Factors Affecting Nonmarital Pregnancy in Teenagers at Soe City Public Health Center Work Area, Soe City Sud-District, South Mid-East Regency

Teen pregnancy is an international phenomenon that has not been resolved until now. Free sex behavior is an effect of out of wedlock pregnancy. The purpose of this research is what factors that affect out of wedlock nonmarital pregnancy on the teenager in the working area of Soe city public health center, South Central Timor regency. This research used descriptive quantitative research design, factors that affect out of wedlock pregnancy on teenager as a variable and 127 total population and simple random sampling used as a technique with 55 respondents. This research was conducted on 29-11 June 2019, in the work area of Soe city public health center, South Central Timor Regency. Research instrument used a questionnaire and data analysis used distribution of frequency percentage. The results showed that, 32 respondent (59%) were lack of knowledge, 35 respondent (64%) were influencing promiscuity, 31 respondents (57%) were more permissive to peer group norms, 35 respondents (64%) were parenting support while 21 respondent (38%) were technology and social media affect. This indicated that the most influential factor out of wedlock nonmarital pregnancy on teenager were individual factor that the teenager were lack of knowledge about reproductive health and sexuality, behavior factor that the teenager influenced by promiscuity, and environmental factor that parenting issue.


INTRODUCTION
Early marriage, pregnancy and childbirth are the leading causes of school dropout among young people in Africa (Mori,et al, 2017). Globally, about 16 million girls aged 15-19, and 1 million younger than 15 years, give birth each year. It estimated that between 2.0 and 4.4 million adolescents in developing countries undergo unsafe abortions to terminate unwanted pregnancies. Complications arising from early pregnancy and childbirth are the second leading cause of death among adolescents aged 15-19 years in low-and middle-income countries. (WHO, 2014).
Data was obtained in North Malawi that of the 14 year olds, there were 890 adolescents and 56 who had had sexual intercourse (Grynn et al, 2018). According to Ameyaw (2018), in Ghana, high unwanted pregnancies were among women aged 15-19 years 69.4%, of which 45.1% were unmarried women and 40.0% non-working women. Factors that cause include age, parity and education level.
Based on the results of the Population Census, Indonesia has a population of 237.6 million people, 63.4 million of whom are adolescents consisting of 32,164,436 men (50.70%) and 31,279,012 women (49, 30%). The size of the population of this youth group will greatly affect population growth in the future (BKKBN, 2011).
World Health Organization (WHO) sets the theme for World Population Day, namely "Teenage Pregnancy". This indicates that this case needs to be considered by all citizens of the world. The incidence of teenage pregnancy occurs mostly in low and middle income countries, including Indonesia. World Health Organization (WHO) Globally, states that 16 million girls aged 15-19 years give birth each year. 60% of them are pregnant outside of marriage, the majority (95%) occur in developing countries. (WHO, 2013).
Indonesia is a country with a fairly high percentage value in the world and the second highest in ASEAN with a pregnancy rate among adolescents 15-19 years of age reaching 48 out of 1,000 pregnancies. The latest data shows, there are 1.7 million adolescents under the age of 20 giving birth each year (BKKBN, 2017).
This does not only occur in metropolitan cities such as Jakarta, Surabaya, Semarang, Yogyakarta but also in small cities and rural areas outside Java, one of which is Kupang, East Nusa Tenggara province with a percentage of 51.3% of pregnancies outside of marriage in adolescents, while the remaining 30% is voluntary and 13% because of the parents' wishes. (BKKBN, 2017).
Based on a data collection survey based on the pregnancy and childbirth register book of the Soe City Health Center conducted by researchers, for the total data in the work area of the Soe City Health Center who experienced pregnancy outside of marriage from 2018-2019, there were 127 people.
Premarital sex among adolescents is influenced by the weak moral values of adolescents and society due to the increasingly rapid flow of globalization and the easy access to pornographic information through the mass media (Wydiastuti, 2009).
Family is the first place for adolescents to prevent nonmarital pregnancy, the importance of the role of parents to provide support to their children in directing positive social behavior. Age-appropriate sexual health education is essential for adolescents to develop safe sexual and reproductive health and to prevent teenage pregnancy. Lack of communication between parents and adolescents about reproductive health is one of the factors that can lead to pregnancy in adolescents Good communication between parents is also very necessary, if communication is lacking between parents and adolescents, it tends to make the teenager feel unattended so that will look for friends who pay attention to them, if the theme is wrong it can lead them to the wrong association (Kassa, et al, 2018;Breuner, et al, 2016) .
