CHAPTER 2

Review of Related Literature

This chapter presents the review of related studies

and literature that is relevant in this study, included in

this chapter are about premarital sex, early pregnancy and

abortion rate in the US and the norm of morality in the

Philippines which needs and necessary for the reference of

the title under study.

FOREIGN LITERATURE

Although only 13% of U.S. teens have ever had sex by

age 15, sexual activity is common by the late teen years.

By their 19th birthday, seven in 10 teens of both sexes

have had intercourse. Between 1995 and 2006–2008, the

proportion of teens aged 15–17 who had ever engaged in

sexual intercourse declined from 38% to 28%. Among teens

aged 18–19, that proportion declined from 68% in 1995 to

1
60% in 2006–2008.

The pregnancy rate among young women has declined

steadily, from 117 pregnancies per 1,000 women aged 15–19

in 1990 to 70 per 1,000 in 2005. However, in 2006, the rate

1
Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing,
(National Survey of Family Growth 2006–2008) pp 65-66
 9

increased for the first time in more than a decade, rising

3%. Of the approximately 750,000 teen pregnancies that

occur each year. The 2006 teenage abortion rate was 19.3

abortions per 1,000 women. This figure was 56% lower than

its peak in 1988, but 1% higher than the 2005 rate.2 The

majority (86%) of the decline in the teen pregnancy rate

between 1995 and 2002 was the result of dramatic

improvements in contraceptive use, including increases in

the proportion of teens using a single method of

contraception, increases in the proportion using multiple

methods simultaneously and substantial declines in nonuse.

Just 14% of the decline could be attributed to a decrease

in sexually activity.3 82% are unintended. Fifty–nine

percent end in birth and more than one–quarter end in

4
abortion. In 2009, there were 39.1 births per 1000 women

aged 15-19, marking an historic low. This was a decline of

37% from the peak rate of 61.8 in 1991.5Although teens in

the United States have a level of sexual activity similar

to that among their Canadian, English, French and Swedish

peers, they are more likely to have shorter and less

2
Thomas Griffin, U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends
by Race and Ethnicity,( Trends Among Teenager, Guttmacher Institute, 2010)pp 12-16
3
Joseph Santelli et al., “Explaining recent declines in adolescent pregnancy in the United States: the
contribution of abstinence and improved contraceptive use”( American Journal of Public Health, 2007) pp
97
4
Librado , Finer et al, Perspectives on Sexual and Reproductive Health, (Disparities in rates of unintended
pregnancy in the United States,2006) , 38(2):90–96.
5
Ventura Hamilton, U.S. teenage birth rate resumes decline, (NCHS Data Brief, 2011), No. 58.
 10

consistent sexual relationships and are less likely to use

contraceptives, especially the pill or dual methods. The

United States continues to have one of the highest teen

pregnancy rates in the developed world—more than twice as

in Canada (27.9 per 1,000 women aged 15–19 in 2006) or

Sweden (31.4 per 1,000).6Every year, roughly nine million

new STIs occur among teens and young adults in the United

States. Compared with rates among teens in Canada and

Western Europe, rates of gonorrhea and chlamydia among U.S.

teens are extremely high.7

In 2006–2008, most teens aged 15–19 had received

formal instruction about STIs (93%), HIV (89%) or

abstinence (84%). However, about one-third of teens had not

received any formal instruction about contraception; males

were even less likely to receive this instruction than

females (62% vs. 70%). Seventy percent of male teenagers

and 79% of female teenagers reported talking with a parent

about at least one of six sex education topics (how to say

no to sex, methods of birth control, STIs, where to get

birth control, how to prevent HIV infection and how to use

a condom). Girls were more likely than boys to talk with

6
Anthony McKay A et al., “Trends in teen pregnancy rates from 1996–2006: a comparison of Canada,
Sweden, USA and England/Wales,”( Canadian Journal of Human Sexuality, 2008) pp 34-35
7
Hegard, Weinstock Sexually transmitted diseases among American youth: incidence and prevalence
estimates, 2000, (Perspectives on Sexual and Reproductive Health, 2008), pp 36-38
 11

