An Exploration of the Culturally-Rooted Meaning and Consequences of Unintended Adolescent Pregnancy in Rwanda: A Multi-Dimensional Perspective
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.