Adolescents with nonmarital pregnancy, will experience confusion with the realities they face. It is not easy for adolescents to accept the state of being pregnant before marriage. The pressure received by this teenager causes stress on him. Whether they are aware of it or not, adolescents will take action to overcome the pressure they are facing, they may make decisions to make other mistakes such as doing an abortion or suicide (suicidal), this action is considered a shortcut to what happens to him, Do not stop there, in general adolescents who experience pregnancy outside of marriage will experience rejection from their educational institutions, namely schools. Social rejection will also accompany it as the norm in Indonesia which still considers nonmarital pregnancy to be a mistake which results in him feeling ostracized by society, this will make the psychological condition of adolescents even more depressed, by bearing shame, withdrawing from the environment and despair. Not only that, as a teenage mother, you can experience anemia. Young mothers can experience postpartum depression compared to older mothers. Children of adolescent mothers are more likely to be born prematurely and at lower birth weight, the risk of fetal abnormalities and the likelihood of infant death (Kusmiran, 2011).
Cases of nonmarital pregnancy pose many dilemmas. Where the problem of pregnancy in adolescents is very troubling for parents, society, and even the state, considering what teenagers do today is very dangerous to society and has an impact on the interests of many people and the future of the nation where teenagers are the successors (Arifin, 2011).
To prevent nonmarital pregnancy in adolescents, the role of parents is needed as a function of teasing, loving, and caring for example, reminding not to have sexual intercourse before marriage, doing positive activities, avoiding actions that give negative encouragement, such as sexual behavior, do not get caught up in flirtation. , avoiding going out with people who are not famous, and getting closer to God (Puspitasari, 2016). Prevention of premarital pregnancy in adolescents can be done by providing youth with education about sexuality, the impact of free sex and premarital pregnancy. In addition, society must address injustices in providing opportunities that place women in a condition where they are at greater risk of becoming victims of social problems, such as teenage pregnancy. (Aziza and Amperaningsing, 2014).
The phenomenon mentioned above proves that during adolescence interest in sex increases. Teens begin to be attracted to the opposite sex, they begin to recognize what is called love, give and receive affection from others (Hurlock, 2001).
Teenage pregnancy has implications for educational opportunities, population growth and the poor health of women. Therefore, the government needs to pay attention to the prevention of early marriage in adolescents and nonmarital pregnancy to form a good development in the future. Reducing the high rate of teenage pregnancy and maternal mortality is considered the key to the success of sustainable development (SDGs) (Nove et al, 2014).
There are many factors that cause nonmarital pregnancy, including: sociodemographic factors such as residence, marital status, adolescent educational status, parenting styles, communication with parents, peer support. To prevent the occurrence of unwanted pregnancies, it requires the roles of various parties, the need for cross-sectoral cooperation from education, religious leaders, from the sub-district and its staff. In order to do reproductive health education to adolescents, audio-visuals or leaflets can be used. Peer support is formed to provide counseling, this can be done by holding a youth posture which can be used as a forum for adolescents to carry out activities that are positive and useful for the community in their environment. If in school, this can be done with extra-curricular improvements, for example: scouting, religion, youth red cross, sports.
In accordance with the above reasons, the authors want to examine more deeply about the factors that affect nonmarital pregnancy among adolescents in the working area of the Public health Center Soe City, Soe City District, South Central Timor Regency

METHOD
The design of this study used a descriptive research design in the Work Area of Soe City Health Center, Soe City District, South Central Timor Regency on May 29, 2019 to June 11, 2019. The population in this study was all adolescents who had experienced a pregnancy outside of wedlock or who had given birth using the simple random sampling technique. From a population of 127, a sample of 55 respondents was obtained. The instrument used a questionnaire and percentage frequency distribution data analysis.    Based on Table 5, it is found that of the 55 respondents, most of the respondents engaged in promiscuity, namely 35 (64%).

No Age When Pregnant
Based on Table 6, the results show that of the 55 respondents, the environmental factor of peer group norms, most of them are permissive, namely 31 (57%).

