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Estimates suggest that about eight million American teens and young adults experience clinical symptoms of mental illness. For many, these mental health challenges will develop into a diagnosable and potentially life-long psychiatric disorder. Together they form a large population of adults who enter their prime reproductive age as psychiatric patients. Though individuals with mental illness enjoy the same reproductive rights as those without psychiatric conditions, social and medical discourses often portray their parenthood as risky and undesirable. Women with mental illness are in a particularly difficult position. As women, they are subjected to the gendered expectation that they become mothers. Yet at the same time, their mental illness results in their motherhood being frowned upon. Carrying these contradicting values, this study asks how women with psychiatric disorders make reproductive decisions. Do these women think of their reproductive capacity through the psychiatric framing of risk, or through gendered narratives of desired motherhood? Using open ended interviews with women with a psychiatric diagnosis, this study shows that women with mental illness approach their reproductive decision-making by utilizing narratives of both normal reproduction and disability. Some women portray their mental illness as an obstacle to motherhood while others create a separation between their mental and reproductive health. Still others defy the distinction between psychiatry and normalcy and describe their reproduction as a way to bring the two together. Despite the difference in framing, all the women in this study engage with the discourse of risk(s) that is brought on by their mental illness. To weigh risk and act upon it, they visit their and their peer’s biographical stories of illness, assess their fitness into normative ideas of good motherhood, and evaluate the worth of medical and scientific information. They question the way medical information is created, distributed, and made applicable to the idiosyncrasy of their reproductive life. In doing so, these women draw boundaries around trust as well as redefine medical neutrality. Finally, we show that women with mental illness and their health providers rely on a vaguely defined stepwise plan to approach reproduction. This plan brings normativity – and desirability - to their reproduction at the same time that it threatens to exclude them from motherhood. By bringing these arguments together we arrive at the overall conclusion that women with mental illness do not approach their reproduction as a monolithic group. Nor do they organize along diagnosis lines. This study shows that women across psychiatric diagnoses share similar reproductive desires, some hoping to have children and others wishing to avoid motherhood altogether. The popular idea that certain psychiatric diagnoses render women unsuitable for motherhood is not echoed by the women in this study. Instead, their embodied experience of mental illness allows them to embrace the newfound reproductive choice of psychiatric patients and highlights the stigma that perpetuates fears of motherhood with mental illness.

