Public discourses about teenage pregnancy: disruption, restoration, and ideology

'There is no more future for me? Like really, are you kidding?': agency and decision-making in early motherhood in an urban area in Johannesburg, South Africa

Background: The South African development goals for young women aged 15 to 24 are to reduce HIV incidence, teenage pregnancy and gender-based violence, and to increase school completion and economic security. Early, unintended pregnancy undermines these goals, creating discourses of early motherhood that position young women as powerless. There has been scant attention on the agency of young women in their structural context.Objective: This study explored how young women exercise agency after an unintended pregnancy and make decisions concerning their future, including sexual and reproductive health, school completion and/or income generation, and caregiving for their babies.Methods: I used narrative analysis to explore the lived experiences of young mothers, paying attention to decision-making during pregnancy and motherhood. Domains of analysis included health care, education, and caregiving. I conducted in-depth interviews with 30 young mothers: 30 were interviewed once, nine were interviewed twice, and six were interviewed three times. I interviewed four significant people in the lives of young mothers and six health care providers at a health centre.Results: Progressive policy facilitates increased access to services for young pregnant and parenting women. However, education and health care providers continue to discriminate against them, formally through denying them access to services and informally through discourses of shame which pervade their structural context. Kinship capital in urban and rural contexts and the Child Support Grant mitigate some struggles in early motherhood and help young mothers navigate decision-making.Conclusion: Young mothers exercise agency along a continuum to realise their aspirations. Social and structural support mediate their agency. Policy needs to expand the focus from prevention to include issues of care and support after an early, unintended pregnancy to ensure the health and wellbeing of young mothers and their children.

"It's not something you expect a 15-year-old to be sad about": Sources of Uncertainty and Strategies of Uncertainty Management among Adolescent Women Who Have Experienced Miscarriage

Approximately 10%-25% of adolescent pregnancies end in miscarriage, yet we know little about the experience of miscarriage among women in this age group. To better understand the medical and psychosocial challenges faced by adolescent women who experience a miscarriage, we conducted interviews with 31 college-aged women who had experienced a miscarriage between the ages of 15 and 19. We analyzed interview transcripts using qualitative descriptive analysis and found that adolescent women experience various medical (e.g., insufficient medical knowledge, unknown etiology), personal (e.g., competing identities, lack of autonomy in decision-making), and relational (e.g., emotional invalidation, relational insecurity) sources of uncertainty in miscarriage in ways that are unique to the population of adolescent women. Women in our sample appraised their uncertainty positively and negatively (sometimes simultaneously) and reported using a variety of management strategies to facilitate their desired level of uncertainty, including information seeking, avoidance, health behavior change, and reframing the miscarriage.

Public Perception of Female Fertility: Initial Fertility, Peak Fertility, and Age-Related Infertility Among U.S. Adults

Perceptions of fertility are thought to impact reproductive behaviors, yet little is known about how lay people conceptualize the female fertility timeline. In this research, public perception of the female fertility timeline was assessed via a national survey of U.S. adults (N = 990) ranging in age from 18 to 89 years. Although there is no scientific consensus on the makeup of the female fertility timeline, results from this research indicate that the U.S. public posits fertility onset at (approximately) 13 years, peak fertility at 22, ideal first pregnancy age at 23, too late for pregnancy at 46, and infertility at 49. Regression analysis revealed that perceived peak fertility and ideal pregnancy age were positively correlated such that participants perceived the ideal pregnancy age as directly following peak fertility. Education was significantly related to fertility perceptions; those with more education perceived initial fertility to be lower and peak fertility and ideal pregnancy age to be higher. In other words, more highly educated individuals perceived fertility to manifest over a longer period of time as compared to individuals with less education. Black and Hispanic participants and participants with lower income perceived ideal first pregnancy age as significantly lower than did White participants and participants with higher income. These differences may suggest that the seeds of health disparities associated with phenomena such as adolescent pregnancy are lurking in fertility timeline perceptions.