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CHAPTER I

INTRODUCTION

Background and Rationale The news of pregnancy is a source of joy for couples because it signifies the coming of a new member of the family. Pregnancy, however, can become a burden and cause a worry if it occurs to unmarried couples, more so if they are adolescents. Pregnancy in adolescents (aged 19 years and below) is a global problem that cuts across the different levels of socioeconomic class, race and ethnicity. Every year, approximately 15 million young women give birth. This comprises more than 10 percent of all births worldwide. In less developed countries, adolescents account for 17 percent of all births, while among developed countries, U.S. has one of he highest rates (19 percent) of teen childbearing (Noble, J. et al, 1996). In the Philippines, adolescent pregnancy with its obstetrical consequences was only studied a decade ago and perceived as a serious problem because of the effects of early childbearing (National Demographic Surveys, 1993). Consequences of adolescent childbearing are that adolescent mothers and their children are vulnerable to economic, health and educational difficulties. Younger mothers are less likely to receive adequate prenatal care and to deliver normal birth weight babies. Pregnant teenagers have many obstacles ahead of them. With regards to education, seven out of ten girls who become pregnant are unable to successfully support themselves and their children. After birth, it

2 becomes more difficult to get an education that will help them find a good job. Since child care is expensive, the result of these obstacles is a high dependency on the extended family. Children of teenage parents are more likely to have health and cognitive disadvantages and to be neglected or abused. Iloilo has 288 incidence of teenage pregnancy in 2007 and the top three municipalities are: Oton (124), Lambunao (84) and Miag-ao (80). Other municipalities with high incidence of teenage pregnancy are Leon, Pototan, Carles, San Dionisio, Sara, Cabatuan and Barotac Viejo. This study hopes to generate valuable information about health outcome of adolescent mothers and their child in Barotac Viejo, Iloilo.

Objectives of the Study Generally, this study will be conducted to determine the factors associated with the health outcome of teenage mothers and their child. Specifically, this study aims to determine: 1. the educational attainment, family monthly income and support system of mother 2. the health status of teenage mothers and their children 3. if factors such as educational attainment, family monthly income and support system have significant relationships on the health outcome of mothers and their children

Hypotheses Educational attainment, economic status and support system of mothers have no significant relationships on the health outcome of mothers and their children.

3 Theoretical Framework According to the life options model, disadvantaged youths do not perceive themselves as having positive life options and therefore do not plan for their future and do not avoid barriers to that future such as early out-of-wedlock childbearing (Dryfoos, 1984). If disadvantaged youths do not perceive that doors are open to them, it is perhaps difficult for them to see teen pregnancy as closing any doors. Specifically, it explored the relationship between internal and external poverty (low educational and occupational aspirations and poor personal efficacy) and adolescent pregnancy.

Conceptual Framework Three factors such as family monthly income, support system, and educational attainment are considered to have a great influence on teenage pregnancy and could strongly be related to the health outcome of the mother and child. Having a child means responsibility. Many things should be taken into consideration to assure the health of the mother and the child after birth. One of which is the family monthly income of the direct provider of the mother. Because of financial insufficiency, mothers fail to avail of health services that are very much vital for the nourishment of both the mother and child after birth. Aside from providing the basic needs of both the mother and the child, the family has a big role in motivating the teenage mother to continue the pregnancy. Thus, proper upbringing will be given to the child.

Figure 1.1.Schematic Flow of Relationships between Variables INDEPENDENT VARIABLES Educational Attainment Family Monthly Income Support System DEPENDENT VARIABLE Health outcome of teenage mother and their child

4 Variables of the Study and their Operational Definitions Educational attainment. Highest level of education graduated from. It was categorized as primary level (grade six graduate), secondary level (fourth year high school graduate), tertiary level (college graduate). Family monthly income. This refers to the total family income per month during pregnancy. Support system. This refers to the emotional support the teenage mother got from the immediate family, relatives and significant others during pregnancy. Health outcome of mother. Refers to the health status of the mother after delivery up to one year. As used in the study, this was evaluated if the mother has or had these common illnesses such as iron deficiency anemia, hypertension, sexually transmitted disease, urinary tract infection and others. Common behavioral outcomes were also included such as depressive disorder and alcohol and substance abuse. It was categorized according to the number of illnesses attained: no complication, one complication, two complications and three complications. Health outcome of child. Health outcome refers to the status of child from the time of birth up to one year. As used in this study, this was evaluated if the child has or had any of these illnesses: mumps, measles, chickenpox, iron-deficiency anemia, asthma, infection and others. It was categorized according to the number of illnesses attained: no complication, one complication and two complications.

