CHAPTER 2

REVIEW OF RELATED LITERATURE

There are several literatures that were found to be useful in the course of this study.

These include articles found in books, internet sources, studies and thesis that are relevant to the

topic. In this chapter, these literatures are discussed to further understand the current

investigation.

RELATED LITERATURES

THE PREGNANT ADOLESCENT

Pillitteri (2007) recognized adolescent pregnancy as a major health problem and is one of

the leading causes of maternal mortality and morbidity rate in the US. Reasons for high numbers

of adolescent pregnancy are earlier age of menarche in girls, increase rate in sexual activity

among teenagers, lack of knowledge about contraceptives and desire by young girls to have a

child. These issues clearly pointed out adolescent’s inadequate knowledge and can be addressed

by health care providers through educational programs on reproductive health care. Adolescent

pregnancy is also considered a high risk pregnancy. Adolescent pregnancy in the US is reported

to have a high incidence in Pregnancy-Induced Hypertension, Iron Deficiency Anemia, with low

birth weight infants and preterm births. These complications are may be results of immaturity of

their physical and psychological well-being. Adolescents are adjusting to the alterations in their

body and thinking attributes as she goes through a transition from childhood to adulthood so this

is a vulnerable time for pregnancy. Pregnant adolescents may feel devastated after realizing her

pregnancy because she may have to give up herself from acquiring a vocation and focus in

thinking about her pregnancy. Pregnant adolescent seek prenatal care late in their pregnancy due
to denial of pregnancy, lack of knowledge in the importance of prenatal care, dependence for

others and feelings of awkward and fear in going to prenatal setting. Effective method in

decreasing adolescents feeling of apprehension during prenatal period is primary nursing care

approach to minimize the number of health care providers she is exposed to. Some pregnant

adolescent do well in a group prenatal care because it allows them to interact with a peer group.

Special considerations such as offering increased guidance and support during childbearing and

the following year is essential to eliminate problems relating to adolescent pregnancy.

RELATED STUDIES

Adolescent pregnancy remains a serious health and social problem worldwide (Mchunu,

Pelzer, Tutshana & Seutlwadi, 2012) in their investigation of the prevalence of adolescent

pregnancy and its associated factors in South African youth. It is found out that adolescent girls

engaged in sexual intercourse and pregnancy to prove their maturity or identity as a woman.

Some adolescent respondents (55.5%) reported that they don’t understand the risk involved and

how pregnancy happens. Others revealed that they do it in exchange for gifts or money-

transactional sex which usually occurs in adolescent with older partners. Pregnant adolescent in

this study were also asked about their perceptions on gender power relations. Women in this

study (55.9%) said they endure much greater hardships than men. A majority of 70.8%

adolescent respondents agreed that women have more responsibilities, fewer opportunities and

felt more vulnerable to violence and abuse than men. This study also discussed the various

communication sources of sexual and reproductive information and services. Identified

reproductive health services information sources are schools (85%), health care providers

(74.1%) and family members. Research findings also indicate that lack of employment and job

opportunities, greater poverty, higher sexually permissive attitudes and high contraceptive
condom use index are associated with teenage pregnancy. These contributing factors can be used

in targeting young people on the prevention of adolescent pregnancy.

EMOTIONAL SUPPORT

On a quantitative study conducted by Ruppel on 2001, the researcher recognized that

social support plays an important role in pregnant adolescent’s health beliefs and health

behaviors. Social support was related to health beliefs about barriers to prenatal care (r =-.4853),

barriers to quitting smoking (r = .2601), barriers to adequate nutrition (r = -.2749) and beliefs

about the susceptibility/seriousness of drinking alcohol while pregnant (r = .389). The type of

social support needed may be dependent on the adolescent’s transition from childhood to

adulthood. Although the major goal of adolescence involves differentiation from parents,

pregnant adolescents are more dependent to their parents or family due to physical and emotional

needs. It was also discussed that including the support system of the pregnant adolescent in

planning and providing her care may be a way to positively influence her health behavior.

Ngoc-Vo (2008) focused on the level and type of social support teen pregnant and

parenting teens received and their experiences of stress from this support sources in a

quantitative study conducted in Iowa State University. Teen pregnant and parenting teens have

few differences on many of the support variables, on their attitudes about motherhood, and their

perceptions of motherhood. They have significant difference in how much contact they have with

the child’s father. Teen pregnant recognized their boyfriend as the primary support source but

teen parents had less contact with child’s father.

Ngoc Vo (2008) also investigated the relationship of the total support and their attitudes

about motherhood and any correlation among the factors (social support, stress, and perception
of motherhood) for the group. As illustrated in the study, pregnant teens and parenting teens

actually share similar ideals and expectations about social support and attitude about

motherhood. They appeared to be more realistic about motherhood from these teens’ experiences

with infants and young children. Understanding teen pregnant and parenting teens’ needs is

important in making policies and interventions that will maximize their potential in rearing

strong and healthy children.

INFORMATIONAL SUPPORT

Secor-Turner (2008) revealed that adolescents must go through mixed social messages

from adolescents’ everyday support network. Five themes related to the social context of social

messages were identified: Getting Ready and Getting It Over With, The Path for African

American Girls, Insecurity and Independence (Gender Expectations), Living Into a Future, and

Instability and Uncertainty. Participants in this study described learning about reproductive and

sexual health through direct verbal communication and nonverbal messages by observing the

people action. Sources of social messages included their mothers, other family members, sexual

partners, friends and peers. Young women described their mothers as their role model that they

aspired to be. They play an important role in shaping pregnant adolescent beliefs, attitude and

practices on reproductive health and sexuality. Family members including their aunts,

grandmothers, siblings and cousins are also influential in shaping pregnant adolescents’

reproductive health beliefs and behaviors. Findings also revealed that sexual partners have direct

and indirect influence on the pregnant adolescents’ reproductive and sexual health beliefs and

behaviors. Friends and peers experiences and behaviors have indirect influence on reproductive

and sexual health beliefs and practices. Health promotion messages on reproductive and sexual
health should fit into the social context that pregnant adolescents are living in order to foster

resilience and provide a healthier support in their decision making.

Malleshappa, Shivaram, Nandini (2011) evaluated the effectiveness of health education

by health professionals on adolescents’ knowledge and attitude towards reproductive health.

Findings have shown a significant increase on the adolescents’ knowledge on puberty, menstrual

cycle, pregnancy, contraception and also transmission and prevention of STDs. Before

intervention, adolescent girls in Kuppam area are unaware about many aspects of reproductive

health especially about contraceptives. Adolescents’ social support network lacks confidence and

skills and finds it difficult to discuss the topics related to reproductive and sexual health.

Adolescent girls usually acquire knowledge on reproductive health through books and media

sources. It is also found out that reproductive health education by health professionals has

become acceptable to urban areas; however, acceptability on in rural areas should be determined

before universal implementation to ensure its effectiveness. Study results suggest that

reproductive health education can improve adolescents’ level of awareness on reproductive

health especially in rural areas and empower them to take care of their own health as well as

protect themselves from the risk of STDs.