research about child and adolescent development in the philippines

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Home ⇛ philippine journal of psychology ⇛ vol. 36 no. 2 (2003), research on adolescent development in the philippines: a review and evaluation of the past two decades.

Liane Peña-alampay | Alma S. Dela Cruz | Ma. Emma Concepcion D. Liwag

Discipline: Psychology

Adolescents comprise 30% of the Philippine population, and are directly implicated in the country’s development prospects. However, adolescence, as a developmental period, has been treated unsystematically and virtually neglected in Philippine psychology research (Ventura, 1981). While this situation has changed in recent years, the extent to which research on Filipino adolescents has grown remains undetermined. This review addresses the gap by providing a comprehensive evaluation of the status of research on Filipino adolescent development from 1983 to the present. A total of 147 scholarly published and unpublished papers were examined in terms of their themes, bibliographic features (i.e., year published/completed; source of report), sampling characteristics (i.e., participants’ age, gender, SES, study setting, sampling size and method), and methodological elements including research objectives, design and procedures. The results indicate that adolescence research has indeed grown exponentially since the early 80’s, mostly concentrating on socio-emotional aspects and problems of the youth. In this body of research, school-going middle to late adolescents from urban areas appeared to be overly-sampled in large groups through convenience sampling. Lastly, fully a quarter of studies were found to be only incidentally about adolescent development. Recommendations therefore focused on the utility of the developmental perspective in analyzing and interpreting data from youth research, the need for clearer definitions of Filipino adolescence, and the call for wider dissemination of scholarly works on the lives of the Filipino youth.

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Research on Adolescent Development in the Philippines: A Review and Evaluation of the Past Two Decades

• Liane Peña-alampay , A. Cruz , M. Liwag
• Published 2003
• Sociology, Psychology
• Philippine journal of psychology

7 Citations

An empirical analysis of research trends in the philippine journal of psychology: implications for sikolohiyang pilipino, "falling hair and drilling bone": a phenomenological inquiry into the lives of adolescents undergoing chemotherapy, philosophical, psychological and religio-cultural roots: contemporary challenges to religious education, examining the career construction model of adaptation among filipino senior high school students, development of multidimensional self-concept scale (mscs) for filipino college students, trends of sexual and reproductive health behaviors among youth in the philippines, resilience in low-income filipino mothers exposed to community violence: religiosity and familism as protective factors., related papers.

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Mental health and well-being of children in the Philippine setting during the COVID-19 pandemic

Grace zurielle c. malolos.

1 College of Medicine, University of the Philippines Manila, Manila, Philippines

Maria Beatriz C. Baron

Faith ann j. apat.

2 Matias H. Aznar Memorial College of Medicine, Cebu City, Philippines

Hannah Andrea A. Sagsagat

3 West Visayas State University-College of Medicine, La Paz, Iloilo City, Philippines

Pamela Bianca M. Pasco

Emma teresa carmela l. aportadera.

4 Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines

Roland Joseph D. Tan

5 Baguio General Hospital and Medical Center, Baguio City, Philippines

Angelica Joyce Gacutno-Evardone

6 Department of Pediatrics, Eastern Visayas Regional Medical Center, Tacloban City, Philippines

Don Eliseo Lucero-Prisno III

7 Faculty of Management and Development Studies, University of the Philippines Open University, Los Banos, Laguna, Philippines

8 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

The coronavirus disease 2019 (COVID-19) pandemic has subjected the mental health and well-being of Filipino children under drastic conditions. While children are more vulnerable to these detriments, there remains the absence of unified and comprehensive strategies in mitigating the deterioration of the mental health of Filipino children. Existing interventions focus on more general solutions that fail to acknowledge the circumstances that a Filipino child is subjected under. Moreover, these strategies also fail to address the multilayered issues faced by a lower-middle-income country, such as the Philippines. As the mental well-being of Filipino children continues to be neglected, a subsequent and enduring mental health epidemic can only be expected for years to come.

Introduction

The Philippine Development Plan for 2017-2023 highlights that children are among the most vulnerable population groups in society, including them in strategies for risk reduction and adaptive capacity strengthening. 1 Approximately 40% of the total Philippine population is comprised of Filipinos below 18 years of age. 2 Despite having a large portion of the Philippine population declared as vulnerable, concerning issues involving them still persist and remain unaddressed.

Among Filipino children aged 5 to 15, 10% to 15% are affected by mental health problems. 3 According to the World Health Organization (WHO), 16.8% of Filipino students aged 13 to 17 have attempted suicide at least once within a year before the 2015 Global School-based Student Health survey. 4 This is just one of the many indicators showing the state of mental health of these children. These statistics involving children’s mental health are concerning as childhood is a crucial period where most mental health disorders begin. Efforts should be made to identify these issues early for proper treatment in prevention of negative health and social outcomes. 4 Childhood mental and developmental disorders also frequently persist into adulthood, making it more likely for them to have compromised growth with greater need for medical and disability services and higher risk of getting involved with law enforcement agencies. 5 In this context, the COVID-19 pandemic threatens to worsen these numbers, affecting the delivery of the Philippines’ health care services, including those for children’s mental health.

Since the beginning of the pandemic, children have been subjected to multiple threats to their mental health. Adding insult to injury, several concurrent factors in the Philippine society exacerbate this. While these are experiences shared by all people regardless of age, impediments to emotional and social development are greater in children than in adults. 6 They may also be more vulnerable to developing mental health issues such as depression and anxiety. 7 Together with these circumstances and the weakened health care system, children’s vulnerability towards mental health problems may be worsened by the pandemic, leading to more new cases and exacerbating existing ones. 2

Status of mental health system for children in the Philippines

According to the National Statistics Office (NSO), mental health illnesses rank as the third most common form of morbidity among Filipinos. 8 In the assessment conducted on the Philippine mental health system, a prevalence of 16% of mental disorders among children was reported. 9 With this alarming number of cases, it is surprising to see how the Philippines is currently responding to this problem. To date, there are only five government hospitals with psychiatric facilities for children, 84 general hospitals with psychiatric units, and 46 outpatient facilities from which there are only 11 that are designated for children and adolescents. Additionally, there are only 60 child psychiatrists practicing in the Philippines, with the majority of them practicing in urban areas such as the National Capital Region. Hence, children with mental health problems who are in rural areas have less access to such services. 10

As the pandemic continues, combined with the menace of the typhoon season, thousands of children are placed in a situation where the future is uncertain. A local study showed that youth age and students are among those with significant association to a greater psychological impact due to the pandemic. 11 In addition, UNICEF also reports that children nowadays face a trifecta of threats which include direct consequences of the disease itself, interruption in essential services, and increasing poverty and inequality. All of these can lead to higher incidences of stress, anxiety, and depression. 12

General mental health implications of COVID-19 on Filipino children

The fear and anxiety of contracting the virus, the suspension of physical classes, the disruption of regular daily routine, and the decrease of social support from school peers collectively add burden to the mental well-being of children. 7 , 13 The shift to online classes increases the burden on the mental well-being of children. Excessive use of these technologies has been associated with developmental delays and has resulted in sleep schedule disruptions. 14 This situation is aggravated by the strict implementation of the confinement of children at home. Children living with preexisting mental health concerns, 13 and living in cramped households and communities face worse circumstances.

Militarization of the Philippine COVID-19 response

Aside from being regarded as one of the countries with the longest lockdown, the Philippines has also been called out by the United Nations for employing a highly militaristic approach in response to the COVID-19 pandemic. 15 Militarization may come across as threatening, because it implies a potential for violence. 16 Furthermore, few studies abroad have reported that children and adolescents may tend to view police forces as punitive figures whom they fear. 17 , 18 While these qualitative studies were conducted long before the current health crisis began, it may be possible for increased military presence in communities to exacerbate the fears already emanating from the pandemic itself; this can negatively impact a child’s psychological development. 4 Still, local evidence to confirm these associations, especially in the context of the pandemic, is lacking. Many studies have already documented the impact of lockdown on children, but none of them have looked into how the strategies for implementation may also be contributory to their mental health or well-being.

Typhoons and the mental health of Filipino children

The Philippines has been hit by 22 tropical typhoons during the COVID-19 pandemic, leaving thousands of families homeless. 19 Children who are already frightened of COVID-19 and previous tropical storms have had to relive their experience with each new typhoon that came. In addition, children in crowded evacuation centers are at increased risk of contracting diseases and experiencing gender-based violence. 20 Given how past typhoons of similar strength and destruction have caused lasting adverse mental health effects on children, 21 the same or even worse, may be expected as a result of the more recent calamities. Super typhoons Goni and Vamco have caused further disruptions in schooling and livelihood, therefore leaving more children vulnerable to the effects of the pandemic. Those who have been forced to seek refuge in evacuation centers are at an increased risk of acquiring COVID-19, among other diseases. 20

Child Labor and Abuse in the Time of COVID-19

The COVID-19 crisis caused an unprecedented reduction in economic activity and working time, thus increasing poverty. Fewer employment opportunities and lower wages drive exploitative work. Further suppression of wages induces child labor. There may be deliberate recruitment of children to cut costs and boost earnings. 22

In addition to the threats of child labor, a study entitled The Hidden Impact of COVID-19 on Children reported that violence occurred in nearly one-third (32%) of households. Lesser household incomes were associated with more reports of violence towards children. 23 According to UNICEF, the Philippine government saw a 260% increase in online child abuse reports from March-May. Many victims are first abused by their parents, who livestream sexual violence for predators in wealthy Western nations. This occurrence resulted from job and income loss and more time spent at home due to strict quarantine measures. The abuse in children occurs at an average of 2 years before being rescued. 24

Strategies Addressing the mental health implications of COVID-19 on Filipino children

Numerous strategies have been utilized to address the mental health impacts of COVID-19 on Filipinos. With the mental health implications predicted at the beginning of the pandemic, the Psychological Association of the Philippines has compiled a list of free telemedicine consultations. As of August 24, the Philippine Red Cross has also established a COVID-19 hotline with 9790 helpline volunteers to address mental health and other similar concerns. The Department of Health has also conducted nationwide campaigns in observance of the National Mental Health Week. 25

Albeit present, these interventions are limited to the general population, and strategies specific to addressing the mental health situation of children remain scarce and staggered. Compounding factors of classifying among the lower- to middle-income countries of militarization, natural disasters, and child labor and abuse have yet to be considered. In addition, it is also important to consider that happiness, with its multifactorial nature, is a vital component of an individual’s overall wellbeing. 26

The already-challenged state of mental well-being of Filipino children has been worsened by the pandemic and the lack of good mental health policies by the government. While there is increasing awareness for mental health, children-centered interventions remain deficient. Approaches must integrate commonly-known mental health effects on children with existing and anticipated Philippine societal issues. Without doing so, it may be expected that as the COVID-19 pandemic is mitigated, a mental health epidemic will replace it.

Competing interests

The authors have no conflicts of interest.

Ethical approval

Not applicable.

