Early Sexual Debut and Conversations about Pregnancy Prevention (CAPP) Among Urban Young Adult Black South African Females within the Birth to Twenty Cohort Open Access

Chiseri, Katharine (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/r781wg14x?locale=en


Objectives: Teenage pregnancy is high in South Africa (about 30%). This high rate is driven by many factors, including a lack of communication about sex and sexual behavior. This study aims to document and explore the content of conversations about sex and sexual behavior occurring between adolescents and their primary caregivers, family members, peers, partners, and in school, and explore how adolescent sexual behavior is influenced by these conversations in a South African context.

Methods: Twenty young adult female members of the Birth to Twenty Cohort participated in semi-structured in-depth interviews about the types of conversations they had about sex and sexual behavior during adolescence. Ten participants self-reported not being pregnant by age 18, and ten participants self-reported being pregnant by age 18.

Results: Many participants reported not engaging in conversations about sex with family members, particularly primary caregivers, due to a variety of cultural barriers and feelings of discomfort. Peer pressure was evident among all participants, and pressure from friends and peers was predominantly negative, encouraging unsafe sexual behaviors and attitudes of needing to engage in sexual activity in order to fit in. The biggest influences on the sexual decision-making of the two groups differed; the participants themselves were the dominant source for those who did not get pregnant by age 18, and friends/peer were the biggest influence for those who did get pregnant by age 18. There was a great desire among almost all participants to have had more conversations with their primary caregivers, and they felt that things would have been different if conversations about sex had occurred.

Discussion: Teenage pregnancy presents many health, economic, and social risks for all involved. Communication about sex between adolescents and caregivers has been shown to have positive impacts on health in other contexts, and should be explored further in Soweto. In addition, changes to the existing Life Orientation curriculum are proposed to include skill-building to enable adolescents to more effectively stand up to peer pressure. Finally, an intervention is proposed to provide caregivers with the knowledge, resources, and confidence to have conversations with their children about sex.

Table of Contents

Distribution Agreement. i

Abstract. ii

Acknowledgements. iv

Chapter 1: Introduction and Background. 1

Chapter 2: Review of the Literature. 8

Chapter 3: Methods. 24

Chapter 4: Results. 32

Conversations about sex and sexual behavior between adolescents and their caregivers. 34

Family members other than caregivers. 38

Friends/Peers. 39

Romantic/Sexual Partners. 42

In schools/Life Orientation. 43

With other community members or individuals, outside sources of information. 45

Influence of conversations about sex and sexual behavior that adolescents engaged in. 47

Desire for communication from primary caregivers. 49

Chapter 5: Discussion. 53

Public Health Implications. 59

Recommendations for Future Practice. 59

Course for parents/caregivers. 59

Adaptations to Life Orientation. 60

Limitations. 62

Conclusion. 63

References. 64

Appendices. 68

Appendix A - Individual Interview Guide. 68

Appendix B - Code Tree and Code Book. 75

Appendix C - Analysis Grids. 80

Appendix D - Data Analysis Summary Sheets. 136

Appendix E - My Future - My Choice Worksheet (Curriculum). 157

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