41344643--Aspek Psikologis Remaja Hamil Di Luar Nikah Zambia

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Psychosocial Aspects of Unwed Adolescent Pregnancy in Lusaka, Zambia

Author(s): Karl Peltzer and Rosemary LikwaSource: International Journal of Mental Health, Vol. 21, No. 4 (Winter 1992-93), pp. 50-58Published by: M.E. Sharpe, Inc.Stable URL: http://www.jstor.org/stable/41344643.

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int. .Meni. ealth,ol. 1,No. ,pp. 0-58M.E.Sharpe,nc., 992-93

Karl Peltzer and Rosemary Likwa

Psychosocial Aspects ofUnwed Adolescent Pregnancyin Lusaka, Zambia

Teen-age pregnancies i.e., amonggirls12-19 yearsofage) accountedfor 22.5% (totaln = 3,910) of thepregnancies een at theUniversityTeaching Hospital in Lusaka, Zambia, in 1979/80 [1]. Reasons forincreases in adolescentpregnancy n Africancountrieshave been re-ported to be earlier sexual maturation, ocietal permissiveness,de-creased family ontrol, nd increased sexual activity t younger ges[2-4]. Unplanned pregnanciesamong adolescent girls are oftenper-sonallyself-defeatingndmedicallydisruptive 1]; they nterruptdu-cation,with serious ramifications or ob opportunities; nd anotherinfantn the household can constitute n additionaleconomic burden.Copeland [5] has listedamongthepsychosocial consequences ofteen-age pregnancy: /) failure to develop self-reliance, 2) an arrest npersonality evelopment,3 interferencen thedevelopment f stableheterosexual elationships,4) a diminishmentnlifedirection nd roledevelopment, nd (5) increasedmaternal ependency.In thepresent tudy,we have triedto identify sychosocial factorsin preventingheoccurrence ndmanagement f adolescentpregnancy.This study s, we think, elevant o Zambia's populationpolicy: thepopulationgrowth atebetween1985 and 1990 was estimated t 3.6%;and of thenormalpopulation, 4% were ntheage group10-19 years,Dr. Peltzer s associatedwith hePsychosozialesentrumr uslndischeFlchtlinge,interenUlmen 5,6000Frankfurt/M.0,Germany.t the imethis rticle aswritten,e waswith he nstituteorAfricantudies, niversityofZambia,Lusaka,Zambia.Ms. Likwa s associatedwith heDepartmentfObstetricsndGynaecology,niversityeaching ospital,usaka, ambia.

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UNWED DOLESCENTREGNANCYN ZAMBIA 1ofwhom,accordingto previous findings, bout22.5% would becomepregnant.MethodPregnantunmarried dolescents 12-18 years) were identified t con-secutive first onsultations at the antenatalclinic of the UniversityTeachingHospital (n = 40) and at a low income antenatal linic n =40) in Lusaka in 1987. (It should be notedthat pproximately alf ofthe adolescents served at the clinics are unwedadolescents.)The num-ber was limited o 80 to allow enoughtimefor n-depthnterviewsyetmeet therequirement or a statistically ignificant umber. Unwedwas defined as not having received a bride price. Married pregnantadolescentswere excluded since a pilotstudy f 25 patientshad shownthattheirpsychosocial problemsrelatedto pregnancywere fewer nnumber han n the unwed pregnant dolescents.A control ample of80 nonpregnant nwed adolescents was selected in orderto identifypsychosocial factors ausing and preventing een-age pregnancy.Thecontrolsample was drawn from adolescent girls attending he sametwo medical institutions orproblemsother thanpregnancy; he twogroupswere matchedfor ge, education, ndsocioeconomicstatus.With thepatients' consent,unstructured,n-depth nterviewswereconductedbybothauthors,nprivacyand,preferably,n the anguagein which the subjectwas most conversant.Questionswere posed re-garding hegirl's psychosocialbackground;herknowledgeoffertility,conception, ontraception,nd abortion;her attitude oward ove, sex,pregnancy, nd marriage; ntention nd unconsciousmotivesforget-tingpregnant; he nvolvement f thepartner; he reactions fparents,peers, and others towardthepregnancy; nd strategies ormanagingtheoutcome of thepregnancy.For assessment of theunderlyingmo-tives forbecoming pregnant, our pecificstories, llustratingmotivesranging rom motional ttachment oeconomicreasons,were narratedto each subjectforranking ndcomments.ResultsAt the time of the interview, he durationof the girls' pregnanciesrangedfrom to5 months, hemeanbeing3.8 months.The resultsweredivided ntopreventive ndmanagement spectsof



