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Joseph Kanku (kanku@telkomsa.net)
Department of Family Medicine, Stellenbosch
December, 2009
 

Abstract

Background: South African teenage pregnancy rates remain high by international comparison and in the rural town of Taung the rate is twice the national average of 6.5%. Teenage pregnancy is a risk factor for disruption of education, future unemployment, sexually transmitted infections, HIV, preterm birth and poor mental health. The aim of this study was to understand the attitudes and perceptions of teenagers in Taung regarding teenage pregnancy and to explore their understanding of sexuality and contraception. This study intended to contribute to a deeper understanding, by exploring teenager’s own perceptions on the matter, to identify factors that, in their view, may influence the risk of pregnancy and suggest possible interventions. No previous studies from the Taung area have been identified.

Methods: A qualitative study involving 13 in-depth interviews with pregnant teenagers and 3 focus groups with 10 women aged 19-25 years who had a baby as a teenager, 14 teenage girls aged 16-19 years who had never been pregnant and 11 males aged 18-23 years.

Results: Factors influencing teenage pregnancy were found to be broad and complex:

1) Socio economic factors included poverty, the controversial influence of the child support grant, trans-generational sex and financial support from older partner to secure income for the teenage girl or her family.

2) Substance abuse, particularly alcohol, in either the teenager or her parents was found to have a critical influence. A lack of alternative entertainments and social infrastructure made shebeens a normal part of teenage social life.

3) Peer pressure from boyfriends and the broader social network.

4) Other factors included the right to motherhood before becoming HIV positive, poor sexual negotiation skills, the need to prove one’s fertility, sexual coercion and low self-esteem.

Understanding of contraceptives and reproductive health was poor, condoms were the contraceptive method most known by teenagers and their understanding of the menstrual cycle was inaccurate.

Most teenagers perceived falling pregnant as a negative event with consequences such as unemployment, loss of boyfriend, blame from friends and family members, feeling guilty, difficulty at school, complications during pregnancy or delivery, risk of HIV, secondary infertility if abortion is done and not being prepared for motherhood. A number of teenagers however perceived benefits and saw that it could be a positive event depending on the circumstances.

Conclusion: Social cognitive theory provides a useful framework to make sense of the various factors uncovered in this study that influence behavior leading to teenage pregnancy. A model utilizing this theory is presented.

Strategies to reduce teenage pregnancy should focus on building social capital for teenagers in communities, exploring further the influence of the child support grant, targeting trans-generational sexual norms, applying the law on underage drinking, making information on contraception more accessible and offering programmes that empower girls in the area of sexuality. Multifaceted and inter-sectoral approaches are required and it is likely that strategies to reduce teenage pregnancy will also impact on HIV and other sexually transmitted infections.



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