Within South Asia, there

is some divergence in teenage pregnancy data. Afghanistan recorded 87 adolescent

births (per 1000 women aged 15–19 years), and Sri Lanka recorded the lowest in the

region at 20.3 births per 1000 women (WHO 2018). Studies on adolescent pregnancy

from countries like Nepal, Bangladesh, India, and Sri Lanka are very limited and there

is almost total absence of any studies from Pakistan, the Maldives, or Bhutan. Thus, it

reduces the degree of generalization of the findings to the whole of South Asia. One

may speculate that reasons for a lack of such studies to the same socio-cultural factors

which do not consider adolescent pregnancy as a public health issue. Secondly, the

parameters adopted in different studies on adolescent pregnancy are so diverse that it

becomes almost impossible to draw some definitive conclusions from these studies.

To reduce adolescent pregnancy, the World Health Organization (WHO) in 2011 had

come up with specific guidelines and suggested minimum age of marriage to be

limited to18 years, promoting the idea of women becoming mothers after attaining 20

years of age, increasing contraceptive use, reducing unsafe abortion, and increased

institutional delivery, and both antenatal and postnatal care (Darroch et al. 2016a; Raj

and Boehmer 2013). These steps might reduce 2.1 million unplanned births, 3.2

million abortions, and 5600 maternal deaths annually. In most South Asian countries,

the legal age for marriage is 18 years. Yet, in certain communities, this law is often

violated due to socio-cultural factors like the family structure, gender-bias, taboos

around discussion on sex and sexuality. These violations have a significant impact on

adolescent pregnancy. In parts of South Asia, family often means members of the

extended family living together under one roof. The elderly male members or the head

of the family have tremendous power over others, particularly over the female

members in the family. The custom of child marriage allows them to continue with
the subjugation of women. Secondly, being a taboo topic, sex, and sexual activity is

rarely discussed with parents and elders. School education does not permit discussions

on sexual health leaving the female adolescents either in complete darkness or

exposed to misleading information about sex and sexual health. The trauma of

adolescent pregnancy can get exacerbated with the attendant issue of single

motherhood. The single mother is often deprived of financial and emotional support

because of ostracization by her family and the community. Teenage pregnancy may

lead to several medical complications like anemia, hypertension, genital tract

infection, to mention a few. The babies born to teenage mothers are likely to suffer

from low birth weight, accidental trauma and poisoning, minor acute infections, lack

of immunization or vaccinations, and developmental delays (Johnson 2011). Thus,

female adolescents are the most vulnerable and at the receiving end of the ill effects

of early marriage and consequent pregnancy (Agampodi et al. 2008)

Adolescent pregnancy (occurring < age 20) is considered a public health problem that

creates and perpetuates inequities, affecting not only women, but societies as a whole

globally. The efficacy of current approaches to reduce its prevalence is limited. Most

existing interventions focus on outcomes without identifying or addressing upstream

social and biological causes. Current rhetoric revolves around the need to change

girls’ individual behaviours during adolescence and puberty. Yet, emerging evidence

suggests risk for adolescent pregnancy may be influenced by exposures taking place

much earlier during development, starting as early as gametogenesis. Furthermore,

pregnancy risks are determined by complex interactions between socio-structural and

ecological factors including housing and food security, family structure, and gender-

based power dynamics.

Between 2010 and 2018, the Philippines had a 203% increase in new human

immunodeficiency virus (HIV) infections. The use of condoms is an effective and

practical means to prevent HIV transmission. The purpose of this study was to

identify facilitators and barriers to condom use among Filipinos guided by the

Ecological Model of Health Promotion.

An estimated 25 million unsafe abortions have taken place around the globe in 2019,

and nearly four million of these are adolescents aged 15–19. Similarly, in the

countries under study: Cambodia, Lao People's Democratic Republic (Lao PDR),

Myanmar, Thailand and Vietnam still experience high adolescent birth rates and

unplanned pregnancies, the leading cause of abortion. Furthermore, adolescents also

encounter challenges in obtaining contraceptives and seeking advice. Due to the

increasing size of the adolescent populations in the countries under study, attention is

needed to understand their health and wellbeing, particularly their sexual reproductive
health experience. Thus, it is essential to explore adolescent knowledge, attitudes, and

contraceptive use in the selected countries, which could help to identify the gaps in

accessing health-related information.

Despite the existence of laws and policies, full realization of sexual and reproductive

health and rights (SRHR) and gender equality continues to be a challenge in the

Philippines. Hence, civil society organizations explore different strategies to improve

reproductive health (RH) service delivery and to create safe spaces for women. To

understand these efforts further, this study will examine four themes among the best

practices of civil society organizations: education, male engagement, empowerment

and advocacy. Here, I will explore some of their experiences in educating the

community about their SRHRs, enhancing male responsibility on reproductive health,

empowering gender-based violence victims and contextualizing global campaigns for

local women’s activism.

In developing countries, sexual and reproductive health care (SRH) services are

primarily female centered, and the presence of men in SRH clinics, especially those

offering specifically family planning (FP), is negligible (Porche, 2012), and various

barriers to access and accept SRH services exist for men. Gender dynamics and men’s

disapproval of FP methods have a significant negative impact on levels of

contraceptive use in many countries (Hossain et al., 2007; Islam et al., 2006; Withers

et al., 2015). Although there is increased recognition that men often want to be

involved in FP services, the focus on integrating them into SRH/FP programs has

been limited (Sternberg & Hubley, 2004).