5 Significance of the Study Teenage pregnancies and childbearing are a source of increasing concern because of their impact on the young mothers themselves, on their infants in society at large. It is envisioned that the results of this study can bring into light the factors associated with the health outcome of teenage mothers and their child at Barotac Viejo. The results of this study can also benefit the adolescents, the parents, and health care providers. Adolescents. Knowledge about problems and untoward outcomes of early childbearing can guide adolescents to act responsibly in sexual matters, to delay pregnancy and childbearing to improve their quality of life. They can also work with parents, community leaders, and health care providers to design mutually acceptable approaches to meet their own reproductive health needs. Parents. Information about adolescent pregnancy can help parents understand their childrens problems better and help them understand and cope with their adolescent childrens physical, social and emotional needs, as they go through this critical stage of growth and development. The family as a whole plays an important role in the socialization of the youth, therefore, education and sexuality and reproductive health must start at home. Health Care Providers. Knowledge of pregnancy problems and its influence on the outcomes of adolescent pregnancies will benefit health care providers especially doctors, nurses, and midwives. They can use the result of this study as bases for planning and providing preventive, promotive, curative, therapeutic, rehabilitative health care for pregnant teenagers. Lastly, future researchers can be guided on how much have been investigated and explored about teenage pregnancy.

6 Scope and Limitation of the Study This is an investigation of the factors associated with the health outcomes of teenage mothers and their child in Barotac Viejo, was conducted on December 2008. This study involved 38 mothers who had their first pregnancy when they were still teenagers. Mothers aged 20 and below, at present, were the respondents of the study. Data was generated through structured interview. Considering the status of the subjects and the nature of the investigation, researchers obtained the consent of the mothers included in this study and to protect the privacy, their names were not revealed or mentioned in the study.

7 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

Teenagers who become parents are known to experience greater educational, health, social and economic difficulties than young people who are not parents. Teenage mothers are less likely to receive prenatal care and their children are more likely to be born with complications. Teenage mothers are more likely not to complete their education than moms over twenty years of age.

Teenage Period Teenage is the period between 13 to 19 years, a time that serves as a transition between childhood and adulthood. It can be divided into an early period, a middle period, and a late period. During all periods, adolescence is defined not so much by chronologic age as by physiologic, psychological, and sociologic factors. The drastic change in physical appearance and the change in expectation of others (especially parents) that occur during the period may lead to both emotional and physical health problems. Adolescents invariably feel a sense of pressure throughout this period because they are mature in some respects but still young in others. For example, adolescent sexual interests are awakening. Yet personal or parental pressures discourage sexual exploration. This duality causes a major dilemma for an adolescent, leading to many of the growth and developmental concerns of the age.

8 There is such a strong adolescent subculture today parents may feel from the minute their child enters the teenage years that all communication stops. Parents may expect difficulty guiding a child or understanding teenage values, as though entering this period locks an adolescent into a shell or pulls down a curtain between child and parents. This can become a selffulfilling prophecy, whereby the parents actually cause the communication breakdown. At other times, communication problems can begin when a teenager refuses to respect parents opinions or stops asking for them. Many of the problems adolescence bring to healthcare personnel arise from this communication impasse, no matter how it started. They often come to healthcare facilities with many misconceptions, seeking adult help and guidance (from http://www.answers .com/topic/teenage-pregnancy).

Teenage Pregnancy Teenage pregnancy is not a new phenomenon; historically, it was common for women to marry at an early age and have a first baby during adolescence. In todays society, however, marriage and childbearing during teenage years are not encouraged. New educational programs on the importance of delaying pregnancy have decreased the number of births in the United States to girls under age 18 years from a rate of 117/1000 to 41/1000, but this number is still higher than that of other industrialized countries (Davis, 2003). Reasons for this high number include earlier age of menarche in girls (many girls begin menstruating at age 10 and so are ovulating and able to conceive by age 11), increase in the rate of sexual activity among teenagers, lack of knowledge about (failure to use) contraceptives, and desire by young girls to have a child. The principal risk factors associated with teenage pregnancy, such as socioeconomic deprivation; limited involvement in education; low educational attainment; limited

