MEd (Curriculum Studies) / Department of Curriculum Studies / See the attached abstract below

MCur / Department of Advanced Nursing Sciences / MAAS / Centre for African Studies / See the attached abstract below

A dissertation submitted to the School of Social Sciences, Faculty of Humanities, University of Witwatersrand in fulfilment of the requirements for the Degree of Doctor of Philosophy in Demography and Population Studies, October 2017 / Teenage pregnancy is noted as one of the key development challenges in sub-Saharan Africa and globally due to its adverse social, health and demographic consequences. An avalanche of studies has emerged to identify the predictors of teenage pregnancy in South Africa which indicate a persistently high prevalence of teenage pregnancy. This study intends to examine how social disorganisation contributes to the prevalence of teenage pregnancy in South Africa. Social disorganisation is defined here as family disruption, service delivery inaccessibility, community unemployment and residential mobility. The theoretical basis of the study is the social disorganisation theory propounded by Shaw and McKay (1942). The theory was deemed appropriate due to its ability to investigate unfavourable factors beyond the individual-level occurring within society. This theory has not been applied to any teenage pregnancy study in South Africa. The data source for the study is South Africa’s 2011 census. The target population includes females aged 12 to 19. The study uses multilevel logistic regression modelling allowing heterogeneity at the individual and community levels to test the applicability of the theory in explaining teenage pregnancy. Results indicate that teenage pregnancy remains at critical levels with 3.97% of teenage females having given birth in the preceding year yet incidence among 15-19 year olds is 15 times higher than that of 12-14 year olds. Family forms other than two-parented marriages and communities with high levels of family disruption increase the likelihood of teenage pregnancy. Similarly, increasing household service delivery inaccessibility predisposes teenage females to higher odds of pregnancy, as expected. However, higher community unemployment was negatively associated with teenage pregnancy as were higher levels of residential mobility, which is contrary to previous international research findings. To this end, the study provides empirical evidence of the social disorganisation determinants of teenage pregnancy in South Africa. Additionally, the study shows the contribution of certain household and community factors in pregnancy likelihood among young women locally. In light of these findings it becomes necessary for practitioners to create intervention strategies that target these factors to curb the levels and chances of teenage pregnancy nationally. Furthermore, it is vital that government and other stakeholders financially support investigation and prevention campaigns that intentionally address contextual factors to increase adolescent sexual and reproductive health. Consequently, this study contributes to the investigation of structural derivatives to determine pertinent factors in the quest to decrease teenage pregnancy in South Africa. / XL2018

Thesis (MPH.) --University of Limpopo, 2015 / Background: There are a high number of teenagers seeking Termination of Pregnancy (TOP) at Maggys Hope Clinic in Polokwane Municipality in Capricorn District in Limpopo Province after the Termination of Pregnancy Act was passed in 1997. The numbers have doubled since the inception of the Children's Act no 38 of 2005 and the Sexual Offences Bill in 2008. The report by Stats SA and Department of education also indicated that the numbers have also doubled. Objective: The aim of the study was to determine the factors contributing to termination of pregnancies amongst teenagers at Maggys Hope Clinic in Polokwane Municipality, Limpopo Province. Methods: An exploratory, descriptive qualitative research design was used to identify and describe the factors contributing to termination of pregnancies among teenagers in Maggys Hope Clinic in Capricorn district Limpopo Province South Africa, in April 2014. Results: The results of the study revealed that CTOP legislation is one of the reasons why teenagers terminate. All the twenty participants indicated age and marital status as the motivation as the contributing factor. Looking at the age and educational level the most pushing factor is that thirteen of the participants are still at school. Eleven of the participants have no knowledge of contraceptives. This is a serious concern. Participants indicated that they had very little knowledge on reproductive health issues. The rest of the pushing factors are parental pressure, contraceptive failure, fear of parental disappointment and unpreparedness to raise a child as well. Conclusion: It can thus be concluded that teenage termination of pregnancies is a major health concern in South Africa, Africa and globally. Teenagers’ health is in danger due to engaging in unprotected sex banking on TOP as a solution. The study found that age and fear from dropping out of school, lack parental involvement in sexual matters, family economic status and marital status, including lack of knowledge and information on reproductive health issues, were the main factors contributing to termination of pregnancies among teenagers in Maggys Hope Clinic in Capricorn District, Limpopo Province.

