Table 1 shows demographic characteristics of participants. All participants were Black Africans, 24 years old at the time of the interview, and self-reported age of sexual debut by 15 years of age. Many participants lived with extended family members as primary caregivers. Only one participant reported living with both parents. Completion of secondary school was more common among those who did not become pregnant before 18 years (Group 1).
Table 1:
Participants socio-demographic characteristics
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Total number of Participants (N=20)
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Group 1: Did not become pregnant (N=10)
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Group 2:
Became pregnant (N=10)
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Area of residence during adolescence
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Soweto
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18
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9
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9
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Outside of Soweto*
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2
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1
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1
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Primary Caregiver(s) during adolescence**
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|
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Both parents
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1
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1
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0
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Both parents and siblings
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3
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2
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1
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Mother
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4
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2
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2
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Mother and siblings
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3
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1
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2
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Grandparents
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3
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2
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1
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Other relatives (aunt/uncle/cousins/siblings)
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6
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2
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4
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Completed high school
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|
|
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Yes
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13
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9
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4
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No
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4
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0
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4
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Unknown
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3
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1
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2
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* Participants who reported not living in Soweto during adolescence attended boarding school outside of Soweto or temporarily living in another province
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** Participants reported who they lived with as an adolescent - this person or these people were categorized as “Primary Caregiver(s)”
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The results were examined by looking at overall themes and further examining differences between the two groups of young women. Although both groups were predisposed to similar risk factors to becoming pregnant, results suggested that participants who did not become pregnant by age 18 years had strong family support systems, were exposed to conversations about sex, access to information etc., which helped them to make decisions and choices such as consistent condom use that protected them from early pregnancies. We present our results along the three key themes that emerged from this study as discussed in the next section.
1. Conversations about sex
One of the main aims of this study was to investigate whether conversations about sex occurred before or after the participant’s sexual debut, and how this influenced her sexual behavior.
Group 1 Participants (those who did not become pregnant before 18 years):
Participants in group 1 largely reported that they had conversation with their mothers (whether mother was a primary caregiver or not), followed by relatives e.g. aunts and grandmothers. Most participants engaged in conversation about sex before sexual debut.
“[mother] was educating me a lot about sex about using protection, diseases, all the things like sexual intercourse and pregnancy”.
At age 15, [My] aunt started the conversation because she was a teen mother herself; [Aunt emphasized that] ‘boys [will] give you babies; you have to be careful of them when you grow up.’
However, one participant narrated that despite her mother being her primary caregiver, she never had any conversations with her about sex: “I didn’t talk with mother at all […], I wish she had told me about it…”
Others mentioned that conversations with grandmothers or aunts were too general or untimely and only emerged when adolescents were pregnant or after giving birth – a factor that drove adolescent to get more information by themselves from other sources:
I didn’t formally sit down before debut and talk about contraceptives or anything, they just talked in general […]. I had to learn contraceptives myself.
Group 2 participants (those who became pregnant before 18 years):
Out of the ten participants in group 2, six reported that they did not have any conversations about sex with any of the primary caregivers. One participant believed lack of conversation was due to caregiver not knowing what to say: “… really they can’t say anything to you because they don’t want you to start [sex] and then they don’t know what to say really.” Another participant said; “I didn’t know why she [grandmother] didn’t have the conversations [with me]”.
The few who said that they had conversations about sex reported that conversation was initiated when it was late – when they were either already sexually-active, pregnant or after giving birth:
She just didn’t really think that I was there or that I was thinking about that [sex]. I think she only maybe started mentioning it when I got to university, but obviously by then she didn’t know that I had already started having sex.
She [mother] only started talking to me about sex when I was already pregnant. She probably would have given me good advice earlier. Maybe I wouldn’t be pregnant by now, raising a child as a single mom.
Interestingly, two participants revealed that they were uncomfortable discussing about sex, as illustrated below:
It was too odd for me it was like a foreign language for me when she talked about sex with me; it was because she saw my first [menstrual] period.
For the few who had had conversations before or after sexual debut, they found the information helpful, and it influenced their sexual behavior, by guiding them on what they should or shouldn’t do to avoid early pregnancies. Those who did not engage in any conversation about sex narrated how lack of this important information influenced them to doing things they could have prevented (see summary in Table 2).