9 access to consistent, positive adult support; being a child of a teenage mother; low self esteem; and experience of sexual abuse, are to be found more often in the looked after population than among children and young people who are not in care (from http://www.scie.org.uk/publications /briefings/briefing09/index.asp) At one time, pregnant unmarried girls were sent to a secret home or shelter where they would stay through the pregnancy, give birth, place the child for adoption, and return home as if nothing had happened to them. But something did happen, as much as the girl and her family wanted to pretend it did not. Often, the girl was affected psychologically because she developed a relationship with the stranger inside her and then had to give the newborn away and never mentioned him or her again. Today, pregnant girls attend prenatal clinics or come to physicians offices just as older women do. They deliver in birthing rooms at hospitals, and as many as 90% keep their babies (DHHS, 2000). Few give birth in alternative birth centers because adolescent pregnancies are considered high risk. Home birth is not recommended for the same reason. Offering increased guidance during pregnancy and for the following year can be an important nursing role (Koniak-Griffin et al., 2003).

Developmental Task of Pregnant Adolescents Adolescent is a vulnerable time for pregnancy because the developmental tasks of pregnancy are superimposed on those of adolescence. A girl in the process of separating from her parents may be devastated by knowing that in less than a year someone will be dependent on her. When she realizes that she is pregnant, she may have decreased ability to separate from her parents because she needs their financial help more than ever to obtain prenatal care and to buy clothing for her new baby.

10 Parents may have difficulty allowing their daughter to make her own health care decisions this way. You may need to remind them that a pregnant adolescent be regarded in permission for her own care. Soon she will be caring for an infant, so she needs this practice in independence. Pregnancy may interfere with the development of a healthy sexual relationship and cause difficulty in establishing future intimate relationship if the girl realizes that her current relationship has led to a situation detrimental to her. Encouraging her to continue school is crucial to her self-esteem and to her future, as well as to the future of her unborn child (from http://www.womenshealthchannel.com/teenpregnancy/ index.html).

Maternal and Child Health Outcome Pregnant teens themselves are at greater risk of health problems including, for example, anemia, hypertension, renal disease, eclampsia, and depressive disorders. As well, teenagers who engage in unprotected sex are putting their own health at risk of sexually transmitted infections. Young mothers and their babies are also at greater risk of contracting HIV. The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than those between the ages 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as Sub-Saharan Africa. Risks for medical complications are greater for girls 14 years of age and younger, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labor is normally dealt

11 with by Caesarean section in industrialized nations; however, in developing regions where medical services are unavailable, it can lead to eclampsia, obstetric fistula, infant mortality or maternal death. For mothers of their late teens, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology. Early motherhood can affect the psychological development of the infant. The occurrence of developmental disabilities and behavioral issues is increased in children born to teen mothers. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling and verbal communication, or to be sensitive and accepting toward his or her needs (from http://www.answers .com/topic/teenagepregnancy). Teen mothers are considered high risk clients because they have the high incidence of pregnancy-induced hypertension and iron deficiency anemia. They also have higher incidence of preterm birth, with low-birth weight infants, and high rate of intimate partner abuse. They are at an increased risk for pregnancy-induced hypertension, probably due to immature blood vessels. Teenage pregnancy carries an increased incidence of pregnancy-induced hypertension, iron-deficiency anemia, preterm labor and cephalopelvic disproportion. Common complications are pregnancy induced hypertension because adolescents are more prone than the average woman and iron deficiency anemia because many adolescents girls are deficient in iron because their low protein intake cannot balance the amount of iron lost with menstrual flow (Moldenhauer and Sibai, 2003).

12 Educational Attainment and Maternal and Child Health Outcome Teen mothers are more likely to drop out of high school than girls who delay childbearing. With her education cut short, a teenage mother may lack job skills, making it hard for her to find and keep a job. Teen mothers need a great deal of health teaching during pregnancy because they do not know many common measures of care that an older woman has learned from experience (from http://www.marchofdimes.com/professionals/14332-1159.asp). Many teenage parents live below the poverty level and rely on welfare. The children of teenage parents receive inadequate medical care, have more problems in school, and spend more time in prison then children of adult parents (from http://www.bookrags.com/researchtopics/ teenage pregnancy/). Educational achievement had a significant and powerful effect on the age of first birth, the more years of education completed the older the age at first birth. The causal effect of age at first birth on educational achievement was also positive, though insignificant. Due to knowledge deficit regarding pregnancy, teenage mothers and their child are at increased risk for a number of health risks. These include teenage mothers are less likely to gain adequate weight during their pregnancy, leading to low birth weight. Low birth weight is associated with several infant and childhood disorders and a higher rate of infant mortality. Low birth weight babies are more likely to have organs that are not fully developed, which can result in complications, such as bleeding in the brain, respiratory distress syndrome, and intestinal problems (from http://www.womenshealthchannel.com/teenpregnancy/index.html). Pregnancy is an egocentric time when outside interests do not always seem important. Help her to see that the months of pregnancy will go faster if she is busy. Doing well in school is a way of keeping busy. It is also important in preparing an adolescent for the future, because a

13 high school education is necessary to obtain marketable skills to support herself and her baby. Once she has given birth, returning to school is difficult because she may have child care problems and because she may feel she is more mature than the other girls (or other girls may make her feel this way).

