Vol. 21 - Num. 83
aTrabajo Social. Universidad Adventista de Chile. Chillán. Chile.
Correspondence: M Venegas. E-mail: firstname.lastname@example.org
Reference of this article: Venegas M, Valles BN. Risk factors that affect teenage pregnancy from the perspective of pregnant students. Rev Pediatr Aten Primaria. 2019;21 [en prensa].
Published in Internet: 31-07-2019
Introduction: the students under study experienced direct and indirect emotional neglect by their parents within a context of social and cultural deprivation. Teenage pregnancy also involves disadvantages described by the students: loss of freedom, engagement in parental responsibilities and exclusion from the peer group, as the adolescent mother is devoted to the care of the baby.
Objectives: the aim of this study was to establish the risk factors that play a role in teenage pregnancy from the perspective of pregnant students.
Material and methods: we conducted a qualitative study from a phenomenological perspective. We performed semi-structured interviews with 6 pregnant students aged 16 to 19 years from a rural area in Chile.
Results: most participants did not drop out of the school system, but they did not live adolescence like their peers that had no children, as they focused on their role as mothers and not as daughters dependent on their parents, which generated inner conflicts, anxiety, fear, feelings of guilt and frustration, drastically changing their reaction or responses to events in everyday life, accelerating the cognitive maturation process relative to their age, and changing their behaviour, needs and priorities.
Conclusions: the results of our study raise a red flag and call for the revision and promotion of strategies for the prevention of teenage pregnancy.
Keywords● Risk factors ● Teenage pregnancy
Adolescence is considered an especial period of maturation. It is an important stage characterised by the initiation of conscious individuation and the definition of self-identity, ultimately leading to autonomy.1 A salient feature of this stage is the blurry boundary between identity and narrative, which will gradually solidify on the path to adulthood.2 It is expected that by the end of this period adolescents will become independent from the family of origin and pursue goals and objectives fitting their intelligence and skills and according to the opportunities given by the environment.3 However, it is important that adolescents have the necessary information to make conscious choices and for families to allow them to play out the roles they have selected for themselves; that is, to allow autonomy, as establishing one’s own rules is part of making one’s own choices.4
In this stage of life, teenage pregnancy is a significant issue in most countries of the world. This manifests both in its epidemiological characteristic and the social, family and individual repercussions associated with it.
There is a growing number of adolescent mothers who suffer various negative repercussions in their social integration. Teenage pregnancy in Latin America has given rise to a vicious cycle of inequality that prevents women and their children to get out of poverty.5
In Chile, approximately 40 355 children are born each year to mothers aged 15 to 19 years. To this we ought to add another 1175 births in girls aged less than 15 years. This corresponds to an incidence of teenage pregnancy of about 16.16%.6
From a sociocultural perspective, pregnant adolescents have fewer opportunities to study or work, as most are forced to drop out of the school system, resulting in a very low educational attainment that precludes them from obtaining good enough jobs to at least cover their basic needs. This situation is aggravated by the condition of single mothers that most of these adolescents end up facing, as their partner is usually a male adolescent or young man that refuses to take on the responsibilities of fatherhood, which results in neglect of the mother and child at the emotional, economic and social level.7
The scientific literature on school dropout is extensive. Some studies on the subject have summarised the risk factors for school dropout, which can be categorised into individual, school, family and community factors. Individual factors include poor academic performance, negative attitudes towards learning or behavioural problems unrelated to academic performance (such as teenage pregnancy or substance use). The school factors that have proven to be significant in dropout mainly involve the quality of the teaching. Some of the important family factors are belonging to a single-parent household and low parental educational attainment.8
Of all pregnant students, 40% are adolescents aged 14 to 17 years. When it comes to school dropout as a result of pregnancy, age has been identified as one of the most important factors, as 28.9% of teenagers that get pregnant drop out of school. This is why research has explored what other factors play a role in the social changes experienced by adolescents and how their environment may promote early pregnancy.9
The results of the 2013 Encuesta de Caracterización Socioeconómica (Socioeconomic Characterisation Survey) revealed differences between male and female individuals in the reasons to not go to school: the main reason in males was limited economic means (23.6%), while in females it was pregnancy or motherhood (28.7%).10
We conducted a study with qualitative methodology from a phenomenological perspective, exploring the point of view of participants to reconstruct the feelings, thoughts and actions of pregnant students. We obtained data from in-depth interviews and field observations, exploring and interpreting the phenomenon of teenage pregnancy from a holistic, interpretational and also empathic perspective, guided by the experiences of interviewees
We conducted individual interviews over a period of several days in the absence of any third parties. The interviews were semi-structured, so that interviewees could add any element they considered relevant to make the interviews more interactive, participatory and personal.