Over the last 20 years, adolescent health researchers, practitioners and advocates have zeroed-in on the global problem of ‘child marriage.’ Defined as a formal or informal marital union before 18 years, child marriage affects both boys and girls, but disproportionally affects girls. Globally, child marriage is noticeably prevalent but on a downward trend, with the proportion of 20-24 year old women marrying before 18 years decreasing from 25% to 19%, from 2008 to 2020 (UNICEF, 2018; 2022). Extensive research has shown the adverse consequences of marrying during adolescence, ranging from increased risk of maternal mortality and birth complications, intimate partner violence (IPV), adverse mental health and intergenerational poverty outcomes (Burgess et al., 2022; Clark, 2004; Nour, 2009; Otoo-Oyortey & Pobi, 2003; UNICEF, 2018). From a rights perspective, child marriage is considered a violation of girls’ and boys’ ‘right’ to fully consent into marriage before reaching age of majority, internationally recognized as 18 years of age (Bruce, 2003; Nour, 2009). As such, child marriage is recognized as a human rights violation under several international treaties, including the Convention on the Rights of the Child (CRC). The term ‘child marriage’ is commonly used to convey the human rights violations that early marital practices have for under-age girls and boys. While the term ‘child marriage’ has mobilized consensus and solidarity toward the issue, this terminology also homogenizes the issue of marriage as a problem affecting the ‘girl child’ with little to no agency in the marriage decision-making process. More specific to Uganda, this ‘child marriage’ terminology can be problematic where marriage more commonly occurs during middle to late adolescence (15-19 years) and when adolescents may exert varying degrees of agency and consent in the marital decision-making process. Except for Chapter 1 which explores ‘child marriage’ global and national movements, I intentionally use the terminology ‘adolescent marriage’ (as marriage before age 18), rather than ‘child marriage,’ throughout this dissertation. Despite the global push to ‘end child marriage’ over the last decade, there is limited research about how broader social and structural factors may be driving declines in adolescent marriage (Muthengi et al., 2021; Plesons et al., 2021). In particular, we have a limited understanding about how global efforts, social processes and norms might work together to drive marriage declines among adolescents. Through a mix of policy, quantitative and qualitative methods, this dissertation examines the policy, structural and social mechanisms that have contributed to declining adolescent marriage among adolescent girls in the context of southcentral Uganda. Chapter 1 begins with a broader contextual lens, examining the political evolution of the global ‘child marriage’ movement, and how the ‘problem’ of child marriage was then taken-up by government and civil society actors in Uganda. This chapter is informed by 20 key informant interviews with Ugandan and global stakeholders working on child marriage and a desk review of over 130 documents gathered across four years. This chapter highlights how the global ‘child marriage’ movement marked a political shift in adolescent girl funding, repackaging the issue of early marriage as an issue of ‘child protection.' The focus on child protection, rather than adolescent sexuality, was instrumental in mobilizing attention from liberal and conservative funders in the Global North and policy-makers in the Global South. In the priority country of Uganda, multiple factors influenced the national policy uptake of child marriage, including: 1. Regional campaigns that created consensus among Eastern and Southern African country leadership to address child marriage; 2. The availability of national data that showed the reach and severity of child marriage within Uganda; 3. The cultural and political appeal of child marriage as an issue of ‘child rights’, rather than one of ‘sexuality,’ and; 4. A network of government leaders, academics, international non-governmental organizations (INGOs) and civil society organizations (CSOs) who coalesced behind the issue in Uganda. Chapter 2 focuses-in on the southcentral region of Uganda, leveraging close to 20 years of quantitative data to understand how social and structural factors are affecting adolescent marriage declines in the region. Using data from 13 surveys (1999-2018) of the Rakai Community Cohort Study (RCCS), I couple decomposition and causal inference methods to assess how social determinants and adolescent pregnancies have contributed to adolescent marriage declines among 15 to 17 year old girls. I find that both marriages and pregnancies among adolescent girls substantially declined over the last 20 years, from 24% to 6%, and 28% to 8%, respectively, between 1999 and 2018, as a result of educational and economic improvements. Among all social determinants, girls’ secondary schooling was more closely associated with lower risk of marriage and pregnancy (aOR marriage = 0.09; 95%CI=0.07, 0.12; aOR pregnancy = 0.14; 95% CI=0.11; 0.19). In the causal mediation analyses, lower pregnancy rates partially explained the positive effect of higher secondary schooling on lower risk of adolescent marriage. Decomposition analyses showed that the declines in adolescent marriage between 1999 to 2018 were primarily attributed to pregnancy declines, and to a lesser extent, improvements in education and SES. These findings reemphasize the sizeable role of education in preventing adolescent marriages, in line with Uganda’s national educational investments such as universal primary education (UPE). Yet, these findings also underline the importance of adolescent pregnancy prevention to delay age at marriage. In the same region of southcentral Uganda, Chapter 3 uses secondary ethnographic data to more deeply explore the social mechanisms and norms that have contributed to changes in adolescent marriages. I qualitatively explore how the region’s social and economic changes have affected social norms about adolescent sex, courtship, and marriage in Rakai, Uganda. This analysis is informed by 16 focus group discussions and 15 key informant interviews conducted in 2018 with younger and older women and men, ranging from 16 to 77 years old. In comparing generational perspectives, I identify a ‘normative transition’, in which new structures are transforming courtship and marriage processes for young people. First, the HIV epidemic significantly weakened family structures, and in the process, courtship and marriage guidance previously provided by families and elders; second, the loss of land ownership in between generations has made marriage preparations more difficult for young people; and third, new social spaces outside the family home – including discos, mobile phones and schools - have expanded young people’s romantic geographies prior to marriage. These changes have reduced the importance of the family institution in the marital decision-making process, while increasing young women’s and men’s autonomy in engaging in premarital sex, choosing their partners, and delaying marriage. Although these changes have delayed age at marriage beyond adolescence, this transition has introduced unanticipated challenges for young people as they enter adulthood, including lack of overall parental, familial and elder guidance in their relationship and marriage formation processes. Taken together, these findings highlight the complexity of adolescent marriage changes and prevention efforts at the global, Ugandan, and southcentral region of Uganda. First, global and national ‘child marriage’ movements played a significant role in the uptake of child marriage as an issue of ‘child protection’, rather than one about ‘sexuality’ in Uganda. Yet looking at the context of southcentral Uganda, adolescent pregnancies and adolescent marriages declines appear to be closely linked, highlighting the importance of conceptualizing adolescent marriage as not just a child protection issue, but one of adolescent sex and sexuality. Lastly, I find that broader structural and social changes in Rakai have substantially changed adolescent norms around sex, courtship, and marriage, delaying age at marriage in between generations. However, young people are encountering new challenges as they enter adulthood and romantic relationships in the absence of pre-existing elder and familial systems and networks. Additional research should focus on understanding the unintended consequences of catalyzing norm change and delaying age at marriage, including how these changes might affect familial and community relationships and kinships. Twenty years into the global push to end ‘child marriage’, this dissertation research provides new insights into the complex structural, social and sexuality drivers of adolescent marriage changes in Uganda. Despite the substantial progress in adolescent marriage declines, this research points to key gaps that will need to be addressed to improve adolescent SRH rights and needs in Uganda, the East African region, and beyond. Of particular importance is the need to center adolescent sexuality within current child marriage efforts, as well as focusing on the broader social changes affecting adolescent relationship formation, rather than exclusively focusing on age at marriage as a marker of social change.