Family Monthly Income and Maternal and Child Health Outcome Teenage pregnancy also has economic consequences. Childbearing may curtail education and thereby reduce a young womans employment prospects in a job market that requires ever higher levels of training. In addition, recessions in the early 1980s and 1990s meant that to maintain an adequate standard of living, dual earning became the norm in many Canadian households. But teenagers, who give birth, particularly at ages 15 to 17, are likely to be single. Consequently, most teenage mothers lack a partner to contribute to the household income (from http://www.statcan.ca/english/kits/preg/preg3.htm). A teenage mother may become financially dependent on her family or on public assistance. Teen mothers are more likely to live in poverty then women who delay childbearing. (from http://www.marchofdimes.com/professionals/14332-1159.asp) The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. Studies have indicated that young mothers who are given high-quality maternity care have significantly healthier babies than those that do not. Many of the health issues associated with teenage mothers, many of whom do not have health insurance, appear to result from lack of access to high-quality medical care. Due to low economic many pregnant teens are subject to nutritional deficiencies from poor eating habits. Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries.

14 Complications of pregnancy results in the deaths of an estimated 70,000 teen girls in developing countries each year.

Support System and Maternal and Child Health Outcome Teen mothers come disproportionately from poor inner-city populations rife with unstable, broken families. Children of such mothers are more likely to have health and learning problems, and thus to underachieve and place a burden on social services for years to come. Belsky thinks the theory hes helped formulate has something to say about this mess. In his view, the unstable early environment of many an inner-city teenage girl produces earlier puberty and the whole range of attendant opportunistic behavior that ends in an increased risk of pregnancy. These teenagers arent necessarily carrying out bad behavior, he says. Their bodies are just responding to forces that have emerged over the course of evolution. (Discover the World of Science, 1992). Teenagers have a strong need for peer companionship. When they become pregnant, they often are cut off from fellow adolescents. They may leave home if their family disapproves the pregnancy, joining the ranks of homeless or adolescent runaways. Others do not leave home, but separate themselves emotionally from their family. Trying to manage by themselves leaves young girls with tremendous financial strain and a devastating sense of loneliness. Because of family relationship problems, a girl may need help in making arrangements for the next few months of her pregnancy and for a child care afterward. Family and social supports for pregnant adolescents have been shown to be important influences on maintenance of a healthy pregnancy lifestyle and help prevent low-birth weight in their children.

15 The teens also learn about developing a strong support system. That could mean distancing themselves from friends and acquaintances who engage in harmful behavior. Teens tend to absorb those lessons more easily in a group setting. The group helps them feel supported and enables them to learn in a less-threatening environment. They also are able to learn from each others experiences and question. Studies have shown that babies born to teen mothers who participate in group visits have a lower incident of low birth weight. Teen pregnancy support program will increase breastfeeding, a decrease3 in repeat pregnancy during teen years and healthier choices during pregnancy. That was when the teen pregnancy program was launch (from http://www.ucdmc.ucdavis.edu/welcomr/features/200621_teen_moms/index.html). Every pregnant teenager, teenage mother and teenage father should have access to a dedicated personal adviser provided through Childrens Trusts. Individual needs should be assessed and a package of support coordinated, linked to specialist education, health and housing services, and continued until the young person is able to conduct his/her affairs independently. To ensure continuity of care, maternity services should provide advisers with details of teenage parents (with their consent). Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment (from http://www.womens healthchannel.com/teenpregnancy/index.shtml).

Synthesis All the data gathered support that the health outcome of the mother and the child are affected by several factors such as the educational attainment, the family monthly income and the support system of the mother after teenage pregnancy.

16 CHAPTER III

METHODOLOGY

This chapter discusses the research design, the process used in the identification of the study population, data collection and the instrumentation, data processing and data analysis.

Research Design This study which employs a one-shot survey design is a prospective investigation of the pregnancy problems and its relationships to the pregnancy outcomes among adolescent mothers at Barotac Viejo. Data were obtained through personal interviews with the respondents. Based on the nature and objectives of the study, the descriptive relational analysis was used. In this study, the researcher described the factors associated with the health outcome of the mother and the child.

