<p>The aim of the study was to explore the socio-cultural influences in decision making involving sexual behaviour among adolescents in Khayelitsha, Cape Town. Cultural beliefs associated with adolescents&rsquo / decision to become sexually active were explored, as well as the social norms influences involved in adolescents&rsquo / sexual behaviour. The theoretical framework used for the study was Bronfenbrenner&rsquo / s ecological systems theory of development. The results indicated that adolescent pregnancy was perceived as unacceptable behaviour although found widespread in communities. Social influences such as peer influence, low socioeconomic status, alcohol use and lack of parental supervision were found to play a role in adolescents&rsquo / risky sexual behaviour. Cultural beliefs, cultural myths and social norms were identified as socio-cultural influences that endorsed issues such as gender disparities, which made adolescent mothers vulnerable. Findings from this study suggest that female adolescents are faced with sexual behaviour complexities.</p>

This study explored adolescent girls‟ subjective experiences of being young mothers in school, focusing on their personal and interpersonal relationships within their social contexts. Participants included 15 young black mothers aged between 16 and 19 years from three high schools in Khayelitsha, Cape Town. Conducted within a feminist social constructionist framework, the study adopted an exploratory qualitative structure. Data were collected through life histories that were analysed within a thematic narrative framework. The narratives revealed that the young mothers found motherhood challenging and overly disruptive of school. Although contexts of childcare emerged as pivotal in how young mothers balanced motherhood and schoolwork, these were also presented as characterised by notions of power and control. Because of the gendered nature of care work, the women who supported the young mothers with childcare dominated the mothering spheres. The schools were also experienced as controlled and regulated by authorities in ways that constrained the young mothers‟ balancing of school and parenting. Equally constraining to a number of adolescent mothers were structural challenges, for example, parenting in spaces that lacked resources. These challenges were compounded by the immense stigma attached to adolescent motherhood. The study recommended that the Department of Education work closely with all the parties concerned in ensuring that pregnant learners benefit from the policy. It is necessary that educators are encouraged to shift attitudes so that communication with adolescent mothers is improved.

Adolescent pregnancy has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. In Ecuador, where 20% of girls aged between 15-19 years get pregnant, the adolescent fertility rate has increased and inequalities between adolescent girls from different educational, socio-economic levels and geographical regions are prominent: 43% of illiterate adolescents become pregnant compared to 11% with secondary education. The highest adolescent fertility rates are found in the Amazon Basin.   The overall aim of this study was to explore adolescent pregnancy in the Amazon Basin of Ecuador (Orellana province) from a rights and gender approach. Specific aims and methodologies included: to explore women‟s reproductive health situation, focusing on government‟s obligations, utilization of services, inequities and implementation challenges, assessed through a community-based cross-sectional survey and a policy analysis (Paper I); to examine risk factors associated with adolescent pregnancy, through a case-control study (Paper II); to explore experiences and emotions around pregnancy and motherhood among adolescent girls, using content analysis (Paper III); and to analyze providers‟ and policy makers‟ discourses on adolescent pregnancies (Paper IV).   Reproductive health status findings for women in Orellana indicated a reality more dismal than that depicted in official national health data and policies. Inequities existed within the province, with rural indigenous women having reduced access to reproductive health services. In Orellana, 37.4% of girls aged 15-19 had experienced pregnancy, almost double the national average. Risk factors associated with adolescent pregnancy at the behavioral level included early sexual debut and non-use of contraception, and at the structural level poverty, having suffered from sexual abuse, and family disruption. Gender inequity played a key role through the machismo-marianismo system. Girls were raised to be fearful and ignorant regarding sexuality and reproduction, to be submissive and obedient, to be fatalistic, and to accept the established order of the male and adult dominance. Sexuality was conceptualized as negative, while motherhood was idealized. Those gender structures constrained girls‟ agency, making them less able to make choices regarding their sexual and reproductive lives. Providers‟ discourses and practices were also strongly influenced by gender structures. Adolescent sexuality was not sanctioned, girls‟ access to contraceptives still faced opposition, adolescent autonomy was regarded as dangerous, and pregnancy and reproductive health issues were conceptualized as girls‟ responsibility. However, mechanisms of resistance and challenge were also found both among adolescent girls and providers.   Programs addressing adolescent pregnancies in the area need to look at the general situation of women‟s reproductive health and address the gaps regarding access and accountability. Adolescent pregnancy prevention programs should acknowledge the key role of structural factors and put emphasis on gender issues. Gender inequity affects many of the factors that influence adolescent pregnancies; sexual abuse, girls‟ limited access to use contraceptives, and girls‟ curtailed capability to decide regarding marriage or sexual intercourse, are strongly linked with young women‟s subordination. By challenging negative attitudes towards adolescents‟ sexuality, the encounter between providers and adolescents could become an opportunity for strengthening girls‟ reproductive and sexual agency.