For the full interpretation of the content provided by interviewees, we performed a descriptive analysis of their narratives. We also established dimensions and subdimensions to allow a more detailed analysis.
We arranged the content of the interviews by dimensions, grouping content with a similar subject matter.
The perceptions about teenage pregnancy of the students varied, as their emotional stability in this process depends on the support offered by the main players involved in the situation: the fathers of their babies and their families, who in some instances resulted in caring for the students, although due to the experience of a stressful life event, they had to go through various conflicts as individuals and within the family.
However, the greatest challenge of maternity at an early age for these students is that they continued to depend financially on their families, with whom they lived in 80% of cases. This also has an impact on the family system, as a pregnancy is an event that restructures family functioning and introduces new roles in the family, which gives rises to several social changes and friction within the family system, such as crowding, interpersonal conflicts, etc.
The families of pregnant teenagers exhibited a variety of initial reactions in response to this stressful event in the adolescent’s life.
Each human being is unique, and this individuality manifests in the personality, beliefs and goals of each person. However, despite the singularity of each pregnant student, they do share some psychosocial characteristics that have been previously described, such as low self-esteem, limited interaction with their peers and a need to belong, which was implicitly expressed in the in-depth interviews and the life narrative of each of the participants.
When it comes to their self-image, some pregnant teenagers perceive themselves negatively and in a critical light, focusing only on the negative aspects of their personality, and this is directly correlated to the low level of self-esteem that they express having. Broadly speaking, the individuals that have the greatest impact on the development of personality and self-acceptance are the primary groups to which we belong as human beings: family groups, friends, and love relationships.
There is no question that self-esteem is a subjective perception that each individual has of him or herself on account of personal virtues and flaws; in the case of the pregnant teenagers in our sample, despite the initial decline in self-esteem, it did bounce back. Their self-esteem has increased with time, since having a stable partner makes them more confident in themselves, as does fulfilling the responsibilities that come with motherhood and the countless joys they perceived through pregnancy, all of them a reflection of the resilience that allows the necessary adaptation to the changes brought about by this momentous event. Thus, the mental health of the adolescents (associated with the inner emotional life of the interviewees) determined how they acted and perceived their lives.
The feeling of belonging is a vital need for humans, and it seems that it is a risk factor for teenage pregnancy, as the families in our sample seemed to be detached, so that participants sought to satisfy this need outside the family circle, as the romantic partner can be a very important source of social support and emotional safety in adolescence. However, the arrival of the child provides an anchor that motivates the adolescents and gives them the sense of security that they crave, as from that moment on they have a child that belongs to them and furnishes the company that they were unconsciously seeking.
During adolescence, the most important influence in the psychosocial development of the individual comes from the peer group, including friends, class mates, etc, as the adolescent seeks to identify models of behaviour that then get internalized.
One of the psychosocial risk factors for teenage pregnancy is limited social interaction with peers, either in the context of informal groups or with the friends or groups that the adolescent seeks to belong to.
One of the factors that may play a role in the limited interaction with peers is the personality of the adolescents that become pregnant, which may have predominantly introverted traits, interact little with people or have shallow relationships; however, there are instances where romantic relationships pose a barrier, when the partner is excessively controlling of the activities of the adolescent and keeps them from spending time with friends of either sex, which makes the adolescent withdraw and become dependent on a single relationship.
