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CHAPTER ONE
INTRODUCTION TO STUDY
1.1. Introduction The research study focuses on the perceptions of adolescent males on their involvement in teenage pregnancy prevention in Kliptown. This chapter briefly discussed the problem statement of the study, the rationale for undertaking this study, the research question, the aims and objectives of this study. In addition it will conclude by providing an overview of the chapters to follow.
1.2. Problem statement Teenage pregnancy has long been a worldwide social and educational concern for the developed, developing and underdeveloped countries. Many countries continue to experience high incidence of teenage pregnancy despite the intervention strategies that have been put in place (Maseko, 2006). Moultrie and McGrath (2007) indicate that teenage pregnancy rates in South Africa have dropped from 7.8% in 1996 to 6.5% in 2001. In addition the official statistics from the Department of Health revealed a drop in the rates of teenage pregnancy in South Africa by 13.2 % between 2009 and 2010 (Oyedele, Wright & Maja, 2015). However Kanku and Mash (2010) note that South African rates are comparatively high when compared to the USA (5.3%), Brazil (4.5%), Australia (1.6%), Japan (0.4%) or Italy (0.6%).
Teenage pregnancy is a major challenge facing South Africa, thus presenting one of the most important public health problems. In the past few decades South Africa has seen a decline in teenage fertility; and yet rates of teenage pregnancy remain high with around 30% of 15- year olds reporting having ever been pregnant, with the majority of these pregnancies being among 18 and 19 year olds (Willan, 2013). A national household survey conducted in 2003 indicated that one third of 15-19 year olds and over half (59%) of 20-24-year-old women had ever been pregnant and that two-thirds of the pregnancies were reported to be “unwanted” (Holt, Lince, Hargey, Struthers, Nkala, McIntyre & Blanchard, 2012).
The results of the studies done showed that approximately 90% of the teenagers are sexually active (Love Life, 2007). Unprotected sex exposes teenagers to sexually transmitted diseases (STDs) and increases their risk to become infected with HIV/AIDS. Health Statistics (2007) reported that one in five pregnant teenagers is infected with HIV/AIDS. This indicates that it
is important to understand teenage pregnancies and the pattern of high risk sexual activity that teenagers indulge in.
It was reported by the Department of Basic Education that in 2014 there were 20 000 teenage pregnancies in South Africa, the highest being accounted for within the Gauteng Province with just over 5000 (Govender, 2016). Due to Gauteng Province having the highest statistics in South Africa in 2014, the study focused on teenage pregnancy in Kliptown, Gauteng Province.
Teenage pregnancy has several detrimental effects for both teenage mothers and fathers such as increased chances of dropping out of school, increased risk of sexually transmitted infections (STIs), mental health problems, and economic family burden (Kanku & Mash, 2010). However Hanson, McMahon and Kenyon (2014) note that teenage mothers are more likely to drop out of school, which holds unfavourable consequences for their long term financial prospects.
Swartz (2004) notes that adolescent fathers themselves are still developmentally immature and thus emotionally and cognitively unprepared to cope with parental responsibility. An argument supported by Sheldrake (2010) that fathers under the age of 21 years are frequently characterised as ‘sexually reckless youths who fail in their responsibilities to the children they father and the mothers of their children’. Swartz (2004) adds that very often, the fathers are young unemployed with low levels of education and they are unable to give emotional or financial support or any form of material support to teen mothers. Due to the negative and long-term consequences associated with teenage pregnancy, the prevention of unplanned teenage pregnancy is very important (Solomon-Fears, 2011).
1.3. Rationale for the Study A lot of studies have been conducted to identify the causes of teenage pregnancy in South Africa and many factors contributing to teenage pregnancy included: early sexual debut among teenagers; gender inequalities; gendered expectations of how teenage boys and girls should act; sexual taboos (for girls) and sexual permissiveness (for boys); poverty; poor access to contraceptives and termination of pregnancies; inaccurate and inconsistent contraceptive use; judgmental attitudes of many health care workers; high levels of gender- based violence; and poor sex education (Bearinger, Sieving, Ferguson & Sharma, 2007; Chigona & Chetty, 2007; Jewkes, Morrell & Christofides, 2009; Oyedele, Wright & Maja,
knowledge needs to be developed on pregnancy prevention programs that involve males (Lindberg, Ku & Sonenstein, 2000).