The study aimed to explore indigenous methods used to prevent teenage pregnancy from the perspective of traditional healers and traditional leaders. Furthermore, it aimed to explore with traditional healers and traditional leaders whether these methods have relevance today as form part of teenage pregnancy intervention. The data were collected through conducting semistructured interviews with ten traditional healers and five traditional leaders from the rural area of Umhlathuzane, Eshowe. The interviews were guided by an interview schedule which allowed the researcher to keep in touch with the purpose of the study while having face to face conversation with participants. All interviews were tape recorded and transcribed. The findings of the study revealed that traditional healers and traditional leaders are concerned by high rate of teenage pregnancy within the community. They felt strongly that ignoring indigenous cultural practices due to modernity has led to major non-resolvable social issues such as teenage pregnancy, spread of HIV/AIDS related diseases, poverty, drugs and alcohol misuse. The study findings also revealed that there is a high demand for re-instituting elders' and family roles in addressing the erosion of cultural practices and traditional methods. Traditional practices such as virginity testing, ukusoma (non-penetrative thigh sex), ukushikila (physical maturity examination) as well as traditional ceremonies were identified as indigenous methods previously used to groom girls and to prevent teenage pregnancy. Furthermore, traditional healers and traditional leader were totally against contemporary teenage pregnancy interventions and policies around this issue, and have mixed views towards the idea of combining modern and traditional methods for teenage pregnancy prevention. Based on the findings of the study, recommendations were made regard to collaboration between South African government and indigenous experts so that to deal effectively with teenage pregnancy. Recommendations for further research were also made. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

High adolescent childbearing in South Africa has been sustained over several decades (Kaufman, De Wet and Stadler, 2001:149). Findings from the South African Demographic Health Survey (1998) show that 35 percent of 19-year-old girls had given birth at least once (DoH, 1999). Early childbearing can affect the economic, social and physical well-being of the mother and child. In addition young women who are sexually active are also at high risk of HIV infection and other STIs (Rutenberg, Kaufman, McIntyre, Brown and Karim, 2003). Apart from the health risks, there are also social consequences of early childbearing. Studies that have examined the factors influencing early childbearing show that there is a variation in the prevalence of early childbearing that is by place of residence (rural vs. urban), educational attainment, socio-economic status and population group (Palmuleni, Kalule-Sabiti.and Makiwane, 2007; Dickson, 2003). However, there have been few studies that explore the influence of family structure on early childbearing and sexual intercourse. In an attempt to tease out family influences on teenage sexual behaviour, recent literature explores the correlation of timing of sexual activity and childbearing among sibling pairs. Findings confirm that a sister’s sexual initiation and timing of childbearing and other forms of family formation have an independent strong effect on the timing of family formation for a younger sibling (East, 1996). Exploring a sister’s influence in the context of high early childbearing, such as one observed in South Africa, could contribute in understanding escalating teenage pregnancies and childbearing. The 1998 South African Demographic Health Survey will be used to analyse the sexual behaviour patterns of young women between 15 and 24 years of age, focusing specifically on their age at sexual debut, and age and the covariates associated with teenage pregnancy. These results show that having an older sister who has given birth to a child during adolescence could influence the age at which a younger sister has a child and her age at sexual debut. From the results sisters could be a strategic population to target for pregnancy prevention, which would help reduce early childbearing and also the spread of HIV and AIDS in Africa. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Teenage pregnancy is seen, on the whole, by researchers and service providers as a social problem. Various theoretical approaches have been utilised in the attempt to explain teenage pregnancy, and to find 'solutions' to the problem. What is common to these approaches is the assumption of the reality of teenage pregnancy, and the legitimation of the intervention of the expert. This thesis is concerned with these fundamental premises of the scientific literature and professional practice with regard to young women, their sexuality and reproductive behaviour. A feminist post-structuralist approach, which draws on the insights of Derrida concerning the absent trace and Foucault's analytics of power and governmentality, is taken. The tensions and commonalities between feminism and a Foucauldian approach are explored, and a radically plural post-structural feminism is explicated. The data used in this study consisted of South African scientific literature on teenage pregnancy (the technologies of representation), and transcriptions of interviews with service providers at a regional hospital (the technologies of intervention). The bulk ofthe thesis is taken up with analysis of the first of these. The aims of these chapters are to analyse how: (1) a range oftaken-for-granted assumptions or absent traces regarding, inter alia, the nature of adolescence, adolescent sexuality, mothering, and family formation and function underlie the scientific statements regarding the causes and consequences of teenage pregnancy; (2) the governmental tactics of medicalisation, psychologisation and pedagogisation are invoked in the literature with regard to teenage pregnancy; and (3) broader governmental tactics (the familialisation of alliance, the conjugalisation of reproduction, racialisation, the economisation of activity) are deployed in the literature to achieve particular gendering, racialising and class-based effects. The section on the technologies of intervention analyses how the governmental tactics described above are installed in the everyday lives of teenagers and their families through the deployment of the mechanisms of security at the interface between the service provider and the teenager or her parents. Finally, the undermining of the assumption of the reality of teenage pregnancy, the link between expertise and government, and the efficacy of the feminist post-structural approach are reviewed. / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 1999.

