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PETER JAMES B. VITUG
Family and Community Medicine
Pre-Resident Report
PREGNANCY PREVENTION
IN ADOLESCENTS
Introduction
Teenage Pregnancy
 Also known as Adolescent Pregnancy
 Pregnancy in human females under 20 years of age
 Can take place in pubertal females
Teen pregnancy"(2004) in Encyclopedia of women's health.
Incidence
 Annually 13 million children are born to women under age 20
worldwide
 90% in developing countries
 Complication of pregnancy and Childbirth – leading cause of mortality
among women between ages 15 to 19 years old
Save the Children Fund, UK 2019; https://www.savethechildren.org/
 Among young adult women age 20 to 24, 43 percent are already mothers
Results of the 2013 National Demographic and Health Survey (NDHS)
 One in ten young Filipino women age 15-19 has begun childbearing:
8 percent are already mothers
 One in five (19 percent) young adult Filipino women age 18 to 24 years had
initiated their sexual activity before age 18.
 Survey reveals that 15 percent of young adult women age 20 to 24 had their
first marriage or began living with their first spouse or partner by age 18.
in Philippines setting
Adolescent Pregnancy
 Major public health problem with lasting repercussions
 Community programs, responsible sexual behavior education, and
improved contraceptive counseling and delivery.
 Family physician plays a key role by engaging adolescent in confidential,
open, and nonthreatening discussions of reproductive health, responsible
sexual behavior and contraceptive use
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam
Physician. 2004 Oct 15;70(8):1517-1524/
Causes of Teenage Pregnancy
The Lack of Education on Safe Sex, Peer Pressure, Drugs, Alcohol and
Unprotected Sexual Intercourse
A sexually active teenager who does not use contraception has a 90%
chance of becoming pregnant within one year
Potential behavior pattern for a teenage girl becoming pregnant include:
 Early dating behavior
 High-risk behaviors
 Lack of support group
 Unhealthy environment at home
 Stress and depression
 Delinquency and criminal behavior
 Exposure to domestic and sexual violence
 Financial constraints
Allen, C., (2003).”Peer Pressure and Teen Sex
Impact of Teenage Pregnancy
 Less likely to graduate
 Low self-esteem and symptoms of depression
 Behavior and substance-abuse problems
 Lack resources to fully foster the emotional development and
enrichment of their children’s lives
Children of adolescent mothers are at greater risk of preterm birth, low birth
weight, child abuse, neglect, poverty, and death.
Infant mortality rate (i.e., deaths in infants younger than one year per 1,000
live births) is higher in children of teenage mothers than in other children
Mayor's. (2004)."` pregnancy and childbirth are leading causes of death in teenage girls in developing countries".
Save the Children Fund, UK (2019); https://www.savethechildren.org/
Effects of Adolescent Pregnancy
Health Effects
 Higher risk for anemia
 Pregnancy-induced hypertension
 Lower genital tract infections
 low birth weight babies
Social Effects
 Isolation guilt
 Stress
 Depression
 Low self esteem resulting in lack of interest in studies
 Limited job prospects and
 Lack of a support group or few friends to name just a few.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
ON THE CHILD
 Psychosocial development
 Developmental disabilities
 Behavioral problem
 Poor academic performance
ON THE MOTHER
 Affect one's education
 Drop out of high school
 Employment and social class
Impact on Adolescent Pregnancy
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
Strategies for Prevention
 Aim to improve the use of contraception and to modify the high-risk
behaviors associated with teenage pregnancy and STDs.
A. Youth Social Development
 target social and psychologic skills that are necessary to avoid high-risk
behaviors
 adolescents who delay sexual activity have high educational aspirations,
peers with similar norms, and parent-child relationships
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
Seattle Social Development Project
Designed to increase students’ social skills and attachment to school and family.
Eighteen elementary schools were assigned to receive intensive training or the usual
education curriculum.
Teachers and parents received annual training in proactive classroom management,
problem- solving skills, child behavior management, and drug use prevention in
adolescents
RESULT: 93 percent of the 349 participants intervention group compared to control group
 Had their first sexual experience later
 fewer lifetime sex partners
 fewer pregnancies
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
Children’s Aid Society - Carrera Program
600 disadvantaged New York City adolescents 13 to 15 years of age
RESULTS: 79 percent of participants at three years showed that the girls in the
intervention group had lower odds of being sexually active and of having been
pregnant
Teen Outreach Program (TOP)
695 high school students were randomized by classroom to TOP or no intervention.