Authors’ contributions

GZCM and DELP were involved in the conception of the paper. GZCM led the writing of the manuscript and acted as corresponding author. GZCM, MBCB, FAJA, HAAS, PBMB, ETCA and RJDT wrote sections of the manuscript. AJGE and DELP reviewed and edited the initial draft of the manuscript prior to submission. All authors have reviewed and agreed to the final version of the paper.

• Introduction
• Conclusions
• Article Information

Data were compiled from the final master file of the Québec Longitudinal Study of Child Development (1998–2019), Gouvernement du Québec, Institut de la Statistique du Québec (Quebec Institute of Statistics). Details on the scales used and scoring are found in the Methods section and Table 1. NEET indicates not being in education, employment, or training; OR, odds ratio; and SES, socioeconomic status.

a NA (not applicable) represents variables that were not kept in the final model because they did not reach statistical significance.

b Factors remaining significant ( P  < .05) after applying Bonferroni adjustment.

eTable 1. MIA and SBQ Depression Symptoms Items

eFigure. Correlation Plot of All Depression Symptoms Scores

eTable 2. Comparison of Included and Excluded Participants for Each Outcome

eTable 3. Estimated Coefficients (β or OR) Associated With an Increased Risk of Reporting Impaired Adult Outcomes

eTable 4. Estimated Coefficients (β or OR) of Unadjusted and Adjusted Depression Symptoms at Every Time Point Associated With an Increased Risk of Reporting Impaired Adult Outcomes

Data Sharing Statement

• Depressive Symptoms in Childhood and Adolescence and Adult Psychosocial Outcomes JAMA Network Open Invited Commentary August 8, 2024 Natan J. Vega Potler, MD

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Psychogiou L , Navarro MC , Orri M , Côté SM , Ahun MN. Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes. JAMA Netw Open. 2024;7(8):e2425987. doi:10.1001/jamanetworkopen.2024.25987

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Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes

• 1 Mood Disorders Centre, University of Exeter, Exeter, United Kingdom
• 2 Department of Public Health, Bordeaux Population Health Research Centre, Institut National de la Santé et de la Recherche Médicale U1219, Bordeaux, France
• 3 McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
• 4 Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada
• 5 Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Quebec, Canada
• 6 Axe Cerveau et Développement de l’Enfant, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
• 7 Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
• 8 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• Invited Commentary Depressive Symptoms in Childhood and Adolescence and Adult Psychosocial Outcomes Natan J. Vega Potler, MD JAMA Network Open

Question   Are depression symptoms during childhood and adolescence associated with poor mental health and psychosocial outcomes in young adulthood?

Findings   In this cohort study using a representative population-based Canadian birth cohort of 2120 infants, depression symptoms during adolescence (ages 13 to 17 years) were associated with higher levels of depression symptoms and perceived stress in early adulthood (at ages 20 and 21 years), while both middle-childhood (ages 7 to 12 years) and adolescent depression symptoms were associated with decreased social support for participants at age 21 years, independent of early risk factors. There were no associations of depression symptoms with binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Meaning   The findings of this study underscore the importance of screening children and adolescents for depression, which may reduce depression symptoms and compromised psychosocial functioning in young adulthood.

Importance   Depression is a leading cause of disability. The timing and persistence of depression may be differentially associated with long-term mental health and psychosocial outcomes.

Objective   To examine if depression symptoms during early and middle childhood and adolescence and persistent depression symptoms are associated with impaired young adult outcomes independent of early risk factors.

Design, Setting, and Participants   Data for this prospective, longitudinal cohort study were from the Québec Longitudinal Study of Child Development, a representative population-based Canadian birth cohort. The cohort consists of infants born from October 1, 1997, to July 31, 1998. This is an ongoing study; data are collected annually or every 2 years and include those ages 5 months to 21 years. The end date for the data in this study was June 30, 2019, and data analyses were performed from October 4, 2022, to January 3, 2024.

Exposures   Depression symptoms were assessed using maternal reports in early childhood (ages 1.5 to 6 years) from 1999 to 2004, teacher reports in middle childhood (ages 7 to 12 years) from 2005 to 2010, and self-reports in adolescence (ages 13 to 17 years) from 2011 to 2015.

Main Outcomes and Measures   The primary outcome was depression symptoms at age 20 years, and secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived stress; not being in education, employment, or training; social support; and experiencing online harrasment) at age 21 years. All outcomes were self-reported. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019. Risk factors assessed when children were aged 5 months old were considered as covariates to assess the independent associations of childhood and adolescent depression symptoms with adult outcomes.

Results   The cohort consisted of 2120 infants. The analytic sample size varied from 1118 to 1254 participants across outcomes (56.85% to 57.96% female). Concerning the primary outcome, adjusting for early risk factors and multiple testing, depression symptoms during adolescence were associated with higher levels of depression symptoms (β, 1.08 [95% CI, 0.84-1.32]; P  < .001 unadjusted and Bonferroni adjusted) in young adulthood. Concerning the secondary outcomes, depression symptoms in adolescence were only associated with perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P  < .001 unadjusted and Bonferroni adjusted), while both middle-childhood (β, −1.58 [95% CI, −2.65 to −0.51]; P  = .003 unadjusted and P  < .001 Bonferroni adjusted) and adolescent (β, −1.97 [95% CI, −2.53 to −1.41]; P  < .001 unadjusted and Bonferroni adjusted) depression symptoms were associated with lower levels of social support. There were no associations for binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Conclusions and Relevance   In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

Depression is a leading contributor to global disease burden. 1 A nationally representative US study of 2016 data found that 3.2% of children and adolescents (ages 3 to 17 years) were depressed and that prevalence rates tended to increase with age. 2 The timing of depression onset and symptom persistence may differentially impact an individual’s functioning. Longitudinal and meta-analytic evidence suggest that depression symptoms during adolescence are associated with mental health problems and impaired functioning in adulthood. 3 - 7

Because available studies do not often examine depression symptoms during childhood, it is not yet clear whether symptoms occurring during early (ages 1.5 to 6 years) and middle (ages 7 to 12 years) childhood and adolescence (ages 13 to 17 years) are independently associated with adult mental health and psychosocial outcomes. Additionally, focusing on 1 developmental period precludes the examination of whether individuals with persistent symptoms are at higher risk for worse outcomes later in life. This omission has implications for prioritizing the allocation of support to individuals who are most at risk. 8 Moreover, most studies focus on mental health as the primary outcome, thus overlooking the association of depression symptoms with pertinent psychosocial outcomes. 9 Therefore, it is important to examine a broad range of outcomes to understand the associations of depression symptoms with overall functioning in adulthood to inform policymaking. 9

Previous studies have investigated the associations of the timing of depression symptoms with adult outcomes. 8 , 10 A study examining trajectories of depression symptoms from ages 10.5 to 25 years found that individuals with persistent early-onset depression symptoms during adolescence were associated with poorer mental health and work and educational outcomes in early adulthood. 8 Another study found that depression during childhood and adolescence was associated with physical and mental health problems, risky behaviors, and problems in psychosocial functioning in adulthood. 10 Importantly, individuals who had adolescent-onset vs childhood-onset depression and individuals with depressive symptomatology across childhood and adolescence had worse outcomes in adulthood. 10

A limitation of the existing literature is that studies have often not considered a broad range of confounding factors. 10 Several factors, including being female, having a limited-income background, being exposed to parental psychopathology, and experiencing problematic family relationships, are known risk factors for depression symptoms and impaired adult functioning. 11 - 15 Therefore, it is important to consider these and other confounding factors to obtain an accurate estimate of the associations of childhood and adolescent depression symptoms with adult outcomes. 10

The objective of this study was to examine the associations of depression symptoms in early and middle childhood with depression symptoms (primary outcome) and psychosocial outcomes (secondary outcome) in young adulthood. Our hypothesis for the current study was that childhood and adolescent depression symptoms would be associated with primary and secondary outcomes in early adulthood, but no a priori hypotheses were made about the associations of childhood and adolescent depression symptoms on any specific adult outcome.

Data for this cohort study were drawn from the ongoing Québec Longitudinal Study of Child Development (QLSCD), a large, representative population-based birth cohort conducted by the Institut de la Statistique du Québec in Canada. The cohort in the QLSCD consisted of 2120 infants born from October 1, 1997, to July 31, 1998 (see the cohort profile for more information on the overall cohort 16 ). The end date for the data in this study was June 30, 2019. Baseline characteristics were assessed when children were aged 5 months old by trained research assistants during interviews held at participants’ homes or using mailed questionnaires. Depression symptoms during early childhood (ages 1.5 to 6 years) were reported by children’s mothers, from 1999 to 2004 and during middle childhood (ages 7 to 12 years) by teachers, from 2005 to 2010, whereas adolescent depression symptoms were self-reported by participants at ages 13, 15, and 17 years from 2011 to 2015. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019 using online questionnaires. Informed written consent was obtained by all participating families (and teachers) at each assessment point. Participants consented to data collection from age 18 years onward. Ethics were approved by the health research ethics committees of the Institut de la Statistique du Québec and the Sainte-Justine Hospital Research Centre. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for standard reporting in cohort studies. 17

The primary outcome of the present study was depression symptoms assessed at age 20 years. The secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived levels of stress; not being in education, employment, or training [NEET] status; social support; and experiencing online harrasment at age 21 years.

We examined the independent and joint associations of depression symptoms in early and middle childhood and adolescence with young adult outcomes. Based on prior evidence, a broad range of covariates were adjusted for in the analyses. The early-childhood depression symptoms were reported when children were 1.5, 2.5, 3.5, 4.5, and 5, and 6 years of age, and middle-childhood symptoms when children were aged 7, 8, 10, and 12 years using items from the Social Behavior Questionnaire (SBQ 18 ). The SBQ integrates items from the Rutter Children’s Behaviour Questionnaire, 19 the Child Behavior Checklist, 20 the Ontario Child Health Study scales, 21 and the Preschool Behavior Questionnaire. 22 Mothers and teachers ranked the frequency with which children experienced different dimensions of depression (eg, unhappy, sad, or depressed or lacked energy) on a scale from 0 (never) to 2 (often), with higher scores indicating more depression. Given our focus on depression symptoms, we used 5 SBQ items that were similar to the items used to assess depression in adolescence (ages 13-17 years) and young adulthood (ages 18-24 years) (eTable 1 in Supplement 1 ). The internal consistency of these items ranged from 0.19 (95% CI, 0.14-0.25) to 0.63 (95% CI, 0.60-0.65).

To create childhood depression variables, we first calculated the mean scores, separately, of mother-reported and teacher-reported depression symptoms. To account for variation in the measures used to assess depression symptoms across developmental periods, we identified children in the top quintile of mother-reported and teacher-reported depression symptom scores. These variables were used as binary indicators of early-childhood (mother-reported) and middle-childhood (teacher-reported) depression symptoms, in which 1 indicated children rated in the top quintile of depression symptoms by mothers and teachers, respectively, and 0 indicated all other children.