Table 2:
Conversation about sex and influence on adolescent sexual behavior
Group 1
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Yes- conversation with mother before pregnant
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“Yes, oh yes…. I learned not to fall pregnant at an early stage, and diseases, I never had those diseases, like vaginal diseases or whatever”
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Yes- conversation with friends
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“…some of them [friends] had kids at a very young age. So, it was mostly their advice that made me think twice about getting myself in such situations, yes.”
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Yes- conversation with family members
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“They [family] supported me and I think it is probably something I want to do when I have my kids. I want to keep the communication open and tell them….”
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No conversation
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“[I] didn’t talk with mother at all. Looking at the experience that I’ve had, I wish maybe that she had told me more, told me more about it [sex], maybe I would have waited for a later stage.”
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Group 2
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Yes- After pregnant
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“…she was telling me I should always use protection. I think it did change my behavior because, after talking with her I realized that I will have to use protection
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Yes- when pregnant
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“I regret a lot of things when I think about my past. And I really wish that my mom had taken the time to sit down and talk to me…. I think things would be a whole lot different”
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No conversation
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“I would have liked to talk to grandma though, maybe I wouldn’t have had sex at such an early age. Maybe I would have made wiser decisions.”
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2. Risk factors for early pregnancy
Findings from this study show that participants in both groups experienced similar risks of becoming pregnant before 18 years of age as discussed below.
Family issues
Adolescents reported family issues, including strict parents, unstable families (fragmented due to divorce, separation or death of parents), or generally having poor family relationships which hindered conversations about sex. These challenges exposed adolescents to risks of early pregnancies:
I only talked to my sister […] when my sister told her [mother], she was shouting most of the time. Uhm..., why did I have sex, why didn’t we use a condom, yeah.
Living with grandparents was particularly difficult for adolescents to talk about sex and topics around sexuality due to the generation gap. Some participants thought their elderly grandparents (or parents) were too “old-fashioned” to talk about sex.
“I didn’t feel comfortable talking to my grandma about it because she is old”
Limited conversations about sex were also linked to culture and taboos around such topics. For example, some participants felt that talking about sex would signify being rude to their parents or would signify that one was already engaging in sex. Others mentioned that conversations about sex were perceived by their caregivers as a way of encouraging sex:
The Black society, it is totally forbidden to speak to the elders about sex, because if you mention it, they think you are doing it. If they say anything about it, it seems like they are promoting it.
Peer/friends influence
Secondly, both groups of adolescents discussed being exposed to a great deal of negative peer pressure, particularly surrounding sex and sexual behavior. For example, some reported that older friends who were sexually experienced tended to have a negative influence on participants, and often encouraged them to have sex even if participants indicated that they weren’t yet ready. One common trend that was discussed among participants in both groups was the pressure from friends and peers to have sex with one’s boyfriends, because if they didn’t someone else would.
… [friend said] if you aren’t having sex with your partner, it means that your partner is having sex with someone else and not you, so you should just do it, they would say. It is nice, just try it…
However, one difference between the two groups of participants was the ability to rise above and overcome the peer pressure. It was clear that peer pressure existed, and was particularly strong at times, but many of the participants who did not become pregnant by age 18 years were focused on future goals, particularly school completion, and took specific steps to try and prevent pregnancy.
Religion
Religion was also discussed as a risk factor in the sense that, sex topics were rarely discussed in church and adolescents who were found engaging in sex were considered sinners. Ultimately, this kind of perception prevented adolescents from discussing sexual issues that were bothering them with members of their faith group:
Well in church you can’t really talk about sex because everyone in church is holy…
“At church, they always preach sex before marriage is a sin. So, if you were doing it, you don’t feel comfortable talking to them [church members] about sex.”
3. Protective factors against early pregnancy
Despite being sexually-active or exposed to several risk factors, more participants from group 1 reported taking steps or demonstrated ability to navigate choices e.g. consistent condom use to prevent early pregnancies and desire to finish school. Family support was key and largely centered on timely communication/conversations about sex and providing general guidance to adolescents. Other social support structures within their community including school, health services and peers were found to be paramount in helping to protect adolescents from early pregnancies as summarized below:
4. Adolescents’ ability to navigate choices:
The most frequent action mentioned by adolescents who successfully prevented early teenage pregnancy was consistent condom use. While other methods of protections e.g. contraception pills were cited, condom use was mentioned as a primary action by almost all the participants who did not become pregnant by age 18 years. The ability to use protection depended on several factors. One was the ability to communicate with one’s partner and their partner’s receptivity to using condoms. Participants who indicated that they had an understanding partner, or had been in a long term relationship with one partner (as opposed to multiple partners) discussed how helpful this was in negotiating condom use and preventing early pregnancies:
Yeah, I said [to partner] that we should use condoms and he was very supportive.
