DEDICATION • My parents: Thank you for your unconditional support with my studies. I am honoured to have you as my parents. Thank you for giving me a chance to prove and improve myself through all my walks of life. Please do not ever change. I love you. • My family: Thank you for believing in me; for allowing me to further my studies. Please do not ever doubt my dedication and love for you. • My brother: Hoping that with this research I have proven to you that there is no mountain higher as long as God is on our side. Hoping that you will walk again and be able to fulfil your dreams. i ACKNOWLEDGEMENTS • I thank Almighty God for giving me the courage and the determination, as well as guidance in conducting this research study, despite all difficulties. • I wish to extend my utmost gratitude to all the research participants for their wonderful participation and cooperation. • I would like to express my gratitude to Philisiwe Gumbi, Ouma, and Warren, for typing and Dr. C H van der Linde for editing my research. • I also extend my heartfelt gratitude to my supervisors, professors Marie Poggenpoel and Chris Myburgh. You were so wonderful to me. You made me believe that I had so much strength and courage to persevere even when I felt lost. You showed me light in a tunnel where everything was dark. You were very tolerant and determined to see me through. You were such wonderful motivators even when the coping seemed tough for me. I aspire to emulate you. • Finally, I thank all those who assisted, encouraged and supported me during this research, be assured that the Lord will bless you all for the contributions you made. ii ABSTRACT The number of adolescents who become pregnant each year has, for the past two decades, been a topic of serious concern among international education and health professionals. The Department of Education established a new policy that allows adolescents to pursue their studies during pregnancy. This policy frustrated parents and educators because it interfered with social norms and values. It also puts pregnant adolescents’ lives at risk (Mwamwenda, 1996: 206). The pregnant adolescent finds herself in the midst of a multifaceted crisis situation which is characterised by the emotional and physical reality of pregnancy. She also faces the interruption of normal physiological development, a possible change in educational and career pursuit as well as parental kinship support, an increase in medical risks during pregnancy, and the premature assumption of the adult role with its associated responsibilities. The shock of an unwanted pregnancy can be emotionally traumatic for the adolescent. Some receive emotional support from their close family members, others do not. In the absence of emotional support, the pregnant adolescent may experience increased anxiety and frustration, while others may develop depression. Together with middle-aged childbearing women, adolescents are viewed as a high risk maternity population. Complications such as high blood pressure, toxaemia, anemia and cardiac and other physiological conditions may develop, endangering the life of the adolescent (Bodak & Jensen, 1984: 938) The researcher’s curiosity about adolescent pregnancy was raised when she studied the statistics of adolescent pregnancy between 2000 and 2003, at the local clinic in Duduza. She realised that more adolescents are becoming pregnant every year. She decided to conduct research about adolescent pregnancy. The intention was to explore and describe the experience of adolescents during pregnancy at Duduza Location and to determine guidelines for educators, parents and health workers to support adolescents during pregnancy. She also intended to make recommendations for parents, educators and health workers on how pregnant adolescents can be supported. iii This research was aimed at describing and exploring the experiences of adolescents during pregnancy. This research was qualitative in nature. The sample was taken from pregnant adolescents in a township. Data gathering methods used in this research were individual interviews and observations. The observation for this study was conducted by the researcher at the local clinic and individual homes. A total of ten interviews were conducted