Este trabalho tem como objetivo relatar o processo de desenvolvimento de um programa de visita domiciliar para adolescentes gestantes e mães, implementado pelo Núcleo de Estudos da Violência da Universidade de São Paulo (NEV/USP). O local inusitado em que este programa tem origem um núcleo de pesquisas que tem como seu principal eixo de trabalho a relação entre democracia e direitos humanos, possibilitou que alguns conceitos, muitas vezes implícitos nas práticas de intervenção, fossem questionados e revistos a partir de questões relacionadas à cidadania, direitos e a democracia. Neste sentido, buscou-se, a partir de uma leitura de Michel Foucault sobre as práticas govenamentalizadas de poder, discutir questões que, tomadas como verdades, passam a acionar práticas prescritivas, normatizas e regularizadoras. Práticas que ativam e reativam relações de poder, muitas vezes de forma arbitrária e autoritária, principalmente quando tem alvo de suas intervenções o pobre e/ou a população empobrecida. Tendo como foco os saberes e, consequentemente, a produção discursiva que se forma em torno da adolescência e, posteriormente da gravidez na adolescência, buscou-se compreender em que contexto esta última se transforma não só em problema como também, a partir de sua associação com as idéias de risco e vulnerabilidade, passa a justificar práticas interventivas focadas, sobretudo, no indivíduo e/ou população. Por fim, busca-se descrever como estas questões conceituais foram constantemente tensionando os saberes e as práticas tanto da equipe envolvida na criação e implementação de um programa como também, posteriormente, das próprias participantes / The objective of this work is to report the process of development of a program of home visitation for adolescent pregnant women and adolescent mothers carried out by the Center for the Study of Violence of the University of São Paulo (NEV/USP). The unexpected institution where this program was born a research center that has as its main axe of work the relationship between democracy and human rights , made it possible that some of the concepts, frequently implicit on intervention practices, be questioned and revised from the point of view of matters of citizenship, rights and democracy. Departing from a reading of Michel Foucault about the governmentalized practices of power relations, this work sought to discuss matters that, taken as truths, trigger prescriptive, normative and regulating practices. Practices that activate and reactivate power relations, very often on arbitrary and authoritarian way, especially when the focuses of interventions are poor individuals or poor communities. Having as its focus the knowledge and, therefore, the discursive production that takes form surrounding adolescence and, latter, surrounding pregnancy during adolescence, the thesis sought to understand in which context this last one transforms itself into problems, as well as, from its associations with ideas of risk and vulnerability justifies interventions focused mainly on individuals and population.Lastly, it was sought to describe how these conceptual matters were constantly tensioning knowledge and practices not only among the professional team that developed and implemented the program but also, latter, by the participants themselves

Philosophiae Doctor - PhD / This study explored adolescent girls' subjective experiences of being young mothers in school, focusing on their personal and interpersonal relationships within their social contexts. Participants included 15 young black mothers aged between 16 and 19 years from three high schools in Khayelitsha, Cape Town. Conducted within a feminist social constructionist framework, the study adopted an exploratory qualitative structure. Data were collected through life histories that were analysed within a thematic narrative framework. The narratives revealed that the young mothers found motherhood challenging and overly disruptive of school. Although contexts of childcare emerged as pivotal in how young mothers balanced motherhood and schoolwork, these were also presented as characterised by notions of power and control. Because of the gendered nature of care work, the women who supported the young mothers with childcare dominated the mothering spheres. The schools were also experienced as controlled and regulated by authorities in ways that constrained the young mothers balancing of school and parenting. Equally constraining to a number of adolescent mothers were structural challenges, for example, parenting in spaces that lacked resources. These challenges were compounded by the immense stigma attached to adolescent motherhood. The study recommended that the Department of Education work closely with all the parties concerned in ensuring that pregnant learners benefit from the policy. It is necessary that educators are encouraged to shift attitudes so that communication with adolescent mothers is improved. / South Africa

Magister Artium (Psychology) - MA(Psych) / The aim of the study was to explore the socio-cultural influences in decision making involving sexual behaviour among adolescents in Khayelitsha, Cape Town. Cultural beliefs associated with adolescents' decision to become sexually active were explored, as well as the social norms influences involved in adolescents' sexual behaviour. The theoretical framework used for the study was Bronfenbrenner's ecological systems theory of development. The results indicated that adolescent pregnancy was perceived as unacceptable behaviour although found widespread in communities. Social influences such as peer influence, low socioeconomic status, alcohol use and lack of parental supervision were found to play a role in adolescents' risky sexual behaviour. Cultural beliefs, cultural myths and social norms were identified as socio-cultural influences that endorsed issues such as gender disparities, which made adolescent mothers vulnerable. Findings from this study suggest that female adolescents are faced with sexual behaviour complexities. / South Africa