These studies have provided insight into the nature of the teenage pregnancy prevention programmes and they have highlighted different aspects to focus on. However there is a lack of information about how teenage males could and should participate in pregnancy prevention efforts in research studies. Moreover the research studies have overlooked the perceptions and attitudes of male teenagers on what their role is in teenage pregnancy prevention. Sexual behaviour involves two partners, and decisions to have sex and to use contraception undoubtedly reflect both partners’ perspectives as a result it is important to understand overlooked the perceptions and attitudes of male teenagers on what their role is in teenage pregnancy prevention.
In South Africa most teenage pregnancy prevention programs have specifically targeted young women and not young men. There hasn’t been much focus on the impact of teenage pregnancy on the teenage fathers in research and literature. According to Willan (2013) this in many ways reflects societal, gendered prejudices that responsibilities for ‘falling pregnant’ and being a ‘teenage parent’ lie with the girl, and further that the role of parenting should be born almost exclusively by the mother.
Therefore the research is going to explore the role of adolescent men and their motivation for fertility decision-making in their relationships. This study intends to get the views of male teenagers as both potential and actual fathers, on their role in combating adolescent pregnancy in Soweto Township, Gauteng. The results of this study might lead to bigger research and may add to a gap in the existing knowledge regarding the role adolescent boys in teenage pregnancy prevention.
1.4 Research Question What are the perceptions of adolescent on what their role is in teenage pregnancy prevention in Kliptown?
1.5 Aims and objectives of the study Primary aim of the research
The primary aim for this research was to explore the perceptions of adolescent males on their involvement in teenage pregnancy prevention in Kliptown.
Secondary objectives of the research
To investigate what adolescent males perceive as their role in teenage pregnancy prevention. To explore the adolescent males’ level of awareness about teenage pregnancy. To identify what sources of information adolescent males used to obtain information about teenage pregnancy. To assess adolescent males awareness of the various forms of available contraception. To investigate the attitude of adolescent males on the use of contraceptives, abortion and the risk of HIV/AIDS and STI’s. To explore adolescent males’ perceptions on the responsibilities placed on being a teenage father.
1.6 Organization of the research report Chapter two discusses the literature reviewed for this study and theoretical framework and chapter three discusses the research design and methodology employed in this study. Chapter four presents the data analysis through interviews. Chapter five will provide a discussion of the findings of the study, limitations of the study and recommendations.
Jewkes, Morrell and Christofides, (2009, p. 678) reflected on the teen years as a key time for exploring and establishing ones gender identity, they noted that for boys ‘in a context of poverty and limited alternatives, securing and maintaining sexual relationships are critical to self-evaluations of masculine success as well as peer group positioning’.
Gendered norms shape the way adolescents view sexuality and play an important role in sexual behaviour, risk-taking attitudes and their use and access to information and services (World Health Organization, 2011). Mkhwanazi (2010) argues that gendered norms encourage boys to be sexually active whilst girls are encouraged to be ‘sexually innocent’. Despite the fact that pregnancy involves both males and females girls are told that they must protect themselves from pregnancy and are blamed should they fall pregnant, and also expected to be ‘sexually ignorant’’ (Mkhwanazi, 2010). This confusion on which Mkhwanazi (2010) commented on as the mixed messages sent out to girls while boys are encouraged to be sexually active.