their parents about birth control or “how to say no to

sex.”8 Many sexually experienced teens (46% of males and 33%

of females) did not receive formal instruction about

contraception before they first had sex. About one in four

adolescents (23% of females and 28% of males) received

abstinence education without receiving any instruction

about birth control in 2006–2008, compared with 8–9% in

1995.9 Among teens aged 18–19, 41% report that they know

little or nothing about condoms and 75% say they know

little or nothing about the contraceptive pill.10 Similarly,

public school districts were more likely to require

instruction on STI prevention for high schoolers (87%) than

at the elementary and middle school levels (33% and 77%

middle, respectively). Adolescents rank parents, peers and

the media as important sources of sexual health

information. Even when parents provide information, their

knowledge about contraception or other sexual health topics

may often be inaccurate or incomplete. More than half (55%)

of 7th–12th graders say they have ever looked up health

information online in order to learn more about an issue

affecting themselves or someone they know. The Web sites

8
Martinez G, Abma J, “Educating teenagers about sex in the United States”( NCHS Data Brief, 2010) p.
44.
9
Lindberg LD, Changes in formal sex education, (Perspectives on Sexual and Reproductive Health, 2006)
pp182–189.
10
Kaye Kinston et al., The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put
Young Adults at Risk for Unplanned Pregnancy, (Washington, DC: National Campaign to Prevent Teen
and Unplanned Pregnancy, 2009.) pp 34-37
 12

teens turn to for sexual health information often have

inaccurate information. For example, of 177 sexual health

Web sites examined in a recent study, 46% of those

addressing contraception and 35% of those addressing

abortion contained inaccurate information.11Exposure to high

levels of sexual content on television has been shown to be

associated with an increased risk of initiating sexual

activity, as well as a greater likelihood of involvement in

teen pregnancy.12 Twenty-eight states and the District of

Columbia require that sex education be age-appropriate. In

December 2009, Congress replaced the rigid Community-Based

Abstinence Education Program with a new $114.5 million teen

pregnancy prevention program to support evidence-based

interventions, as well as others that have demonstrated

promise. Medically accurate sex education remains rare,

however. A recent review of 13 commonly used abstinence-

only curricular found that 11 had incorrect, misleading or

distorted information. In March 2010, Congress created

through health care reform a five-year Personal

Responsibility Education Program (PREP). Its stated purpose

is to educate adolescents on both abstinence and

contraception and to prepare them for adulthood by teaching

11
Edurdo Buhi ER et al., “Quality and accuracy of sexual health information web sites visited by young
people”, (Journal of Adolescent Health, 2010,)pp 47
12
Alexandra Chandra A et al., “Does watching sex on television predict teen pregnancy?”( National
longitudinal survey of youth, Pediatrics, 2008,) pp 122 .
 13

such subjects as healthy relationships, financial literacy,

parent-child communication and decision-making. Congress

also renewed (per another provision in the health care

reform legislation) the Title V abstinence-only program for

five years. This funding stream makes available $50 million

annually for grants to the states to promote sexual

abstinence outside of marriage. Strong evidence suggests

that comprehensive approaches to sex education help young

people both to withstand the pressures to have sex too soon

and to have healthy, responsible and mutually protective

relationships when they do become sexually active. A 2007

congressionally mandated study found that federally-funded

abstinence-only programs have no beneficial impact on young

people’s sexual behavior. Leading public health and medical

professional organizations, including the American Medical

Association, the American Nurses Association, the American

Academy of Pediatrics, the American College of

Obstetricians and Gynecologists, the American Public Health

Association, the Institute of Medicine and the Society for

Adolescent Health and Medicine, support a comprehensive

approach to educating young people about sex There is no

evidence to date that abstinence-only-until-marriage

education delays teen sexual activity. Moreover, research

shows that abstinence-only strategies may deter

 14

contraceptive use among sexually active teens, increasing

their risk of unintended pregnancy and STIs. A November

2007 report found that “two-thirds of the 48 comprehensive

programs that supported both abstinence and the use of

condoms and contraceptives for sexually active teens had

positive behavioral effects.” Many either delayed or

reduced sexual activity, reduced the number of sexual

partners, or increased condom or other contraceptive use.