Disproportionately large numbers of infants showing atypical growth patterns are reportedly born to young mothers. Infants with these atypical growth patterns consistently show differences in measures of infant state. The purpose of this study was to examine the relation between maternal age and infant state. The behavioral state of 61 newborn infants was rated at 30-sec. intervals using Thoman's (1975) state scale during a one-hour observational session. The total number of epochs in quiet sleep, active sleep, alert, transitions from quiet sleep to active sleep, transitions from active sleep to quiet sleep, and the range of states for each infant were regressed on maternal age in an attempt to demonstrate a quadratic relation between infant state and maternal age. The regression analysis showed that maternal age could not predict any of the state measures. However, in this study, maternal age and poverty were confounded. An overrepresentation of biomedical risk factors may have concealed differences in infant behavioral state. Exploratory regression analysis did not provide a meaningful interpretation of the relation between the biomedical risk factors and infant state measures. However, this study provides indirect support for the hypothesis that atypical patterns of fetal growth in infants born to adolescent mothers may be explained, in part, by a decreased net availability of nutrients resulting from the mothers growth needs and the growth needs of her fetus. / M.S.

It is not an uncommon feature anymore to find young mothers in Venda secondary schools busy with their studies. These young mothers, referred to as schoolgirl mothers in this investigation, do however, battle in general with their studies and experience problems different from those of ordinary schoolgirls. It was, therefore, decided to launch an investigation into the problems related to the learning situation of such schoolgirl mothers. The formation of relationships by the adolescent has been used as a point of departure for this study. Contrary to expectations, the empirical investigation has revealed that schoolgirl mothers maintain basically good relationships with themselves, their studies and others. On the other hand, their academic achievements are significantly lower than those of ordinary schoolgirls. Further research is necessary to shed more light on the situatedness of schoolgirl mothers in general and in Venda secondary schools in particular. / Psychology of Education / M. Ed. (Psychology of Education)

It is not an uncommon feature anymore to find young mothers in Venda secondary schools busy with their studies. These young mothers, referred to as schoolgirl mothers in this investigation, do however, battle in general with their studies and experience problems different from those of ordinary schoolgirls. It was, therefore, decided to launch an investigation into the problems related to the learning situation of such schoolgirl mothers. The formation of relationships by the adolescent has been used as a point of departure for this study. Contrary to expectations, the empirical investigation has revealed that schoolgirl mothers maintain basically good relationships with themselves, their studies and others. On the other hand, their academic achievements are significantly lower than those of ordinary schoolgirls. Further research is necessary to shed more light on the situatedness of schoolgirl mothers in general and in Venda secondary schools in particular. / Psychology of Education / M. Ed. (Psychology of Education)

The purpose of this study was to explore individual characteristics that allowed college achievement in Latina women who experienced teenage pregnancy. A specific objective of this study was to examine strengths for overcoming barriers and obstacles to higher education.

MPM / Oliver Tambo Institute of Governance and Policy Studies

This study was undertaken in order to determine how black teenage primigravidae in the Umlazi area of KwaZulu perceived their pregnancies. This was an exploratory study. An interview schedule was used to elicit information from the primigravida teenagers concerned. One hundred and sixteen primigravida teenagers were interviewed. The sampling frame stretched over 6 antenatal clinics at Umlazi. This study revealed that most primigravida teenagers stand in need of consideration from health professionals of the comprehensive health services. / Health Studies / M.A. (Nursing Science)