In this dimension, we analysed the influence of the local culture, within which we considered aspects like socioeconomic level and educational attainment, in addition to assessing whether these factors were related to teenage pregnancy.
In Bronfenbrenner's ecological model,11 the fourth level or macrosystem represents that the development of individuals is the product of multiple influences that come from the different contexts where their lives unfold. The influences exerted between the subject and the environment are bidirectional. This theory conceives of the subject as a dynamic being that is influenced by the environment but that also has the capacity to restructure this same environment.
This aspect refers to the standard of living of the interviewed students, who placed in the first three quintiles of household income, a reflection of the scarcity of economic and social network resources, which hinders personal fulfilment.
The students reported feeling that the environment conditioned how they experienced their pregnancy, and particularly considered the socioeconomic factor essential in their conception and planning of their life trajectory, and they did not contemplate within their personal and social resources the possibility of accessing social and institutional networks as possible sources of support to counteract their adverse socioeconomic status.
This brings up questions regarding the true social impact of institutions serving the most vulnerable groups of our society from the perspective of the social responsibility that they have to improve quality of life in these disadvantaged subpopulations and reaching out to individuals that do not currently have access to the benefits afforded by social services. It raises doubts regarding the impact of social integration and equal opportunity programmes based on sex and the impact of sexual and reproductive health programs, and reflects how these programmes do not seamlessly reach the low-income female adolescent population.
The indicator used to assess the socioeconomic status of the students was the income of their parents, who had temporary employment, which is poorly paid and resulted in income below the poverty level (source: student files).
This dimension refers to the level of education obtained in important subject areas, especially by the parents of the students in the sample. In this dimension we analysed the influence of attainment throughout generations and how low attainment can be a risk factor in families for poor personal development and quality of life, as knowledge provides confidence and the necessary tools to lead and prevent.
The indicator of educational attainment used in the study was whether parents of the students in the sample failed to complete their secondary education; we found that the majority did not complete lower secondary education, which plays a role in the low household income. Furthermore, the students we interviewed were adolescents midway through their lower secondary education (source: personal student files).
We can conclude that most of the interviewed students had commonalities when it came to social factors. We ought to highlight the type of employment in their family, belonging to families with low educational attainment, and socioeconomic status in general.
On the other hand, when it comes to the reasons why they eventually became pregnant, these where the most salient:
This dimension studies household structure as a dominant social factor in the proliferation of teenage pregnancy among students, as adequate functioning of the nuclear family results in adequate childrearing measures that allow each member of the family to correctly go through each of the stages of psychosocial development.12
Family dynamics refers to the interaction between different subsystems within the family system, and determining these dynamics is essential for the purpose of understanding how the family system functions in relation to adherence to family roles, communication between family members and boundaries between subsystems; when the boundaries are blurry, it is more likely that the family is dysfunctional or has multiple problems.
When it came to the interaction between the pregnant students and their families, there were several factors involved, parents and children with communication problems that resulted in conflicts within the family system, the emotional neglect experienced by these adolescents, and dyads, triads and other alliances that formed between family subsystems either due to affinity or to the attention granted to different children in these families, as sometimes siblings from different parents lived together in the same household, so that excluded members would seek to fulfil their needs outside the family unit, either within their peer groups or through their romantic relationships.
We ought to mention that most of the families of origin of the participants were characterised by detachment due to the boundaries formed within the family group, due to the aforementioned formation of dyads, triads and alliances between subsystems. The students expressed that their parents had either permissive or authoritarian parenting styles that promote dysfunction in the family unit, with a lack of adherence to parental roles, in part influenced by the lack of education of the parents.
Sex education is a key aspect in the integral education of individuals, for beyond knowledge of pure biology, it includes essential processes such as the development of gender identity or love relationships, patterns that are usually transmitted from the family unit influenced by the cultural patterns of the larger community to which the students belonged. However, affection plays a heavier role in the onset of sexual activity in these teenagers, for if the family to which they belong fulfilled their emotional needs, these girls would not hurry to seek sexual intimacy or emotional security in a partner this early in life.