Adolescents self-reported their depression symptoms using the SBQ at age 13 years and at ages 15 and 17 years (α = 0.90), using the Mental Health and Social Inadaptation Assessment for Adolescents. 23 We first calculated the mean of depression symptoms at ages 15 and 17 years using the Mental Health and Social Inadaptation Assessment for Adolescents and then identified participants in the top quintile of this mean score. We then identified participants in the top quintile of depression symptoms at age 13 years. The final variable was binary, with 1 indicating adolescents rated in the top quintile of depression symptoms at ages 13 or 15 and 17 years and 0 indicating all other children. To examine correlations between depression scores reported by different informants across different ages, we used the Spearman correlation coefficient. This test was used due to the nonnormal distribution of depression scores.

Outcomes in young adulthood were self-reported only at ages 20 and 21 years. At age 20 years, participants reported their depression symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale, 24 a validated and widely used measure of depression symptoms in adults. Psychosocial outcomes were reported at age 21 years. Perceived levels of stress in the past month were assessed using the Perceived Stress Scale. 25 Social support was assessed using the validated short version of the Social Provisions Scale. 26 Experiencing online harrasment was assessed using a single item asking about the frequency (never, once, sometimes, often, or very often) with which the participant had been harrased (eg, insults, threats) over the internet or by telephone in the past year. We created a binary variable with 1 for participants who indicated being harrased at least once and 0 otherwise. Binge drinking was also assessed with a single item asking how often participants had consumed 4 (for females) or 5 (for males) or more drinks on a single occasion in the past year. Participants’ NEET status was determined using 2 items asking about their current studies and employment. Participants who indicated that they were not in school, in training, or employed were classified as NEET.

We searched previous literature for variables that could confound associations between depression symptoms and each of the adult outcomes. Different covariates were used in different models, as each outcome was included in a separate model. All of the following covariates were assessed at baseline when children were aged 5 months old: family socioeconomic status (derived from parental educational and occupational status and household income), maternal and paternal depression symptoms (based on the CES-D scale 24 ) and antisocial behavior in their adolescence and adulthood (assessed with 5 binary questions on conduct problems based on Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] 27 criteria), maternal employment status, maternal substance use during pregnancy (ie, tobacco, alcohol, or an illegal drug), in-home observations of mother and child interactions (stimulation and verbalization) using the Home Observation Measurement of the Environment, 28 self-reported maternal and paternal parenting practices (self-efficacy, reactive hostility, overprotection, affection, warmth, and parental impact) using the Parental Cognitions and Conduct Toward the Infant Scale, 29 and the child’s sex. Family functioning was assessed using the Family Dysfunction Scale, in which scores range from 0 to 10.00, with higher scores indicating higher levels of family dysfunction. 30

Data analysis was performed from October 4, 2022, to January 3, 2024. We estimated the association of early and middle childhood and adolescent depression symptoms with each adult outcome in separate regression models that were adjusted for the relevant covariates. Linear regression models were used for continuous outcomes (depression, perceived stress, and social support) and logistic regressions for binary outcomes (experiencing online harrasment, binge drinking, and NEET status). We also tested the interactions of depression symptoms in early childhood, middle childhood, and adolescence in each model. The interactions between depression symptoms in early childhood and at other time points were not significant and were therefore dropped from the models. Given the use of multiple testing, we present both the unadjusted and adjusted (Bonferroni-corrected) P values for all models; the Bonferroni correction was used for the final model of each outcome. A 2-sided P  < .05 was considered significant.

Participants were included in analyses if they had available data for at least 1 time point for depression symptoms in early or middle childhood and adolescence and 1 adult outcome. The excluded and analytic samples significantly differed in baseline characteristics; we therefore used inverse probability weighting, in which weights represent the probability of being included in an analytic sample, in all analyses. 31 The comparison of each analytic sample with the excluded sample on the variables used for weighting is presented in eTable 2 in Supplement 1 . Missing data for covariates, ranging from 4.89% to 5.19% depending on the sample, were handled using multiple imputation by a chained equation (n = 50 imputed datasets). Statistical analyses were performed using R, version 4.2.3 (R Project for Statistical Computing). 32

Among the 2120 infants in the cohort, the analysis sample size varied from 1118 to 1254 across outcomes and included 648 to 713 females (56.85% to 57.96%) and 470 to 541 males (42.04% to 43.14%) ( Table 1 ). Participants who experienced high depression symptoms in adolescence were more likely to experience depression symptoms in young adulthood (β, 1.08 [95% CI, 0.84-1.32]; P  < .001 unadjusted and Bonferroni adjusted) and to report higher levels of perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P  < .001 unadjusted and Bonferroni adjusted) after adjusting for covariates ( Figure and eTable 3 in Supplement 1 ). Depression symptom scores were created in the cohort of 2120 infants, including the mean, SD, range, and cutoff scores for children and adolescents in the top quintile in each developmental period (early childhood: mean [SD] score, 1.18 [0.87; range, 0-7.14]; middle childhood: mean [SD] score, 1.88 [1.54; range, 0-10.00]; adolescence: mean [SD] score, 3.62 [2.08; range, 0-10.00]) ( Table 2 ). The correlations between depression scores across different ages are presented in the eFigure in Supplement 1 . Depression symptoms’ correlation coefficients were greater when reported by the same informant compared with coefficients between informants.

High depression symptoms in middle childhood were not associated with higher levels of depression symptoms (β, 0.43 [95% CI, −0.03 to 0.90]; P  = .07) and perceived stress (β, 1.90 [95% CI, 0.03-3.77]; P  = .05) in young adulthood; these results remained nonsignificant after adjusting for multiple testing (depression symptoms: β, 0.43 [95% CI, −0.03 to 0.90]; P  = .11 and perceived stress: β, 1.90 [95% CI, 0.03-3.77]; P  = .10) (eTable 3 in Supplement 1 ). A similar pattern was observed between high depression symptoms in adolescence and NEET status in young adulthood, in which the statistical significance (β, 2.46 [95% CI, 1.09-5.56]; P  = .03) did not survive the Bonferroni correction ( P  = .06) (eTable 3 in Supplement 1 ).

The only outcome with which high depression symptoms in middle childhood and adolescence were associated was social support ( Figure and eTable 3 in Supplement 1 ). Participants in middle childhood (β, −1.58 [95% CI, −2.65 to −0.51]; P  = .003 unadjusted and P  < .001 Bonferroni adjusted) and adolescents (β, −1.97 [95% CI, −2.53 to −1.41]; P  < .001 unadjusted and Bonferroni adjusted) who experienced more depression symptoms reported lower levels of social support in young adulthood. The interaction between high depression symptoms in middle childhood and adolescence was not significant, suggesting that the independent associations of depression symptoms in each period were more relevant than the cumulative experience of high depression symptoms ( Figure and eTable 3 in Supplement 1 ). We found no association between high depression symptoms across developmental periods with any outcome. The experience of high depression symptoms across (early and middle) childhood and adolescence was not associated with binge drinking, NEET status, or experiencing online harrasment ( Figure and eTable 3 in Supplement 1 ). To test whether the associations of depression symptoms with adult outcomes were mediated by depression symptoms at a later point, we conducted simple regression analyses between depression symptoms in each developmental period and adult outcomes to ensure that the impact of childhood depression symptoms was not overshadowed by later depression symptoms (eTable 4 in Supplement 1 ). As almost all of the results were not significant, it appeared that the association of childhood depression symptoms with adult outcomes was not masked by later depression symptoms, and therefore, we did not test mediation models.

In this cohort study using prospective longitudinal data from children, adolescents, and adults aged 1.5 to 21 years, we found that depression symptoms during adolescence were associated with increased depression symptoms at age 20 years and perceived stress at age 21 years, adjusting for covariates and multiple testing. Additionally, depression symptoms during adolescence were associated with compromised psychosocial outcomes at age 21 years, but the result was nonsignificant after correcting for multiple testing. Social support was the only outcome for which depression symptoms during middle childhood and adolescence had an association that persisted after adjusting for covariates and multiple testing. Depression symptoms were not associated with experiencing online harrasment, NEET status, or binge drinking.

Being in the top quintile of depression symptoms in adolescence was associated with a 1-point increase on the CES-D scale, an association that corresponds with a medium effect size (Cohen d  = 0.5) and is thus relevant from a population and clinical perspective. These findings provide some support for the stability of depression symptoms and are consistent with previous research suggesting that depression symptoms during adolescence increase the risk of mental health problems in emerging adulthood. 7 Additionally, in our study, young adults who experienced depression symptoms during adolescence self-reported increased perceived stress at age 21 years, independent of early risk factors. One explanation for this finding is that the experience of depression symptoms may have contributed to cognitive vulnerabilities and the perception of events as more stressful. Alternatively, it could be that young adults may have experienced stressful life circumstances at the time of the assessment or that structural or social determinants not captured at birth may have contributed to depression symptoms. 33 - 35 Notably, these results were not significant for childhood depression symptoms, suggesting that the associations were confined to adolescent depression symptoms. However, it is worth mentioning that adolescence and adult depression symptoms were measured with self-reports, which may have reflected common rater bias, while early- and middle-childhood depression symptoms were measured with mothers’ (early childhood) and teachers’ (middle childhood) reports, which may have reflected measurement and rater difference. 36

The experience of depression symptoms in middle childhood and adolescence was associated with decreased social support at age 21 years. There were no significant interactions, suggesting that the independent associations of depression symptoms in each developmental period were more relevant than the cumulative experience of high depression symptoms. This finding is consistent with a previous study’s finding that adolescent depression symptoms were associated with lower social support in early adulthood 37 and adds to the existing literature by showing that the experience of depression symptoms during middle childhood (ages 7 to 12 years) may be independently associated with diminished social support. This is a concerning finding, as it implies that young adults may go through life transitions (eg, family and career) without adequate social support. 38 Similarly, they may be reluctant to access support provided by health services. 37 , 38 Future research should examine why this occurs and if the associations of childhood vs adolescent depression with social support have distinct environmental and genetic causes.