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52 .PELTIER R. UKWunwed adolescentpregnancy.The preventive spects included (i) sexsocialization and motives for getting pregnant; 2) knowledge of,attitudes oward, nd use ofcontraceptives;3) socioeconomicfactors;and (4 family oherence.The management spectscovered reaction oandmanagement f thepregnancy.Sex socialization andmotives orgetting regnantThe mean age at menarche was 13.2 years for the unwed pregnantadolescents and 13.5 yearsfor the controlgroup,which seems to beslightlyower than hatreportednotherAfrican opulations 2,4,6,7].Of theexperimental roup,86% had knownnothing bout menstrua-tion at the time of onset; the remaining14% had more often beeninformed yfriends hanby familymembers.A formal nitiation ere-monyhad been performedn only 3% of theexperimental roupand8% of the controls.The principal preventive nformation romolderfamilymemberswas to avoid boys forexample, You should re-fusemoneyfrom boybecause hemightdemand hismoneyback, andif you cannotrepay,he may touchyou and make you pregnant, ndthiswill give you problems.The number f male friends f theexperimental roup averaged2.8,comparedwith1.8 forthe controlgroup;and the numberof sex part-ners was 2.4, comparedwith0.5. Girls nthe controlgroupmore oftensaid theyended a relationship f the boy wanted sex. Girls in theexperimental roup thought hat 19.8 yearswas the deal age formar-riage, following mean courtship uration f 8 months; orrespondingfigures or he controlgroupwere 20.2 yearsand 9 months.On average,theteen-agernoticed herpregnancy fter .8 months,therange being a fewdays to4 months. n 34% of cases, thegirldidnot realize she was pregnant ntil oldbyhermother, nother elative,or herboyfriend. Mothernoticedthat was pregnant; did notknow,but I feltsomethingmovingin my stomach,but I thought t was anillness. )Elicitingthemotives forgetting regnant sually required eadingquestions. n orderofrank, heywere identified s follows morethanone responsewas possible):(1) economicsupport ytheboyfriend85%);(2) in love, andhope formarriagenthe near future67%);



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UNWED DOLESCENTREGNANCYN ZAMBIA 3(3) peerpressurefrom othsexes (54%);(4) testing ffertility;dentification ith hemother ole 26%);(5) pleasureandexperimentation15%); and(6) unaware of family-planningmethods. For relatedstudies,see[8-13].)

Knowledge of, ttitude oward,and use ofcontraceptives

SocioeconomicfactorsAbout three-fourthsf the total sample came from ow-income orhigh-density reas, and about one-third f the heads of householdswereunskilled.Average lengthof formal ducation was 6.2 yearsforthepregnant roupand 6.8 yearsforthe controls. n theexperimentalgroup,68% had been in school at the onset ofpregnancy, nd all hadhad to leave school, in accordance withZambian school practice they

