Center for Evaluation & Research for STEM Equity (CERSE), University of Washington, Box 353340, Seattle, WA, 98195, USA.
Int J Equity Health. 2019 May 2;18(1):60. doi: 10.1186/s12939-019-0965-7.
Rural areas of South Africa face persistently high teenage and premarital childbearing rates, reflecting a lack of or inconsistent use of modern contraception. In attempting to understand this behavior, much of the literature has denied agency to young women, portraying them solely as victims of their environments. This study moved beyond these approaches to understanding adolescent contraceptive use, to reframe the investigation to focus on the tension around exercising agency within specific structural constraints.
Findings are based on a qualitative study in Agincourt, South Africa. Data were collected through six focus group discussions with 63 women aged 18-44. A grounded theory approach utilizing emergent coding was performed focusing on the decision-making processes around family planning. The focus group participants discussed attitudes and norms around: early first births, contraceptive use, unplanned pregnancy, abortion, and HIV testing. When possible, differences that emerged around these topics according to the age groups (18-24, 25-34, and 35-44) and/or nationality of village (South African or Mozambican) are highlighted.
Participants of all focus groups agreed that early first birth were common and undesirable. Younger participants described pregnancy prevention as a key rationale for contraceptive usage, while older participants were more inclined to cite HIV prevention. Women of all focus groups discussed the importance of women taking the initiative with family planning. Participants expressed a range of opinions about the acceptability of abortion, and all focus groups discussed concerns about the safety of abortion. Finally, all of the focus group participants stressed the importance of HIV testing, both to protect themselves and to protect their families.
This study found many locations of agency for young women in rural South Africa. The decision-making surrounding contraceptive use consists of a series of decision junctures at which women must assign values to certain factors and then select their behavior on the basis of those values. Young women weigh the costs and benefits of contraception and of pregnancy, while also taking into account the chances of actually becoming pregnant along with the costs and benefits of abortion. Furthermore, the women explicitly viewed contraception as within their own realm of decision-making and action (as opposed to within the realm of their male partners).
南非农村地区青少年和未婚先育率一直居高不下，这反映出现代避孕措施的使用率低且不一致。在试图理解这种行为时，许多文献否认了年轻女性的能动性，将她们仅仅描绘成环境的受害者。本研究超越了这些理解青少年避孕措施使用的方法，重新构建了调查框架，重点关注在特定结构限制下行使能动性的紧张关系。
研究结果基于南非阿格诺科特的一项定性研究。数据通过与 63 名 18-44 岁的女性进行的 6 次焦点小组讨论收集。采用扎根理论方法，利用新兴编码，重点关注计划生育决策过程。焦点小组参与者讨论了以下方面的态度和规范：初次早育、避孕措施使用、意外怀孕、堕胎和 HIV 检测。在可能的情况下，根据年龄组（18-24 岁、25-34 岁和 35-44 岁）和/或村庄国籍（南非或莫桑比克）突出了这些主题之间出现的差异。
所有焦点小组的参与者都认为初次早育很常见且不受欢迎。年轻参与者将预防怀孕描述为使用避孕措施的主要理由，而年长参与者更倾向于将 HIV 预防作为理由。所有焦点小组的女性都讨论了女性在计划生育方面采取主动的重要性。参与者对堕胎的可接受性表达了一系列看法，所有焦点小组都讨论了对堕胎安全性的担忧。最后，所有焦点小组的参与者都强调了 HIV 检测的重要性，既是为了保护自己，也是为了保护家人。
本研究发现南非农村地区的年轻女性有很多能动性的空间。围绕避孕措施使用的决策包括一系列决策关头，在此期间，女性必须对某些因素赋予价值，然后根据这些价值选择自己的行为。年轻女性权衡避孕和怀孕的成本和收益，同时还要考虑实际怀孕的机会以及堕胎的成本和收益。此外，女性明确将避孕视为自己决策和行动的领域（而不是其男性伴侣的领域）。
