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Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Oudshoorn, Abram

Affiliation

Arthur Labatt Family School of Nursing, Western University

Abstract

Unintended pregnancy has been a longstanding health, social, and political issue in Rwanda, with a significant impact on the perinatal and maternal health outcomes of childbearing women, especially in the case of adolescents. Despite the government's and stakeholders' efforts to improve access to sexual and reproductive health services, unintended adolescent pregnancy continues to be a socially complex issue in Rwanda, associated with cultural expectations, health inequality, gender inequality, and social and relational norms. One of the objectives of this critical ethnography was to explore perceived social, cultural, and personal consequences of unintended adolescent pregnancy in Rwanda. This critical ethnographic study aimed to explore the culturally-rooted and personal meanings of unintended adolescent pregnancy in the Rwandan context and examine the perceived consequences and management of unintended adolescent pregnancy with and for this population from a multidimensional perspective.

The study utilized both critical and intersectionality theoretical lenses; purposive criterion and maximal variation sampling strategies were used, and eight focus group discussions (FGDs) were conducted with participants from various groups (N=74). Participants included adolescent mothers, adolescent boys and girls, parents of adolescents, men of varying ages, nurses, midwives, religious leaders, leaders of schools that offer primary and secondary education, local government leaders, and staff from nongovernmental organizations (NGOs) working with adolescents.

The thematic analysis identified three overarching themes, including ‘shame’, ‘fallen youth’, and ‘vulnerability’, shaping the meaning of unintended adolescent pregnancy. The findings help to understand that the meaning of unintended adolescent pregnancy in Rwandan society could be captured in the concept of ‘shame’ and is associated with shame felt personally by the pregnant adolescent, shame enacted interpersonally by family members, and socio-cultural positioning of adolescent pregnancy as shameful. Additionally, the issue of adolescent pregnancies is linked to the broader sense of youth as deviant, to poverty, and to vulnerability, exposing adolescents to a variety of harms.

To understand the perceived consequences and management of unintended adolescent pregnancy, the findings of this study revealed that adolescent pregnancy in the Rwandan context often includes a journey of impossible decisions, involving emotional and psychological effects related to keeping or terminating an unintended pregnancy, as well as the associated stigma. This study highlighted that adolescent mothers’ journey in the Rwandan context is characterized by moral ambivalence and was captured through the following two overarching themes: 1) Violence, including marginalization, sexual assault, and moral violence, and 2) Moral Ambivalence.

This study highlights that all efforts to prevent unintended adolescent pregnancy in Rwanda should take into account the broader societal norms and cultural values that frequently shape the perception of adolescent pregnancy as shameful and deviant. In addition, addressing poverty and vulnerability in families, providing access to sexual and reproductive health services and education, and empowering adolescent girls can help prevent unintended pregnancies and improve maternal and perinatal health outcomes. To address unintended adolescent pregnancy in Rwanda, multi-sectoral approaches incorporating collaboration between the government of Rwanda and all stakeholders are essential for addressing social, cultural, and personal consequences, as well as the emotional and psychological impacts and social stigma.

Summary for Lay Audience

Unintended adolescent pregnancy is a big public health problem in Rwanda, and it negatively affects both mothers and their children's health. Despite the government's and stakeholders' efforts to improve access to sexual and reproductive health services, unintended adolescent pregnancy is still a complex issue in Rwanda. Cultural norms, gender inequality, and social and relational norms influence the complexity of unintended adolescent pregnancy. Therefore, to understand the meanings and consequences of unintended adolescent pregnancy in the Rwandan context, a qualitative, critical ethnography study was conducted in rural Rwanda. This study involved 74 participants, including adolescent mothers, adolescent boys and girls, parents of adolescents, men of varying ages, nurses, midwives, religious leaders, leaders of schools that offer primary and secondary education, local government leaders, and staff from nongovernmental organizations (NGOs) working with adolescents who participated in eight focus group discussions.

The findings noted that the meaning of unintended adolescent pregnancy is still shameful in Rwandan society. The pregnant adolescent feels shame personally, and that shame is enacted interpersonally by family members and societal and cultural positioning of adolescent pregnancy as shameful. From this study, we learned that adolescent pregnancies are connected to other sociocultural issues like seeing youth as deviant, poverty, and other forms of vulnerability, exposing adolescents to different forms of harm.

This study also explored the consequences of unintended teenage pregnancies in Rwanda. Findings from this study showed that adolescent pregnancy leads to difficult decisions accompanied by emotional and psychological effects associated with keeping or terminating an unintended pregnancy without ignoring the stigma attached to it. Other consequences of adolescent pregnancies also include violence, including marginalization, sexual assault, moral violence, as well as moral ambivalence.

This study recommended that efforts to prevent unintended adolescent pregnancy in Rwanda should consider broader societal norms and cultural values that create and shape perceptions of adolescent pregnancy as shameful or signs of youth deviance. In addition, this study calls for joint action to address poverty and vulnerability in families, provide access to sexual and reproductive health services and education, and empower adolescent girls to help prevent unintended pregnancies and improve the health of young mothers and their babies. Finally, to respond to unintended adolescent pregnancy in Rwanda, it is so important for the Rwandan government and all stakeholders to work together to address all social, cultural, and personal consequences, as well as social stigma and emotional and psychological impact of unintended adolescent pregnancy.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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