No significant ifferencewas foundbetween theexperimental nd thecontrolgroup in termsof knowledge of, attitude oward,and use ofcontraceptives.Neitherformal nitiation oradvice from lderfamilymembershadincluded information n contraception. wenty-eight ercentof thepregnant irlsclaimed to knowabout countingdays, butquestioningrevealed thatonly 1% were correctlynformed.n a numberof cases,thegirlsreportedhat heir oyfriends adkept askingthem bout theirperiods, butmost of thegirlshad not knownwhy.Friends or a sisterhadmentioned thepill to 22% ofthegirls,butmost believed that hepill wouldmake them nfertile, ick,or even die, so theyhad made noeffort o obtainand use it. One girlhad taken hepill,butstoppedwhenit got finished. Thirty-eightercentknew about traditionalmedicalmeans ofpreventingnd/or iscontinuing regnancy. he condomwasmentioned n only 6% of cases, but it was never used: in general,contraceptiveswere conceived of as somethingfor the girl,not theboy. In summary, 5% of thepregnantgirls said theyhad not been

using any formof contraception,% were countingdays (but incor-rectly), nd 1% had used thepill, but was notusing it at the time ofconception.None of the girlshad attended family-planninglinic,andonly6% hadproperknowledgeof thesubject.



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54 . PELTZER R. UKWare, however,allowed to return o school after heyhave delivered);29% had droppedout of school beforetheybecame pregnant two-thirdsbecause of academic failureand one-third ecause of financialproblems);and 3% hadneverbeen to a formal chool. Of the 68% whobecame pregnantwhile in school, 34% admitted hattheywere notdoingwell academically.In 12% of the pregnant ample, therewas a relationship etweenlow socioeconomic status lack of financialsupport nd poor schoolperformance) nd becoming pregnant.This became particularly vi-dent in cases in which the girl expected and was offeredfinancialrewardsbyherboyfriend.The same motive was observed in pregnantgirls 5%) who werejust staying t home and in those who had come from rural rea tolive withrelatives nLusaka inthepastthreeyears. n the atter roup,gettingpregnant n town was usually associated with not having toreturn o the rural rea. In such cases urban ife was especially associ-ated with an opportunityo marry or materialwealth and social ad-vancement ndthus oescape from illage life.Pregnancy s a gratificationor ocioeconomically deprivedyouthswas reflectedn the low socioeconomic status of theirmale partners:52% of the male partnerswereunskilled,comparedwith33% of theheads of the families of girls in the experimental roup and 38% ofthose in the controlgroup.Moreover,6% of themale partnerswerealreadymarried which thegirls learnedonly after heyhad becomepregnant),and unstable obs such as those of musician or footballplayerwerecommonamongthem.FamilycoherenceOf thepregnant dolescents,61% were livingwithboth real parents,compared with 68% of the controlgroup (this proportion s almostdouble that mongpregnant rbanZulu schoolchildren n SouthAfrica[3]); 20% lived withone real parent theotherhavingdied, divorced,orremarried),omparedwith18% inthecontrolgroup;and 19% (14%inthecontrol ample) lived with omeother elative generally sisteror an aunt). n terms ffamily oherence, he twogroupsdo not differsignificantly a finding hat s interestingnlightof the factthat een-age pregnancy s commonly regardedas a manifestation f brokenhomes. Neitherwere there ignificant ifferences etweentheexperi-