HIV and hypertensive disorders in pregnancy, in particular pre-eclampsia, are the main causes of maternal mortality in South Africa. In HIV associated pre-eclampsia, it is biologically plausible that the immune activation associated with pre-eclampsia may be neutralised by the immune suppression of HIV infection. The precise aetiology of pre-eclampsia is unknown, however leptin has been implicated in its development. Leptin is an adipocyte hormone, also produced by the placenta. It has a role in the development of inflammation. Adipose tissue is reduced in HIV infected individuals, resulting in lower leptin levels with consequent impaired immune function. This study aimed to compare serum and placental leptin levels in HIV infected and uninfected normotensive and pre-eclamptic pregnancies. Since insulin levels may affect the secretion of leptin, the study also compared insulin levels in these pregnancies. Following ethical clearance and hospital permission, 180 participants were recruited during their antenatal period. The groups were HIV- normotensive (n = 30), HIV+ normotensive (n = 60), HIV– pre-eclamptic (n = 30) and HIV+ pre-eclamptic (n = 60). Blood samples were collected ante-natally and placental samples post delivery. Serum leptin and insulin levels were determined by ELISA. Placental leptin levels were determined by ELISA and immunohistochemistry with morphometric image analysis. The placental production of leptin was determined by RT PCR. There was a non-significant increase in serum leptin levels in HIV- pre-eclampsia compared to HIV- normotensive pregnancies (p = 0.42). However leptin was decreased significantly in HIV+ pre-eclampsia compared to HIV- normotensive (p = 0.03). Based on HIV status leptin levels were decreased in HIV+ groups compared to HIV- groups in both pre-eclamptic (p < 0.01) and normotensive pregnancies (p < 0.01). Insulin levels of the HIV positive groups were lower than those of the HIV negative groups (p < 0.001). Insulin levels were also decreased in pre-eclampsia compared to normotensive pregnancies, irrespective of HIV status (p = 0.02). Immunohistochemistry demonstrated an increase in immuno-reactivity of leptin in the exchange villi of pre-eclamptic compared to normotensive placentae, irrespective of HIV status (p < 0.001). Supporting this finding, ELISA also demonstrated elevated leptin levels in the placenta of pre-eclamptic compared to normotensive pregnancies (p < 0.001). Placental leptin levels were similar in both HIV positive and negative pregnancies (p = 0.36). However, the placental leptin mRNA expression was up-regulated in HIV negative pre-eclampsia (p = 0.04) but not in HIV positive pre-eclampsia (p = 1.00). In conclusion, the elevated placental leptin in pre-eclampsia, irrespective of HIV status, is consistent with hypoxia. These elevated levels are not reflected in the maternal serum which raises the possibility of decreased leptin expression by adipose tissue especially in HIV infection where serum leptin levels are decreased. This would negate the increased placental leptin expression in pre-eclampsia. Furthermore, the elevated placental leptin levels are suggestive of an autocrine role of leptin in the placenta. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