While no firm conclusions can be made about the timing (childhood vs adolescence) of depression symptoms and its prospective associations with adult outcomes, it appears that depression symptoms during adolescence were associated with a broader range of adult outcomes (depression symptoms, perceived stress, and social support) compared with depression symptoms during childhood (social support only). There was no evidence that individuals with persistently elevated depression symptoms relative to peers had worse adult outcomes. Except for social support, young adults whose depression symptoms did not persist beyond childhood showed no other impairments, suggesting that it was depression symptoms in adolescence that were associated with adult outcomes. However, this finding should be interpreted with caution because the association may be an artifact of the fact that depression symptoms were reported by different informants at different ages with different measures. 36

The onset and course of depression symptoms were not captured in this study. Future studies should examine trajectories of depression symptoms and their prospective associations with adult outcomes. Moreover, the overall low internal consistency of depression items in early childhood, reported by mothers and teachers, has to be considered, as it indicates a potential lack of validity of depression measures. There were no data on whether participants were treated with antidepressant medication or psychological therapy, which may have impacted depression symptoms and adult outcomes. Exposure variables during adolescence and outcomes in early adulthood were assessed using self-reports, which may have inflated associations between variables (eg, individuals experiencing depression being more vulnerable to negative self-perceptions). 39 , 40 However, different reporters (mothers, teachers) were used to measure depression symptoms across childhood, and self-reports are reliable for internalizing problems. 41 , 42

The findings have implications for mental health interventions. It is of clinical importance to identify children and adolescents experiencing depression early to decrease depression symptoms and prevent compromised functioning. Our findings suggest that mental health interventions including interpersonal/social components may improve psychosocial functioning in adulthood. Furthermore, some of the early risk factors we considered showed associations with adverse adult outcomes. Thus, mental health interventions that address exposure to early adversity or trauma could be beneficial to children and adolescents experiencing depression symptoms. 43 Last, mental health interventions should identify and monitor children and adolescents experiencing subclinical symptoms as our findings suggest that individuals who had increased depression symptoms during childhood or adolescence experienced adverse outcomes in young adulthood.

The findings of this cohort study suggest that both childhood and adolescent depression symptoms may be associated with adverse psychosocial outcomes, while adolescent depression symptoms were associated with depression symptoms and perceived stress in young adulthood independent of early risk factors. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

Accepted for Publication: May 21, 2024.

Published: August 8, 2024. doi:10.1001/jamanetworkopen.2024.25987

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Psychogiou L et al. JAMA Network Open .

Corresponding Author: Marilyn N. Ahun, PhD, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 5252 Boulevard de Maisonneuve, Montréal, H4A 3S5, Quebec, Canada ( [email protected] ).

Author Contributions: Drs Navarro and Ahun had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Psychogiou and Navarro were co–first authors.

Concept and design: Psychogiou, Navarro, Côté, Ahun.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Psychogiou, Ahun.

Critical review of the manuscript for important intellectual content: Navarro, Orri, Côté, Ahun.

Statistical analysis: Navarro, Orri, Ahun.

Obtained funding: Côté.

Administrative, technical, or material support: Côté.

Conflict of Interest Disclosures: None reported.

Funding/Support: The Québec Longitudinal Study of Child Development (QLSCD) was supported by funding from the Ministère de la Santé et des Services Sociaux, the Ministère de la Famille, Ministère de l’Éducation et de l’Enseignement Supérieur, the Lucie and André Chagnon Foundation, the Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, the Research Centre of the Sainte-Justine University Hospital, the Ministère du Travail, de l’Emploi et de la Solidarité Sociale, and the Institut de la Statistique du Québec. Additional funding was received by the Fonds de Recherche du Québec-Santé, the Fonds de Recherche du Québec-Société et Culture, the Social Science and Humanities Research Council of Canada, and the Canadian Institutes of Health Research.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: We are grateful to the children and parents of the QLSCD and the participating teachers and schools.

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• Published: 26 May 2021

Early union, ‘ disgrasya ’, and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth

• Christine Marie Habito   ORCID: orcid.org/0000-0003-2464-7493 1 , 2 ,
• Alison Morgan 2 &
• Cathy Vaughan 1  

Reproductive Health volume  18 , Article number:  107 ( 2021 ) Cite this article

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Few studies explore what it means to be an adolescent parent in the Philippines from the young parents’ perspective. This study sought to improve understanding of how adolescent mothers and young fathers experienced pregnancy in Palawan, Philippines.

We conducted narrative analysis of 27 semi-structured interviews with 15 Filipino young parents.

Our findings point to three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: through early unions, through ‘ disgrasya ’ (accident) in romantic relationships, and when pregnancy is directly related to adversity and disadvantage. Some young people adopted agentic narratives and had intended pregnancies within early unions. Young people who had unintended pregnancies in romantic relationships recounted constrained choice narratives, taking responsibility for their decisions while emphasising external factors’ influence on their decision-making. Other young mothers described the ways that prior adversity and disadvantage gave rise to unfavourable circumstances—including sexual violence—that led to unintended pregnancy but shared narratives showing how they had reclaimed agency in their lives.

Our findings highlight the need to (1) address underlying poverty and structural inequalities that limit Filipino young people’s life choices and contribute to their pathways to adolescent pregnancy; (2) provide Filipino young people with access to essential sexual and reproductive health information, services, and supplies; and (3) change social norms to rectify gender-based power imbalances and sexual violence.

Plain language summary

This study sought to improve understanding of how adolescent mothers and young fathers experienced adolescent pregnancy in Palawan, Philippines. By analysing the narratives of 15 Filipino young parents, we found three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: intended pregnancy through early, cohabiting unions; unintended pregnancy through ‘ disgrasya ’ (accident) in romantic relationships; and unintended pregnancy following prior difficult life circumstances where pregnancy led to reclaiming of agency. Our findings highlight the need to address poverty and inequalities, ensure that Filipino adolescents have access to sexual and reproductive health information, services and supplies, and change social norms that perpetuate gender-based power imbalances and sexual violence.

Peer Review reports

Around the world, adolescent pregnancy is viewed as a problem largely due to potential health and socioeconomic risks this gives rise to for young mothers and their children. Extensive literature highlights the association between adolescent pregnancy and risks of pregnancy- and childbirth-related morbidity and mortality, and compromised educational and employment prospects, especially in low- and middle-income countries [ 1 , 2 , 3 , 4 , 5 ]. Within these contexts, some factors underlying adolescent pregnancy include early marriage (or union formation) and timing and context of first sex [ 6 ]. In addition, structural inequalities—institutionalised social conditions that assign unequal status to some categories of people over others [ 7 ] such as age, gender, and class—also make young people more vulnerable to adolescent pregnancy by denying them access to education and sexual and reproductive health (SRH) resources such as SRH information, services, and contraceptive supplies [ 8 ].

Despite global and regional trends indicating declining fertility overall, the Philippines is among a few Southeast Asian countries where adolescent fertility rates have either remained stable or increased since the Millennium Development Goals targets were set in 2000 [ 9 ]. Childbearing among Filipino adolescents exhibited a generally increasing trend over the last 20 years [ 10 ], with data collected in 2017 showing roughly one in 10 Filipinas in this age group was already a mother or pregnant with their first child [ 11 ]. Further analyses of Demographic and Health Surveys data found that two out of three women (aged 20–24) who experienced adolescent sexual initiation (i.e. before their 20th birthday) also experienced adolescent pregnancy [ 12 ], and that the younger their age at first birth, the more likely they were to experience a repeat pregnancy [ 13 ]. However, sexually active adolescent women aged 15–19, whether married or unmarried, also had the highest unmet need for family planning among all women of reproductive age [ 11 ]. Consequently, unintended (mistimed and unwanted) births were more likely among adolescent mothers compared to older women, with roughly 30% of births to adolescent mothers reported as unintended [ 11 ].

Dominant religious beliefs and values have a strong influence over Filipino adolescents’ SRH and rights [ 14 ]. Roughly 80% of Filipinos identify as Roman Catholic [ 15 ] and conservative Catholic teachings remain embedded in Filipino social norms, policy and legislation. Catholic doctrine dictates that sex should only occur for procreation within marital unions and as such, premarital adolescent sexuality (especially for young women) and use of modern contraceptives are generally frowned upon [ 16 , 17 ]. The influence of Catholic teachings is evident in prevailing social norms and sexual double standards that grant men sexual freedom while limiting the sexual and reproductive rights of women [ 18 , 19 ]. Yet, though conservative ideals and norms remain dominant, progressive Catholics have been dissenting [ 19 ] and there is evidence that Filipino women are finding ways to reinterpret restrictive Catholic teachings in ways that allow them to meet their sexual and reproductive needs while maintaining a moral equilibrium [ 20 ]. Furthermore, data show that Filipino young people have been gradually adopting more liberal attitudes on sexuality over the years [ 21 ].

In 2012, the Responsible Parenthood and Reproductive Health Act (more commonly known as the ‘RH Law’) was signed into law to help improve maternal health and SRH outcomes—especially among poor and marginalised groups—through the provision of essential SRH resources (i.e. information, services, and supplies), emergency obstetric care, and comprehensive sexuality education for adolescents in formal and non-formal education systems, among others [ 22 ]. As of this writing, there are other legal measures pending in the Congress of the Philippines that will also affect adolescent SRH in the country, particularly, bills seeking to raise the age of consent from 12 to 16 [ 23 , 24 ] and provide targeted comprehensive sexuality education and social protections for pregnant and parenting adolescents [ 25 ]. However, a significant number of governmental norms and standards continue to impede adolescents’ SRH and rights, among them, the continuing prohibition on legal and safe abortion [ 14 , 26 ].

Filipino young people’s relationship patterns and social contexts are different to those of previous generations and recent studies affirm that young people’s sexual behaviours do not necessarily align with conservative ideals regarding sexuality [ 27 , 28 , 28 ]. National survey data show growing proportions of young people reporting mostly premarital adolescent sexual initiation over a 20-year period [ 30 ]. At the same time, the rise of the Internet, digital technology, and social media has been transforming young Filipinos’ social interactions and allowing them to bypass social expectations and norms that do not align with their SRH needs and desires [ 31 ]. Studies among Filipino youth have shown that mobile phones and social media are enabling easy access to communication and vast amounts of content, and facilitating online and offline intimacy [ 32 , 33 , 34 , 35 , 36 ]. This has been accompanied by rising cohabitation and the deferral of formal marriage, often due to costs associated with the wedding ceremony and reception and obtaining a marriage license [ 37 , 38 , 39 ]. More recent studies have found that cohabitation was more likely among less educated women and men, and argued that the preference for cohabitation among Filipinos was indicative of socioeconomic disadvantage [ 40 , 41 ].

Conservative social norms regarding premarital adolescent sexuality and contraceptive use contribute to gender-based power differentials within relationships [ 42 , 43 ] and the stigmatisation of pregnant and parenting adolescents [ 16 ]. Dominant depictions of adolescent pregnancy in the Philippines often assign blame to young people’s lack of responsibility [ 44 ] and moral decline [ 45 , 46 ]. However, there has been growing recognition of other important contributing factors, such as poverty and inequality [ 47 , 48 , 49 ] and sexual violence [ 47 , 50 , 51 ]. For example, a study in Cebu City, Philippines found that 72% of young women experienced unwanted sexual initiation [ 52 ], while another cited that Filipino adolescents’ intimate partners commonly used verbal pressure to pursue coercive sex [ 53 ].

