Stigma stories: four discourses about teen mothers, welfare, and poverty

Early union, 'disgrasya', and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth

BACKGROUND

Few studies explore what it means to be an adolescent parent in the Philippines from the young parents' perspective. This study sought to improve understanding of how adolescent mothers and young fathers experienced pregnancy in Palawan, Philippines.

METHODS

We conducted narrative analysis of 27 semi-structured interviews with 15 Filipino young parents.

FINDINGS

Our findings point to three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: through early unions, through 'disgrasya' (accident) in romantic relationships, and when pregnancy is directly related to adversity and disadvantage. Some young people adopted agentic narratives and had intended pregnancies within early unions. Young people who had unintended pregnancies in romantic relationships recounted constrained choice narratives, taking responsibility for their decisions while emphasising external factors' influence on their decision-making. Other young mothers described the ways that prior adversity and disadvantage gave rise to unfavourable circumstances-including sexual violence-that led to unintended pregnancy but shared narratives showing how they had reclaimed agency in their lives.

CONCLUSION

Our findings highlight the need to (1) address underlying poverty and structural inequalities that limit Filipino young people's life choices and contribute to their pathways to adolescent pregnancy; (2) provide Filipino young people with access to essential sexual and reproductive health information, services, and supplies; and (3) change social norms to rectify gender-based power imbalances and sexual violence.

Teenage Childbearing, Reproductive Justice, and Infant Mental Health

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women's family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents' use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana

Objective

Using our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana.

Methods

We drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models.

Results

In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55).

Conclusions

Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.

Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana

Young women's experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.

A narrative analysis of the birth stories of early-age mothers

The telling of birth stories (i.e. stories that describe women's experiences of giving birth) is a common and important social practice. Whereas most research on birth narratives reflects the stories of middle-class, 'adult' women, we examine how the birth stories told by early-age mothers interconnect with broader narratives regarding social stigma and childbearing at 'too early' an age. Drawing on narrative theory, we analyse in-depth interviews with 81 mothers (ages 15-24 years) conducted in Greater Vancouver and Prince George, Canada, in 2014-15. Their accounts of giving birth reveal the central importance of birth narratives in their identity formation as young mothers. Participants' narratives illuminated the complex interactions among identity formation, social expectations, and negotiations of social and physical spaces as they narrated their experiences of labour and birth. Through the use of narrative inquiry, we examine the ways in which re-telling the experience of giving birth serves to situate young mothers in relation to their past and future selves. These personal stories are also told in relation to a meta-narrative regarding social stigma faced by 'teenage' mothers, as well as the public's 'gaze' on motherhood in general - even within the labour and delivery room.

Social discrimination, stress, and risk of unintended pregnancy among young women

PURPOSE

Prior research linking young women's mental health to family planning outcomes has often failed to consider their social circumstances and the intersecting biosocial mechanisms that shape stress and depression as well as reproductive outcomes during adolescence and young adulthood. We extend our previous work to investigate relationships between social discrimination, stress and depression symptoms, and unintended pregnancy among adolescent and young adult women.

METHODS

Data were drawn from 794 women aged 18-20 years in a longitudinal cohort study. Baseline and weekly surveys assessed psychosocial information including discrimination (Everyday Discrimination Scale), stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies-Depression Scale), and reproductive outcomes. Multilevel, mixed-effects logistic regression and discrete-time hazard models estimated associations between discrimination, mental health, and pregnancy. Baron and Kenny's method was used to test mediation effects of stress and depression on discrimination and pregnancy.

RESULTS

The mean discrimination score was 19/45 points; 20% reported moderate/high discrimination. Discrimination scores were higher among women with stress and depression symptoms versus those without symptoms (21 vs. 18 points for both, p < .001). Pregnancy rates (14% overall) were higher among women with moderate/high (23%) versus low (11%) discrimination (p < .001). Discrimination was associated with stress (adjusted relative risk ratio, [aRR], 2.2; 95% confidence interval [CI], 1.4-3.4), depression (aRR, 2.4; CI, 1.5-3.7), and subsequent pregnancy (aRR, 1.8; CI, 1.1-3.0). Stress and depression symptoms did not mediate discrimination's effect on pregnancy.

CONCLUSIONS

Discrimination was associated with an increased risk of mental health symptoms and unintended pregnancy among these young women. The interactive social and biological influences on reproductive outcomes during adolescence and young adulthood warrant further study.