2.4 The status on teenage pregnancy in South Africa
Adolescent pregnancy is a complex issue with many reasons for concern; it is an important public health problem as well as socioeconomic challenge to society (Osaikhuwuomwan & Osemwenkha, 2013). Teenage pregnancy is a global reproductive health promotion problem that affects teenagers, families and communities, both in developed and developing countries, as children aged 10 to 19 years, unmarried and still at school, become pregnant (Mchunu et al. 2012:428). Teenage pregnancy may be coupled with complications associated with a variety of obstetric, social, educational and health-related problems; hence it is important to prevent its occurrence (Masemola-Yende & Mataboge, 2015).
According to Masondo (2013) Statistics derived from the 2013 Household Survey in South Africa indicated that there were 99 041 pregnant school girls in 2013, which showed an increase of 17 363 over the previous year. Masondo (2013) noted an increase from the 81 000 pupils who fell pregnant in 2012 and 68 000 in 2011. According to the General household survey conducted by Statistics South Africa (2015) the prevalence of teenage pregnancy in 2015 increased with age, rising from 0, 6% for females aged 14 years, to 9, 7% for females aged 19 years.
2.5. Factors that contribute to teenage pregnancy
Individual factors Arain, Haque, Johal, Mathur, Nel, Rais & Sharma (2013) argues that adolescents are limited by their cognitive development in making critical decisions. Berk (2010) argues that although adolescents can consider many possibilities when faced with a problem, they often fail to apply this reasoning to everyday situations. This suggests that due to their limited formal reasoning skills, some adolescents may take risky decisions or behave in ways that put their lives at risk, such as choosing not to use condoms in all their sexual encounters.
Teenage pregnancy has been associated with frequent sex without reliable contraception, sexual coercion, poor sexual communication between partners, the perception that most of your friends have been pregnant or that one has to prove one’s fertility and promiscuity (Vundule, Maforah, Jewkes & Jordaan, 2001). According to Ekstrand, Larsson, Von Essen & Tyden (2005) liberal attitudes `towards casual sex, alcohol consumption, fear of hormonal contraceptives and poor school-based sexual education have also been associated.
In a study conducted by Willan (2013) which was aimed at exploring knowledge, access to, and use of, contraceptives they found that many teenagers have a basic knowledge about contraceptives and protection from unplanned pregnancies, STIs and HIV. However, many reported insufficient contraceptive knowledge and not using contraceptives correctly and consistently, as well as limited reproductive knowledge about fertility and conception (Willan, 2013). Buga, Amoko & Ncayiyana (1996) notes that the reasons for not using contraception also include ignorance, fear of parents finding out, shyness in going to the clinic and disapproval from the boyfriend.
Societal factors
Teenage pregnancy in South Africa is driven by many factors including: gender inequalities; gendered expectations of how teenage boys and girls should act; sexual taboos (for girls) and sexual permissiveness (for boys); poverty; poor access to contraceptives and termination of pregnancies; inaccurate and inconsistent contraceptive use; judgmental attitudes of many health care workers; high levels of gender-based violence; and poor sex education (Jewkes, Morrell and Christofides, 2009).
Children born to teenage mothers are themselves more susceptible to falling pregnant as teenagers (Kanku & Mash, 2010). Parents of teenage mothers and teenage fathers are often
Sexual health education in the form of life skills has been introduced as a compulsory part of the school curriculum, but the way in which it is implemented is not successful (Kanku & Mash, 2010). Most educators are not well equipped on how to implement it. Eventually teenagers do not get the necessary information about sex education (Panday et al (2009, p. 53).
2.6 The status of teenage fathers in South Africa
Available international research suggests that the profile of young fathers is no different from young women – they tend to come from low income homes, have poor school performance, low educational attainment and seldom have the financial resources to support the child and the mother. In South Africa the teenage years are characterised by generally socially sanctioned freedom and sexual experimentation for both genders, but particularly for young men (Wood & Jewkes, 1998).
According to Jacob and Marais (2013) in a context of poverty and limited alternatives, young fathers’ sense of responsibility is mostly tied to their sense of masculinity, which is defined and achieved as the following: sexual performance and the belief that men should be seen as sexually vigorous; securing and maintaining sexual relationships are critical to self- evaluations of success and peer group positioning. Teenage fathers are often overlooked in attempts at addressing the challenge of teenage pregnancy and most research studies have focused on the teenage mother and baby who need support and help but neglect to think about the impact of fatherhood on teenage males (Swanson, 2013).
