'You just have to learn to keep moving on': young women's experiences with unplanned pregnancy in the Cook Islands

The experience of abortion for Cook Islands women: exploring the socio-cultural dimensions of abortion safety

Abortion is significantly restricted by law in most Pacific Island countries, impacting the rights, health and autonomy of people who experience pregnancy. We undertook qualitative research between February and August 2022 on Rarotonga, Cook Islands, where abortion is illegal under most circumstances. We conducted interviews with women who had accessed or tried to access abortion services; people who had supported women to access abortion services; health workers; and advocates to understand their experiences regarding abortion. We conducted focus groups to explore broader social perceptions and experiences of sexual and reproductive health and rights, including abortion. Participants described their abortion decisions and methods, and their negotiation of the personal context of their sexual behaviours, pregnancies, and abortions relative to their socio-cultural context and values. As defined by the World Health Organization, safe abortion relates to the methods and equipment used and the skills of the abortion provider. We argue for an expansion of this definition to consider inclusion of reference to individuals' 'abortion safety nets' as the sum of their access to financial, political, health care and socio-cultural resources. These safety nets are shaped by discourses related to abortion and socio-cultural support and values, impacting physical, emotional, psychological, social and spiritual health.

Childhood adversity, perceived social support, and depressive symptoms among pre-abortion Chinese women

BACKGROUND

Unintended (unwanted) pregnancy is a sexual and reproductive health issue with psychosocial consequences for the individual, their family, and society. However, the relationship between social support and related mental health issues, like depression and the effects of childhood adversity, is poorly studied. This study aims to explore the connections between childhood adversity, perceived social support, and depressive symptoms in pre-abortion women (women who have decided to have an abortion) in a clinical setting, based on the common risk factor approach and social support theory.

METHODS

A total of 299 pre-abortion Chinese women 18-45 years were recruited in a hospital in Shantou, China. Hierarchical linear regression analyses were employed to examine the relative effects of childhood adversity and sources of social support on depressive symptoms, controlling for sociodemographic influences.

RESULTS

The results show that 37.2 percent of participants reported at least one adverse experience in childhood. More than half of the respondents were at risk for depression. Results of regression analysis showed that childhood adversities were negatively associated with depressive symptoms before sources of social support were entered into the model. However, when the sources of perceived social support were added, the effect of childhood adversity was not significant. Perceived social support explained the additional 15 percent variance in depressive symptoms. Additionally, being married (β = -.12, p < .05) and number of siblings (β = .13, p < .05) were significantly related to depressive symptoms.

DISCUSSION

Pre-abortion women are at risk of mental health problems. Peer and familial social supports can alleviate the influence of childhood adversity on depression among pre-abortion Chinese women. Strengthening the role of various sources of social support can help to improve the mental health conditions of pre-abortion women.

Cultural values influencing iTaukei women's discussion of family planning in the home

Pacific Sexual and reproductive health is influenced by cultural taboos and sensitivities. Although Pacific values are integral to family planning, open communication in the home is often difficult in the face of changing socio-cultural norms. This study explores the experiences of iTaukei Pacific women living in Fiji and Aotearoa New Zealand, and their discussion of family planning within the family setting. The study utilises talanoa methodology to understand women's realities and their navigation through shifting sexual and reproductive norms in both countries. The study found that although family may be seen as a place of 'truth' in which appropriate, culturally sensitive family planning communication should be available, this was challenged by cultural taboos or tabu which were persistent in family planning discussions. The study calls for greater reliance on holistic approaches to Pacific family planning perspectives and a greater examination of vā or the spaces within which Pacific women's experiences are negotiated and informed.

Using social capital to address youth sexual and reproductive health and rights in disaster preparedness and response: A qualitative study highlighting the strengths of Pacific community organisations and networks

In the Pacific region, youth sexual and reproductive health and rights (SRHR) are strongly influenced by sociocultural and structural factors, which limit access to SRHR information and services for youth. As climate-related disasters intensify in the Pacific, existing challenges to youth SRHR may increase the risk of worse SRHR experiences and outcomes for youth before, during and after disasters. Community-based models of SRHR service provision models increase accessibility for youth in non-disaster times, but there is limited evidence of how community organisations address youth SRHR in disaster contexts. We conducted qualitative interviews with 16 participants from community organisations and networks in Fiji, Vanuatu, and Tonga following the 2020 Tropical Cyclone (TC) Harold. Guided by the Recovery Capitals Framework (natural, built, political, cultural, human, social, and financial capitals), we explored how community organisations addressed challenges to facilitate access to youth SRHR information and services. Social capital in the form of peer networks and virtual safe spaces was used to navigate challenges in political, financial, and natural capitals. Existing relationships and trusted collaborations were crucial to address cultural taboos related to youth SRHR. Previous experiences of disasters and knowledge of contexts enabled participants to provide sustainable solutions to identified SRHR needs. The work conducted by community organisations and networks pre-disaster made it easier to identify and address youth SRHR risks following disasters. Our research offers a unique perspective into how social capitals were used to mitigate challenges to youth SRHR across natural, human, financial, cultural, built, and political capitals. Findings offer important opportunities to invest in existing community strengths, for transformative action to advance the SRHR of Pacific youth.