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UNWED DOLESCENTREGNANCYN ZAMBIA 5mental and the controlgroupin numberof siblings, family tressorssuch as recent oss of a parent throughdeath or divorce, frequentabsence of thefather, r poor communication etween thestudy ub-ject andherparent(s). n one-parent amilies n which the motherwasthe head of thehousehold, hegirlwas more often he first-bornaugh-ter ntheexperimental roup 8%) than nthecontrolgroup 4%).Reaction toand.managementofthepregnancyBy the timethe unwedpregnant dolescent came to an antenatal linic,she oftenhad developed a morepositiveattitude owardherpregnancythan she had had initially. Only 6% statedthattheyhad wanted tobecome pregnant.Most of those for whom the pregnancywas un-wantedfeltguilty, itter,rupset, nd some (6%) considered bortion.Accordingto the pregnant een-agers, n 67% of cases theirmalepartners'reactionto theirconditionwas negative; though64% of themale partners ccepted thepregnancy, heydid not make any seriousattempt o pay the bridepriceand/or amages; 16% rejectedthepreg-nancy,and often hepartnerwas never seen again. Six percentof themale partners uggested bortion, nd,as a result, ome of thegirlshadconsideredtrying raditionalmedicine.The parents,however,had to-tally rejectedthe idea of abortionexcept in two cases in which themale partnerwas alreadymarried nd theparentsdid not wanttheirdaughterto become a second wife. Though in most cases the malepartner'sreactionto thepregnancywas fairly rresponsible, hepreg-nantgirl and her parentsrarelymade a serious issue of it, probablybecause of the traditional racticeof risking rundertaking regnancyas a reasonablemarriage trategy.n 34% of cases, thepregnant irlswere hoping to get marriedeventually;47% would have liked tomarry,but had littlehope of doing so; and 19% did not intendtomarry. nlytwogirls ntended o take theirmale partnero court.Generally heparents, speciallythemother, f thepregnant doles-cent nitially eactedbitterlyndangrily, ometimes pbraiding hegirland slappingher, nthree ases, thedaughter ad been drivenfrom hehouse. After he initial angerof the parentshad subsided, however,theyusually triedto negotiatewith themale partner'sparents.Espe-cially if the male partnerwas still in school, his fathermighthavepreferredo pay damages rather han the brideprice, since the latter



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56 . PELTZER R. UKWwould probablyhave included additionalsupportfor the new familyuntil he son finished chool and was able to support wife 13].In 84% of cases, friends f thepregnant irlsfelt orryforher,butsome (9%) were bitter nd startedneglectingher. The girl usuallystopped goingto churchbecause of her llegitimate regnancy, ut allthegirlsplanned to go back to church after hebaby had been born.Thirty-two ercentof the girls hoped to return o school (or nightschool) after elivery. n most cases (63%), the mother f thegirlwasprepared o care forthe nfantwhile herdaughterwent back to schoolor sought employment. ooking to thefuture, lmost all thepregnantadolescents were in theprocess of acceptingtheirpregnancy,whichoftenwas reflectedn theirdreams aboutdelivering r breast-feedingtheir aby.DiscussionThe girls n the controlgroupmore often nded a relationshipfa boywanted sex than did those in theexperimental roup.Their relativesseem to have placed more emphasis on not becoming involved withany boy, and thegirlsthemselves seem to have acquired a more re-sponsibleattitude owardnotbecomingpregnant,n attitude einforcedby familymembers nd by theexperiencesofpeerswho had droppedout of school because ofpregnancy.The controlgroupreacted differ-entlyto peer pressures,or perhapswas subjected to peer pressuresdifferent rom hose experiencedby thegirlswho became pregnant.Unlike n SouthAfrica 3] orinthe USA [10,14], family tressorswerenot foundto have played an important ole in the occurrenceof teen-age pregnancy. Pregnancyhas been regardedas a gratification orsocioeconomically deprived girls [14-17], and thismay have been afactor n our subjects. Especially in the absence of thefather, first-borngirl appearedto have a close relationshipwithher mother nd tohave assumed an economically supportivefunctionfor her family,whichsometimeshad led to a premature elationshipwitha boyfriendin an effort o gain moneyand support 5,14,18]. In a few cases (3%),theboyfriend lso served as consolation n coping withpersonal lossandfamily roblems 19].There were no majordifferences etween theexperimental nd thecontrolgroup nterms f socioeconomic status ndknowledgeof con-traception. othadults and adolescentswereambivalent boutpremar-