and all of them were transcribed and edited. The participants had to comment on their experiences during pregnancy. These ten interviews formed the basis of this study to facilitate the attainment of the primary objectives which were to explore and describe the experiences of adolescents during pregnancy. The data from these interviews were analysed by using an open coding method. An independent coder did an analysis independent from the researcher. A consensus validation discussion was held with the independent coder on the analyses of the data. The detailed discussion of results obtained from the interviews and observations were presented in verbatim quotes, descriptive and reflective notes and illustration of emergent themes and categories. Rigor and adequacy were ensured by the data collected and the results obtained from the data analysis indicated convergence and saturation. The measures of trustworthiness, that is, credibility, transferability, dependability and confirmability, were applied throughout the study. Ethical considerations were addressed in the assent letters which were presented to the participants. Ethical considerations included the preserving of anonymity, confidentiality, and the ethical role of the researcher that had to be adhered to. The research results indicated that adolescent pregnancy has psychological effects on the adolescent and there is insufficient support from significant others when they find out that the adolescent girl is pregnant. The guidelines for parents, educators and health workers to support adolescents during pregnancy were formulated and recommendations discussed. iv ABSTRACT Ukukhulelwa kwentsha kuyindabamlonyeni kwabezempilo kanye nabezemfundo, eminyakeni eyevile emashumini amabili. Abezemfundo bahlele umgomo wokuthi intsha ekhulelwe ivunyelwe ukuqhubeka nezifundo zayo. Lomgomo wakhahlameza abazali nothisha ngoba uphambene nendlela yempilo yabantu bakuleli futhi ubeka impilo yentsha ekhulelwe esicengeni (Mwamwenda, 1996:206). Ukukhulelwa kwentsha kudala ukuphazamiseka ekukhuleni komzimba, komqondo, ukuphazamiseka kokufunda, ukuntuleka kwamathuba emisebenzi, nokuba sesicengeni kwempilo yabo. Ukukhulelwa kwentsha kungumshopi entsheni. Abanye bathola ukusekelwa imindeni yabo, kanti abanye abakutholi. Ngenxa yokungasekelwa ,intsha igcina isizibophela uzungu lokuzibulala. Intsha kanye nabesimame beminyaka eyevile kwamashumi amabili impilo yabo ibekeka esicengeni ngenxa yokukhulelwa. Izinkinga ezifana ne-high blood pressure, Toxeania, Anaemia, Lardiac, kanye nokunye ukukhahlamezeka komzimba kuyaqubuka bese kubeka impilo yentsha esicengeni (Bodak & Jensen 1984:938). Imbangela yokuthi ngihlolisise isimo sentsha ekhulelwa ngaphambi kwesikhathi ibangelwe ngumlando wentsha ekhulelwe kusukela ngonyaka ka 2000 ukuya ku 2003, emtholampilo waselokishini . Ngabona ukuthi intsha eningi iyakhulelwa unyaka nonyaka. Ngaqala ukuhlola ngentsha ngenjongo yokuhlola futhi ngichaze ngezimo intsha ekhulelwe ezithola ikuyo uma isikhulelwe elokishini laseDuduza. Enye injongo yaba ukuthi ngihlele indlela yokunakekela intsha ekhulelwe, ukunceda abezemfundo, abazali kanye nabezempilo. Futhi ngihlele imibono yokunakekela nokusekela intsha ekhulelwe. Indalo yalesisifundo ubuciko obuyinqayizivele. Uhlobo lwabantu abakhethelwe lesifundo intsha ekhulelwe. Indlela yokuthola ulwazi kulesifundo bekungukusebenzisa inkulumompikiswano kanye nokuhlolisisa izimo zempilo ezahlukene. Lenhlalo kanye nenkulumo mpikiswano amahlandla ayishumi yase ibhalwa phansi futhi ihlolwa. v Intsha ekhulelwe ixoxa kabanzi ngezingqinamba ezibhekene nazo uma zikhulelwe. Lenkulumo mpikiswano yakhe isisekelo salesimfundo ukuze kutholakale injongo yalesisifundo obekungukuhlola kanye nokuchaza izimo zempilo zentsha ekhulelwe. Ulwazi olutholakele ngenkulumo mpikiswano ehlaziywe nge Open Coding Method, ihlolisiswe yi-Indipendent Coder kanye nomcwaningi walesisifundo. Kwase kuvunyelwana. Imiphumela yenkulumo mpikiswano yakhe izihloko ezahlukene kucikelelwe ukuthi ulwazi olutholakele oluphelele nolanele kulesisifundo. Kuhloliwe ukuthi lesisifundo sineqiniso futhi siyiqiniso. Imigomo yokuhlolisiswa kanye nokuhlonishwa kwamalungelo entsha ekhulelwe kwenziwe, kanti futhi nezincwadi zokubacela ukuthi babuzwe