Attitudes, perceptions and understanding amongst teenagers regarding teenage pregnancy, sexuality and contraception in Taung
Background: South African teenage pregnancy rates remain high by international comparison and, in the rural town of Taung, the rate of 13% is twice the national average of 6.5%. Teenage pregnancy is a risk factor for disruption of education, future unemployment, sexually transmitted infections, HIV, preterm birth and poor mental health. The aim of this study was to understand the attitudes and perceptions of teenagers in Taung regarding teenage pregnancy and to explore their understanding of sexuality and contraception. This study intended to contribute to a deeper understanding by exploring teenagers' own perceptions on the matter, to identify factors that, in their view, may influence the risk of pregnancy and suggest possible interventions. No previous studies from the Taung area have been identified. Methods: The qualitative study entailed 13 in-depth interviews with pregnant teenagers and three focus groups: one with 10 women aged 19 to 25 years who had a baby as a teenager, one with 14 teenage girls aged 16 to 19 years who had never been pregnant, and one with 11 males aged 18 to 23 years. Qualitative data was analysed through the framework method. Results: Factors influencing teenage pregnancy were found to be broad and complex: 1) Socioeconomic factors included poverty, the controversial influence of the child support grant, transgenerational sex and financial support from an older partner to secure income for the teenage girl or her family. 2) Substance abuse, particularly alcohol, in either the teenager or her parents was found to have a critical influence. A lack of alternative entertainment and social infrastructure made shebeens (local bars) a normal part of teenage social life. 3) Peer pressure from boyfriends and the broader social network. 4) Other factors included the right to motherhood before becoming HIV positive, poor sexual negotiation skills, the need to prove one's fertility, sexual coercion and low self-esteem. Understanding of contraceptives and reproductive health was poor, condoms were the contraceptive method most known by teenagers and their understanding of the menstrual cycle was inaccurate. Most teenagers perceived falling pregnant as a negative event with consequences such as unemployment, loss of a boyfriend, blame from friends and family members, feeling guilty, difficulty at school, complications during pregnancy or delivery, risk of HIV, secondary infertility if an abortion is done and not being prepared for motherhood. A number of teenagers, however, perceived some benefits and saw that it could be a positive event depending on the circumstances. Conclusions: The study identified a number of factors that may influence the teenage pregnancy rate. These factors may influence teenagers' behavioural intentions through altering their perceptions of the personal and social consequences of falling pregnant and their self-efficacy in relation to sexual behaviour. Environmental factors may also facilitate or prevent teenagers from fulfilling their intentions. Teenagers may also vary in their ability to carry out these intentions. Strategies to reduce teenage pregnancy should focus on building social capital for teenagers in communities, further exploring the influence of the child support grant, targeting transgenerational sexual norms, applying the law on underage drinking, making information on contraception more accessible and offering programmes that empower girls in the area of sexuality. Multifaceted and intersectoral approaches are required and it is likely that strategies to reduce teenage pregnancy will also impact on HIV and other sexually transmitted infections. © SAAFP.