The participants' age ranged from 14 to 19 years. Only three of those interviewed were in formal employment. Twenty three participants had no formal education, and only five had gone up to secondary level of education. All reported that the relationships that led eventually to the conception were consensual. Only four were in marital relationships which had been formalized or legally recognized, though another six reported that they were cohabiting (living with their partners/boyfriends with the knowledge of their parents or other close relatives). They reported anxiety, loss of self esteem (when they conceived), difficulty in accessing financial, moral and material support from parents or partners and stigmatization by health workers when they sought care from health facilities. There was no major distinction in coping mechanisms according to age group of the adolescents. Analysis of the data revealed three major themes: Utilizing opportunities for change (thriving), accommodating the challenges while tolerating the abandonment of support (bargaining and surviving), or failure to handle the stress in their lives to such an extent that they were overwhelmed by the struggle(despairing).
Utilizing opportunities for change
Overall, motherhood was a positive experience for the younger and older adolescents, and was looked upon with pride and joy for most adolescents interviewed and those in the focus group discussions. To many adolescents, it was apparent that they had partly achieved what was their heart's desire. This is exemplified by one 18-year-old participant who was having her second pregnancy:
"I was (at the beginning) dismissed from school. My brother (with whom I was staying with) sent me away when I became pregnant, saying that this will embarrass his family as he was a preacher... It is important that you get your children when you are young and strong.... I (later) stayed with my grandmother in the village. Life (then) was not easy. (When) I moved in with my boyfriend, he put me in his shop (where I worked) until I delivered (the first child). (Later) we got married, .... and he gave me money to enroll for a computer course and secretarial work at Y.W.C.A. I (now) have a good job stay with my young sister. He (my husband) pays my school fees."
Whereas some adolescents were eager to settle down into parenting and childrearing roles, some adolescent mothers had high hopes of returning to school once they have given birth. Some had no immediate plans to settle down in marriage, and were ready to go back to school as long as there was someone ready to look after their child, especially if it was their parents or one of the relatives. With such optimism, they were willing to nurse their children and cope with the stress of pregnancy, childbirth and parenthood. This optimism is exemplified by one 16-year old mother:
"It (getting pregnant) was a mistake... I do not plan to marry. I (think) I will go back to school... I will have to change to a new school. I don't think they will accept me back (in my former school). I even got some notes (from some friends) and will go for coaching (if this is necessary). ...(Probed on who will look after the child): My mother is ready to take care of my child. My father will get for me fees. I (promised them) will not be involved in this (relationship) again. In fact they have already secured me a place in a day school, .... and I don't care whether he gets someone else."
The findings demonstrate that the optimistic coping style (emotion-focused) was frequently used as an effective coping style for the stress of pregnancy and motherhood in these women. From the focus group discussions, such optimistic approaches suggested lack of understanding of the challenges that pregnancy, childbirth and motherhood will place upon them. Participants acknowledged that some adolescents settle down to serious studies after pregnancy, arguing that they have "learnt their lessons", "have no need to adventure", "are more mature and understanding of the world". Such successful participants can be described as thriving despite the adolescent pregnancy and parenthood. The acknowledgement/acceptance of the adolescent pregnancy, moral support to the adolescent mother and material/financial support to look after the child, were important factors that minimized the adolescents' stress and enabled them to cope adequately with pregnancy and subsequent motherhood.
For some adolescents, it was apparent that the pregnancy was planned, and even where it was unplanned, financial, relationship and security were assured, guaranteed or expected. Such adolescents described their relationships as "stable" or "strong", and expressed positive attributes of an adolescent pregnancy and motherhood, as exemplified by one 19-year-old participant from one focus group who was not staying with the partner:
"I am happy where I am. I do not regret getting pregnant. Actually he (the man) advised on family planning but I refused (for no particular reasons). I am now in a stable relationship (though he has another family). I am happy with my two children even though most of the time he(the child's father)is not around. But (he is a soldier) so I understand his situation even when he does not send (financial) support. ...I wouldn't advise anyone to get children when they are too old, and I don't regret."
