Experiences of pregnancy among Iranian adolescents: A qualitative study
Abstract
Background:
Pregnancy rate among Iranian adolescents below 20 years of age is increasing. Pregnancy during adolescence is considered a social issue associated with medical, emotional, and social outcomes for the mother, child, and family. The current research examines the experience of pregnancy among Iranian adolescents.
Materials and Methods:
The qualitative content analysis method was used. A purposive sample of 14 pregnant adolescents was enrolled in the study. Deep interviews were carried out with them.
Results:
Three themes were came up after analyzing the interviews: 1. Psychological reactions including three subthemes of feelings, concerns, and fears; 2. physical reactions including the subthemes of symptoms and feelings; and 3. spiritual reactions including religious beliefs and faith.
Conclusions:
The present study showed that for the purpose of assessing pregnancy in adolescents, one should consider the context and culture in which the adolescent lives. This is because factors such as preplanned or unwanted pregnancy and imposed or consensual marriage within or outside the family may draw different reactions from adolescents. Hence, all those factors need to be considered in order to plan health education during pregnancy for this age group.
Keywords: Adolescents, Iran, pregnancy
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INTRODUCTION
Pregnancy rate among Iranian adolescents below 20 years of age is increasing. According to the World Health Organization (WHO), 10% of the girls from low- and medium-income countries become pregnant at the age of 16 and mothers aged between 10 and 19 years account for 11% of all births worldwide. The WHO figures also show that nearly 23% of childbirth-related diseases in the world occur in adolescent mothers.[1] Given the characteristics of adolescence, pregnancy during the period is basically different from other age groups and creates different feelings in women. Pregnancy during adolescence is considered a social issue associated with medical, emotional, and social outcomes for the mother, child, and family.[2] Studies have shown that childbirth during adolescence is associated with the risk of negative outcomes for the mother and child. Pregnant adolescents are exposed to unique challenges. Adolescent mothers are more likely to have poor prenatal health behaviors and poorer health status.[3]
Over the past decades, many studies have been conducted on pregnancy among women below 20 years of age. Most of the studies were quantitative, while a few assessed the experience of women below 20 years of age.[4] The researches usually address the physiological results of pregnancy during this period, the risks of pregnancy, and ways to control them. So, what adolescents experience during the period has been studied to a lesser extent.[5,6,7,8,9,10,11,12] Furthermore, the studies have been conducted mainly in countries where adolescent pregnancies occur outside marriage and their culture is totally different from that of Iran. In Iran, most adolescent pregnancies occur within legal marriages. This can lead to a different experience during pregnancy. It is necessary to assess the adolescent pregnancy under such circumstances to see if it is different from pregnancy at a higher age. Furthermore, nurses, particularly those working at the health and prenatal department for women below 20 years of age, play a key role in this regard. The healthcare services cannot be provided without considering the emotional and psychological aspects.[13]
Gaining an insight into pregnancy of women below 20 years of age, particularly the experience of pregnant women, can boost the knowledge of nurses who give healthcare services to the women. Perception of adolescent pregnancy may provide basic knowledge for healthcare workers, so that they can take care of the mothers below 20 years of age at this transitional stage. This can help the service providers develop their special interventions so that they would satisfy the needs of young women in the best possible way and correct the childbirth outcomes for them.[14] Considering the significance of the matter and lack of any information about the experience of pregnant women below 20 years of age, the present study was conducted to gain an insight into that experience.
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MATERIALS AND METHODS
In the present study, qualitative content analysis technique was used. The healthcare centers of Karaj formed the research setting. Purposive sampling method with maximum variation sampling was used. Sampling continued until the data saturation. The interviews conducted with 14 participants yielded no new categories or subcategories in addition to the previous ones. Deep and semi-structured interviews with open-ended questions were used to collect data. This type of interview is suitable for qualitative research because it is flexible and deep.[15]
The interview began with open-ended questions like: How did you feel when you realized that you were pregnant? What was your experience like? What created this experience? Was your pregnancy preplanned? The interview lasted between 30 and 45 min. All the interviews were recorded and then typed verbatim for analysis. In qualitative studies, the researcher needs to immerse himself in the data.[16] Hence, the researcher listened to the interviews several times and reviewed the transcriptions many times. Conventional content analysis was used. In this approach, the researcher usually avoids using predetermined categories. Instead, he allows the categories and their titles to be extracted.[17] In the present study, the analysis of data involved three stages: Encoding, re-creating the categories, and abstracting.[15]
To assess the validity and reliability of the data, Lincoln and Guba criteria were used. One of the best techniques to validate the data is to have a long engagement with the subject. In the present study, the researcher was involved in the topic of the research, the data collected, and the pregnant women for a year. Since the author worked as an instructor at healthcare centers before starting the study, she established a good relationship with the subjects before and throughout the research. The findings were checked out with the participants. Thus, a summary of the researcher's interpretation of the key points was given as feedback to the participants so as to ensure their validity. The supervisors cross-examined them. For this purpose, some parts of the interview along with the related codes and categories were sent to the supervisors so that they would examine the process of analysis and express their opinion on their validity. To determine transferability of the data, a diverse sample was used so as to help transfer the findings. To this end, expecting women below 20 years of age who had planned or unplanned the pregnancies were studied at different gestational ages. For confirmability and dependability of the research, the author accurately recorded and reported all stages of the study so as to make it possible for others to check out the research.
Ethical considerations
The Ethics Committee of Tehran University of Medical Sciences approved this study. The participants signed written consent. Authors had no conflict of interest.
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RESULTS
The participants in the study consisted of 14 adolescents. All the participants said their mothers and sisters or both had a history of becoming pregnant under the age of 18. Most of them had got married because they were not interested in higher education [Table 1]. The author came up with three themes after analyzing the interviews: 1. Psychological reactions including three subthemes of feelings, concerns, and fears; 2. physical reactions including the subthemes of symptoms and feelings; and 3. spiritual reactions including religious beliefs and faith.
Table 1
Characteristics of participants (n=14)
Psychological reactions
The theme involved the subthemes of feelings, concerns, and fears. The subtheme of feelings included those about pregnancy, spouse, and child. As for the good feelings about pregnancy, the participants whose marriage and pregnancy were consensual referred to such feelings as life, happiness and feeling great, leaving behind childhood, sense of responsibility, enthusiastic for early pregnancy, sense of being a mother, a beautiful feeling, increased happiness, enthusiasm for a growing belly, waiting anxiously for the end of the pregnancy, and sweetness of pregnancy despite difficulties. One of the participants said about her pregnancy thus:
“One feels like leaving behind childhood. I mean first you only care about yourself. After marriage, you still care about yourself. But when you are pregnant, you feel that there is someone else in your abdomen; you feel that someone else is growing; you try to be careful much more; and you care about that someone. Now, I’m like that. I care more about my child than myself. I try hard to learn how moms behave so I will be the same.”
Some participants who considered their age to be low for pregnancy had different feelings compared to other mothers. Their feelings ranged from feeling unthankful for pregnancy, lazy, and heavy. They also said they had bad feelings when they were alone, or they felt frightened or thought they were in danger, or felt that pregnancy was difficult and they were suffering or worried. One of them said:
“I said I don’t want this child at all; I mean it was sort of being unthankful, you know; I said I want abortion and stuff. I was pissed off. I was feeling terrible.”
As for the child, most participants who had consensual marriage or preplanned pregnancy expressed good feelings. The feelings included life being sweet with a child, being in a hurry to give birth, feeling that someone else exists within oneself, speaking to the fetus out of happiness, and loving the child. One participant said:
“I feel great; the sense of becoming a