Indeed, national statistics show that women with lower levels of education and from resource-poor backgrounds are more likely than their wealthier and more educated counterparts to have begun childbearing as adolescents [ 11 ]. Government leaders point to early union formation on account of pregnancy as the main reason for school ‘dropout’ among Filipino youth [ 54 ], thereby limiting their lifetime wage-earning potential and costing the country billions in lost gross domestic product [ 55 , 56 ]. However, others emphasise that sometimes, poverty and other adverse life events forces a young person to abandon their education which subsequently results in adolescent pregnancy, highlighting how adolescent pregnancy may arise when young people—especially girls—have limited educational and employment opportunities [ 42 , 57 ]. Furthermore, some women pointed to having little or no choice but to accept sex when male partners were manipulative or coercive [ 20 ]. Recent vital statistics data suggest that most births to adolescent women (i.e. 10–19 years old) were fathered by older (non-adolescent) men [ 50 , 58 ], indicating that power differentials within relationships may be increasing the risk of sexual coercion and abuse. Studies have found that Filipino women from lower wealth quintiles were more likely than women from higher wealth quintiles to experience forced first sex [ 59 ] and women who experienced unwanted first sex were more likely to go on to experience unintended pregnancy than women whose first sex was wanted [ 52 ]. These studies suggest that the circumstances leading up to Filipino adolescents’ experiences of pregnancy are varied and complex.

Qualitative research can serve as an important counterbalance for dominant narratives that are often based on quantitative analyses and are limited to describing associations between a range of determinants and adolescent pregnancy outcomes [ 60 , 61 ]. Studies from other settings have focused on young mothers’ narratives of their lived experiences and sought to offer more balanced views of pregnant and parenting adolescents’ realities by presenting positive along with negative experiences and outcomes [ 62 , 63 ]. Deirdre Kelly discusses four discourses of adolescent mothers commonly presented in mainstream media [ 64 ]. These include the ‘wrong girl’ frame which blames the young woman and her ‘dysfunctional’ upbringing for an adolescent pregnancy; the ‘wrong family’ frame which laments the breakdown of ‘traditional’ (heterosexual, two-parent families) families and government spending on young, single parents; the ‘wrong society’ frame which argues that adolescent pregnancy is a marker of structural inequalities within society; and the ‘stigma is wrong’ frame which represents the viewpoints of the young parents who believe that they should not be stigmatised as they are capable of being good parents to their children. These discourses can be useful for analysing and rethinking common assumptions made about adolescent pregnancy.

This study is a component of a larger doctoral research project that aimed to gain a deeper understanding of factors associated with adolescent pregnancy and parenthood among Filipino young people. We explored experiences of adolescent pregnancy from the perspective of pregnant and parenting Filipino youth and examined them guided by the four discourses outlined by Deirdre Kelly [ 64 ]. We believe that it is important to consider young parents’ motivations and contexts to better understand how they interpret their experiences of adolescent pregnancy amid the very real impacts of poverty and structural inequalities on their lives. In doing so, we hope to highlight their unique circumstances and needs so that they can be provided with more meaningful health services and forms of support. This paper presents our findings pertaining to Filipino young people’s pathways to adolescent pregnancy through the narratives of young women who became mothers during adolescence, as well as those of young men who became fathers with adolescent partners.

Study setting

We conducted this study in Puerto Princesa City in the Province of Palawan, Philippines. Puerto Princesa is made up of 19 urban and 47 rural barangays (villages) [ 65 ]. The majority (80%) of the population of Puerto Princesa identify as Roman Catholic and about one-third are young people (aged 10–24) [ 66 ]. Between 2010 and 2015, Puerto Princesa was experiencing rapid population growth alongside economic and infrastructure development, largely due to the growth of the tourism industry [ 67 ]. However, this growth and development was most visible in the central business district, outside of which there were large stretches of sparsely populated forested and agricultural lands where agriculture and fisheries remained the dominant source of livelihood [ 68 , 69 ].

Study design

This study used semi-structured, individual interviews with Filipino young people to inquire about their lived experiences of pregnancy and parenting, including their relationship contexts leading up to pregnancy; feelings on first learning of the pregnancy; hopes and fears for their child and themselves; and the kinds of services and support they believed were needed by young people and young parents in their community. We used a semi-structured interview guide (Additional file 1 ) but also allowed some flexibility during interviews to discuss other related topics that were important to the participants. The study received ethical clearance from the Human Ethics Sub-Committee of the University of Melbourne (ethics ID 1851023.1), and the De La Salle University Research Ethics Review Committee (ethics ID EXT-008.2017-2018.T2).

Recruitment

We partnered with a local non-government organisation (NGO) that provides health services to women and young people. Participants were recruited at the partner NGO’s clinical services and through referral by some of the NGO’s staff and volunteers. We invited 24 adolescent women (aged 15–19 who had experienced pregnancy or were pregnant at the time of data collection, as well as seven young men (aged 15–24) who had an adolescent partner/girlfriend (aged 15–19) who was pregnant at the time of data collection or had experienced pregnancy in the last few years. To avoid potentially causing conflict between partners, we did not invite participants who were partnered with each other to both participate (i.e. only one person from a partnership was invited). The first author approached each prospective participant in person; gave a brief description of the study, its purpose, and what participation entailed; gave the participant time to ask questions; and provided a copy of the plain language statement for the participant to keep. We asked prospective participants for their preferred method of follow-up, and at least 24 h after the initial meeting, confirmed in-person, or via call or text message whether they were willing to participate in the study. Sixteen of the prospective participants did not respond to our efforts to confirm their interest or expressed that they were too busy to participate. In all, ten adolescent mothers and five young fathers agreed to participate in our study. All the participants were from low- to lower-middle income backgrounds—their family members and partners were either unemployed or subsistence wage-earners working casual jobs in the fisheries, construction, tourism, and service industries. Twelve participants were from urban or peri-urban communities, and three young women were from rural communities.

Data collection

Data used in this study were collected between August 2018 and March 2019. All data collection activities were conducted in Tagalog by the first author who is a female PhD candidate with a background in development studies and research, a native speaker of Tagalog, and fluent in English. Before each interview, the first author endeavoured to establish rapport and trust with the participant by reassuring them that she was neutral to the subject and that the interview was a safe space for them to share their thoughts and experiences. Fifteen initial interviews were conducted (each lasting 20–60 min). Interviews were done at participants’ homes or in quiet spaces in public locations where participants felt comfortable and privacy could be assured. In three interviews conducted at participants’ homes, some family members were present, and privacy could not be assured. In these cases, the first author proceeded with the interview but also returned at another time to conduct another interview when privacy could be assured. All interviews were audio-recorded with the informed consent of each participant. The first author made note of recurrent themes and took field notes. We conducted 12 follow-up interviews (each lasting 12–90 min) with participants who were willing and able to continue participation in the months following the initial interview. Though we sought to arrange follow-up interviews with all participants, some were not available due to childcare, work, or other responsibilities. The first author reviewed all audio recordings of the initial interviews before scheduling follow-up interviews to ensure that anything unclear could be clarified with the participant. Each participant received a cash incentive of PhP100 (~ US$2) at the end of every interview and was reimbursed any costs associated with travelling to the interviews in instances where this was necessary.

Data analysis

The first author transcribed each audio recording verbatim and translated relevant excerpts to English. We used QSR International’s NVivo 12 to organise the interview transcripts and to support coding and analysis. We assigned pseudonyms to each participant and these are used in quotations in the Findings section. Original language versions (in Tagalog/Taglish) of all quotations cited are provided in Additional file 2 .

We used a narrative approach as described by Clandinin [ 70 ] when analysing young people’s lived experiences of adolescent pregnancy. Narrative analysis is an appropriate approach for understanding how people process their life experiences (in this case, adolescent pregnancy) and what is important to them [ 71 ]. As in Riley and Hawe [ 71 ], we took note of how our participants told their stories and constructed their sentences; what their assessments were of specific events in their lives leading up to their pregnancies and why they felt that way; who the ‘supporting cast’ were that they included and excluded in their narratives; the context within which their story was being told (and our role in it); and what the point of their story seemed to be about. We also paid attention to the structure of participants’ narratives, noting whether they depicted themselves in agentic positions—taking responsibility for their circumstances and having a plan for themselves—in victim positions that focus on the tragic elements of their life experiences and resigning their future to fate, or a combination of the two. Based on the details participants shared through their narratives, we mapped each participant’s trajectory to adolescent pregnancy, taking note of pivotal life events, contributing factors, and depictions of choice and control included in their stories, and identified commonalities to come up with pathways to adolescent pregnancy. In presenting our participants’ narratives, we remain mindful of the importance of not ‘finalising’ the stories of participants for them, giving them room to change the direction of their stories and their lives [ 72 ].

Our data revealed three pathways to adolescent pregnancy. The pathways are not mutually exclusive—there are some elements of participants’ stories that overlap with those also found in other pathways. However, each pathway was differentiated by participants’ specific life circumstances and their perceived self-efficacy—what they believe they can achieve through their actions [ 73 ]—under those circumstances, including contextual factors preceding conception, perceived control (or lack of it) over their past, present, and future, and their feelings about their experiences. While the young people described pregnancies occurring in diverse circumstances, our participants’ narratives can be clustered into three main pathways to adolescent pregnancy: (1) Early union as a life choice; (2) ‘ Disgrasya’ (accident) in romantic relationships; and (3) Prior adversity and disadvantage. These pathways highlight important life events that participants included in their narratives and the ways in which they linked those events to their experiences of pregnancy and parenthood.

Pathway 1: Early union as a life choice

We'd waited for years. We were going on three [years together], only then did I get pregnant. ... I was very happy because he wanted a child, I also wanted a child. We had the same joy. ... [Our parents] were happy too. Very happy, because of course, they wanted a grandchild. (Belle, age 19, seven months pregnant)

Pathway 1 aligns with the trajectory of young people who chose to begin family life in cohabiting unions with the support of their families and then had a planned pregnancy in the context of that union. For three young women in this study, pregnancy and parenthood were expected, valued milestones in their transition to family life.

Belle, 19, moved into her partners’ family home when she was 16 years old and stopped attending school around the same time. Elements of her narrative indicated that her natal family’s financial difficulties likely influenced her decision to move in with her partner early. Belle was aware that legal marriage was still preferred over informal unions in her community, yet she seemed perfectly happy in her live-in relationship and role as partner and mother-to-be. She recounted experiences of not having enough or any food to eat and worried about whether her partner’s income as a fisherman would be enough to support their future family. However, this did not detract from her excitement about the birth of her baby or dampen her hopes of a better future. She was determined to return to school eventually to finish her education and become a teacher so she could help her partner to earn income for their family. Though Belle talked about the difficult aspects of her life that were beyond her control and represented disadvantage, she used these experiences to imagine the ‘good life’ that she wanted for her family while remaining cognisant that ‘life is difficult’.

One young mother demonstrated considerable agency in her decisions leading up to union and pregnancy. For Diane, 19, moving in with her boyfriend at age 17 was at her parents’ suggestion, but she did not want to get pregnant immediately, and her parents supported her decision. They provided her with the consent that she needed to access free contraceptive pills at the local health centre.

