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34 young women (16–22 y) were recruited from young mothers' groups, general practices, young people's sexual health clinics, and by snowball sampling; 16 were young mothers or were pregnant and most (n=24) lived in socioeconomically “disadvantaged” circumstances.
Data were collected through indepth interviews and participant observation of 4 different young mothers' groups. Interviews were audiotaped and transcribed. Descriptive accounts and accompanying field notes were organised around major themes within the context of young women's sexual and emotional relationships and social circumstances.
Attitudes towards adolescent pregnancy. Young women from disadvantaged backgrounds thought the ideal age for starting a family was 17–25 years. Women from advantaged backgrounds wanted to wait until their late 20s or early 30s, emphasising career, university, money, and personal development; these women said they would be likely to have an abortion if they became pregnant during adolescence. Some of the young mothers considered abortion, but were unable to go through with it; others concealed their pregnancy in the early stages to avoid having to consider abortion as an option.
The young mothers felt they had to prove that they were good mothers, and did so by buying expensive children's clothing or strollers. To position themselves as “good mothers,” they often portrayed other adolescent mothers in stereotypic, derogatory terms. Although early motherhood was less acceptable to women from advantaged backgrounds, they were more tolerant towards young mothers.
Sex and love in relationships. Contraceptive use was influenced by how women felt about their sexual relationships and partners. Some used emotional attachments to explain risk taking behaviour. For example, women who perceived their relationships to be long term did not always use careful contraception.
Knowledge and behaviour in relation to contraception. Although both pregnant and non-pregnant women had unprotected sex, they differed in terms of the nature, length, and responses to this risk behaviour: women from advantaged backgrounds tended to use emergency contraception, whereas those from disadvantaged backgrounds tended to “wait and see.”
Participants in young mothers' groups revealed that they became sexually active at an early age. They felt that sex education was provided too late and did not explain enough about contraception or the emotional aspects of sexual relationships and pregnancy. They were poorly informed about contraception and health and used contraception ineffectively. Young women from advantaged backgrounds were more knowledgeable about health services, better able to access them, and better able to obtain and use contraception. Young mothers talked about problems obtaining suitable contraceptive advice and services, describing negative encounters and other obstacles. Women from advantaged backgrounds had no such experiences.
Adolescents from socioeconomically disadvantaged and advantaged backgrounds had different attitudes towards adolescent pregnancy and contraception. Those from advantaged backgrounds were able to access reliable contraceptive services more easily, considered abortion and emergency contraception to be acceptable options, and were more tolerant of teenage mothers. Those from disadvantaged backgrounds were less able to access sexual health services and use contraceptives reliably.
There are almost 15 million births to adolescents each year worldwide, with important physical and socioeconomic consequences.1 It has been assumed that this problem could be resolved by increasing teenagers' knowledge of contraception. However, by exploring the attitudes and beliefs of young women in the UK related to pregnancy and reproductive self care, Jewell et al show that other factors are also important. These findings are consistent with previous research.2,3
The findings provide strong direction for nursing practice. Goals for personal advancement were instrumental for women from advantaged backgrounds who delayed pregnancy by choosing emergency contraception or abortion. This finding suggests the importance of supporting the self esteem and future orientation of young women. Another important finding relates to teens' social relationships. Women, particularly those from disadvantaged backgrounds, often set contraception aside in “love” relationships that they perceived to be stable and long term. In contrast, women from advantaged backgrounds had supportive social networks that facilitated access to sex education and contraception. Together, these findings suggest that sex education that includes discussion of the emotional aspects of relationships with role playing might be helpful in strengthening young women's assertiveness skills about contraception. The young mothers felt this was inadequately addressed.
These findings show that teen pregnancy is not only an educational issue, but also a matter of social norms and expectations. Therefore, nurses should assess thoroughly and be sensitive to adolescents' goals, values, beliefs, social circumstances and supports, particularly with respect to reproductive self care.
Source of funding: South West Research and Development Directorate.
For correspondence: Dr D Jewell, Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. Fax +44 (0)117 928 7340.