Study Population This study was conducted in Barotac Viejo. Thirty-eight mothers who had their first pregnancy when they were still teenager and their children were the respondents of this study. The mother had a maximum age of twenty one at the conduct of the study and the childs health outcome was based on the first year after birth.

17 Data Collection and Instrumentation The data of this study were obtained through structured interview. Instruments were constructed based on the objectives of the study. The interview schedules generated information about the identification and personal background of the respondents. A letter was sent to the Barangay Captain of Barangay Poblacion, Barotac Viejo and also to the respondents of the study, which stated the purpose and the assurance of the confidentiality of the information that will be obtained in the study. The interview schedule was validated through jury validation or by the analysis or opinion of an expert or any person who can render intelligent judgment in order to check the adequacy and appropriateness of the content and format of the instrument. It was also pre-tested in Barangay San Pedro, San Jose, Antique last December 6-7, 2008 prior to actual data collection. Considering the nature of the study and the status of the study subjects, who for some were not yet of legal age, an informed consent was obtained for ethical reasons. The purpose, nature of study, and how data will be obtained was explained to both the respondent and a responsible member of her family, preferably her mother or father and if married, her husband. The respondent was requested to sign a consent form provided by the researcher, with her husband, mother, father or any responsible member of her family present to sign as witness. The researcher observed utmost precaution to protect the identity of the study subjects.

Data Processing and Analysis Upon completion, the instrument was reviewed by the researchers to ensure completeness of the data gathered. The collected data were computer processed. The Statistical Package for

18 Social Sciences (SPSS) was utilized for the processing and analysis of data. Analysis of the data was descriptive and inferential. For the descriptive analysis, frequency distribution was used. To determine the relationship among factors such as educational attainment, economic status, support system and health outcome of mother and child, the chi-square test was used. The results of the statistical analysis were tested at a 0.05 level of significance.

19 CHAPTER IV

RESULTS AND DISCUSSIONS

This section presents the findings of the study. The first part includes the respondents characteristics in terms of educational attainment, family monthly income, support system, maternal health outcome and child health outcome. The second part presents the results of the relational analysis between maternal health outcome and a.) educational attainment b.) family monthly income c.)support system, and relational analysis between child health outcome and a.) educational attainment b.) family monthly income c.)support system

Characteristics of Respondents In the year 2007, out of 684 total number of births in the province of Iloilo, there were 47 (6.7%) total number of births delivered by teenage mothers in Barotac Viejo, Iloilo aging 13 to 19 years old. Of this number, 38 teenage mothers were interviewed as respondents of the study. The remaining nine (9) were not included in the study due to change of residence at the time the study was conducted.

Factors The respondents are distributed according to the factors; educational attainment, family monthly income and support system related to the maternal health outcome and child health outcome.

20 Educational Attainment In Table 1, a half (50%) of the respondents were primary level graduate because most of them got pregnant at the age of 19 years old, thus most of them stopped going to school. There were (39.5%) of adolescent mothers who were secondary level graduates. Only a small proportion (5.3%) was tertiary level graduates and two out of 38 did not avail an education at all.

Table1. Distribution of the Respondents as to Educational Attainment Educational Attainment No Schooling Primary Secondary Tertiary Total f 2 19 15 2 38 % 5.2 50.0 39.5 5.3 100

Family Monthly Income The data in Table 2 shows that (63.2%) of the respondents earned a monthly income below 3000 pesos, while the smallest proportion of the respondents (10.5%) earned a monthly income above 6000 pesos. A little over one-fourth of the respondents (26.3%) earned a monthly income that ranges from 3000 to 6000 pesos.

Table 2. Distribution of Respondents According to Estimated Family Income Per Month Estimated Family Income Below PhP 3,000 PhP 3,000-5,999 Above Php 6000 Total f 24 10 4 38 % 63.2 26.3 10.5 100.0

21 Emotional Support In terms of emotional support, the data in Table 3.a shows that the emotional support is mainly given by the immediate family members. Focusing on the immediate family members, 23 (60.5%) were supported by their own mothers and only 15 (39.5%) were given emotional support by their father. The majority of teenage mothers were supported by their boyfriend or husband (63.2%) as shown in Table 3.b. Ten of the respondents are being supported by their mother/father-in-laws as members of the relatives. Both friends and classmates got the least percentage (2.6%) of emotional support given to teenage mothers.

