Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
BMC Int Health Hum Rights. 2010 Jun 7;10:12. doi: 10.1186/1472-698X-10-12.
Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.
We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.
Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.
Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.
青少年怀孕是一种常见现象，可能既有积极影响，也有消极影响。权利框架使我们不仅可以将青少年怀孕视为孤立事件，还可以将其与女孩的性和生殖自由以及她们有权获得包括健康服务和所谓的健康决定因素在内的健康保护制度联系起来。本研究旨在探讨政策制定者和服务提供者对青少年怀孕的看法，并讨论这些观点对厄瓜多尔亚马逊流域奥雷利亚纳省女孩行使性和生殖权利的影响。
我们对奥雷利亚纳的 41 名服务提供者和政策制定者进行了六次焦点小组讨论和十一次深入访谈。访谈内容被转录并进行了话语分析，特别是寻找解释性剧目。
从访谈中得出了四个解释性剧目。第一个剧目是“性不是为了好玩”，反映了对女孩性和生殖健康的道德建构，强调禁欲，并对避孕使用发出相互矛盾的信息。第二个剧目是“性别化的性行为和生育”，将女性构建为性不感兴趣且负责任的母亲，而男性则被构建为性驱动且不可靠的人。第三个剧目是“将青少年怀孕专业化”，导致对青少年的屈尊态度和对非医学专业知识的重视。第四个剧目是“理想化的传统家庭”，将家庭构建为养育青少年的适当空间，同时承认家庭内性虐待和暴力很常见。
提供者和政策制定者的剧目确定了性和生殖健康服务应包括的领域，排除了那些更容易引起冲突和反对的领域，如性别平等、提供堕胎和为怀孕的青少年提供福利服务。存在道德态度和性别歧视——即使也存在分歧——限制了服务促进女孩性和生殖健康和权利的能力。