Barriers and enablers to young people accessing sexual and reproductive health services in Pacific Island Countries and Territories: A scoping review

BACKGROUND

The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people's low access to sexual and reproductive health information and services in this region.

METHODS

Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes.

FINDINGS

Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people's limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members.

CONCLUSION

This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people's sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.

Exploring the psychosocial challenges faced by pregnant teenagers in Ditsobotla subdistrict

Background

Pregnant teenagers usually experience psychosocial challenges such as a great amount of stress when they have to deal with an unwanted pregnancy, unpreparedness for parenthood and a lack of income as well as labour and birth complications. These are further complicated by the stigma from their families, friends and community. Unaddressed psychosocial challenges during teenage pregnancy can adversely affect the health outcomes of both mother and the child.

Aim

This study explores and describes the psychosocial challenges faced by pregnant teenagers in the Ditsobotla subdistrict.

Setting

The study was conducted in three health centres in the Ditsobotla subdistrict.

Methods

A qualitative-exploratory-descriptive and contextual research design was used. Non-probability purposive and convenience sampling techniques were used to select the participants. Semistructured individual interviews through WhatsApp video calls were used to collect data, which were analysed using conventional content analysis.

Results

Three themes emerged from the findings of the study, namely psychological challenges, social challenges and suggestions to address psychosocial challenges faced by pregnant teenagers.

Conclusion

The findings established that pregnant teenagers in the Ditsobotla subdistrict are faced with psychosocial challenges which negatively impact their psychological health and social life. Suggestions made in this study have the potential to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict if implemented.

Contributions

The findings of this study provide important information that may be used to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict.

Women's Life Experiences and Shifting Reports of Pregnancy Planning

BACKGROUND

Unplanned pregnancy is associated with adverse consequences for women. Yet, these associations are typically based on women's reports of pregnancy planning provided post birth. Therefore, women's recollection of their pregnancy planning may be influenced by their adverse life circumstances following the pregnancy, artificially driving these associations.

METHODS

To understand how post-birth experiences pattern women's recall of their pregnancy planning, we conducted 17 in-depth interviews with young women (24-34 years old) enrolled in a longitudinal study in southern Malawi. Respondents who were pregnant at the time of data collection in 2015 answered close-ended questions about the planning of their pregnancy. During in-depth interviews three years later, women discussed their life experiences since the pregnancy and were re-asked a subset of the same questions about the planning of the 2015 pregnancy. We thematically coded respondents' narratives about their relationships, parenting, and economic situations in the three years following their pregnancy and mapped these onto changes in women's pre- and post-birth reports of their pregnancy planning.

RESULTS

More than one-half of respondents recalled their pregnancy planning differently than they did pre-birth-some as more planned, others as less planned. The presence and direction of women's changing reports were patterned by the quality of their relationship with the child's father, the father's involvement as a partner and parent, and their economic situation.

CONCLUSIONS

Women's life experiences following a birth correspond with changes in their pregnancy planning reports, emphasizing the limitations of using retrospective measures to study the consequences of unplanned fertility.

Intersectional discourses of reproductive agency in the Philippines: A mixed methods analysis of classed constructions of pregnancy resolution

Women negotiate gendered discourses of reproductive agency in resolving unplanned pregnancies. Invoking an intersectional lens, this paper examines how these discursive dynamics differentiate across social class in the Global South context of the Philippines. Utilizing a novel mixed methods strategy, we triangulate quantitative findings from a Q sort task and qualitative accounts of pregnancy resolution to identify classed discourses of reproductive agency as (a) reclaiming maternal virtue and (b) asserting autonomous choice. Statistical analysis reveals significant discursive divergence across class, wherein working-class women primarily adopt maternal virtue discourses while middle-class women disproportionately subscribe to autonomous choice. Interpretative analysis of women’s accounts complicates this bifurcated characterization by surfacing the diverse ways by which women negotiate both discourses in narratives of abortion and carrying to term. We discuss our contributions to the literature in terms of multilevel theoretical engagement with classed complexity in gendered issues like reproductive agency as well as innovating mixed methods in intersectional research. We conclude with reflections on advancing reproductive justice, especially in Global South societies like the Philippines.