No
The Influence of Group  % Norms with Peers Based on Table 7, it is found that of the 55 respondents, most of them get permissive parenting, namely 36 (65%). Table 8, the results showed that of the 55 respondents on technological development factors in accessing the internet and social media, a small proportion is active, namely 21 (38%).

Individual Factors: Knowledge of reproductive health and sexuality
The results showed that of the 55 respondents, most of the respondents were less obedient as many as 32 people (59%), 21 people had sufficient knowledge (39%), while those who had good knowledge about Reproductive Health and Sexuality were very small, namely 2 people (2%). ). Based on general data on the characteristics of the latest education, almost half of the respondents have a junior high school education, the rest have a high school and elementary education.
Seeing the results obtained, the lack of knowledge about reproductive health and sexuality is also the risk that will occur due to pregnancy outside of marriage in adolescence, if knowledgeable, at least women understand and can take care of themselves and do not do this.
Azinar and Fibriana (2018) The importance of reproductive health in adolescents is because it can increase the knowledge and attitudes of adolescents so that they have a good responsibility for reproductive health.
Adolescents who have sufficient knowledge of sex tend to have healthy and safe sex behavior, on the other hand, adolescents who have less knowledge of sex will tend to have uncontrolled sexual behavior that results in pregnancy in adolescence. The development of adolescent sex life is currently showing symptoms that lead to promiscuity. Therefore knowledge is very influential on the incidence of nonmarital pregnancy in adolescents.

Behavior Factors: promiscuity
The results showed that of the 55 respondents, most of the respondents engaged in promiscuity, namely 35 (64%), while those who did not were 20 (33%). It can be concluded from the data of statements number 1 and 7 where the respondent agrees to have sexual intercourse on the basis of consensuality and evidence of seriousness with a partner, from 55 respondents who agreed, namely 52 people. Not only that, for them, they often go out at night, kissing on the cheek and lips with their partner is a common practice in sharing affection.
According to Banepa et al (2017) at the Bakunase Kupang health center there were 13 people who experienced premarital sex and 9 people experienced unwanted pregnancies.
According to Amalia (2017), teenage pregnancy will cause serious psychological problems. Teenagers who get pregnant outside of marriage will experience low self-esteem, shame, and will always feel guilty because this is seen as violating norms and is a disgrace to their family. In some cases people have had unsafe abortions, committed suicide, because they felt very guilty and experienced confusion, frustration and depression.
The need for parental supervision so that teenagers do not have promiscuity. By frequently being invited to communicate between parents and adolescents. From adolescents themselves, it is also necessary to strengthen their religious knowledge to make them more able to act not to violate norms, ethics and religion. It is necessary to provide health research directly by health workers, because it will be easier to understand. If they learn by themselves from the internet, it will cause a misperception if no one is guiding them directly.

Environmental Factors: Group Norms with Peers
The results showed that of the 55 respondents who were permissive or open in any matter with their friends, there were 34 people according to them that told them everything they experienced not only that, they even answered questions about sexual activity with their partners, they shared with each other compared to gathering with parents or their brother.
According to the research of Ismarwati and Utami (2017), the results show that the influence of peer roles has a 19.7 times greater chance of engaging in premarital sexual behavior compared to those who do not get influence from peers.
The dating style of peers is a model or reference used by a teenager in dating. Friends used to kiss their boyfriends, so it was justified that he also kissed. Adolescents tend to develop their own norms that go against the prevailing norms. Teens are very open to peer groups. They hold discussions about norms, philosophy of life, recreation, jewelry, clothes, for hours. Peer influence forms a very strong bond. Friends / peers are friends who are of the same age and between them usually builds up intimacy. The role of friends / peers in adolescents is very large in everyday adolescent life. Teens are more outside the home with peers as a group, the influence of peers on attitudes, conversations, interests, and behavior is greater than the influence of family.

