Adjusting aspirations: exploring agency in early motherhood in an urban area in Johannesburg, South Africa
Date
2019
Authors
Pillay, Nirvana
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Abstract
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.
Description
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