Background and Objectives The improved uptake of antenatal Opt-out testing has been documented internationally. In South Africa little is known about the efficiency and die acceptability of Opt-out testing. This study compared VCT with Opt-out testing by measuring the efficiency (defined as uptake of testing, number of women identified as HIV positive and consultation duration of the testing approach) and the acceptability to patients and staff. Methodology We conducted a prospective, quasi-experimental equivalent time-samples clinical trial in which we enrolled a consecutive sample of women who presented at die McCord Hospital antenatal clinic from June to August 2006. The study consisted of 2 phases. During the 6 week intervention period women were offered HIV testing with the Opt-out mediod. During die 6 week control period women were offered midwife-provided VCT. Efficiency was measured in each phase, with 150 participants in the VCT arm and 150 in die Opt-out arm. Participants also completed a survey questionnaire. In depth interviews were conducted with 9 purposefully selected participants from each arm. Two focus group discussions were held with staff. The staff focus group findings were followed-up and validated by conducting in-depdi interviews with die staff members who participated in die focus groups 18 mondis later. Results The uptake of HIV testing during the VCT period was 134/150(89.3%) compared to 147/150(98.0%) in die Opt-out period (p<0.001). The percentage of women identified as being HIV positive during the VCT period was 7.33% (11/150) vs. 12.6% (19/150) during the Opt-out period (p=0.133). Time was saved as a decrease in the duration of midwife consultations from 34 min (VCT) to 26 min (Opt-out) was found with p<0.001. Qualitative analysis revealed Opt-out testing to be an acceptable way of testing. Patients found Opt-out emotionally less distressing than VCT (p<0.05). Staff reported that Opt-out decreased the burden on human resources (only one person needed to facilitate the group and shorter consultations) while it identified more women infected with HIV. Conclusion Opt-out testing is significantly more efficient and acceptable than VCT. Opt-out testing should include a group pre-test information session, adequate and ongoing post-test counselling, to be effective and acceptable. / Thesis (M. Med.)-University of KwaZulu-Natal, Durban, 2008.

Adolescent pregnancy is a concern worldwide and has risen at an alarming rate in South African societies. Many teenage pregnancies end up being aborted. Despite the availability of contraceptives free of charge in public institutions, unintended pregnancies among adolescents still persist. These unintended pregnancies result in a high rate of induced abortion, both safe and unsafe. The study was conducted to explore and describe the perceptions of adolescents regarding induced abortion in two public hospitals in East London, South Africa. This was a qualitative, phenomenological research study to explore the perceptions of adolescents regarding the induced abortion. Participants were purposively selected to participate in the study. Data were collected by means of individual interviews using interview guide in order to allow the participants to express their perceptions freely because of the sensitivity of the issue. Data were collected until saturation was reached. Saturation was reached after 24 participants were interviewed by the researcher. Data analysis used Tech’s (1990) steps as outlined by Creswell (2014:198). Themes, categories, and subcategories were identified following the data analysis. All adolescents admitted having consensual unprotected sex. Engagement in early sexual behaviour by the adolescents was evident as their sexual debut was between the ages of fifteen and sixteen years. Adolescents emphasised that they had abortions because they had no choice. Adolescents cited poor-socio economic status as their main reason for having abortions. Some findings were that adolescent men were against abortion and they had to be persuaded by their female counter parts. A recurrent factor in the results was the infrequent use of contraceptives, including condoms by the adolescents. This indicated that adolescents practised unsafe sex, with little or no regard for sexual transmitted diseases including Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS). The results also indicated poor treatment by the nursing staff at the family planning clinics. This poor treatment resulted in adolescents not attending family planning clinics. This led to adolescents using abortion as the only method of contraception. Shortage of staff was a contributing factor to the poor treatment of adolescents in the family planning clinics. Adolescents cited that contraception at the clinics is not prioritised. The participants suggested that they should be reminded when to come to the clinic for family planning. Perceptions of reasons for adolescents choosing induced abortion ranges from psychosocial to socio-economic reasons. The knowledge of participants of what was happening to them and what they were doing seemed adequate. The perceptions of the adolescents regarding induced abortion were that abortion is wrong, against their morals as they are Christians; they use abortion because they have no choice due to their poor socio-economic status. The strategies to reduce the unintended pregnancy through the proper management of the contraception programmes, including the change in negative attitudes of health care providers in the family planning clinics could yield positive results.