Although there is no supporting evidence for federally-

funded abstinence-only-until-marriage education, a recent

randomized controlled trial found that in specific cases,

abstinence-only education programs that are specifically

tailored to the local community and do not criticize

contraceptives nor advocate abstinence until marriage can

be effective in delaying sexual debut among younger teens.13

LOCAL LITERATURE

A way of looking at the problem of morality in the

Philippines is to consider the actual and prevailing norms

of right and wrong among Filipinos. It is quite obvious

that there is a conflict between what they say as

Christians and what they do as Filipinos; between their

13
Joseph Jemmott III JB et al., Efficacy of a theory-based abstinence-only intervention over 24 months: a
randomized controlled trial with young adolescents, (Archives of Pediatric Adolescent Medicine,2010,
pp152–159.
 15

actual Filipino behavior and their ideal Christian

behavior; in short, between what is and what ought to be.

One norm of morality in the Philippines is based on

"group-centeredness" or "group-thinking." One's in-group

determines for the individual what is right or wrong. The

individual who has not yet attained moral independence and

maturity will ask: "What will my family, or my relatives

and friends, or my barkada think or say?" "What will others

say" usually determines Filipino moral behavior; it is

"conscience from the outside." For instance, parents tell

their daughter who is being courted: "Iha, please entertain

your boyfriend at home. Do not go outside. What will the

neighbors say? Nakakahiya naman." Shame or hiya makes the

parents and the girl conform to the social expectations of

the neighbors lest they become the object of chismis or

gossip. Here again there is a conflict between the

individual and social morality, between internal and

external morality. The norm of morality should be

internalized so that the mature individual should form his

own moral "conscience from the inside."

Another norm of morality in the Philippines is

characterized by the "Don't be caught" attitude based on

shame or fear of the authority figure. The authority figure

 16

may be a parent, teacher, priest or policeman. As one law

student puts it:" What's wrong with cheating in the bar

examinations as long as you do not get caught?" During the

war, it is told that a prison official of Muntinglupa

addressed his new prisoners thus: "Here, there are no Ten

Commandments. You can obey or break the rules as you

please. But God help you if you get caught." This norm of

moral behavior also gives rise to a conflict in the

individual between the "don’ts" of the authority figure and

"what every else does" in the latter's absence. As long as

a policeman is on duty, Filipino drivers will obey traffic

rules but if there is no policeman, then everyone else

tries make puslit or get ahead of the others often causing

a traffic jam.

We find in the Filipino whose norm of behavior is

purely external, a split between the ideal Christian norm

of morality and the actual Filipino norm of morality. He

will put on the externals of Christian moral behavior in

front of the authority figure while at the same time follow

in "real life" an inconsistent moral behavior when the

latter is "at a distance."

The problem for the Filipino individual is to be

"aware" that the two inconsistent norms of morality are

 17

allowed to coexist in his personality and life and that he

must overcome this split if he is to become a mature

Christian Filipino.

What can be done about the problem of morality in the

Philippines? In this respect, the question of attitudes,

whether on the part of the individual or on that of society

as a whole, is quite relevant. The solution to a problem

depends to a great extent on one's awareness of the problem

and his attitude towards it. Let us consider the various

attitudes that the Filipino individual or Philippine

society can take towards the problem of morality and

religion.

The worst possible attitude is not to be aware of the

problem at all. The person who is not aware that he has a

cancer or heart trouble will not see the doctor. Another

wrong attitude is complacency when one is aware but is not

concerned. The individual who feels secure and comfortable

with the status quo sees no need for change. Some

individuals see the problem but it is too frightening.

Hence they are afraid to make a decision and initiate

change because it is painful and difficult. This is the

attitude of timidity. Others try to escape from their real

problems. They skirt confrontation with the real issue in

 18

their lives and hence raised up pseudo problems as

camouflage.

Finally a very common attitude is rationalization.

People who know they are doing wrong but do not want to

change easily find excesses like "ako'y tao lamang" (I'm

but human), "ganyan lamang ang buhay" (life is like hat),

"bahala na" (come what may), or "eveybody is doing it." In

this age of "passing the buck", another excuse for

shrinking personal responsibility is the Filipinism, "I am

not the one".

All these attitudes of mind are wrong and without the

proper attitude there can be no solution to the problem.