[My mama gave consent] because I told her that I didn't want to have a child yet. … Papa, too. I said, ‘I don't want it [to get pregnant] yet, Pa, even though I married early, I don't want to get pregnant immediately.’ (Diane, age 19, four months pregnant)

For 2 years, Diane took pills and opted to not tell her partner because she was ‘ nahihiya ’ (embarrassed; ashamed) to admit to him that she did not want a baby yet, even though he and his family did. She experienced pressure from extended family members to bear a child to secure her relationship but remained steadfast in her decision to wait. Eventually, when she felt ready for parenthood and became convinced that her partner was too, she stopped taking the pills. She was happy about her pregnancy but admitted that part of her motivation was to accommodate her partner’s elderly parents’ request to see a grandchild from them before they died. Delaying pregnancy allowed Diane to complete a post-high school vocational course before she became a mother, so she was confident that her qualification would allow her to find employment opportunities when she was ready to work. With the support of her parents, Diane met her educational goals, took control of her reproductive decisions, and made concrete plans for her future.

Pathway 2: ‘Disgrasya’ (accident) in romantic relationships

I didn't know I was already pregnant then. … I took a pregnancy test, then I was pregnant. I said [to my boyfriend], ‘This is already here, it would be a big sin if we abort.’ … It was only when we found out that I was pregnant [that] he said he could do it [provide for us]. … [I was having] second thoughts … because I am still a baby, then I already have a baby. (Giselle, age 15, five months pregnant)

Young parents who followed the second pathway had unintended pregnancies in the context of romantic relationships, largely when couples had been exclusively dating for at least a few months. The term ‘ disgrasya’ (accident) was often used by study participants to refer to unintended pregnancies. Despite their awareness that sexual activity before marriage was not socially accepted, some participants explicitly linked their unintended pregnancy to consensual sex that had been motivated by curiosity and romantic love. For example, Noel was 16 years old and in a romantic relationship with his girlfriend when they had sex out of curiosity and had an unintended pregnancy. Similarly, 16-year-old Jenny admitted thinking that maybe she wanted to get pregnant but changed her mind upon learning of her pregnancy.

That love-love – it’s like you think that you want to get pregnant. But when I got pregnant, that’s when I realised that it was very difficult, especially when your partner leaves you. (Jenny, age 16, eight months pregnant)

Although the resulting pregnancies were unintended, these young people described sex as having been sporadic and opportunistic but wanted; it was an expression of emotional intimacy with a trusted partner, albeit with an unexpected outcome.

Learning of their pregnancy, figuring out what to do, and breaking the news to their parents, relatives, and friends was a stressful ordeal for the young people who aligned with this pathway. They feared being scolded, physically hurt, disowned, and/or kicked out of the house by their parents. Nevertheless, for most of them, family and friends were quick to ‘accept’ (or become resigned to) the pregnancy news and from then on, became the young parents’ primary sources of support. The ‘acceptance’ of family and friends gave way to feelings of relief and allowed the young parents to feel excited about the birth of their baby while remaining mindful of the challenges ahead.

Initially, they associated the pregnancy with external factors or circumstances that they perceived to be beyond their control, such as partners initiating sex or boyfriends failing to practice withdrawal; not having/being given SRH information and supplies; and, as in the case of Leo, 18, wanting to escape problematic situations at home.

I was a working student, and every morning, my parents were noisy [fighting]. … I felt like I was alone. … I was stubborn, too, because my girlfriend – I would always go to her. Of course, I was getting irritated [with my parents] already. Then I thought, ‘What if I just live on my own?’ That was what was on my mind during that time. Then, that was what happened – [we] bore fruit. (Leo, age 18, 17-year-old partner was seven months pregnant)

Sixteen-year-old Elaine looked back at her unintended pregnancy as ‘God’s will’ for her and a ‘blessing’:

At first, [I thought it was] probably God's will for me. Because if it wasn't, why would he give this to me, right? So, I thought, ‘God probably gave this to me, this kind of blessing.’ (Elaine, age 16, baby was 1 month old)

These young parents recognised that their decisions led to unintended pregnancies, but it was important to them to highlight in their narratives that specific life circumstances were affecting their decision-making, and they were not fully informed or equipped at the time. Some young mothers felt they lacked knowledge about and access to contraceptives. For instance, one young mother did not know about women’s contraceptive choices when she became sexually active because she believed that contraceptives were only for married people. Meanwhile, young mothers and fathers downplayed the possibility of pregnancy based on myths and misinformation about sex and reproduction, especially the common belief that withdrawal was an effective way to prevent pregnancy. Young fathers acknowledged knowing about contraceptives but that they had not thought contraception was important and had not used modern methods consistently (if at all). Oscar, 23, recalled giving little thought to pregnancy even though he and his then-17-year-old girlfriend were aware of the possibility.

It didn't become important [to us] during those times. Because when you are young, you just want to enjoy, right? It's like, we didn't think of that. ‘Ay, that won't happen. Not like that. That's okay.’ … That was probably what was lacking with us. (Oscar, age 23, became a father at age 22 with his 17-year-old girlfriend)

While taking responsibility for their unintended pregnancies, some of these young parents believed they would have made different choices if they had the resources and support that they needed and a better understanding of how unintended pregnancy would change their lives.

Pathway 3: prior adversity and disadvantage

At first, I stopped [attending school] because I took care of my sibling. … That’s why I became careless with myself. ... My thinking back then was, ‘It's always me,’ because I was the only one doing anything in the house. … I was the only one they [my parents] could depend on, I looked after my sibling, I cleaned, I did this and that. … I also wanted to enjoy [myself]. This [pregnancy] is what happened from my enjoyment. (Indy, age 15, baby was four months old)

In the third group of narratives, prior adversity and disadvantage gave rise to pivotal events in the lives of young mothers that were key antecedents of an unintended pregnancy. All the young parents who participated in this study were from resource-poor backgrounds. However, unlike the young people whose stories mapped to pathways 1 and 2, in the third cluster of narratives, poverty and ill-health were prominent factors that led to young women discontinuing their education and this was something over which they felt they had no control. Leaving school introduced changes to these young women’s life circumstances that increased the risk of unintended pregnancy.

For some young women, their families’ lack of resources meant having no choice but to leave school to put their family’s needs before their own, and it was while they were out of school that they became pregnant. Candy, 16, left school when she was 15 because her family struggled to cover her school expenses. Candy met her current partner through text messaging while she was working as a kasambahay (domestic helper). Three months after meeting in person for the first time, they decided to move in together in his rural hometown. All Candy wanted at the time was to always be with her partner; she had not intended to start a family yet. She described taking contraceptive pills but not taking them every day and attributed her pregnancy to this. Although her pregnancy was unintended, Candy was quick to accept it; she decided that she was happy about it and looked forward to having a family of her own. For Candy, being in a stable cohabiting relationship allowed her to embrace the idea of becoming a mother sooner than she intended and adopt a positive outlook in her narrative.

For some young women, adversity took the form of sexual violence. Three young women in this study experienced sexual violence leading up to their pregnancies. Aya, 19, had experienced ill-health, the death of her mother, and had dropped out of vocational school. She was also subject to sexual violence. Aya’s first sex with her boyfriend was forced. Although she reported that their subsequent sexual encounters were consensual, she admitted contemplating suicide when she learned of her first unintended pregnancy.

It came to a point where I thought about killing myself. ... Because there was so much, so much. Also, the things people were saying, it's like they were adding to it. ... I just thought about it, but I didn't do it because I was afraid. (Aya, age 19, first pregnancy at age 16, second pregnancy at age 18)(Aya, age 19, first pregnancy at age 16, second pregnancy at age 18)

Aya saw her first pregnancy through but her baby died of an illness less than two months after birth. Having no work and no money to return to school, Aya was housebound; it was then that she was sexually abused by her father. Aya had no one she could talk to about it, so she coped by spending as much time as she could with her barkada (peer group) to stay out of the house. When Aya had a second unintended pregnancy with a new boyfriend, she felt it was ‘okay’ to start a family; she saw it as her way out of her troubled home situation. Aya’s first sex, pregnancy, and transition to family life happened before she felt she was ready. However, she prioritised her responsibilities as a mother and looked forward to a time when her child could be left in someone else’s care so she could try to find a job.

Two young mothers in this study became pregnant because of rape. Helena, 16, had been in her first romantic relationship for a few months when she experienced forced first sex. She stayed in the relationship despite it, and months later, her boyfriend raped her again, which then resulted in her pregnancy.

The second time [my boyfriend forced me to have sex], I just thought, ‘We're approaching one year together already...’ I thought – because normally, it happens between a boyfriend-girlfriend couple, right? ... After that, I just didn't say anything. … I just let him do what he wanted because I thought, ‘It already happened the first time.’ (Helena, age 17 at follow-up, baby was four months old)

Shortly after, Helena ended her relationship with her baby’s father. Yet, Helena recalled how happy she felt when she had her first ultrasound and heard her baby’s heartbeat. Helena was intent on finishing her education and finding work after giving birth. After her traumatic first relationship experience, she no longer had any ambitions of having boyfriends like other girls her age. She saw the pragmatic choice as being to prepare herself for the reality of impending childbirth and single motherhood. Like the other young women whose stories aligned with this pathway, Helena positioned herself as having been a victim in the past but was taking charge of her present and future by focusing on what she could realistically accomplish given her circumstances and available resources. This allowed her to reclaim control over her future by changing her narrative from that of a victim to an active agent.

Our participants’ accounts of their experiences of adolescent pregnancy illustrate nuanced and complex pathways to parenthood. The key finding of our study was that there is no single track to adolescent pregnancy among Filipino youth. Young parents’ narrative structures varied according to their past experiences, their intentions, how they interpreted and felt about their experiences, and their outlook for the future.

Young parents belonging to pathway 1 told agentic narratives about their planned adolescent pregnancies within the context of informal/cohabiting unions. These young parents portrayed their unions as their decision—rational choices made in light of financial, educational, and social acceptability considerations, and the support of both sides of the family. As in Deirdre Kelly’s ‘stigma is wrong’ discourse [ 64 ], young mothers in pathway 1 drew on ‘themes of empowerment, rejecting messages that portray them as victims’. In contemporary Philippines, informal cohabiting unions have been increasing in place of formal marriage [ 40 ]—one in four 15–24-year-olds were either living with their partner as if married or had ever been married [ 11 ]. The narratives of young people who followed this pathway demonstrated that starting family life early can be an alternative path to self-fulfilment, especially when there are barriers to other age-appropriate life goals (e.g. education, employment) [ 42 , 57 ]. Within these early unions, pregnancy was not only expected but wanted and celebrated.

Through the support of her parents, one young mother in our study was able to use modern contraceptives to assert her reproductive preferences, achieve her educational goals, and plan for her family’s future according to her needs and aspirations. Hers was by far the most agentic narrative we encountered. Yet, this young mother was aware of the social expectation for women to begin childbearing as soon as possible after union formation and instead of openly challenging it, chose to quietly resist. She demonstrated that given the necessary parental support, Filipino young people recognise self-efficacy and exercise agency in their relationships and plan for their futures. However, her narrative also draws attention to the social pressures that Filipino young women continue to face regarding their reproductive choices—in this case, having a baby to secure a partnership and to accommodate family expectations to bear children [ 74 , 75 ].

