'There is no more future for me? Like really, are you kidding?': agency and decision-making in early motherhood in an urban area in Johannesburg, South Africa

Glob Health Action. 2021 Jan 1;14(1):1886456. doi: 10.1080/16549716.2021.1886456.

Abstract

Background: The South African development goals for young women aged 15 to 24 are to reduce HIV incidence, teenage pregnancy and gender-based violence, and to increase school completion and economic security. Early, unintended pregnancy undermines these goals, creating discourses of early motherhood that position young women as powerless. There has been scant attention on the agency of young women in their structural context.Objective: This study explored how young women exercise agency after an unintended pregnancy and make decisions concerning their future, including sexual and reproductive health, school completion and/or income generation, and caregiving for their babies.Methods: I used narrative analysis to explore the lived experiences of young mothers, paying attention to decision-making during pregnancy and motherhood. Domains of analysis included health care, education, and caregiving. I conducted in-depth interviews with 30 young mothers: 30 were interviewed once, nine were interviewed twice, and six were interviewed three times. I interviewed four significant people in the lives of young mothers and six health care providers at a health centre.Results: Progressive policy facilitates increased access to services for young pregnant and parenting women. However, education and health care providers continue to discriminate against them, formally through denying them access to services and informally through discourses of shame which pervade their structural context. Kinship capital in urban and rural contexts and the Child Support Grant mitigate some struggles in early motherhood and help young mothers navigate decision-making.Conclusion: Young mothers exercise agency along a continuum to realise their aspirations. Social and structural support mediate their agency. Policy needs to expand the focus from prevention to include issues of care and support after an early, unintended pregnancy to ensure the health and wellbeing of young mothers and their children.

Keywords: Teenage pregnancy; agency; education; health; kinship; social support.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Female
  • Humans
  • Mothers
  • Pregnancy
  • Pregnancy in Adolescence*
  • Rural Population
  • Sexual Behavior
  • South Africa

Grants and funding

This work is based on the research supported in part by the South African National Research Foundation [Grant Number: APDS 170526233617] and a Centre of Excellence in Human Development National Research Foundation Accelerator Grant, ‘Changing Family Structures and Care in South Africa’ (PI: Lenore Manderson)