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UNWED DOLESCENTREGNANCYN ZAMBIA 7ital sex and about the means of birth ontrol.Many adolescentsfearedthatuse of contraceptives educed long-term ertility,nd sterilitysregardedmuch more negativelythan premaritalpregnancy by bothsexes. The male partners ad little ncentive o use contraceptives,ndnone of themdid.Differenceswere found between the experimental nd the controlgroupwithregardto sex socialization and family oherence. Familialinstructionnd assertion fauthorityver adolescentgirlstookprimar-ily the form f moral interdiction nd restrictionf freedom f move-ment.Familymembersdid, however, xplainthedangersofpremaritalpregnancy n terms of loss of opportunity oran advantageousmar-riageor freedom or elf-advancement.The notion thatphysical ntimacy s partof the mate selectionpro-cess has been retainedfrom raditional ractice,but traditional ocialcontrolhas been replaced by ignorance nd secrecy, ndcontrolled explay has been replaced by coitus. Christian eachinghas been one ofthemovingforces behind the abandonment f former ourtshipprac-tices [3]. Obviously,there s a substantialunmet need on thepartofZambian adolescentsforknowledgeabout healthful eproductionndfor nformationoncerning,nd access to,contraceptives.References

1. Wadhawan,., Narone, .K.,& Narone, .N.1982)ObstetricroblemsnadolescentambianmotherstudiedttheUniversityeaching ospital,usaka.MedicalJournalfZambia, 6,65.2. Akinboye,.O. 1984)Secondaryexual haracteristicsndnormalubertyinNigerianndZimbabweandolescents.dolescence,9,483.3. Craig,A.P., & Richter-Strydom,.M. (1983) Unplanned regnanciesamong rban ulu schoolchildren: summaryf the alient esults rompreliminarynvestigation.ournalf ocialPsychology,21,239.4. Katzarshi, ., Rao,U.K.G.,& Brady, . (1980)PubertynZambian hil-dren.MedicalJournalfZambia, 4,64.5. Copeland, .D. (1981)The mpactfpregnancyn adolescentsychoso-cialdevelopment.dolescentsychiatry,,244.6. Ellis,R.W.B. 1950)Ageofpubertyn the ropics.ritish edicalJournal,1,85.7. Worthman,.M. (1986)Developmentyssynchronys normativexperi-ence:Kikuyu dolescents.n J. Lancaster B. HamburgEds.), School-agepregnancyndparenthood:iosocial imensions.ewYork:Academicress.8. Brand, . (1989)Fertilitynd the nthropologicalignificancef the o-itus. nK. Peltzer P.O. Ebigbo Eds.),Clinical sychologynAfrica. nugu,



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58 .PELTIER R. UKWNigeria:WPA c/o .O. Ebigno, ept.ofPsychological edicine, niversityfNigeria). p.119-29.9. D'Hondt,W.,& Vandewiele, . (1983)Attitudesf WestAfricantu-dents owardove ndmarriage.sychologicaleports53,615.10. Landy, ., Schubert, .,Cleland,J.F.,Clark,C., & Montgomery,.S.(1983)Teenage regnancy:amilyyndrome?dolescence,8,679.11. Peltzer, . (1988) Fertility otivesn married alawians. ournal fAfricansychology7,92.12. Scott, .M.1983)The entimentsf ove nd spirationsormarriagendtheir ssociation ith eenageexual ctivityndpregnancy.dolescence18,889.13. Worthman,.M.,& Whiting,.W.M.10/) ocialchangemadolescentsexualbehaviour, ate election,ndpremaritalregnancyates n a Kikuyucommunity.thos, 5,145.14. Olson, .F.,& Worobey,. 1984)Perceived other-daughterelationsnapregnantndnonpregnantdolescentample. dolescence,9,781.15. Furstenberg,.F. (1976) Unplanned arenthoodNewYork: The FreePress.16. Phipps-Yonas,. (1980)Teenage regnancynd motherhood:reviewof he iterature.mericanournalfOrthopsychiatry,0A 31.17. Shaffer,., Pettigrew,.,Wolkind,., & Zajicek, . (1978)Psychiatricaspectsfpregnancyn choolgirls:review. sychologicaledicine,, 119.18. Cohen, .J. 1983) Intentionaleenage regnancies.ournal fSchoolHealth, 3,210.19. Coddington,.D. (1979)Life vents ssociated ithdolescentregnan-cies.JournalfClinical sychology48,180.

41344643--Aspek Psikologis Remaja Hamil Di Luar Nikah Zambia

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