School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Action. 2021 Jan 1;14(1):1886456. doi: 10.1080/16549716.2021.1886456.
: The South African development goals for young women aged 15 to 24 are to reduce HIV incidence, teenage pregnancy and gender-based violence, and to increase school completion and economic security. Early, unintended pregnancy undermines these goals, creating discourses of early motherhood that position young women as powerless. There has been scant attention on the agency of young women in their structural context.: This study explored how young women exercise agency after an unintended pregnancy and make decisions concerning their future, including sexual and reproductive health, school completion and/or income generation, and caregiving for their babies.: I used narrative analysis to explore the lived experiences of young mothers, paying attention to decision-making during pregnancy and motherhood. Domains of analysis included health care, education, and caregiving. I conducted in-depth interviews with 30 young mothers: 30 were interviewed once, nine were interviewed twice, and six were interviewed three times. I interviewed four significant people in the lives of young mothers and six health care providers at a health centre.: Progressive policy facilitates increased access to services for young pregnant and parenting women. However, education and health care providers continue to discriminate against them, formally through denying them access to services and informally through discourses of shame which pervade their structural context. Kinship capital in urban and rural contexts and the Child Support Grant mitigate some struggles in early motherhood and help young mothers navigate decision-making.: Young mothers exercise agency along a continuum to realise their aspirations. Social and structural support mediate their agency. Policy needs to expand the focus from prevention to include issues of care and support after an early, unintended pregnancy to ensure the health and wellbeing of young mothers and their children.
：南非针对 15 至 24 岁年轻女性的发展目标是降低艾滋病毒感染率、少女怀孕率和性别暴力发生率，提高学校毕业率和经济安全性。过早、非意愿的怀孕破坏了这些目标，使年轻女性成为弱势人群。很少有人关注年轻女性在结构性背景下的能动性。
：本研究探讨了年轻女性在非意愿怀孕后如何行使能动性，并就她们的未来做出决定，包括性和生殖健康、完成学业和/或增加收入以及照顾婴儿。
：我使用叙述分析来探讨年轻母亲的生活经历，关注怀孕和做母亲期间的决策。分析的领域包括医疗保健、教育和育儿。我对 30 名年轻母亲进行了深入访谈：30 名母亲接受了一次访谈，9 名母亲接受了两次访谈，6 名母亲接受了三次访谈。我还采访了四位对年轻母亲生活有重要影响的人和六名医疗中心的医疗保健提供者。
：进步的政策促进了年轻孕妇和哺乳期妇女获得更多服务的机会。然而，教育和医疗保健提供者继续歧视她们，正式地拒绝为她们提供服务，非正式地通过弥漫在她们结构性背景中的羞耻话语来歧视她们。城乡亲属资本和儿童抚养补助金缓解了一些年轻母亲在早期育儿过程中的挣扎，并帮助她们在决策中发挥能动性。
：年轻母亲在实现自己愿望的过程中表现出一定的能动性。社会和结构性支持调节了她们的能动性。政策需要将重点从预防扩大到包括早期非意愿怀孕后的护理和支持问题，以确保年轻母亲及其子女的健康和福祉。
