Agency under constraint: Adolescent accounts of pregnancy and motherhood in informal settlements in South Africa

Abstract

Progress in adolescent sexual and reproductive health (SRH) remains unequal: adolescent pregnancies are more likely to occur in marginalised communities, or in very poor households. This study aimed to comprehend from adolescents' own perspectives, the circumstances of falling pregnant and coping with motherhood in informal settlements in South Africa, to better understand the SRH challenges adolescents in these settings may face. A qualitative study was carried out over a two-month period in 2019 to analyse the perceptions held by adolescents in informal settlements served by four community level clinics in the adjacent township. We found that adolescents face overlapping barriers in seeking to avoid unintended pregnancy in informal settlements.

Hope, agency, and adolescents' sexual and reproductive health: A mini review

“…Similar findings were also reported in South Africa by Gillespie, et al (25) who explored adolescents' perspectives of falling pregnant and motherhood in informal settlements. Gillespie et al (25) found that adolescents' agency to prevent unintended pregnancies was compromised by limited adolescent-friendly SRH services and a lack of communication on SRH practices including issues of safe sex and contraception. Some adolescents reported that they were not comfortable to access SRH services in their community due to fears of being judged and limited privacy at the clinics.…”

“…Agency and autonomy were also linked to uptake of SRH services. Limited access to adolescent friendly SRH services restricted girls' agency to prevent unintended pregnancies (27) or to take up SRH support (25).…”

“…Recognising the influence of the social environment in examining these interactions is key, given the important roles that culture, religion and traditional norms play in shaping risk and protective SRH behaviours in African contexts (27,(38)(39)(40)(41). Many AGYW are hindered from accessing SRH services due to experiences and fears of being condemned, feeling judged and not being able to engage in open dialogue about sex and sexuality with relatively older health care workers (25,27,42,(44)(45)(46). In this regard, we support Desmond et al (21) who argues that we need "to understand how individuals and groups understand their environment, how they interact with and change their environment, and how these understandings and interactions shape behaviour [and access to support or intervention]".…”

“…Although most papers FIGURE 1 were recently published, no studies focused directly on the COVID-19 pandemic. As shown in Tables 1, 2, the majority of the articles made use of quantitative approaches (n = 5) (29-33), followed by qualitative-(n = 4) (25)(26)(27)34), and one mixed methods study (n = 1) (28). Of the studies using quantitative methods, one (n = 1) used a randomized evaluation design, three (n = 3) used a randomized control trial (including the mixed methods study) and two (n = 2) used a cross-sectional design.…”

Shifting Social Norms and Adolescent Girls’ Access to Sexual and Reproductive Health Services and Information in a South African Township

“…Aspects of the interview guides focusing on the causes of adolescent pregnancy, the impact of motherhood, and the gender roles involved, pertaining to interviews with young men and women residing in the informal settlements, were reported in a separate but related paper ( Gillespie et al, 2021 ) and therefore not repeated here.…”