The Philippines is the 13th most populated country in the world, with a population

predicted to reach 125 million by 2030 (World Population Prospects, 2022). As of

2013, one in 10 Filipino women aged 15 to 19 were mothers or bearing children, and

78% of youth who were participating in premarital sex were not using protection

(GALANG Philippines, 2016). In the Philippines, men’s involvement in SRH/FP has

faced challenges, despite international advocacy for the involvement of men, as equal

partners, in reproductive decision making (Asian-Pacific Resource and Research

Centre for Women [ARROW], 2022). The Filipino government introduced women-

focused FP services in the 1970s through the Philippine Population Program with the

primary objective of achieving population control and subsequent poverty alleviation

(Lee, 1999). In 1978, national-level policy efforts began to focus on men’s

involvement, but opposition to modern FP methods by powerful Catholic groups

diminished those efforts throughout the 1980s (Genilo, 2014). In 1994, the

International Conference on Population and Development (ICPD) working group

comprising representatives from more than 180 countries (including the Philippines)

developed the ICPD Programme of Action, which formally acknowledged the

importance of men’s involvement in women’s and men’s reproductive health and

advocated for a holistic approach to SRH that would include men by focusing on

partners (Ketting, 1996). These ICPD goals remain unmet as most Filipino programs

and services have been directed at women’s engagement (ARROW, 2005), including

the Reproductive Health Bill of 2012, which concentrated on expanding women’s

reproductive health rights and women-centered services (Philippine Commission on

Women, 2012). Although the need for men’s involvement in SRH/FP has been

acknowledged within policies that advocate for men’s inclusion, as of the writing of

this article, men’s full involvement in and shared responsibility for FP decision
making has not been realized within the Philippines (Clark et al., 2010; Hardee et al.,

2017).

Despite challenges, there has been a positive shift in attitudes in developing countries

throughout Asia toward engaging men in FP methods (Bietsch, 2015; Kaida et al.,

2005). This shift provides an opportunity to develop evidenced-based approaches to

improve the integration of men into FP services by addressing care delivery from a

family-focused perspective. Men’s participation in comprehensive FP services is

crucial to ensuring successful FP programs that promote women’s empowerment and

positive outcomes in reproductive health (Kassa et al., 2014). Cultural changes in

perception of FP can influence assumptions about traditional masculine roles and

encourage initiatives focused on promoting more equitable SRH/FP decision making

between men and women (Helzner, 1996). Although there are many contextual

factors (e.g., gender roles, moral beliefs, social influences) that must be understood to

develop robust and well-received FP programs that more actively engage Filipino

men (Medina, 2001; Gipson et al., 2012; Lee, 1999), there is a dearth of research that

investigates these various influences and factors within the Philippines (Porche,

2012).

Greater attention to teen mothers’ strengths and aspirations has generated interest in

their resilience. An integrative review of the research was undertaken to determine

how teen mothers’ resilience, risks, and protective factors are conceptualized across

methodological approaches. In total, 10 databases were searched in 2021 to identify

relevant studies. Of the 32 studies meeting criteria, the majority were conducted in the

United States. Qualitative studies mined teen mothers’ accounts for resilient

processes, adversities, and protective factors while quantitative studies

operationalized variables based on the resilience framework. The studies in this

review present a more balanced and contextual perspective on teen mothers and

suggest broader notions of their competence, success, and vulnerabilities. Several

studies draw attention to the potential costs of resilience and the heterogeneity of teen

mothers.

The concept of Reproductive Health (RH) is intertwined with health needs in respect

to social and cultural contexts. Despite the uniqueness of reproductive health

perspective and practices of Mountain Province (MP), it was not well recognized and

understood in the delivery of RH programs and services more so it was not

documented and published. In social and health services, indigenous peoples face

great challenges particularly on reproductive health [1]. Indigenous Peoples (IP)

represent a rich diversity of cultures, religions, traditions, languages and histories, yet

they continue to be among the world's most marginalized population groups [2].

Worldwide however, IPs are one of the poorest and most vulnerable groups today,

despite their resiliency. Many are victims of racial discrimination and social

exclusion. Similarly, IPs are often deprived to the access on basic services like

healthcare [3]. Despite the political and academic interest on the knowledge and

practice of indigenous people on sexual and reproductive health, there is still lack of

awareness and understanding of RH concepts among policy makers, executives,

managers, and service providers of public health since these knowledge and practices

of IPs are still largely undocumented [4]. Despite recent strides in the equality of

Indigenous Peoples’ through international and national programs, RH has largely

been neglected [5]. While rural health units continue to advocate for RH, health

workers and policy makers have executed a generic approach and have left traditional

or indigenous tenets on RH unconsidered [1]. The Responsible Parenthood and

Reproductive Health Act of 2012 [6], is considered as a landmark ruling which

recognizes the basic human right of Filipinos to RH. Despite being ideal by design,

there are documented and undocumented issues on the implementation of RA 10354.

These seem to suggest the lack of positive impact of 10354.The Philippines is at a

turning point where it is slated to reap the benefits of health research investment

towards the country’s economic, social, and scientific growth [7]. In 2017 for

instance, during a consultation in the Cordillera Administrative Region (CAR), the

Regional Unified Health Research Agenda (RUHRA), included Indigenous Peoples’

Health and; Sexuality and Reproductive Health as among the priority. Achieving

health for these indigenous groups require multi-sectoral linkages and efforts and

active community participation [8]. This inquiry on perspective and practices on RH

of the IP of MP is an avenue to guide effective RH policy development and

implementation. Leaders and policy makers can use this study in developing and

evaluating public resources to improve the reproductive wellbeing of IP. Healthcare

stakeholders can likewise be more aware on possible ways to design and promote

viable and meaningful programs that encompass appropriate mechanisms, vertical and

horizontal linkages, and participatory approaches for IP.

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