Adjusting aspirations: exploring agency in early motherhood in an urban area in Johannesburg, South Africa

Pillay, Nirvana
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Background In South Africa, the health and wellbeing of adolescent girls and young women is a critical consideration in development policy. Addressing high rates of early motherhood is one area of policy and intervention aimed to improve development outcomes for young women, particularly in relation to education and health. The teenage pregnancy discourse post-1994 positions early motherhood as threatening to South Africa’s development agenda; young mothers are perceived as a risk to the dominant social order and a challenge to achieving the education, health and social welfare goals of the developing state. This discourse positions young women as disempowered, irresponsible and without agency. In this study I explore the agency of young women who transition to motherhood earlier than socially and politically sanctioned. I examine the relationship between the agency of young mothers in the context of pervasive social and structural inequality, paying attention to how young mothers navigate the world of early childbearing. Methods This ethnographic study was conducted at a health centre in Alexandra, Johannesburg between September 2016 and September 2017. I interviewed 30 young mothers aged 18 to 20 years once, nine young mothers twice, and six young mothers three times. Four significant others (mothers, grandmother, father), identified as the person offering the young mother the most support, were also interviewed. I drew genograms and kinship network maps to understand the composition of households, families and kinship networks in which young mothers were embedded. Using a narrative approach, I developed case studies of young mothers who were interviewed three times. In addition, I interviewed six health care providers at the health centre to understand their experiences with, and perceptions of, young pregnant and parenting women. I also interviewed employees of a non-governmental organisation working with mothers at the health centre, and another one addressing employment for youth. I conducted all interviews in English. Findings The findings of this study resulted in three peer-reviewed publications. A fourth publication is currently under review. The key findings of these articles are summarised below. Young mothers faced considerable barriers in continuing or completing school, securing economic resources and accessing appropriate and acceptable health services. Kinship support and networks were central to mitigating some of the barriers, to enable young mothers to continue with education or employment while caring for their babies. In most instances, families responded to unintended pregnancy through adaptive and malleable practices that accommodated the young mother and her baby. Many fathers were also involved in the lives of their babies, even when the couple was no longer together. The nature of economic and emotional support provided by fathers varied depending on relationship dynamics, family and economic circumstances. Continuing with school was complicated for young pregnant and parenting women. Despite progressive legislation and policy, many schools continue to discriminate against them; overtly through denying access to school during pregnancy, and covertly through discriminatory and stigmatising practices. School attendance and continuation was facilitated by family support, the Child Support Grant, availability of crèches and other childcare arrangements, and enabling school environments. Despite state commitment to adolescent friendly sexual and reproductive health services, health services were not sensitive to the particular needs of young pregnant and parenting women. Pervasive discourses of early motherhood perpetuated stigmatising attitudes of health care workers, and were a limitation to care. In particular, access to termination of pregnancy, and patient-sensitive contraception provision, were hindered by health care provider discrimination and limited health system capacity in the area of adolescent sexual and reproductive health. Conclusion The dominant, pejorative discourse of early motherhood strongly influenced the experiences of young pregnant and parenting women and affected the implementation of policy. In South Africa, there is little consideration of how to support young mothers after an unintended pregnancy. Young mothers adjusted their aspirations to accommodate and mitigate the negative effects of unintended pregnancy; they exercised agency along a continuum, influenced by enablers and constraints in the social and structural context. I recommend more targeted support for young mothers. Uppermost in the minds of young mothers in fragile household economies was economic security, and access to the Child Support Grant was critical. In addition, young mothers need safe and acceptable childcare, psychosocial support, targeted assistance at schools during pregnancy and after, improved access to early pregnancy testing outside of health services, and sensitive contraception services after birth and beyond.
A thesis Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 2019