Program participants had lower self-reported rates of teen pregnancy, school failure, course
failure, and school suspension at one year.
The program’s success might be a result of mentorship as well as increasing self-esteem
through volunteerism
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
B. Abstinence-only Program
Only certain way to avoid unmarried pregnancy, STDs, and associated
health problems; they may not teach about, endorse, or promote
contraception use.
Postponing Sexual Involvement (PSI) program
Five-session program taught by trained adults or teenagers.
7,340 students with varied racial backgrounds were assigned randomly to intervention
or control groups and were followed for up to 17 months.
RESULT: No significant difference in pre- and post-intervention self-reported scores on
the initiation of sex, frequency of sex, number of sex partners, use of condoms and
other birth-control methods, or reported pregnancy rates.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
C. Comprehensive Sex Education Program
Emphasizes abstinence as the most effective method of preventing pregnancy
and STDs
Discuss contraception as the appropriate strategy for persons who are
sexually active.
A review of 28 well-designed experimental studies found that most comprehensive sex-
education programs do not adversely affect the initiation or frequency of sexual activity, the
number of sex partners, or the reported use of condoms and other contraceptive methods.
Successful programs vary in their approach. Program characteristics that are important in
reducing risky sexual behaviors by teenagers
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
C. Sex and Contraceptive Counseling
Success in this regard could have a profound impact on teenage pregnancy rates:
85 percent among young couples who are sexually active for one
year without using contraception, and 15 to 30 percent of
sexually active teenagers do not use contraception.
Encouraged to engage all young people—boys and girls—in
open, nonjudgmental, and confidential discussions during
regular office visits.
Counseling should include complete and medically
accurate information on responsible sexual behavior.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
Family members are encouraged to be actively involved in sex education
efforts
AAFP and AAP recommend that physicians offer adolescent opportunity to
have their examination and counseling sessions separate from their parents
and guardians.
Confidentiality as “an agreement between patient and provider that information discussed
during or after the encounter will not be shared with other parties without the explicit
permission of the patient.” (Society for Adolescent Medicine)
AAFP, AAP, and AMA, recommends informing adolescents and their parents about the
requirements and limits of confidentiality, because some patients may refuse to give accurate
medical information without it
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
The AAFP, AAP, and AMA also advise to stress abstinence as the only
certain way to prevent pregnancy and STDs.
However, if an adolescent chooses to become sexually active, he or she must be
counseled on appropriate contraceptive options
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
American Cancer Society now recommends that cervical cancer screening
be delayed until three years after the onset of vaginal intercourse or no later
than 21 years of age.
Centers for Disease Control and Prevention recommends that all sexually active
women 25 years of age and younger undergo annual screening for chlamydial
infection.
AAP recommends intermittent screening for high-risk behaviors and STDs, and frequent
monitoring of the patient’s satisfaction with and ability to adhere to the plan.
Contraception adherence should be discussed at each visit
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
AAP advises physicians to educate all sexually active adolescents about the
availability and use of emergency contraception.
Emergency contraception is intended only for emergency use, is not as effective in preventing
pregnancy as regularly used hormonal methods, and does not protect against the transmission of
STDs.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
C. Counseling Male Adolescents
Teenage boys typically experience first intercourse at a younger age and have
more sex partners than teenage girls.
Most adolescent health clinics and education programs target the health of girls, with fewer
interventions aimed at boys.
A 1993 survey of publicly funded family planning clinics indicated that only 6 percent of
patients were male. Adolescent boys desire information about STDs, contraception,
pregnancy, and sexual health, but as few as 32 percent of sexually active boys receive this
information from their health care providers.
For an adolescent boy, the primary motivating factors for condom use include not only
pregnancy and STD prevention, but also partner desires, his perception of his ability to use
condoms
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
Several medical organizations endorse efforts to prevent teenage pregnancy and STDs.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
These guidelines are summarized and serve as a model for family physicians’ roles in
teenage pregnancy and STD prevention.
As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
 This adolescent period is hazardous for adolescent health due to absence of
proper guidance and counselling.
 Family has a crucial role in shaping the adolescents behavior.
 They have to ensure a safe, secure, and supportive environment for the
adolescents.
 Family members in the community to be informed and educated about this
problem.
 A positive and encouraging attitude has to be developed among the family
members and parents.
 School teachers should be trained on adolescent health.
Conclusion
 As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam
Physician. 2004 Oct 15;70(8):1517-1524/ www.aafp.org
 Teen pregnancy"(2004) in Encyclopedia of women's health.