Table 3.a Distribution of Respondents According to Emotional Support Emotional Support Family Relatives Significant others Without emotional support f % 12 31.6 24 63.2 14 36.8 With emotional support f % 26 68.4 14 36.8 24 63.2

Table 3.b Distribution of Respondents According to Emotional Support (Multiple Response) Emotional Support Support from Family Father Mother Brother Sister Support from Relatives Uncle Aunt Cousins Mother/Father-in-Law Support From Significant Others Boyfriend/Husband Classmates Friends f 15 23 5 6 2 4 2 10 24 1 1 % 39.5 60.5 13.2 15.8 5.3 10.5 5.3 26.3 63.2 2.6 2.6

22 Maternal Health Outcome The data in Table 4.a shows that half of the respondents had no complications while only two out of the 38 respondents had 3 complications. From the Table 4.b, majority (63.16%) of the respondents developed complication of the Iron Deficiency Anemia. There was a small portion (26.32%) who had acquired urinary tract infection while (15.79%) experienced depressive disorder after they had their first delivery. Very few (10.53%) of the respondents underwent pregnancy induced hypertension.

Table 4.a Distribution of Respondents According to Maternal Health Outcome Classified by Number of Complications Maternal Health Outcome No complication One complication Two complications Three complications Total f 19 14 3 2 38 % 50.0 36.8 7.9 5.3 100

Table 4.b Distribution of Respondents According to Maternal Health Outcome Classified by Complications (Multiple Response) Complications Iron Deficiency Anemia Hypertension Depressive Disorders Urinary Tract Infections f 12 2 3 5 % 63.16 10.53 15.79 26.32

Child Health Outcome The distribution of the respondents according to the childs health outcome is shown in Table 5.a. The data shows that half (50%) of the children did not develop any complication up to first year of age. However, 42.1% of the children had one complication. Basing in Table 5.b,

23 majority (42.11%) of them had flu, 7 (36.84%) suffered from asthma, 6 (31.58%) had infection, 2 (10.53%) each developed mumps and measles and only one (5.26%) experienced chickenpox.

Table 5.a Distribution of Respondents According to Child Health Outcome Classified by Number of Complications Child Health Outcome No complication One complication Two complications Total f 19 16 3 38 % 50 42.1 7.9 100

Table 5.b Distribution of Respondents According to Child Health Outcome Classified by Complication (Multiple Response) Complications Mumps Measles Chickenpox Asthma Infection Flu f 2 2 1 7 6 8 % 10.53 10.53 5.26 36.84 31.58 42.11

Relational Analysis among Variables This section presents results of the relational analysis between the factors; educational attainment, family monthly income and support system and the health outcome of the mother and the child.

Educational Attainment and Maternal Health Outcome It can be seen in the Table 6 that the respondents whose level of education attained is primary tend to have no complications, since out of nineteen respondents under this category,

24 ten of which had no complication; almost half (7) of the respondents whose level education attained is secondary had no complication, moreover, same number of respondents under the said category had only one complication, only one had two complications. All respondents whose level of education attained is tertiary had only one complication. The table below shows that the p-value of 0.656 is greater than the fixed significance level, 0.05. Hence, there is no significant relationship between the health outcome of the mother and the level of education attained. The result suggests that the health outcome of the mother is not influenced by the level of education attained.

Table 6. Relationship between Educational Attainment and Maternal Health Outcome Level of Education Attained Secondary Tertiary Maternal Health No Education Primary Outcome f % f % f % f % No complication 2 100 10 52.6 7 46.7 0 0 One complication 0 0 7 36.8 7 46.7 2 100 Two complication 0 0 2 10.5 1 6.7 0 0 Total 2 100 19 100 15 100 2 100 G 2 ! 4.151, p-value= 0.656

Total f % 19 50 16 42.1 3 7.9 38 100

Educational Attainment and Child Health Outcome The cross tabulation table shows that seven respondents under the level of education attained category primary falls under those whose child did not experience any complications and also for only one complication. Three in every five of the respondents under the category secondary fall under those whose child experience a complication. The table below shows the Pearson chi-square test of relationship between level of education and child health outcome. The p-value of 0.668, signifies that there is no significant relationship between the level of education and child health outcome since the value is greater

25 than the set alpha level of significance, 0.05. The result further implies that he childs health outcome is more or less equally distributed across all categories of level of education.