Teenage fathers are affected by parenthood, they need help, advice, encouragement to take responsibility both for the babies they have fathered and their own education and future (Njambatwa, 2013. Adolescent fatherhood has been associated with: low economic backgrounds; lower educational attainment; and fewer employment opportunities than their childless peers (Jacobs & Marais, 2013). Young men involved in adolescent pregnancies were more psychologically distressed than those who did not have a pregnant girlfriend in adolescent stage (Buchanan & Robbins, 2005). This is because teenage fathers are developmentally immature and thus are emotionally and cognitively unprepared to cope with the responsibility of parenting (Hudson & Ineichen, 1991). Despite this majority of teenage fathers felt obliged to meet certain responsibilities for the baby and mother (Barret & Robinson, 1982).
Jacobs and Marais (2013) argued that some of the reasons for having children at young age ranges from: alcohol use, desire to have sex without a condom, ignorance about condoms, contraceptives and general reproductive biology, beliefs that condom use is associated with mistrust and infidelity/promiscuity, lack of supervision and adult involvement in their lives, sense of invulnerability and wanting and actively seeking an opportunity to father a child (legacy/fear of premature death, desire for fatherhood, secure relationship with teen mother, peer pressure, pride and evidence of masculinity)
According to Swartz, Bhana, Richter and Versfeld (2013) barriers to young fathers’ involvement with their children include financial, cultural and relational. Financial support often overshadows other aspects of fatherhood, such as contact time, physical care and emotional support. This is a challenge for teenage fathers in contexts of poverty as they tend to have limited access to finances due to their continuing education and absence of income. Culturally young, black African men are required to make damage payments to the family of the mother of his child in order to be allowed to be involved in their children’s lives. This is a challenge for teenage fathers as they do not have the money to make damage payments. A poor relationship with the child’s mother can also reduce a teenage father’s ability and desire to play a fathering role. In light of the above South Africa has in its endeavour to reduce the prevalence of teenage pregnancy has formulated the following legislation.
2.7 South African Legislation regarding teenage pregnancy
According to Willan (2013) the South African policy environment creates a relatively progressive space around teenage sexuality, teenage pregnancy and motherhood. The different legislation that have a bearing on teenage pregnancy in South Africa include the Constitution of the Republic of South Africa Act (108 of 1996), the Child Care Act (84 of 1996), the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007, the Education policy and the Choice on Termination of Pregnancy Act (Act 92 of 1996).
The South African Constitution
The South African Constitution (1996) ‘protects the right (of all citizens including children) to make decisions regarding reproduction and the right to access health care services, including reproductive health care’(Hoffman-Wanderrer, Carmody, Chai & Rohrs, 2013, p.4). However, implementation presents a severe obstacle, with many teenagers reporting
termination of pregnancy if she fails to do so. Terminations are performed for free at government hospitals and clinics in the first three months of pregnancy. Despite the legalization of abortion in South Africa in 1996 and the progressive increase of service availability in public and private facilities over time, few teenagers report using legal services for termination of pregnancy in both quantitative (3%) and qualitative data. Failure to use legal services is related to the ensuing lack of information about the costs of termination and the stage of gestation at which legal termination can take place, as well as the stigma of pregnancy and abortion generated in the community and replicated within the health system.
Education Policy
Girls who become pregnant in South Africa are not expelled during pregnancy nor are they prohibited to return to school after giving birth (Olivier, 2000). As a result teenage pregnancy doesn’t interfere with their studies. South Africa’s liberal policy that allows pregnant girls to remain in school and to return to school post-pregnancy, has protected teenage mother’s educational attainment and helped delay second birth. However, only about a third of teenage mothers return to school. This may be related to uneven implementation of the school policy, poor academic performance prior to pregnancy, few child-caring alternatives at home, poor support from families, peers and the school environment, and the social stigma of being a teenage mother.