imibuzo zenziwe, zanikwa intsha ekhulelwe. Lesisifundo siveze obala ukuphazamiseka komqondo okwenziwa ukukhulelwa entsheni. Kanye nokungatholi ukuxhaswa okwanele uma intsha ikhulelwe ebazalini kanye nasemasokeni abo. Indlela engcono yokusekela kanye nokuxhasa intsha uma ikhulelwe indlaliwe ukuze incede abazali, abezemfundo kanyenabezempilo. vi TABLE OF CONTENTS PAGE CHAPTER 1: RATIONALE AND OVERVIEW OF THE STUDY 1.1 INTRODUCTION 1 1.2 RATIONALE AND OVERVIEW OF THE STUDY 1–2 1.2.1 Factors leading to adolescent pregnancy 3 1.2.1.1 Home conditions of the unmarried mother 3 1.2.1.2 Early independence 3-4 1.2.1.3 Lack of information 4 1.2.1.4 Problem solving behaviour 4 1.2.1.5 Peer group influence 4 1.2.1.6 Poor self-image 5 1.2.1.7 Influence of the media 5 1.2.1.8 Attitude of the community 5-6 1.2.1.9 Loneliness 6 1.2.1.10 Low education level 6 1.2.1.11 Contraceptive 6-7 1.2.2 Consequences of adolescent pregnancy 7 1.2.2.1 For the biological mother 7-9 1.2.2.2 For the biological father 9-10 1.2.2.3 For the baby 10-11 1.2.2.4 For the family of the biological mother and father 11-12 1.2.2.5 For the society 12-13 1.2.3 Outcomes of adolescent 13 1.2.3.1 Abortion – termination of pregnancy 13-14 1.2.3.2 Abandoned babies 14 1.2.3.3 Neglect and maltreatment 14-15 1.2.3.4 Mortality and disease profile 15 vii 1.3 PROBLEM STATEMENT 15-16 1.4 RESEARCH OBJECTIVES 16 1.5 PARADIGMATIC PERSPECTIVE 16 1.5.1 Meta-theoretical assumptions 16-17 1.5.2 Theoretical assumptions 18-19 1.5.3 Definition of concepts 19 1.5.4 Methodological assumptions 20 1.6 RESEARCH DESIGN 20 1.7 RESEARCH METHOD 20 1.7.1 Phase one: Exploring and describing experiences of adolescents during pregnancy in the Duduza Location 21 1.7.1.1 Data collection and data analysis 21 1.7.1.2 Literature control 21 1.7.2 Phase two: guidelines derived from phase one to support adolescents during pregnancy 21 1.8 CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS 22 1.9 DIVISION OF CHAPTERS 22 1.10 SUMMARY 22 CHAPTER 2: RESEARCH DESIGN AND METHOD 2.1 INTRODUCTION 23 2.2 RESEARCH OBJECTIVES 23 2.3 RESEARCH DESIGN 23 2.3.1 Qualitative research 23-24 2.3.2 Explorative research 24 2.3.3 Descriptive research 24-25 2.3.4 Contextual research 25 2.4 RESEARCH METHOD 25 2.4.1 Ethical measures 26 24.2 Trustworthiness 27 viii 2.4.2.1 Credibility 27 2.4.2.2 Transferability 29 2.4.2.3 Dependability 30 2.4.2.4 Confirmability 31 2.5 PHASE 1: EXPLORING AND DESCRIBING ADOLESCENT’ EXPERIENCES DURING PREGNANCY IN DUDUZA LOCATION 32 2.5.1 Population and sampling 32 2.5.1.1 Sampling criteria 33 2.5.1.2 Sample size 33 2.5.2 Data collection 33-34 2.5.3 Data analysis 34-35 2.5.4 Literature control 35 2.6 PHASE 2: DESCRIPTION OF GUIDELINES TO SUPPORT ADOLESCENTS DURING PREGNANCY 36 2.6.1 Data collection 36 2.6.2 Data analysis 36 2.7 CONCLUSION 36 CHAPTER 3: EXPERIENCES OF ADOLESCENTS DURING PREGNANCY IN DUDUZA LOCATION 3.1 INTRODUCTION 37 3.2 DESCRIPTION OF THE SAMPLE 37 3.3 DISCUSSION OF THE FINDINGS 37-38 3.3.1 Summary of the findings, themes and categories of adolescents’ experiences during pregnancy in Duduza Location 38-39 3.3.2 Psychological effects of being pregnant 39-41 3.3.3 Anxiety about the disclosure of pregnancy 41-43 3.3.4 Anxiety about physical changes that are caused by pregnancy 43-44 3.3.5 Anxiety about future plans 44-46 ix 3.3.6 Insufficient support from significant others 46-48 3.4 Conclusions about the research findings 49 CHAPTER 4: GUIDELINES, RECOMMENDATIONS FOR SUPPORTING PREGNANT ADOLESCENTS, LIMITATIONS OF THE STUDY AND CONCLUSIONS 4.1 INTRODUCTIONS 50 4.2 GUIDELINES TO SUPPORT PREGNANT ADOLESCENTS 50 4.2.1 Improve the psychological well-being of pregnant adolescents 50-52 4.2.2 Sexuality education 52-53 4.2.3 Education about physical and emotional changes 53-54 4.2.4 Information about the future 54-55 4.2.5 Need for a support structure 55 4.3 RECOMMENDATIONS 55-56 4.4 LIMITATIONS OF THE STUDY 56-57 4.5 CONCLUSIONS 57 5. BIBLIOGRAPHY 58-61 ANNEXURES ANNEXURE 1: CLEARANCE LETTER FROM ETHICS COMMITTEE ANNEXURE 2: LETTER OF CONSENT ANNEXURE 3: LETTER FOR THE INDEPENDENT CODER ANNEXURE 4: EXAMPLE OF AN EXCERPT FROM AN INTERVIEW x LIST OF TABLES TABLE 3.1: Themes and categories of adolescents’ experiences during pregnancy in Duduza Location xi 37-38