“You don’t know half the story”: deepening the dialogue with young mothers in Australia

Pregnant and young mothers’ stories often go untold or are poorly represented within dominant health and social care discourses. Consequently, narratives of young mothers are largely absent from social and health care literature, especially in relation to how young women make sense, understand, and experience young motherhood. Drawing on 7 months of participant observation fieldwork at a community service, and 11 in-depth interviews, we discuss six metaphorical themes which capture the experiences of young mothers using a narrative approach. These include: Picking up the Pieces; Walking a Narrow and Familiar Path; Jumping over Puddles; Riding the Rapids to Motherhood; Living with Dirty Looks; and Asking for Directions. Contrary to the wider community’s deficit view and stereotypes of young mothers, what emerged from the narratives was quite a different story. Becoming a young mother meant taking a stand against stigma from the wider community; recognising motherhood as a significant and transformational turning point in their lives, one that opened doors to alternative storylines of hope, autonomy and agency, especially given a supportive context. These findings enhance our understandings by widening the lens to diverse realities that exist in young mothers’ lives and present a strong case for using a narrative approach to research and practice when working with young mothers.

Differential social evaluation of pregnant teens, teen mothers and teen fathers by university students

Youth may be particularly attuned to social evaluation during the teen years with implications for physical and mental health. Negative attitudes and stereotypes constitute an important type of social evaluative threat. Pregnant and parenting teens not only encounter challenges associated with their early transition to parenthood, but also are confronted with unfavourable attitudes of others. A university sample of 255 men and women responded to surveys targeting their feelings and beliefs about pregnant teens, teen mothers and teen fathers. Teen mothers were generally perceived more positively than pregnant teens who were perceived more positively compared to teen fathers. Social evaluations were generally unrelated to respondents' sex or race, but respondents who had contact with a friend or family member who had experienced a teen pregnancy were selectively more positive, as were freshmen compared to seniors. Risks attributed to early childbearing may be exacerbated by negative social evaluations.

How do health professionals support pregnant and young mothers in the community? A selective review of the research literature

BACKGROUND

The cultural phenomenon of "teenage pregnancy and motherhood" has been socially constructed and (mis)represented in social and health care discourses for several decades. Despite a growing body of qualitative research that presents an alternative and positive view of young motherhood, there remains a significant gap between pregnant and young women's experience of young motherhood and current global health and social policy that directs service delivery and practice.

AIM

This paper aims to heighten awareness of how a negative social construction of young motherhood influences global health and social policy that directs current community health models of practice and care for young mothers in the community.

DISCUSSION

There is clear evidence on the vital role social support plays in young women's experience of pregnancy and motherhood, particularly in forming a positive motherhood identity. This discussion paper calls us to start open and honest dialogue on how we may begin to re-vision the 'deficit view' of young motherhood in order to address this contradiction between research evidence, policy discourse and current practice and service provision. Qualitative research that privileges young women's voices by considering the multidimensional experiences of young motherhood is an important step towards moving away from universally prescribed interventions to a non-standard approach that fosters relational and responsive relationships with young mothers that includes addressing the immediate needs of young mothers at the particular time.

Public discourses about teenage pregnancy: disruption, restoration, and ideology

Two recent incidents in the United States generated a wealth of public discourses about a particular reproductive health issue: adolescent childbearing. As the media, political pundits, and private citizens pondered the meaning of these events, they expressed viewpoints, explanations, and possible solutions in mass-mediated outlets. We examined the discourses communicated in such outlets to understand how public discussion of teenage pregnancy reveals ideological assumptions about reproductive health, ideal family forms, and the expected life course.

COLLEGE ASPIRATIONS AND EXPECTATIONS AMONG NEW AFRICAN AMERICAN MOTHERS IN LATE ADOLESCENCE

It is a generally accepted finding in the sociological literature as well as in public discourse that adolescent mothers are less likely than their non-parenting counterparts to graduate high school and to attend college. For several decades, however, researchers have pointed out that the implied causal process from teen motherhood to academic failure has been largely unsupported by empirical research. In fact, scholars have recently argued that motherhood may actually serve as a positive turning point in the lives of young women. Using a sample of young African American women, the present study assesses the degree to which teen motherhood not only affects college aspirations but also expectations. Further, it tests the ability of these effects to explain the well-known educational attainment gap between teen mothers and their non-childbearing peers. Results indicate that, in general, young mothers' college aspirations are similar to those of non-mothers, but that their generally high aspirations for academic success appear to be effectively countered by their decreased educational expectations.

Story telling: is it really research?

In this paper I will suggest ways in which you may consider a story as a legitimate research product. I view the story as interpreted work communicated through writing as the research product. 'Doing' interpretive research is not an easy option in research. In this paper I will focus upon some of the complexities in creating an acceptable and accessible research product. I will cover five interrelated areas: journaling, observing, listening, writing and rigour. The term 'research product' refers to the outcome of the research process. By that I mean the dissertation, the research report or the published article. The notion of legitimacy is informed by Gadamer's philosophical hermeneutics which does not show us what to do, but asks us to question what is 'going on' while researching. In this paper I ask you to consider the entire research process as a reflexive exercise which provides answers to the question: 'What is going on in methods?'. I claim that if the research product is well sign-posted, the readers will be able to travel easily through the worlds of the participants and makers of the story and decide for themselves whether the story is a legitimate research endeavour.