The stories of participants who aligned with pathway 2 revealed narratives of constrained choice as opposed to dominant narratives that portray young parents as unwitting victims of youthful emotions and impulses. In their narratives, participants reproduced elements of what Deirdre Kelly referred to as ‘wrong girl’ and ‘wrong society’ discourses [ 64 ] which assign responsibility for unintended pregnancy to the young people but also call out how adults and broader society have failed to provide for their needs. These young parents strategically framed their experiences of unintended pregnancy by elaborating on external (social) factors and actors beyond their control, highlighting that their decisions were their own but made without critical resources and support.

Though these accounts aligned in part to dominant narratives that link young people’s transitions to parenthood to ‘disgrasya’ (accident), they also reveal important considerations not always included in mainstream characterisations of ‘teen parents.’ First, for some young people, though pregnancy was not expected, sex was wanted. They had romantic feelings for their partners, were curious about sex, and wanted to be sexually intimate even amid known social disapproval of premarital sex [ 27 , 29 ]. Second, some pregnancy outcomes were linked to external factors over which young people felt they did not have control, such as their partners’ sexual desires or contraceptive behaviour, their access to essential SRH information and supplies, conflict in their home environments, and fate or God’s will. For young women, decisions on whether and when to have sex or use contraception were subject to the balance of power between them and their boyfriends [ 27 , 42 , 76 ]. Third, young parents were aware that they did not know enough about or give enough importance to contraception, and though they took responsibility for their unintended pregnancies, they were also aware that they were not fully equipped to prevent them. Analysis of national survey data found that the most common reason cited by sexually active, unmarried Filipinas for not using contraceptives was that they were ‘not married’ [ 77 ] which aligns with our participants’ beliefs that they were unlikely to get pregnant or that contraceptives were only for married people. Lastly, young parents very much valued and depended on the acceptance and support of their family and friends, especially when their relationships with their partners dissolved. This is consistent with studies with Filipino youth which found that partner and family support were important determinants of whether unintended pregnancy resulted in birth or induced abortion [ 78 , 79 ].

For participants who followed pathway 2, drawing attention to external factors allowed them to distribute accountability among the supporting cast in their stories (i.e. their partners, families, friends) while still taking responsibility for their decisions. Our findings from this pathway underscore the need to recognise young people as emerging adults with needs, emotions, and desires; consider the role of power relations between intimate partners in sexual decision-making and contraceptive behaviour; address myths and misinformation that contribute to low pregnancy risk perception and contraceptive mis- and non-use; and encourage young people’s families and friends to adopt more accepting, supportive attitudes in the event of unintended adolescent pregnancy.

The third pathway affirmed how structural inequalities can create what Deirdre Kelly referred to as the ‘wrong society’ [ 64 ] where young people become more likely to experience unintended pregnancy. As all our participants were young people from resource-poor backgrounds where conservative social norms perpetuated gender-based inequalities, structural inequalities pertaining to age, wealth, and gender were present across pathways. However, for young parents belonging to pathway 3, leaving school because of a confluence of poverty, ill-health, and other forms of adversity and disadvantage (e.g. non-inclusive school policy, lack of childcare support to indigent families) was a salient aspect in their pathway to unintended pregnancy. The storylines of young mothers belonging to pathway 3 demonstrated how structural inequalities can force families to sacrifice a young person’s education due to lack of options or constrain their ability to assert their sexual and reproductive preferences in their relationships, thereby influencing their life trajectories. They shared narratives where they had been victims, recounting their historical experiences of adversity and disadvantage, but transitioned to agentic narratives in discussing the present and future. Unlike participants belonging to pathway 1 who viewed early union and pregnancy as deliberate and desirable life choices, young parents aligned with pathway 3 perceived the adversity and disadvantage that they experienced as beyond their control and as important elements in their narratives of unintended pregnancy. Like their counterparts in pathway 1, however, they were also cognisant of the opportunities and possibilities still available to them and worked within their constraints to find meaning and purpose in their lives.

Recently, policymakers have turned their attention to the role of sexual abuse in adolescent pregnancies in the Philippines, noting that sexual violence in the country is high [ 50 ]. For three of the ten young mothers we interviewed, their unintended pregnancies were preceded directly or indirectly by experiences of sexual violence. Yet, they were determined to move forward with their lives as they saw no other choice and had a child for which to provide and care. These young mothers included tragic elements in their stories of the past, but they resisted being defined by their experiences of violence and were reclaiming narrative agency [ 80 ] in the way they discussed their current situation and outlook for the future. They showed that even after enduring sexual abuse, young mothers can demonstrate an emerging resilience as a ‘choice of the necessary’ [ 62 , 81 ]. However, the social structures that perpetuate gender-based inequality and sexual violence need to be addressed if SRH programmes seeking to curb unintended adolescent pregnancies are to result in better health and life outcomes for Filipino young women and men.

Limitations

We note three main limitations to our study. Our use of non-random sampling and a small number of participants limits the generalizability of our findings. Nonetheless, there is value in re-evaluating dominant narratives about young parents, especially if this facilitates a better understanding of who young parents are and what they need [ 80 ]. Second, young mothers were recruited at health clinics offering free prenatal check-ups for pregnant women from resource-poor communities, as well as through referral of the partner NGO’s staff and volunteers. The fact that the young mothers were demonstrating health-seeking behaviour could mean that our participants were more likely to have resolved to care for their baby regardless of their pregnancy intention, and thus, be more willing or better able to see their pregnancy in a positive light. Also, our sample does not capture the experiences of young people who opted to abort their pregnancies. Abortion remains illegal in the Philippines, but as our study participants pointed out, community members were well-aware of how to access clandestine abortion services when needed. Although we were able to capture rich, nuanced narratives from our participants who chose to see their pregnancies through, there would certainly be merit in research with young people for whom pregnancy termination was the ‘responsible choice’ [ 82 ]. Finally, our participants were at different stages of pregnancy and parenthood and were asked to reflect on their lived experience to date, which could have introduced bias in their responses. It is possible that our participants may have forgotten certain aspects of their experiences, or that their assessments of their circumstances and feelings had since evolved. Also, our participants were aware that sex and pregnancy before marriage are generally frowned upon in Filipino society, so it was also possible that they tailored or tempered their narratives to better align with what they perceived to be socially acceptable or desirable.

We sought to explore Filipino young people’s experiences of adolescent pregnancy in the hope of improving understanding of who young parents are and what they need through their narratives. We found that there is no single track to early parenthood among Filipino youth, and each young person’s trajectory to adolescent pregnancy is differentiated by specific combinations of adversities and by their perceived self-efficacy given their circumstances. Programmes and policy need to be grounded in the realities of the target population to be truly effective, and thus, young people’s narratives of their experiences of pregnancy are valuable inputs to interventions seeking to improve adolescent SRH outcomes. Our findings highlight the need to address poverty and structural inequalities that limit young people’s life choices and contribute to their trajectories to unintended adolescent pregnancy; provide Filipino adolescents with access to SRH information, services, and supplies in enabling environment; and challenge social norms that perpetuate gender-based power differentials and sexual violence.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Abbreviations

Demographic and Health Surveys

Non-Government Organisation

• Sexual and reproductive health

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Acknowledgements

We are grateful to our partner NGO for their assistance with recruitment and logistics during data collection activities, and for the young parents who shared their stories with us. We are also deeply grateful to the late Associate Professor Jesusa Marco, for her local supervision, mentorship, and friendship.

This study is a component of the doctoral research project of CMH which was made possible by the Nossal Global Health Scholars Programme of the Nossal Institute of Global Health, Melbourne School of Population and Global Health, University of Melbourne. We also received partial funding for data collection from the Population Health Investing in Research Students’ Training (PHIRST) grant of the Melbourne School of Population and Global Health, University of Melbourne, and the Riady Scholarship of the University of Melbourne.

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Christine Marie Habito & Cathy Vaughan

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CMH conceptualised the study, collected and analysed the data, and drafted the manuscript. CV played a key role in guiding the analysis and structure of the manuscript, and both CV and AM contributed to the conceptualisation of the study and writing and revision of the manuscript. All authors read and approved the final manuscript.

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This study was granted ethical clearance by the Human Ethics Sub-Committee of the University of Melbourne (ethics ID 1851023.1), and the De La Salle University Research Ethics Review Committee (ethics ID EXT-008.2017-2018.T2).

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Supplementary Information

Additional file 1..

Interview guide for pregnant and parenting young people.

Additional file 2.

Original language versions (Tagalog/Taglish) and English translations of interview transcripts.

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Habito, C.M., Morgan, A. & Vaughan, C. Early union, ‘ disgrasya ’, and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth. Reprod Health 18 , 107 (2021). https://doi.org/10.1186/s12978-021-01163-2

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A development concept of adolescence: the case of adolescents in the Philippines

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Adolescent Psychiatry

Editor-in-Chief:

Stephan M.Carlson Comprehensive Psychiatric Emergency Program (CPEP) Brookdale University Hospital and Medical Center Brooklyn NY United States

ISSN (Print): 2210-6766 ISSN (Online): 2210-6774

Child Mental Health in the Philippines

Volume 3, Issue 1, 2013

Page: [11 - 13] Pages: 3

DOI: 10.2174/2210676611303010003

Keywords: Child , mental illness , Philippines , prevalence , access to care

Title: Child Mental Health in the Philippines

Volume: 3 Issue: 1

Author(s): Consuelo Cagande

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KOICA, United Nations call for an Adolescent Pregnancy Prevention Law in PH

Following the commemoration of International Youth Day, the Korea International Cooperation Agency (KOICA) and the United Nations in the Philippines, including the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), jointly call for the urgent passage of the adolescent pregnancy bill in the Philippines. This legislation is crucial in addressing the rising rates of adolescent pregnancy and ensuring the well-being of young people in the country.

The proposed legislation aims to provide a comprehensive national framework for preventing adolescent pregnancies and ensuring the well-being of young children in the Philippines. While the bill has been approved by the House of Representatives, its progress in the Senate has stalled, highlighting the urgent need for action.

Recognizing the pressing need, the UN agencies are collaborating on the KOICA-funded Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar. This program focuses on strengthening comprehensive sexuality education and improving access to adolescent-friendly sexual and reproductive health services.

"Having legislation that ensures access to essential reproductive health services is a crucial step towards a more equitable and sustainable future, where every young person can thrive and reach their full potential,” said  Gustavo González, UN Resident Coordinator in the Philippines. "Adolescent pregnancy is also not just a health issue, but a social and economic one as well. This bill will help us address the root causes of adolescent pregnancy, including lack of access to education and health services."

The urgency of the situation is underscored by data from the Philippines’ Commission on Population and Development, which reveals a 10.2% increase in live births by girls aged 10-19 between 2021 and 2022.