Table 7. Relationship between Educational Attainment and Child Health Outcome Level of Education Attained No Education Primary Secondary Tertiary Child Health Outcome f % f % f % f % No complication 2 100 7 36.8 9 60 1 50 One complication 0 0 7 36.8 6 40 1 50 Two complication 0 0 3 15.8 0 0 0 0 Three Complications 0 0 2 10.5 0 0 0 0 Total 2 100 19 100 15 100 2 100 G 2 ! 6.701, p-value= 0.668

Total f % 19 50 14 36.8 3 7.9 2 5.3 38 100

Family Monthly Income and Maternal Health Outcome The Chi square test below shows that the p-value of 0.714 is greater than the preset alpha significance level, 0.05, thus there is no significant relationship between health outcome of the mother and estimated monthly income. This implies that the health outcome of the mother does not depend on the estimated monthly income. The number of respondents is almost equal across all categories under health outcome of the mother when categorized as to estimated family monthly income.

26 Table 8. Relationship between Family Monthly Income and Maternal Health Outcome Family Monthly Income Php3000Above 6000 Php6000 f % f % 5 50 1 25 4 40 3 75 1 10 0 0 10 100 4 100

Below Maternal Health Outcome Php3000 f % No complication 13 54.2 One complication 9 37.5 Two complication 2 8.3 Total 24 100 G 2 ! 2.120, p-value= 0.714

Total f 19 16 3 38 % 50 42.1 7.9 100

Family Monthly Income and Child Health Outcome The table below shows the distribution of childs health outcome according to estimated family income, emotional support from the family, emotional support from the relatives, and emotional support from significant others. The chi-square tests reveal that there is no significant relationship ( 2=7.406) between childs health outcome and estimated family income since the pvalue (0.285) is greater than the specified level of significance, 0.05.

Table 9. Relationship between Family Monthly Income and Child Health Outcome Estimated Family Monthly Income Below Php3000Above Total Child Health Php3000 6000 Php6000 Outcome f % f % f % f % No complication 14 58.3 3 30 2 50 19 50 One complication 8 33.3 4 40 2 50 14 36.8 Two complication 2 8.3 1 10 0 0 3 7.9 Three Complications 0 0 2 20 0 0 2 5.3 Total 24 100 10 100 4 100 38 100 2 G ! 7.406, p-value= 0.285

27 Emotional Support and Maternal Health Outcome The tables below show the distribution of the mothers health outcome according to emotional support from the family, emotional support from the relatives, and emotional support from significant others. The chi-square tests reveal that there is no significant relationship ( 2=1.954) between the mothers health outcome and emotional support from the family since the p-value (0.376) is greater than the specified level of significance, 0.05; the same implications were followed for relationship between the mothers health outcome and emotional support from the relatives ( 2=4.373, p-value = 0.112); and the mothers health outcome and emotional support from significant others ( 2=2.078, p-value = 0.354). The mothers health outcome is equally distributed across different categories of emotional support from family, relatives and significant others; this means that not matter there is or there is no emotional support from family, relatives, or significant others, the number of respondents across different categories of the mothers health outcome is almost the same.

Table 10.a Relationship between Emotional Support from Family and Maternal Health Outcome Emotional Support from Family Without With Total Support Support f % f % f % 5 41.7 14 53.8 19 50 5 41.7 11 42.3 16 42.1 2 16.7 1 3.8 3 7.9 12 100 26 100 38 100

Maternal Health Outcome No complication One complication Two complication Total G 2 ! 1.954, p-value= 0.376

28 Table 10.b Relationship between Emotional Support from Relatives and Maternal Health Outcome Emotional Support from Relatives Without With Total Support Support f % f % f % 5 62.5 4 28.6 19 50 8 33.3 8 57.1 16 42.1 1 4.2 2 14.3 3 7.9 24 100 14 100 38 100

Maternal Health Outcome No complication One complication Two complication Total G 2 ! 4.373, p-value= 0.112

Table 10.c Relationship between Emotional Support from Significant Others and Maternal Health Outcome Emotional Support from Significant Others Without With Total Support Support Maternal Health Outcome f % f % f % No complication 7 50 12 50 19 50 One complication 7 50 9 37.5 16 42.1 Two complication 0 0 3 12.5 3 7.9 Total 14 100 24 100 38 100 2 G ! 2.078, p-value= 0.354

Emotional Support and Child Health Outcome The tables below show the distribution of childs health outcome according to emotional support from the family, emotional support from the relatives and emotional support from significant others. The chi-square tests reveal that there is no significant relationship ( 2=1.995) between childs health outcome and estimated family income since the p-value (0.573) is greater than the specified level of significance, 0.05; the same implications were followed for relationship between childs health outcome and emotional support from the relatives ( 2=2.450, p-value = 0.484); and childs health outcome and emotional support from significant others

29 ( 2=1.995, p-value = 0.573). The child health outcome is equally distributed across different categories of emotional support from family, relatives and significant others; this means that not matter there is or there is no emotional support from family, relatives, or significant others, the number of respondents across different categories of childs health outcome is almost the same.