In adolescence, risk behaviours are frequent due to a lack of adequate information on contraception, so that teenagers act based on beliefs and ideas that are incorrect and unscientific in most instances. Other possible factors are the incorrect and inconsistent use of birth control methods, engagement in unplanned and sporadic sexual relations, and unprotected sex.13
Thus, on this subject, the pregnant students reported that they used birth control methods inconsistently, however, we found that on this subject the students did not have a particularly strong interest, but rather they stated that they had sexual relations because they needed the affection, the emotional security that they did not find in their homes and instead found in their partners.
In this dimension, we found that the school did not offer sex education programmes, as they did not have the human resources needed to implement this type of programme, did not have a counsellor, and only starting this year offered guidance classes within the curriculum as a way to promote the integral development of their students; however, these classes do not address sex education explicitly, considering what we have presented above.
We believe that the information provided by the accounts of the interviewees reflects the experience of pregnant students, as the methodology employed allowed the research team to reach the roots of the phenomenon beyond the isolated event of the pregnancy, revealing the individual psychosocial perception of the adolescents.
The dimension of self-esteem turned out to be a factor that was associated with pregnancy in all 6 interviewees: since they had low self-esteem, the students did not feel secure on their own and sought someone outside the home to give them love, devotion and affection. It is clear that we internalise the messages we receive from a young age, and self-esteem is shaped by the expression of how others perceive oneself (as conveyed by their words and attitudes), what one believes other think of oneself (which involves the subjective interpretation of those messages) and what one believes oneself to be (a personal perspective that develops in deep association with the previous two).
We ought to highlight the importance of the factor of adolescents developing self-esteem in the household, as this provides the tools that makes them understand the importance of self-acceptance and being valued in the family unit.
When it came to peers, students recognised that from the time they stated their respective relationships they became solely focused on their partners, who were jealous and asked them not to meet with their peers, so the adolescents started to withdraw from all social relationships, getting attached to the affection, love and attention they received from their partners and changing their social behaviour.
As for the roles in the family, in most instances pregnant students experienced direct and indirect emotional neglect by their parents in the context of family dysfunction, as in 50% of cases they belonged to single-parent households where the mothers were the sole providers of the family, so that children spent most of the time alone, which can lead to them seeking to have their needs met outside the home, making them more vulnerable to the influence of third parties, to which we must add the effect of lacking the father figure, which usually provides the boundaries, emotional security and sense of self-reliance; thus, most of these children tend to feel insecure, which has an impact on their self-esteem and psychosocial development.
Furthermore, we found that the parenting style in these families was dichotomous, as in some cases it was a permissive or laissez faire style without boundaries, by which adolescents were allowed to do anything, with no respect to the rules, when human beings need boundaries, as individuals, being social agents in a community, need to adapt to the systems where they participate assuming the rules of conduct, values, traditions etc; and in the other extreme we found authoritarian parents characterised by an excess of rules, so that adolescents had little autonomy, which makes them insecure, easily influenced and unable to make their own decisions.
At the institutional level, the sex education delivered in the school was deficient, not to say non-existent, and the school lacked a counsellor, sex education and emotional health programme, which is a disadvantage that promotes the proliferation of teenage pregnancy, one of the problems most commonly identified by the actors in the school community, be them students, teachers, assistant teachers or administrators, which has motivated the implementation of guidance classes in the curriculum, where teachers have mainly focused on the prevention of social problems such as unwanted pregnancy, school bullying, smoking, violence of any kind etc. At the same time, the lack of a sex education programme is compounded by the scarce and vague information provided by parents.
Lastly, based on the accounts of the students and the rural setting where they are growing up, institutions are not giving sufficient importance to sex education, and myths and false beliefs associated with sexual behaviour are still pervasive. These are the roots of the general ignorance about sex, and which public policy should have a greater impact on, with more vigilant intervention, demanding that institutions representing the state, in cooperation with civil society, undertake their massive and specific dissemination.
The authors have no conflicts of interest to declare in relation to the preparation and publication of this article.
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