Accommodating and enduring
Traditional views of adolescent mothers perpetuate negative stereotypes and fail to acknowledge many who seem to cope adequately and provide care for their children despite the challenges. The acknowledgement/acceptance of the adolescent pregnancy, moral support to the adolescent mother and material/financial support to look after the child were perceived to be dependent on paternal recognition. As long as the fathers of the children acknowledged and accepted the paternity, the parents/relatives were willing to look after the children of adolescent mothers so that they could go back to school.
Paternity acceptance was also a preliquisite for the adolescent mothers to move into a more permanent relationship with the father of the child. Unfortunately, some boyfriends/partners were reportedly unwilling to admit paternity (for three of the babies of adolescent mothers interviewed). From focus groups, participants acknowledged that this problem was common and pervasive. Some of the reasons why it was common were that it (admitting paternity) jeopardizes boys' educational and employment opportunities. Other participants thought it was because partners (and their parents) were irresponsible. This was a major source of stress to the adolescent mother, as described by a 17-year-old mother, who reported rejection of the pregnancy and the baby by her boyfriend's family:
"It is hard to accept (that the father has denied responsibility) because they (his or my parents) can't look after you and the child when pregnant. (Probed on why this is so) Sometimes they are forced to deny (responsibility) by circumstances. (They)...fear arrest and imprisonment and may be discontinued (from school) so that (both) your education may end. But yours has also ended and you have no support so what are you expected to do? Sometimes you have nothing. Even the breast milk may not be adequate and you don't have what to feed the baby."
From the interviews and focus group discussions, many teenage mothers reported renewed vigor, strength and hope in with the birth of the children, despite despair during pregnancy. Motherhood and parenting roles were described as "satisfying" and "fulfilling", as it gave adolescents new identity and status. In others, the adolescents satisfaction was reduced by coexisting burdens such as waking up to nurse the baby, having no assistance with looking after the baby, or rebuke by health workers, relatives and even strangers who disapproved of adolescent pregnancy in particular or adolescent sexual relationships in general. Some felt that most people they interacted with considered them unsuitable to be parents by virtue of their age, and experienced. stigmatization. In focus groups discussions, adolescents felt they got inadequate social, moral, material and financial support from their relatives or their partners, and health workers were singled out as a group that has negative attitudes to pregnant adolescents and mothers. To such mothers, adolescent pregnancy and motherhood was big but bearable burden, and were willing to make sacrifices to succeed in their new roles.
Some adolescents described stories of unhappiness in adolescence which extended through pregnancy into motherhood, disrupted lives, turmoil during adolescence and a need to find love and connection in their lives (which they had partly achieved from the adolescent relationships and subsequent pregnancy and motherhood). Unfortunately for some, this happiness was short-lived, as described by a 16 year old mother:
"At the beginning I did not care about what people said, though I was worried about my safety and that of my baby. My boyfriend was not working, so (though) we had little (but) we shared (what we had). But when (my boyfriend) changed, this affected me as we could no longer understand each other. ...we were always quarreling and fighting. I (at times) regretted my (stubborn) behavior (of getting involved in groups and getting boyfriends) which had landed me in this (trouble). I did not know that he could change because he showed me a lot of love and (actually) things were alright (at the beginning) before they (misunderstandings) started. Now (though) I don't have any where to go (for help, the baby is a girl who does not need much. I can buy clothes for her. ... I have adequate breast milk... (I hope) we will survive."
Such adolescents indicated a surprising level of maturity and commitment to pregnancy, motherhood and adolescent parenthood. Expectedly, these mothers described motherhood and parenthood as a positive force that helped change their lives to a more productive and hopeful future, despite their stress and struggles. To some adolescents, conception and motherhood provided acceptance and recognition by the partners' family, which improved their self worth and esteem. This is exemplified by an 18-year-old mother who was interviewed during pregnancy and six weeks after delivery:
Interview before delivery: "It is hard to leave because you can not stay alone and look after yourself when pregnant. ....My parents and relatives rejected me and they (his people) don't like me. I don't think they like me. I don't think they will change....Sometimes you are forced to go back (to the boyfriend to ask for help) by circumstances, but would not if you could survive on your own."
Interview after delivery: Such (being neglected and lacking financial support) has not happened since delivery..... My concern now is to settle down with him and his family. They (he and his family) have been giving me (financial and emotional) "support", which was not the case (before becoming pregnant or delivery). I think they like (me and) the baby and we will look after the baby (together with them)."