 Mayor's. (2004)."` pregnancy and childbirth are leading causes of death in teenage girls in
developing countries".
 The national campaign to prevent Teen Pregnancy, (2001).
 https://psa.gov.ph/
References
TEENAGE PREGNANCY PREVENTION AND AWARENESS

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TEENAGE PREGNANCY PREVENTION AND AWARENESS

  • 1. PETER JAMES B. VITUG Family and Community Medicine Pre-Resident Report PREGNANCY PREVENTION IN ADOLESCENTS
  • 2. Introduction Teenage Pregnancy  Also known as Adolescent Pregnancy  Pregnancy in human females under 20 years of age  Can take place in pubertal females Teen pregnancy"(2004) in Encyclopedia of women's health.
  • 3. Incidence  Annually 13 million children are born to women under age 20 worldwide  90% in developing countries  Complication of pregnancy and Childbirth – leading cause of mortality among women between ages 15 to 19 years old Save the Children Fund, UK 2019; https://www.savethechildren.org/
  • 4.  Among young adult women age 20 to 24, 43 percent are already mothers Results of the 2013 National Demographic and Health Survey (NDHS)  One in ten young Filipino women age 15-19 has begun childbearing: 8 percent are already mothers  One in five (19 percent) young adult Filipino women age 18 to 24 years had initiated their sexual activity before age 18.  Survey reveals that 15 percent of young adult women age 20 to 24 had their first marriage or began living with their first spouse or partner by age 18. in Philippines setting
  • 5. Adolescent Pregnancy  Major public health problem with lasting repercussions  Community programs, responsible sexual behavior education, and improved contraceptive counseling and delivery.  Family physician plays a key role by engaging adolescent in confidential, open, and nonthreatening discussions of reproductive health, responsible sexual behavior and contraceptive use As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 6. Causes of Teenage Pregnancy The Lack of Education on Safe Sex, Peer Pressure, Drugs, Alcohol and Unprotected Sexual Intercourse A sexually active teenager who does not use contraception has a 90% chance of becoming pregnant within one year Potential behavior pattern for a teenage girl becoming pregnant include:  Early dating behavior  High-risk behaviors  Lack of support group  Unhealthy environment at home  Stress and depression  Delinquency and criminal behavior  Exposure to domestic and sexual violence  Financial constraints Allen, C., (2003).”Peer Pressure and Teen Sex
  • 7. Impact of Teenage Pregnancy  Less likely to graduate  Low self-esteem and symptoms of depression  Behavior and substance-abuse problems  Lack resources to fully foster the emotional development and enrichment of their children’s lives Children of adolescent mothers are at greater risk of preterm birth, low birth weight, child abuse, neglect, poverty, and death. Infant mortality rate (i.e., deaths in infants younger than one year per 1,000 live births) is higher in children of teenage mothers than in other children Mayor's. (2004)."` pregnancy and childbirth are leading causes of death in teenage girls in developing countries".
  • 8. Save the Children Fund, UK (2019); https://www.savethechildren.org/
  • 9. Effects of Adolescent Pregnancy Health Effects  Higher risk for anemia  Pregnancy-induced hypertension  Lower genital tract infections  low birth weight babies Social Effects  Isolation guilt  Stress  Depression  Low self esteem resulting in lack of interest in studies  Limited job prospects and  Lack of a support group or few friends to name just a few. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 10. ON THE CHILD  Psychosocial development  Developmental disabilities  Behavioral problem  Poor academic performance ON THE MOTHER  Affect one's education  Drop out of high school  Employment and social class Impact on Adolescent Pregnancy As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 11. Strategies for Prevention  Aim to improve the use of contraception and to modify the high-risk behaviors associated with teenage pregnancy and STDs. A. Youth Social Development  target social and psychologic skills that are necessary to avoid high-risk behaviors  adolescents who delay sexual activity have high educational aspirations, peers with similar norms, and parent-child relationships As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 12. Seattle Social Development Project Designed to increase students’ social skills and attachment to school and family. Eighteen elementary schools were assigned to receive intensive training or the usual education curriculum. Teachers and parents received annual training in proactive classroom management, problem- solving skills, child behavior management, and drug use prevention in adolescents RESULT: 93 percent of the 349 participants intervention group compared to control group  Had their first sexual experience later  fewer lifetime sex partners  fewer pregnancies As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 13. Children’s Aid Society - Carrera Program 600 disadvantaged New York City adolescents 13 to 15 years of age RESULTS: 79 percent of participants at three years showed that the girls in the intervention group had lower odds of being sexually active and of having been pregnant Teen Outreach Program (TOP) 695 high school students were randomized by classroom to TOP or no intervention. Program participants had lower self-reported rates of teen pregnancy, school failure, course failure, and school suspension at one year. The program’s success might be a result of mentorship as well as increasing self-esteem through volunteerism As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 14. B. Abstinence-only Program Only certain way to avoid unmarried pregnancy, STDs, and associated health problems; they may not teach about, endorse, or promote contraception use. Postponing Sexual Involvement (PSI) program Five-session program taught by trained adults or teenagers. 7,340 students with varied racial backgrounds were assigned randomly to intervention or control groups and were followed for up to 17 months. RESULT: No significant difference in pre- and post-intervention self-reported scores on the initiation of sex, frequency of sex, number of sex partners, use of condoms and other birth-control methods, or reported pregnancy rates. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 15. C. Comprehensive Sex Education Program Emphasizes abstinence as the most effective method of preventing pregnancy and STDs Discuss contraception as the appropriate strategy for persons who are sexually active. A review of 28 well-designed experimental studies found that most comprehensive sex- education programs do not adversely affect the initiation or frequency of sexual activity, the number of sex partners, or the reported use of condoms and other contraceptive methods. Successful programs vary in their approach. Program characteristics that are important in reducing risky sexual behaviors by teenagers As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 16. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 17. C. Sex and Contraceptive Counseling Success in this regard could have a profound impact on teenage pregnancy rates: 85 percent among young couples who are sexually active for one year without using contraception, and 15 to 30 percent of sexually active teenagers do not use contraception. Encouraged to engage all young people—boys and girls—in open, nonjudgmental, and confidential discussions during regular office visits. Counseling should include complete and medically accurate information on responsible sexual behavior. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 18. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 19. Family members are encouraged to be actively involved in sex education efforts AAFP and AAP recommend that physicians offer adolescent opportunity to have their examination and counseling sessions separate from their parents and guardians. Confidentiality as “an agreement between patient and provider that information discussed during or after the encounter will not be shared with other parties without the explicit permission of the patient.” (Society for Adolescent Medicine) AAFP, AAP, and AMA, recommends informing adolescents and their parents about the requirements and limits of confidentiality, because some patients may refuse to give accurate medical information without it As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 20. The AAFP, AAP, and AMA also advise to stress abstinence as the only certain way to prevent pregnancy and STDs. However, if an adolescent chooses to become sexually active, he or she must be counseled on appropriate contraceptive options As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 21. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 22. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 23. American Cancer Society now recommends that cervical cancer screening be delayed until three years after the onset of vaginal intercourse or no later than 21 years of age. Centers for Disease Control and Prevention recommends that all sexually active women 25 years of age and younger undergo annual screening for chlamydial infection. AAP recommends intermittent screening for high-risk behaviors and STDs, and frequent monitoring of the patient’s satisfaction with and ability to adhere to the plan. Contraception adherence should be discussed at each visit As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 24. AAP advises physicians to educate all sexually active adolescents about the availability and use of emergency contraception. Emergency contraception is intended only for emergency use, is not as effective in preventing pregnancy as regularly used hormonal methods, and does not protect against the transmission of STDs. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 25. C. Counseling Male Adolescents Teenage boys typically experience first intercourse at a younger age and have more sex partners than teenage girls. Most adolescent health clinics and education programs target the health of girls, with fewer interventions aimed at boys. A 1993 survey of publicly funded family planning clinics indicated that only 6 percent of patients were male. Adolescent boys desire information about STDs, contraception, pregnancy, and sexual health, but as few as 32 percent of sexually active boys receive this information from their health care providers. For an adolescent boy, the primary motivating factors for condom use include not only pregnancy and STD prevention, but also partner desires, his perception of his ability to use condoms As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 26. Several medical organizations endorse efforts to prevent teenage pregnancy and STDs. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 27. These guidelines are summarized and serve as a model for family physicians’ roles in teenage pregnancy and STD prevention. As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/
  • 28.  This adolescent period is hazardous for adolescent health due to absence of proper guidance and counselling.  Family has a crucial role in shaping the adolescents behavior.  They have to ensure a safe, secure, and supportive environment for the adolescents.  Family members in the community to be informed and educated about this problem.  A positive and encouraging attitude has to be developed among the family members and parents.  School teachers should be trained on adolescent health. Conclusion
  • 29.  As-sanie., et al, 2004: Pregnancy Prevention in Adolescents, Am Fam Physician. 2004 Oct 15;70(8):1517-1524/ www.aafp.org  Teen pregnancy"(2004) in Encyclopedia of women's health.  Mayor's. (2004)."` pregnancy and childbirth are leading causes of death in teenage girls in developing countries".  The national campaign to prevent Teen Pregnancy, (2001).  https://psa.gov.ph/ References

Editor's Notes

  1. Good afternoon everyone. This afternoon, I am tasked to report on pregnancy prevention in adolescents. I lifted my report to an article written from the journal of American academy of Family physician A very concerning and sensitive issue that is timely and relevant in our country. Especially today we are face by pandemic COVID crisis which can result in most teens to spend more time with opposite sex than they would were they to be in school busy with their school works and activities, leading to greater likelihood of engagement in risky sexual behaviour and increased risk of sexual violence and exploitation