Table 11.a Relationship between Emotional Support from Family and Child Health Outcome Emotional Support from Family of the mother Without With Total Support Child Health Outcome Support f % f % f % No complication 5 41.7 14 53.8 19 50 One complication 6 50 8 30.8 14 36.8 Two complication 1 8.3 2 7.7 3 7.9 Three Complications 0 0 2 7.7 2 53 Total 12 100 26 100 38 100 2 G ! 1.995, p-value= 0.573

Table 11.b Relationship between Emotional Support from Relatives and Child Health Outcome Emotional Support from Relatives of the mother Without With Total Support Child Health Outcome Support f % f % f % No complication 13 54.2 6 42.9 19 50 One complication 7 29.2 7 50 14 36.8 Two complication 2 8.3 1 7.1 3 7.9 Three Complications 2 8.3 0 0 2 5.3 Total 24 100 14 100 38 100 G 2 ! 2.450, p-value= 0.484

30 Table 11.c Relationship between Emotional Support from Significant Others and Child Health Outcome Emotional Support from Significant Others of the mother Without With Total Support Support Child Health Outcome f % f % f % No complication 9 64.3 10 41.7 19 50 One complication 3 21.4 11 45.8 14 36.8 Two complication 0 0 3 12.5 3 7.9 Three Complications 2 14.3 0 0 2 5.3 Total 14 100 24 100 38 100 2 G ! 1.995, p-value= 0.573

31 CHAPTER V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This study aimed to determine the relationship between the factors and the health outcome of teenage mothers and their child in Barotac Viejo. Specifically, this investigation sought to (a) determine the educational attainment, family monthly income and support system of mother; (b) determine the health status of teenage mothers and their children; (c) determine if factors such as educational attainment, economic status and support system has a significant relationships on the health outcome of mothers and child. This study was conducted in all the Barangays in Barotac Viejo, Iloilo City from December 26-28, 2008 and January 2-4, 2009 who had teenage mothers as of 2007. Major Findings of the Study From the analysis of the data gathered, the following findings are presented: 1. The majority of teenage mothers studied were primary level graduates only. 2. More than half of the teenage mothers have a family monthly income of less than 3000 pesos with Php 250 as the least income per month. 3. For the emotional support, the highest percentage of 63.2% is from the boyfriend/husband. The mother, for the immediate family members, gives the highest emotional support of 60.5% and the family gives the greatest emotional support of 81.6% to the teenage mother during pregnancy. 4. As far as pregnancy outcome is concerned, the majority of the teenage mothers did not suffer any complication after delivery. Most of them delivered normal babies. Moreover, no

32 significant relationship was found between educational status, family monthly income, support system and the health outcome of the mother. 5. Majority of the children did not develop any complication after one year upon delivery. The analysis shows no significant relationship exists between educational status, family monthly income, support system and the health outcome of the child.

Conclusions It was concluded that maternal and fetal outcomes are influenced by adequacy of continuous support from the adults around them, creating a sense of the opportunities before them, and providing a chance to develop the skills that will help them make the most of both current and future opportunities. It is therefore recommended that the findings of the study be presented to the office of DOH to serve as basis for maternal and child health programs that they should undertake specifically to meet the needs of pregnant adolescents. It is further suggested that in consultation with other government and non-government agencies, health care protocol be adopted and implemented by the local health centers to improve and strengthen delivery services to pregnant adolescents.

Recommendations After the investigation, the researchers suggest that: A. The family, as a vital foundation, should sustain the emotional and financial support all throughout the pregnancy of teenage mothers. Specifically, parents will make a great impact on the teenagers pregnancy. Parents shall encourage the adolescents to postpone sexual activity. They need to be well informed on the reproductive health bill.

33 B. The boyfriend/husband should maintain a confident and non judgmental relationship towards the girlfriend or spouse. C. Prenatal check-up should be consistently followed to maintain and improve the wellness of the child and the teenage mother. The social worker must play an important role in providing referrals and information as well as counseling regarding the pregnancy. D. Lastly, teenage pregnancy is a prevalent concern among the youths of today. Therefore, it is recommended for further study on wider areas.

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