Every year, 16 million women aged 15 to 19 years give birth globally. Adolescent births account for 11% of all births globally and 23% of the overall burden of disability and diseases due to pregnancy and childbirth. In the United States, 750,000 adolescents (15-19 years) become pregnant each year, making the United States the developed country with the highest rates of adolescent pregnancy. The economic burden of adolescent pregnancy in the U. S. is $7-15 billion per year. Adolescent pregnancy brings risks associated with pregnancy induced hypertension, preterm infants, maternal and neonatal mortality. Social factors include poverty, low educational levels, alcohol, and drug use. Between 30-50% of adolescent mothers who have a first birth before age 18 years will have a second child within 12 to 24 months. Subsequent adolescent pregnancies compound fetal and maternal risks. Many vulnerable adolescent mothers succumb to external pressures and have a repeat adolescent pregnancy while others are able to overcome the challenges of an adolescent pregnancy and prevent a repeat adolescent pregnancy. This cross sectional survey designed study investigated the effects of resilience and social influences on contraceptive use or abstinence by Black and Hispanic adolescent parenting mothers to prevent a repeat adolescent pregnancy. 140 adolescent mothers were recruited from three postpartum units of a tertiary hospital system in Miami, Florida. The Wagnild and Young Resilience Scale and the Adolescent Social Influence Scale were used to measure resilience and social influences, respectively. Demographic data, length of labor, plan for contraceptive use or abstinence were measured by an investigator developed instrument. Point biserial correlation showed a significant positive correlation between Black adolescent mothers’ resilience and contraceptive use (r =.366, p2(11, N=133) = 27.08, p =.004. (OR = .28). These results indicate a need for interventional strategies to maximize resilience in parenting adolescents to prevent a repeat adolescent pregnancy.

A relação mãe-filho é um dos elementos fundadores do psiquismo humano e é por meio desta que a criança apreende o mundo a sua volta. São muitas as variáveis que interferem nessa relação como, por exemplo, a experiência pessoal, os legados inter e transgeracionais, as condições históricas, sociais, e econômicas. Tendo em vista a fragilidade dos laços afetivos nos dias atuais e a dificuldade no estabelecimento de vínculos que propiciem o sentimento de confiança, segurança e estabilidade, este trabalho tem como objetivo verificar como três jovens mães, que vivenciaram diversos tipos de violências em suas trajetórias, desempenham a função materna. As participantes encontravam-se em um abrigo para jovens mães no município de São Paulo. Foram realizados cinco encontros com cada dupla (mãe e filho) com cerca de uma hora de duração, onde foram explorados conteúdos a respeito da relação da adolescente com sua mãe e a família, a experiência com a gestação e a maternidade, a experiência com as diversas formas de violência e o vínculo com o filho. Foi empregado o método de pesquisa psicanalítico e, portanto, além da comunicação verbal foram analisados aspectos transferenciais e contratransferenciais. Os conteúdos encontrados articulam-se com as idéias de Winnicott. Por meio desse estudo concluiu-se que o sentimento de abandono e vazio causado pela a ausência de uma relação genuína de afeto é transmitido entre as gerações na relação mãe-filho, tendo muitas vezes como consequência a violência. Esta, por sua vez, interrompe o processo de amadurecimento emocional e a conquista de um sentimento de preocupação real com outro. A possibilidade de restaurar laços e dar continuidade ao processo de integração depende em grande parte da sustentação e do apoio (holding) oferecido a essas jovens mães. Nos três casos analisados, observamos que ainda há esperança, segundo a conceituação de Winnicott, de reencontrar uma experiência de afeto significativa, por meio da qual se constitua um sentimento autêntico de preocupação e comprometimento com o próximo / The mother-son relationship is one of the founding elements of the human psyche and it is through this that the child perceives the world around him/her. There are many variables that affect this relationship, for example, personal experience, the inter-and transgenerational legacy and the historical, social, and economic conditions. Given the fragility of the affective bonds today and the difficulty in establishing links that give the feeling of trust, security and stability, this study aims to determine how three young mothers, who experienced several types of violence in their lives, play the maternal role. The participants were in a shelter for young mothers in São Paulo city. Five meetings were conducted with each pair (mother and son) for about one hour, when the relationship between the teenager with her mother and family, her experience with pregnancy and motherhood, her experience with various forms of violence and the bond with her child, were exploited. The psychoanalytic research method was employed and transference and countertransference aspects, which go beyond the verbal communication, were therefore analyzed. The content found can be linked with the Winnicotts ideas. In this study we concluded that the feeling of abandonment and emptiness caused by the absence of a genuine affection is transmitted between generations in the mother-child relationship and frequently has the violence as consequence. The violence stops the process of emotional maturation and the achievement of a sense of real concern to another person. The possibility of restoring ties and continuing the integration process depends largely on the support and assistance (holding) offered to these young mothers. In these three cases, we observed that there is still hope, according to Winnicott\'s concept, to find a meaningful experience of affection, through which it constitutes a genuine feeling of concern and commitment to the other person