  2. Allow me to define first Teenage Pregnancy Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods.
  3. Some of them would have had their first intimate sexual act before marriage. The survey reveals that 15 percent of young adult women age 20 to 24 had their first marriage or began living with their first spouse or partner by age 18.  Population regulators blame poor implementation of Reproductive Health Law in increasing number of teen pregnancies The agency is pushing for the passage of a pending bill that seeks to prevent teenage pregnancy. It also wants Malacañang to issue an executive order declaring the rise in teen pregnancy as a national social emergency. This uprising incidence of adolescent pregnancy is may be caused by poor information dissemination and health education campaigns President Benigno S. Aquino III signed the RH Law in December 2012, which was immediately challenged in court by various conservative Catholic groups. On March 19, the Supreme Court issued a status quo ante order for 120 days that was later extended indefinitely, halting the RH Law from going into effect.  SOURCE: PSA according to the results of the 2013 National Demographic and Health Survey (NDHS).
  4. Teenage pregnancy remains to be a challenging and   is becoming an emerging crisis in this Coronavirus disease pandemic Although the pregnancy rate in adolescents has declined steadily in the past 10 years, it remains a major public health problem with lasting repercussions for the teenage mothers, their infants and families, and society as a whole. Successful strategies to prevent adolescent pregnancy include community programs to improve social development, responsible sexual behavior education, and improved contraceptive counseling and delivery. - strategies are implemented at the family and community level. family physician plays a key role by engaging adolescent patients in confidential, open, and nonthreatening discussions of reproductive health, responsible sexual behavior (including condom use to prevent sexually transmitted diseases), and contraceptive use (including the use of emergency contraception)
  5. Many prevention programs are designed to reduce the number of adolescent pregnancies and sexually transmitted diseases (STDs) In general, these programs aim to improve the use of contraception and to modify the high-risk behaviors associated with teenage pregnancy and STDs. Youth social development programs -- target social and psychologic skills that are necessary to avoid high-risk behaviors such as early sexual activity. -- programs operate on the premise that adolescents who delay sexual activity have high educational aspirations, peers with similar norms, and parent-child relationships characterized by supervision, support, and open communication.
  6. Seattle Social Development Project is a program designed to increase students’ social skills and attachment to school and family. Eighteen elementary schools were assigned to receive intensive training or the usual education curriculum. In the intensive training arm, teachers and parents received annual training in proactive classroom management, problem- solving skills, child behavior management, and drug use prevention in adolescents. The intervention did not include sex education. 93 percent of the 349 participants at 21 years showed that students in the intervention group had their first sexual experience later than students in the control group
  7. In the Children’s Aid Society–Carrera Program: 600 disadvantaged New York City adolescents 13 to 15 years of age were assigned randomly to a typical after-school program or one with a comprehensive youth development curriculum. Follow-up of 79 percent of participants at three years showed that the girls in the intervention group had lower odds of being sexually active and of having been pregnant. Participation in the program had no impact on boys’ sexual and reproductive behavior. Teen Outreach Program (TOP) 695 high school students from diverse backgrounds were randomized by class- room to TOP or no intervention. Program participants had lower self-reported rates of teen pregnancy, school failure, course failure, and school suspension at one year. The program’s success might be a result of mentorship as well as increasing self-esteem through volunteerism.