KOICA also expressed its strong support for the bill. "We believe that investing in young people is essential for sustainable development. In addition to celebrating 75 years of Korea-Philippines diplomatic relations and 30 years of KOICA’s presence in the Philippines, this bill will make us more inspired to strengthen our assistance to the country’s health projects. We assure you of KOICA’s continuing support and commitment not only for better health and well-being, but also a brighter future for young Filipinos," said KOICA Country Director Kim Eunsub.

UNFPA stresses the necessity of the bill to remove barriers to healthcare access for adolescents. Currently, young people under 18 require written parental consent for family planning services, which can significantly hinder their access to essential care.

“Adolescent pregnancy can result in significant health risks, including increased rates of preventable maternal and infant deaths, as well as the dangerous practice of unsafe abortions. Having a comprehensive framework to address this urgent issue and to protect the sexual and reproductive health and rights of young Filipinos, will help empower adolescents to make informed choices about their bodies and pave the way for better futures," said UNFPA Philippines Country Representative Dr. Leila Saiji Joudane.

Meanwhile, UNICEF underscored the importance of protecting the rights and aspirations of young girls.

“Adolescent girls’ dreams to learn and get decent jobs should not be cut short. UNICEF is committed to supporting girls through laws, policies and programmes that prioritize their rights, their agency, and opportunities to pursue their dreams and to prevent early and unintended pregnancies. This bill needs to retain the clauses that better define roles and accountability of duty bearers, which can help everyone in the community to work together to tackle the social factors that lead to more teen pregnancies,” said Behzad Noubary, UNICEF Philippines Representative a.i. 

“These girls have the right to be informed about decisions that affect their lives. They need support, not stigma and blame,” he said.

The World Health Organization also recognizes that addressing adolescent pregnancy is a global health and development priority.

“Addressing adolescent pregnancy is part of the global health and development agenda. Together with partners, WHO Philippines continues to address adolescent pregnancy by supporting national programmes and policies. Rights-based policies alongside community-based care and evidence-informed interventions are crucial to strengthening frameworks and strategies to scale up interventions and collective action from various sectors, agencies, and communities,” said Dr Graham Harrison, Officer-in-Charge of WHO Philippines.

The UN agencies and KOICA call on all stakeholders, including government agencies, civil society organizations, and young people themselves, to unite in advocating for the passage of the adolescent pregnancy bill to create a brighter future for young people in the Philippines.

About the Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP):

This is a joint initiative of UNFPA, UNICEF, WHO, and KOICA that aims to reduce adolescent pregnancy in Southern Leyte and Samar. The partners are working closely with the Department of Health, the Department of Education, and the governments of Samar and Southern Leyte, as well as other government agencies in rolling out adolescent-friendly services, building the capacity of community adolescent health service providers, accelerating the integration of comprehensive sexuality education in schools, implementing youth leadership and governance initiatives, and conducting research on adolescent pregnancy and child, early, and forced marriage.

The 2021 Young Adult Fertility and Sexuality Study showed that Eastern Visayas, where Samar and Southern Leyte are located, has one of the highest rates of 15 to 19-year-old female youths that had begun childbearing. 

For more information contact:

Kristine Guerrero | Media and Communications Analyst | United Nations Population Fund | [email protected]

Cling Malaco | Communications Officer | World Health Organization Philippines | [email protected]

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In response to the rising number of underage mothers, the Korea International Cooperation Agency (KOICA) and several organizations under the United Nations (UN) called for the swift passage of an Adolescent Pregnancy Prevention Law in the Philippines.

In a joint press statement released on Tuesday, August 13, KOICA with the UN Population Fund (UNFPA), UN Children’s Fund (UNICEF), and the World Health Organization (WHO) said this legislation is critical to address cases of teenage pregnancies and safeguard the future of young Filipinos.

Recent data from the Philippines’ Commission on Population and Development revealed a 10.2% increase in live births among girls aged 10-19 between 2021 and 2022, underscoring the urgent need for this bill.

Although the legislation has passed the House of Representatives, its progress has stalled in the Senate, putting the health and future of countless adolescents at risk.

The proposed law aims to establish a national framework that strengthens comprehensive sexuality education and improves access to adolescent-friendly sexual and reproductive health services.

The initiative is part of a broader effort, with UN agencies collaborating on the KOICA-funded Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar.

The 2021 Young Adult Fertility and Sexuality Study showed that Eastern Visayas, where Samar and Southern Leyte are located, has one of the highest rates of 15 to 19-year-old female youths that had begun childbearing, according to the organizations.

“Having legislation that ensures access to essential reproductive health services is a crucial step towards a more equitable and sustainable future, where every young person can thrive and reach their full potential,” said Gustavo González, UN Resident Coordinator in the Philippines.

“Adolescent pregnancy is also not just a health issue, but a social and economic one as well. This bill will help us address the root causes of adolescent pregnancy, including lack of access to education and health services,” he noted.

KOICA, marking 30 years of partnership with the Philippines and celebrating 75 years of Korea-Philippines diplomatic relations, expressed strong support for the bill. “Investing in young people is essential for sustainable development,” said KOICA Country Director Kim Eunsub.

“This bill will make us more inspired to strengthen our assistance to the country’s health projects. We assure you of KOICA’s continuing support and commitment not only for better health and well-being, but also a brighter future for young Filipinos,” he added.

UNFPA Philippines Country Representative Dr. Leila Saiji Joudane stressed the necessity of the bill to remove barriers to healthcare access. Currently, young people under 18 require written parental consent for family planning services, which can significantly hinder their access to essential care.

“Having a comprehensive framework to address this urgent issue and to protect the sexual and reproductive health and rights of young Filipinos, will help empower adolescents to make informed choices about their bodies and pave the way for better futures,” she said.

The WHO added that adolescent pregnancy is a global health and development priority. Dr. Graham Harrison, officer-in-charge of WHO Philippines, noted that rights-based policies and community-based care are essential for scaling up interventions and driving collective action.”

KOICA and the UN agencies are calling on all stakeholders, including government agencies, civil society organizations, and the youth, to rally behind the passage of the Adolescent Pregnancy Prevention Law to secure a healthier and more prosperous future for the country’s youth.

• Adolescent Pregnancy Prevention Law
• childbearing
• Philippines
• press release
• teenage pregnancy
• underage mothers

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Childhood overweight and obesity in the Philippines

Medicine Cabinet

By Teodoro B. Padilla

More and more Filipino children are getting fatter, and this puts them at risk for serious health problems. The prevalence of overweight and obesity among Filipino adolescents has more than doubled, from 4.9% in 2003 to 11.6% in 2018, which further increased to 13% in 2021, according to the latest Expanded National Nutrition Survey (ENNS) of the Department of Science and Technology-Food and Nutrition Research Institute (DoST-FNRI).

Addressing the increasing number of overweight and obese Filipino children takes on added significance as the country observes Linggo ng Kabataan on Aug. 12, coinciding with the annual celebration of International Youth Day (IYD). This year’s IYD theme is “Transforming Food Systems: Youth Innovation for Human and Planetary Health.”

Overweight is a condition of excessive fat deposits. Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Overweight and obesity are diagnosed by measuring people’s weight and height and calculating the body mass index (BMI) with the formula: weight (kg)/height(m). BMI is a surrogate marker of fatness and additional measurements, such as waist circumference, which can help the diagnosis of obesity. The BMI categories for defining obesity vary by age and gender in infants, children, and adolescents.

The World Health Organization (WHO) warns that being overweight in childhood and adolescence is associated with greater risk and earlier onset of various noncommunicable diseases (NCDs), such as type 2 diabetes and cardiovascular disease.

Obesity can lead to increased risk of type 2 diabetes and heart disease, can affect bone health and reproduction, and increases the risk of certain cancers. It also in fl uences the quality of living, such as sleeping or moving. Childhood and adolescent obesity have adverse psychosocial consequences as well; it affects school performance and quality of life, compounded by stigma, discrimination, and bullying. Children with obesity are very likely to become adults with obesity and are also at a higher risk of developing NCDs in adulthood, said the WHO.

A study by Desnacido et al published on August 2022 in the Philippine Journal of Science identified several factors associated with overweight and obesity in the country, particularly among adolescents. These are higher socioeconomic status, residence in urban areas, higher educational status of household head, physical inactivity (a sedentary lifestyle), and food intake exceeding requirement (excessive eating).

The study utilized data collected in the 2018 ENNS, which was a cross-sectional household-based survey. It is believed to be the first local study to investigate the factors associated with overweight and obesity among adolescents using a nationally representative sample.

A study by Abueg et al published in January 2024 in the online journal Sage Open found that parents’ nutritional knowledge on diet, disease, and weight management; permissive parenting style; and dietary behavior on emotional undereating (eating less in response to stress or negative emotions) are significantly associated with adolescent overweight and obesity.

The study involved 200 students of three high schools and two universities in the City of Manila, which was identi fi ed in the ENNS as one of the top fi ve cities in the country with the highest prevalence of overweight and obese Filipino adolescents.

At the individual level, Abueg et al recommended the implementation in schools and social media of interventions that promote nutrition guidelines for healthy diets, limit the intake of total fats and sugars, and increase consumption of fruit and vegetables. At the societal level, they echoed the WHO recommendations calling on the food industry to reduce the salt content of processed food; ensure healthy and nutritious choices; restrict the marketing of foods high in sugars, salts, and fats, especially those foods aimed at children and teenagers; and ensure the availability of healthy food choices. They also recommended that children and adolescents engage in moderate to vigorous physical activity for at least 60 minutes daily, as well as create more open or designated spaces for recreational and physical activities.

Abueg et al underscored the importance of parent-based interventions aimed at improving parents’ nutrition knowledge, parenting style with regard to children’s nutrition, and eating behavior. This could positively in fl uence children’s behavior and help prevent childhood and adolescent overweight and obesity.

The Department of Health stressed that interventions that address the social determinants of health, highlighting the need to integrate health in all public policies, to enable behavior change and create supportive environments must be put in place. Healthier food options in communities, schools, and workplaces should be made more available, affordable, and accessible to all Filipinos. Moreover, concrete steps must be taken to make the country’s public infrastructure such as parks, roads, and pathways more conducive to physical activity and active mobility.

The DoST-FNRI recommends that National Government agencies develop standard protocols for physical activity programs and routines, and provide parents and caregivers with the latest health information and other resource materials. National Government agencies should also fund and regularly organize seminars or courses on nutrition and physical activity, increase surveillance, and support and fund research focusing on symptoms, prevention, and cure of genetic factors of obesity such as metabolic syndrome.

The DoST and the biopharmaceutical industry have oftentimes similar research objectives. The biopharmaceutical industry continues to conduct research to fi nd clues about how to treat diseases and ways to zero in on symptoms or underlying causes. Once the industry has an understanding of the disease or condition, the process of developing a new medicine begins.

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP).   PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.

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