This quasi-experimental study compared family formation and perceived partner support among pregnant adolescents in a prenatal care program. Participants were assigned to either an intervention group utilizing centering pregnancy (CP) prenatal care and case management, or to a comparison group receiving case management only. Partners were invited to participate in CP group sessions. This study included 173 predominantly minority pregnant adolescents ages 15–18 years who were enrolled in a prenatal program and followed one month postpartum. Family formation included living and relationship arrangements. Perceived partner support included six domains of perceived social provisions. Data were collected through participants’ self-reports using computer-assisted self-interviews. Changes in family formation and perceptions of partner support from baseline to postpartum did not differ between intervention and comparison groups. Male partners who attended at least one CP session were perceived as more supportive at both the beginning and end of the program than partners who did not attend any sessions. After combining groups, pregnant adolescents reported a significant shift in family formation and increased monetary support from partners from baseline to postpartum. Partner support is important for ensuring positive pregnancy outcomes. Additional strategies are needed to engage young fathers who do not readily provide support during pregnancy.

Este trabalho apresenta uma pesquisa com adolescentes grávidas e mães de um primeiro bebê (até cinco meses após o parto), usuárias de um serviço público de pré-natal de Santos (SP). O estudo investiga a percepção das adolescentes sobre si mesmas e sobre suas vidas, usando referências psicanalíticas e trabalhando com três instrumentos de pesquisa - questionários, desenhos de auto-retrato e entrevistas em profundidade. Resultados de 82 questionários com adolescentes grávidas indicaram dificuldades com a educação formal anterior à gravidez, figuras maternas valorizadas e figuras paternas avaliadas negativamente, e gravidez em geral aceita e ocorrida numa relação de namoro. A análise de 150 desenhos de auto-retrato de adoescentes grávidas destacou: sinais de ambivalência, auto-imagens não muito prejudicadas, tendência de se retratar num momento mais próximo ao presente, auto-retratos anteriores à gravidez com menos sinais de conflito, desenhos estando grávida com sinais de ansiedade, e auto-retratos posteriores ao parto com indícios compensatórios. A análise de entrevistas em profundidade com 10 adolescentes mães apontou: gravidez relacionada a conquistas de benefícios sociais, grande valorização das figuras maternas e ataques às figuras paternas e aos pais dos bebês (antes mais idealizados), indícios de busca de engravidar, vida sexual sem maiores impedimentos e com algum conhecimento sobre métodos contraceptivos, queixas de perdas quanto a passeios, relação com a escola tendendo a manter a trajetória anterior à gravidez, e relação cuidadosa com o bebê. Para as adolescentes pesquisadas, pertencentes a segmentos mais pobres de população urbana, a gravidez não pareceu percebida de forma negativa e associou-se a alguns ganhos sociais, durante a gestação e os primeiros meses do bebê. / This work presents a research with adolescents in the first pregnancy and becoming mothers, until five months after delivery, using a specialized public service, offered by the city of Santos, SP, Brazil. The study investigates the self perception of the adolescents, using psychoanalytical references and working with three instruments of research: questionnaires, self portrait drawings and interviews in depth. The results of the 82 questionnaires with pregnant adolescents indicated difficulties with formal education prior to the pregnancy, valorized mother figures, negatively evaluated father figures, no objection to the pregnancy and that it has occurred during the dates with the boyfriends. The analysis of 150 self portraits from pregnant adolescents pointed out to signals of ambivalence, self image not much damaged, tendency to make a self portrait in a moment close to the present, self portraits prior to the pregnancy with few signals of conflicts, portraits of pregnants indicating signals of anguish and self portraits prior to the delivery with compensatory evidence. The analysis of the interviews in depth with 10 adolescents mothers indicated pregnancy related to social benefits, great increasing in the mother figures, as well as aggression to the father figures and to the fathers of the babies (better idealized before), indication of provoked pregnancy, fair knowledge about contraceptive methods, sexual life with few obstacles, some complaints about not going out anymore, same relationship with the studies as they had prior to the pregnancy and a careful relationship with the babies. The pregnancy does not seem perceived in a negative way for these adolescents, belonging to the poorer segments of the urban population, rather it can be related to social benefits, during the period of pregnancy and in the beginning months of the baby’s life.