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.