2.8 Theoretical Framework Guiding the Study
Bronfenbrenner’s ecological model addressed the complex and multi-determined nature of the social problem of adolescent pregnancy with its conceptualization of the individual as being affected by the larger systems levels (Corcoran, Franklin & Bennett, 2000). Moreover Bronfenbrenner's ecological model can be used to help understand the contributing factors in adolescent pregnancy and that the behaviour of teenagers is the result of the knowledge, values, and attitudes of individuals as well as social influences, including the people with whom they associate, the organizations to which they belong, and the communities in which they live (Corcoran, Franklin & Bennett, 2000).
2.9 Summary of Chapter
This chapter reviewed the literature available on teenage pregnancy. The literature helped us to understand why it is important to understand the stage of adolescence when looking at teenage pregnancy. This chapter reviewed the status on teenage pregnancy in South Africa to
understand the severity of the problem. In addition this chapter looked the factors that contribute to teenage pregnancy in South Africa. Moreover this chapter contextualised the status of teenage fathers and the challenges that they face in fulfilling their roles as fathers. In response to the challenge of teenage pregnancy the South African government developed appropriate legislation to address this problem. Bronfenbrenner’s ecological model was applied to the problem of teenage pregnancy.
3.4 Research approach and design Research approach
This research study utilized the qualitative research approach. Creswell (2013, p. 4) notes that qualitative research is “a means for exploring and understanding the meaning individuals or groups ascribe to a social or human problem”. According to Creswell (2013) the process of research involves emerging questions and procedures; collecting data in the participants' setting; analysing the data inductively, building from particulars to general themes; and making interpretations of the meaning of data. A qualitative research approach was useful in this study as it allowed the researcher to get an in-depth understanding of the perceptions of adolescent males on what is or what should their involvement in teenage pregnancy prevention in Kliptown.
Qualitative research approach was useful because it goes hand in hand with social work values, knowledge and skills (Shaw & Gould, 2001). For example when interviewing participants the researcher applied social work skills such as active listening, probing, questioning and clarification skills. The researcher got the opportunity to establish rapport with participant and that will lead to participant feeling free to interact with the researcher (Creswell, 2013). One of the strengths of a qualitative research is working with a small sample, as it provides rich and detailed data (Terre-Blanche, Durrheim & Painter, 2006).
Research design
According to Creswell (2013) research designs are plans and the procedures for research that span the decisions from broad assumptions to detailed methods of data collection and analysis. It involves the intersection of philosophical assumptions, strategies of inquiry, and specific methods. The research study applied the phenomenological research to enable the participants to describe their experiences, their thoughts, feelings and ideas about teenage pregnancy. During the interviews the participants described their experiences without the researcher directing or suggesting their description in any way. to gather the participants' descriptions of their experience. This was important as the purpose of the research was to explore the perceptions of adolescent males on their involvement in teenage pregnancy prevention, not the meaning that the researcher brings to the research. Phenomenological research is a qualitative strategy in which the researcher identifies the essence of human experiences about a phenomenon as described by participants in a study (Creswell, 2014).
3.5 Population and sampling Due to the nature of the research non-probability sampling procedure and convenience sampling was applied. Convenience sampling includes participants who are readily available and agree to participate in a study (Latham, 2007). The population for the study will included male teenagers at the Kliptown Youth Programme. A sample of 10 male teenagers aged 18 to 19 years was drawn from this population.
3.6 Research Instrumentation Semi-structured individual interviews were utilized to collect data in the research process with ten male teenagers aged 18-19 years. An interview schedule with a few open-ended questions was used to guide the interview process and to obtain specific information aimed at understanding participants’ perceptions on their role in teenage pregnancy prevention. The interview schedule involved open ended questions which covered the themes that were relevant to the research topic. A copy of the Interview schedule is provided as Appendix A.
