Agency under constraint: Adolescent accounts of pregnancy and motherhood in informal settlements in South Africa

Abstract

Progress in adolescent sexual and reproductive health (SRH) remains unequal: adolescent pregnancies are more likely to occur in marginalised communities, or in very poor households. This study aimed to comprehend from adolescents’ own perspectives, the circumstances of falling pregnant and coping with motherhood in informal settlements in South Africa, to better understand the SRH challenges adolescents in these settings may face. A qualitative study was carried out over a two-month period in 2019 to analyse the perceptions held by adolescents in informal settlements served by four community-level clinics in the adjacent township. We found that adolescents face overlapping barriers in seeking to avoid unintended pregnancy in informal settlements. Once they become mothers, their trajectory is limited by the resources and support available from their own parents, particularly their mothers, and to a lesser extent, their partners. We draw on the concept of agency to examine their accounts and to highlight the importance of addressing broader contextual constraints.

Keywords:

• adolescent pregnancy
• adolescent motherhood
• South Africa
• informal settlements
• agency

Acknowledgements

The authors wish to thank SC Malebye, research assistant in Gauteng, for her significant contribution to the field research. The field team would like to thank Ute Feucht and the UP/SAMRC Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, the Tshwane District Health Office and the City of Tshwane, as well as clinic authorities and staff for their support. Most importantly, we received invaluable aid from the outreach team leaders and the community health workers, without whom this study could not have taken place. The authors would also like to thank the journal’s anonymous peer reviewers for their very helpful observations on this paper. The analysis presented here is the authors own. Excerpts from this research have been presented orally by the first author at the 6th Global Symposium on Health Systems Research in 2020, and at the Preterm Birth Dialogues Virtual Conference in 2021.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Clinic names have been removed to protect anonymity.

Additional information

Funding

This research was funded by the National Institute for Health Research [NIHR 17/63/26] with additional support from internal University of Sheffield Research England GCRF Quality Related Pump Priming Award [160955] and Rapid Response Travel Fund [013151].