  8. abstinence is the only certain way to avoid unmarried pregnancy, STDs, and associated health problems; they may not teach about, endorse, or promote contraception use. One of the largest and most rigorous studies of abstinence-only programs evaluated the Postponing Sexual Involvement (PSI) program in 31 California counties. PSI is a five-session program taught by trained adults or teenagers. A total of 7,340 students with varied racial backgrounds were assigned randomly to intervention or control groups and were followed for up to 17 months. Result: There was no significant difference in pre- and post-intervention self-reported scores on the initiation of sex, frequency of sex, number of sex partners, use of condoms and other birth-control methods, or reported pregnancy rates.
  9. Comprehensive sex-education curricula present abstinence as the most effective method of preventing pregnancy and STDs but also discuss contraception as the appropriate strategy for persons who are sexually active. A review of 28 well-designed experimental studies found that most comprehensive sex-education programs do not adversely affect the initiation or frequency of sexual activity, the number of sex partners, or the reported use of condoms and other contraceptive methods.
  10. Health care professionals can play a key role in improving contraception use and STD prevention. Success in this regard could have a profound impact on teenage pregnancy rates: the pregnancy rate is 85 percent among young couples who are sexually active for one year without using contraception, and 15 to 30 percent of sexually active teenagers do not use contraception. American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American Medical Association (AMA) advise physicians to provide adolescents with guidance on sexuality and sexual decision making. Physicians are encouraged to engage all young people—boys and girls—in open, nonjudgmental, and confidential discussions during regular office visits. Counseling should include complete and medically accurate information on responsible sexual behavior. These proactive conversations should begin early and continue throughout a patient’s adolescence.
  11. Family members are encouraged to be actively involved in sex education efforts, because an adolescent’s values and sense of sexual responsibility are influenced by family norms and expectations. However, to maintain confidential and open discussions, the AAFP and AAP recommend that physicians offer adolescent patients the opportunity to have their examination and counseling sessions separate from their parents and guardians, while still encouraging adolescents to involve their caregivers in health care decisions. That organization, along with the AAFP, AAP, and AMA, recommends informing adolescents and their parents about the requirements and limits of confidentiality, because some patients may refuse to give accurate medical information without it.
  12. The AAFP, AAP, and AMA also advise physicians to stress abstinence as the only certain way to prevent pregnancy and STDs. However, if an adolescent chooses to become sexually active, he or she must be counseled on appropriate contraceptive options, and condom use should be encouraged regardless of whether another contraceptive method is used. condom failure that leads to pregnancy generally is due to improper and inconsistent use, and not defects or breakage, providing adolescents with confidential access to condoms and education on consistent and proper use is a priority.
  13. Discussing common misconceptions, side effects, and other benefits of contraceptives in simple, age- appropriate terms may improve adherence to a chosen contraceptive plan. A history, pregnancy test (if indicated), and blood pressure reading are adequate to begin hormonal contraception. The pelvic examination may be deferred until a later visit.
  14. The American Cancer Society44 now recommends that cervical cancer screening be delayed until three years after the onset of vaginal intercourse or no later than 21 years of age. The Centers for Disease Control and Prevention45 recommends that all sexually active women 25 years of age and younger undergo annual screening for chlamydial infection. Once the adolescent chooses a contraceptive and STD prevention plan, the AAP recommends intermittent screening for high-risk behaviors and STDs, and frequent monitoring of the patient’s satisfaction with and ability to adhere to the plan. Contraception adherence should be discussed at each visit, emphasizing the plan for missed or delayed doses (if the patient is using hormonal contraceptives), and whether modifications to the plan are needed.
  15. Counseling should emphasize that emergency contraception is intended only for emergency use, is not as effective in prevent- ing pregnancy as regularly used hormonal methods, and does not protect against the transmission of STDs. It is safe and effective, and does not act as an abortifacient.
  16. Teenage boys typically experience first intercourse at a younger age and have more sex partners than teenage girls, yet they seek care for reproductive concerns less frequently. Decreasing the incidence of teenage pregnancy will require focused attention on male adolescents, including establishing avenues for routine sexual health services and targeted educational programs. Results from the National Survey of Adolescent Males in 1995 indicated that nearly 67 percent of teenage boys used condoms during their most recent act of intercourse. Overall, however, only 69 percent of teenage males used condoms consistently. Knowledge about condoms and contraceptives does not appear to encourage initial or consistent use. For an adolescent boy, the primary motivating factors for condom use include not only pregnancy and STD prevention, but also partner desires, his perception of his ability to use condoms (“condom use self-efficacy”), and peer perceptions about condoms.
  17. non-judgemental stance of doctors reassures patients (adolescence) that they can seek medical help without fear of embarrassment or disapproval.