Yes, I only had one partner. We were in a long term relationship and we had talked about sex earlier, he agreed to using condoms until we reached 18 years.
In addition, participants who had prior knowledge about various forms of contraception from their education or conversations with friends, family members, or clinic staff, were more aware of the ways in which they could protect themselves:
I mean I knew about fertility and stuff I mean when I was like 9, by the time I became a teenager I was well aware of sex and yeah.
Moreover, adolescents’ ability to seek additional information and make decisive choices were said to also protect them from early pregnancies as exemplified below:
“It really had nothing to do with her [Aunt], because every time I spoke to her, at the end of the day, its up to me to choose, so yeah I decided to use condoms”.
5. Family support:
As discussed above, family was a key pillar in supporting adolescents during their adolescence. Adolescents who mentioned having a good relationship at home, also revealed that their caregivers introduced conversations about sex in good time. One participant said: “Like I think that I was fortunate enough that I was in a very open family where sex wasn’t taboo just to speak about it, it wasn’t anything foreign or anything.”
6. Social support systems:
Other supportive social systems such as school, peers/friends, health services and religion were indicated to be key in helping adolescents navigate through the decisions they made, and thus helped them to prevent early pregnancies. First, school was found to be key in supporting adolescents through life orientation courses, providing more information not only about pregnancies but also about sexually transmitted diseases; this communication rarely happened at home. One participant said:
“Uhm they [teachers] taught us everything about sex. They taught us about, uhm, all those menstruations, STDs [sexually transmitted Diseases] and everything”.
Second, exposure to friends and peers who were also intent to avoid pregnancy helped adolescents in decision making and positive choices that protected them from an unintended early pregnancy:
We talked about the disadvantages of having sex in high school, and, whether you can get the infections or get pregnant.
Most participants mentioned that they were more comfortable talking to their peers or friends compared to older people:
“it was comfortable talking with my friends. They could talk about condoms flavors, etc.”
Third, a few participants also mentioned that health service staff at the clinic were helpful in providing them information and contraceptives that empowered them to prevent early pregnancy:
The nurse at the clinic… well when we got there, we were actually looking for information about STDs and STIs, yeah, so she was telling us the different types of STIs we should look out for, how it is contracted, yeah.
Table 3 provides a summary of themes and illustrative excerpts on factors that protected against pregnancy before 18 years of age.
Table 3:
Summary of protective factors against early pregnancy
Protective factors
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quotations
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Family support
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e.g. living with mother, lessons from family members who had children, having good family relationships and conversations about sex, etc.
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“[living with mother] I mean I knew about fertility and stuff when I was like 9, by the time I became a teenager I was well aware of sex.”
“Also, them having kids at a very young age, so it was more like advising me, that I should be more informed….”
“My sisters advised me on the abstinence because of what they went through growing up…”
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Ability to make informed choices & Access to information
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This included consistent condom use; adolescent initiated condom use, etc.
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“I’ve always had condoms with me every time. They are in my toiletry, my bag, my purse, always have them. It might not be for me; I might be with friends somewhere and you never know.”
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“I went out there looking for information without anyone telling me to look for information.”
“Magazines, internet, how can I put it? …I have never really had a problem about accessing information”
“I make my own decisions. It is just about me.”
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School
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Motivation to complete school, life orientation courses at school
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“Well I think they [school mates] made me open my eyes at the time, cause I had seem most of the people in high school, they hadn’t finished metric if they had got pregnant…, so all I wanted to do was finish high school.”
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“Uhm they [teachers] taught us everything about sex.”
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Friends/peers
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Exposure to good friends/peers
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“Yes…we all advised each other that it is best to use condoms because we were still at school”
“…He [partner] was a little bit older than me so he knew everything you know. So, he was very cautious in talking me through it…”
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Hospital
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Access to the clinic
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“I used to attend the Birth to Twenty clinic, and they would tell us everything about sex […].”
“We were told at the clinics most of the time, […], you find the stalls where they place condoms and stuff.”
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