Environmental Factors: Parenting Style
The results showed that most of the respondents obtained permissive parenting, namely 36 people (65%).
The parenting pattern is a method, habit and behavior that is usually done in the process of caring for children in a family environment. Parenting is a process of interaction between parents and children that takes place continuously and through this process provides changes to both parents and children (Masni, 2017) Hard parenting style will give birth to tough behavior as well, childhood experiences determine the characteristics of a person as an adult. If the childhood experience of children often gets harsh treatment, it will cause a violent pattern of social behavior. The family is the initial place to interact, good care, which is exemplified by parents, will be assessed and imitated by their children (Cindrya, 2019) In a permissive parenting pattern, parents give freedom to children to behave according to what the child wants. In this case, it means that parents do not place restrictions on what needs to be done and what cannot be done. Permissive parenting is also known as letting go of parenting. This lethargic parenting means that parents are always giving in, obeying every child's wish, so it's no wonder the incidence of extra-marital pregnancy in adolescents in this study is the most influential.
Seeing from their understanding and upbringing, this type of parent is very indifferent to the discipline of teenagers, making them do everything they want without thinking about the risks that will happen later. What's more at this puberty period, a period where teenagers want to find their identity with parental upbringing without any control, it is very likely that children can do things beyond their limits, especially when most teenagers experience nonmarital pregnancy. live with their own parents.
The magnitude of the role of parents in adolescent development, especially in adolescent education. Parents are a source of exemplary life in adolescents within the household. Therefore the need for attention from parents to pay broad attention to the development of adolescents, especially in association that can fall into promiscuity which results in unwanted pregnancy.

Environmental Factors: Technological Development in Accessing the Internet and Social Media with the Occurrence of Nonmarital Pregnancy in Adolescents
The results showed that the technology development factor in accessing the internet and social media, almost half of the respondents were said to be active, namely 21 people (38%) while the majority were said to be inactive by 34 people (62%).
From the results of the statement using a questionnaire sheet from 55 respondents, 21 of them are actively using Android and accessing the internet, while the remaining 34 people are inactive because they do not have an Android, and also in the research location sometimes the network is not as tight as in the capital.
At this time it is very easy to get information including information about sexual problems. This is one of the factors that causes some teenagers to be trapped in unhealthy sexual behavior. Various information can be obtained easily by teenagers via the internet which only teaches ways of sex without any explanation about healthy sexual behavior and the impact of risky sex. One of the risks of premarital sex or casual sex is an unexpected pregnancy (Sari, 2016).
Sources of information for adolescents are now easier to get information, with the convenience of various means of communication. The role of parents is also very necessary to control adolescents in accessing the media, so that they are not mistaken in receiving this information.

CONCLUSION
The results showed that: 1. Most of the respondents had insufficient knowledge, namely as many as 32 people (59%), 21 people (39%) had sufficient knowledge, while those with good knowledge were 2 people (2%). 2. Of the 55 respondents most of them engaged in promiscuity, namely 37 people (67%), while those who did not were 18 people (33%). 3. Of the 55 respondents, most of the respondents were permissive towards the norms of groups with peers, namely 34 people (62%) while those who were not permissive were 21 people (38%). 4. Of the 55 respondents, most of them got permissive parenting, namely 36 (65%), authoritarian parenting, namely 17 (30%), democratic parenting, namely 3 (5%) while parenting. abandonment (0%). 5. Technological development factors in accessing the internet and social media, a small proportion of respondents were active in accessing the internet and social media, namely 21 people (38%), while those who were not active were 34 people (62%).

For Teens
It is expected to further increase knowledge and add information about reproductive health and sexuality, limit oneself from promiscuity and groups with peers, and access the internet as well as social media as necessary. 2. For Parents 1) Opening new insights about adolescent reproductive health, which can be started by reading from various sources about this information which can later be conveyed to children as a provision for knowledge and prevention of adolescent sexuality problems. 2) Establishing closeness with children by inviting children to share or discuss daily activities and problems at school so that children can be more open and parents can participate in providing the best solutions when children face problems. 3) Increasing supervision of their teenage children by directing activities to positive and useful things.

For Soe City Public Health Center
It is hoped that the Public Health Center can provide counseling on adolescent behavior starting from family values, communication between children and parents, and communication between teachers and students and the community environment and can work together with the health department in the formation of ayouth care health service program.

The Institute of School of Health Sciences
Karya Husada Kediri It is hoped that the results of this study can be an additional channel of information for readers and educational institutions to participate more in collaborating with related health centers to provide counseling about teenage behavior which can have a negative impact on the family environment, community environment and school environment.

For Further Researchers
It is hoped that further researchers can analyze more deeply about the factors that influence teenage pregnancy to strengthen the results and it is hoped that by using research methods that are more answerable and provide maximum results in developing this study so that there is no more incidence of extramarital pregnancy in adolescents.