Pre-testing of the research instrument
The pre-test was conducted with two participants in order to determine the appropriateness and clarity of the interview questions. One of the advantages of pre-testing the research instrument is that it might give advance warning about where the main research project could fail, where research protocols may not be followed, or whether proposed methods or instruments are inappropriate or too complicated (Van Teijlingen & Hundley, 2002). The participants in the pre-test were given an opportunity to state their views on the interview questions. The participants indicated that the questions were clear and relevant to the research question. Therefore the researcher did not amend any questions.
3.7 Data Collection Data were collected through semi-structured individual interviews. Semi-structured interviews were used to gain a detailed picture of the participants’ perceptions of their role in teenage pregnancy prevention. The semi-structured interview enabled the researcher to understand what participants perceive as their role in preventing themselves from making someone pregnant. According to Descombe (2000) argue that flexibility on the part of the interviewer and the interview is vital as it ensures that interviews are allowed to speak more broadly on issues raised by the researcher. In addition the semi-structured interview helped the researcher to ask in depth questions and for the participants to express their experiences. Moreover the researcher was able to probe further during interviews with participants and to
made use of thick description strategy to enhance credibility by providing a detailed description of the research procedures and the theoretical framework guiding the study.
Dependability
Dependability is said to be achieved through an inquiry audit, whereby details of the research process including the processes of defining the research problem, collection and analyzing of data, and constructing reports are made available to research participants and other audience (Pitney and Parker; 2009). According to Creswell (2009) ‘external audit’ which means someone examines the research process and product to ensure that the study’s findings are consistence with its data. The researcher kept memos documenting the evaluation of the emergent themes, their answers to research questions, any change to interview questions, and the details of participants’ selections.
Confirmability
According to Pitney and Parker (2009) confirmability refers to the degree of neutrality or the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest. The researcher enhanced confirmability through the use of the supervisor to check if the researcher’s interpretation of the data is an accurate representation of the perceptions of the participants.
3.10 Ethical Considerations The following ethical considerations have been identified as relevant in the conduct of this study:
Ethics approval and permission
I received permission from the manager of Kliptown Youth Programme and the Wits Human Research Ethics Committee (Non-medical) to conduct the study.
Informed consent
According to Monette, Sullivan, De Jong and Hilton (2014) informed consent refers to ensuring that potential participants are informed about every aspects of the research study which will influence their decision to give consent to participate in the study. Therefore the information sheet was provided to participants to request them to take part in this study. Participants were informed of the purpose and procedure of the study. Participants were
informed that their participation in the study is voluntary and that they could withdraw from participating at any point if they wished to do so. The participants’ right to remain confidential was extended to include exclusion of any information that could identify them. Copies of the consent forms for participation in the study and for tape-recording of the interviews are provided as Appendices B and C.
Anonymity and confidentiality
The researcher explained to the participants the principle of confidentiality and its limitations. The researcher explained to the participants that the supervisor will have access to information because she will be marking the research report and will listen to the tape recordings. The researcher kept the interview recordings and the transcriptions in a password protected computer and identifying details of the participants were changed as the researcher used pseudonyms to ensure that what was discussed in the interview would be kept private. The identifying details of the participants were not included in the final report.
Voluntary Participation and right to withdraw
Rubin and Babbie (2007) argue that it is important to emphasize that participating in the research was strictly voluntary and that the participants were not coerced or manipulated to take part in the. The researcher informed the participants about the research and its purposes and invited the participants to participate in the study. The researcher explained to the participants that they did not have to take part in the research if they were not willing to participate. The researcher explained to the participants that choosing not to participate in the study will not affect them negatively.
According to Walsh and Wigens (2003) the researcher should inform the participants that they should feel free to ask questions relevant to the research study, and that if they are not comfortable about answering the interview questions they may decline to do so and may withdraw from the study without any negative consequences. The researcher explained to the participants that they had the right to withdraw from the study at any time if they felt uncomfortable and it was emphasized that there would be no negative consequences or penalties. The researcher provided information to participants regarding these principles in the Participant Information Sheet attached as Appendix B.