Filipinos will make no progress toward a Christian solution

until they realize that the problem is serious and urgent.14

Related Study

In the study conducted by Aries Roman Gungab15

entitled “Moral Values: Its Implication to Nursing

Profession” which is relevant to the present study because

it discusses the different practices given by the

instructors of NEC in enhancing the moral values of the

14
Vitaliano Gorospe,SJ Christian Renewal of Filipino Values(Values,Manila Press 2006) pp 23-24
15
Aries Roman Gungab “Moral Values: Its Implication to Nursing Profession” (Undergraduate Thesis,
Nueva Ecija Colleges, 2006) pp 40-41
 19

students and the advantages and disadvantages of Moral

values.

Findings of the study

Based from the data presented, analyzed and

interpreted the following findings were derived:

1. Profile of participants in terms of :

1.1 Majority of the participants are at the age 19

and above

1.2 senior nursing of Nueva Ecija Colleges is a little

bit dominated by male.

1.3 Great majority of the participants are single

2. The Different practices of the instructors of NEC in

Enhancing the Moral values of the Students in their:

2.1 Rank 1 is Teaches students more confident in

expressing their ideas in rightful manner (WM-3.39)

and it means agree , rank 2 is Practiced loyalty and

perseverance in the academic subjects (WM-3.34) also

agree Behavior of students is develop in a manner of

communicating students is rank 3 Honesty is develop

among students with weighted mean of 3.29 and it means

 20

agree rank 4 is Students are well confident in the

class with 3.20 and it means agree and Teaches

students become more professionals in attending and in

performances in the subjects with 2.90 in weighted

mean and it means agree.

2.2 They strongly agree that Students develops

professionalism in their performance in the clinical

settings with weighted mean of 3.65 and . It teaches

students to be more aware on the behavior of their

clients with weighted mean of 3.52

They agree that it develops the capacity of

students in self awareness with weighted mean of 3.46

3. Description of Moral Values as to its:

Advantages

The advantages of Moral values that students might

posses given in the table are, rank 1 is It creates

competent nursing graduates with 3.65 in weighted mean

and interpreted as strongly agree, rank 2 is Personality

 21

traits is well develop among students with 3.52 and it

means agree and the last is It develops students to

practice their career with confidence with 3.46 and it

means agree.

Disadvantages

The disadvantages of the program shown in the table

are, rank 1 is Hinders students action necessary for the

health care in some instances with 3.65 in weighted mean

and it means strongly agree, rank 2 is Wrong

interpretation of many students in the implementation of

moral values with 3.52 and it means strongly agree and

the last is Many students still prefer what they used to

practice instead of applying moral values to their work

with 3.46 in weighted mean and it means agree.

Conclusions

Based from the enumerated findings of the study, the

following conclusions were made:

1. That the participants of the study were at the right

age to provide a sensible answer to the topic;, Mostly

male have served as the participants of the study; That

the participants majority was single;

 22

2. Moral values plays an important factors in the

development of the students, in this manner nursing

students were given enhancement by means of repeating

some alternative solutions like by means of enhancing

their communication to others, every subjects were

empathized by moral values, they are develop behaviorally

so that upon graduation all of the moral values that

nurses should have, students might posses. Clinical

settings aims to develop the knowledge and understanding

of every nursing students especially when they are in the

problem based situation , it develops students posture

and confidence and teaches them to be more aware on the

behavior of their clients so that they may know what kind

of approaches will be formulated in the betterment of

their client

3. The positive effect of the moral values being given

in each students in the Nursing course can be reflected

on how they treat and mingle with other especially with

their clients and other people, from there they can

observed that the nursing students possess a strong

characteristics that a nurses should have. Time is used

in the personality program of students and the main

subjects is not utilized well, there are also no specific

 23

instructors that specializes in the personality

development program of the nursing students.

4. Students find their way on how to overcome this

problems regarding the moral development of the school,

they tend to find alternative way to adopt themselves by

means of researching and asking again their instructors

and hospital staff on the problems that needs to be

solved regarding the problem based situation in the

hospital , in this way students find it’s a helpful one .

Recommendation

Based from the results of the study stated the

researcher recommends the following:

1. That results of the study be disseminated for the

information of the participants so they would be updated

on the stand of other students like them; to the school

administration to serve as basis for any curriculum or

program revision to involved nursing students in the

nursing education;

2. School administrators must enhance this talent of

students without affecting the academic performance of

students;

3. Students must prioritize their study over anything;

 24

4. That another study should be conducted to be included

parents and guardians from other schools in Cabanatuan

City so as to generate a more reliable data to generalize

the findings of the study at hand.