Social representations of unplanned and unwanted pregnancy in young women from the Guadalajara Metropolitan Area, Jalisco, Mexico

Original Article

2017;14 (No. 3):
Pages:30-
37

Social representations of unplanned and unwanted pregnancy in young women from the Guadalajara Metropolitan Area, Jalisco, Mexico

Authors: ^¹, ^², ^³, ^⁴

¹Bachelor’s degree in Nursing. Scholarship holder from the National Council for Science and Technology of Mexico. Doctoral Program in Public Health Sciences – University of Guadalajara, University Center for Health Sciences. Guadalajara, Jalisco, Mexico

²Bachelor’s degree in Psychology. Scholarship holder from the National Council for Science and Technology of Mexico. Doctoral Program in Public Health Sciences. University of Guadalajara, University Center for Health Sciences. Guadalajara, Jalisco, Mexico

³ Master’s degree in Education. Scholarship holder from the National Council for Science and Technology of Mexico. Doctoral Program in Public Health Sciences. University of Guadalajara, University Center for Health Sciences. Guadalajara, Jalisco, Mexico

⁴Master’s degree in Public Health. Scholarship holder from the National Council for Science and Technology of Mexico. Doctoral Program in Public Health Sciences. University of Guadalajara, Centro Universitario de Ciencias de la Salud. Guadalajara, Jalisco, Mexico

Correspondence:

María de los Ángeles Covarrubias-Bermúdez
Universidad de Guadalajara
Address, Sierra Mojada 950, Puerta 1, Edificio “N”, Planta Alta, Colonia Lomas de Independencia
Guadalajara, Jalisco, Mexico. ZIP code: 44240
angelescovarrubias@hotmail.com

Keywords: Women ‘s health, unplanned pregnancy, unwanted pregnancy, qualitative research, Mexico.

Abstract

OBJECTIVE: To identify the social representations of unplanned and unwanted pregnancy in young women from the Guadalajara Metropolitan Area, Jalisco, Mexico.
METHODS: A qualitative study was conducted with 79 women between 18 and 21 years of age, undergraduate students in the area of health sciences, who were given free lists to indicate proximity or distance in relation to their study phases. The social representations were obtained by applying the Abric theory and expressed through graphs.
RESULTS: The social representation of unplanned pregnancy was “fear, problems and family conflicts”, while unwanted pregnancy was “unprotected, unplanned sex and irresponsibility”.
CONCLUSION: The social representations of unplanned and unwanted pregnancy can be associated with the Mexican stereotype of pregnant adolescents, characterized by a lack of awareness of the implications of the beginning of sexual life, and responsibility committed in pregnancy. The term “unwanted child” is associated with situations such as child abuse and problems with the birth and development of children, and with decreasing employment and educational opportunities for parents.

Abstract:
OBJECTIVE: Identify the social representations of unplanned and unwanted pregnancies in young women from Guadalajara’s Metropolitan Zone, Jalisco, Mexico.
METHODS: This qualitative research was performed with 79 women between 18 and 21 years-old undergraduate level’s students in the area of health sciences, to whom we applied free lists to indicate closeness or distance relating to studied key phrases. We obtained social representations by applying Abric’s theory, and we expressed it by graphics.
RESULTS: The social representation of unplanned pregnancy was “fear, problem and family conflict”, while for unwanted pregnancy was “sex without protection, unwanted and irresponsibility”.
CONCLUSION: The social representations of unplanned and unwanted pregnancies can be linked Mexican stereotype of adolescent pregnancy, characterized by lack of awareness of the implications of the sexual life’s onset, and the responsibility involved in the pregnancy. The key phrase “unwanted child” is associated with events such as child abuse and problems for the birth and development of children, and lower employment and educational opportunities for parents.

INTRODUCTION The World Health Organization defines teenage pregnancy as that which occurs between the ages of 10 and 19 ¹ . It is considered a public health problem because it increases the likelihood of maternal death, dystocia and/or premature birth, risk of low birth weight and premature death. In addition, it has social consequences such as family dysfunction and difficulty in accessing and continuing education, which can perpetuate cycles of poverty, discrimination and social segregation for young parents ² . In response to this problem, the National Strategy for the Prevention of Teenage Pregnancy ⁴ was developed in Mexico. This includes inter-institutional policies and actions (at national, state and municipal levels) focused on: 1) Promoting the completion of basic education for adolescents, 2) Encouraging decision-making that favors the exercise of sexuality, through communication campaigns that promote sexual rights, and equitable health services with a gender perspective, 3) Providing contraceptive methods and family planning advice, 4) Improving health services through ongoing and relevant training for health personnel, and 5) Ensuring sexual education in public and private education. Thus, it is estimated that by 2030 it will be possible to eradicate pregnancies in children under 15 years of age and reduce pregnancies between 15 and 19 years of age by 50%. However, data from the National Institute of Statistics and Geography ² show that in 2014, 98.7% of women aged 15 to 49 reported knowing at least one contraceptive method, and 18.3% of abortions in women of childbearing age occurred in adolescents ⁵ . Furthermore, the number of pregnancies in this group increased from 70.9 per 1,000 women in 2009 to 77 per 1,000 women in 2014 ² . It is estimated that 60% of these pregnancies occurred in the first six months after the initiation of sexual relations, which are increasingly occurring at an early age, so much so that in 2000, cases of pregnancies at the age of 12 were reported ⁶ . These data suggest that adolescent pregnancy should not only be attributed to a lack of knowledge of contraceptive methods, but also to other cultural and/or social factors. Given this scenario, it is necessary to study the meanings women attribute to unplanned and unwanted pregnancies, in order to understand how the social and cultural influence on fertility patterns, motivations and fertility intentions differ between populations, and how they can be interpreted differently. Some authors describe unplanned pregnancies as those that are neither planned ⁷ nor desired ⁸, however, what is unwanted is defined as what occurs at an unfavorable time and in someone who does not want to reproduce ⁹ . Other authors suggest that the terms unplanned and unwanted pregnancy are social constructs, so their definition should represent the cultural and moral particularities of the society to which they belong ¹⁰ , suggesting that current concepts may be ambiguous and useless in understanding the motivations for pregnancy. In this sense, the objective of this study was to identify the meanings of the terms unplanned and unwanted pregnancy for young women in the Metropolitan Area of Guadalajara, Jalisco, Mexico, through the structural approach of social representations ¹¹ . The interest in this group of women is due to the fact that Jalisco is one of the states with the highest number of births to mothers between 15 and 19 years of age (69.9 for every 1,000 women) ² . On the other hand, social representations constitute the way in which individuals relate to and signify the world; they are a form of knowledge constructed and shared by collectives ¹² , and also a body of perceptions, beliefs and opinions regarding an object, which contributes to the formation and justification of individual and group practices ¹¹ . Thus, social representations are an appropriate option for studying the concepts of unplanned and unwanted pregnancy, which allow us to identify the meanings, values, knowledge, attitudes and practices related to these phenomena. METHODS A qualitative investigation of the theoretical perspective of social representations proposed by Abric ¹¹ was carried out using tools from cognitive anthropology ¹³ . A sample of women who met the following inclusion criteria was analyzed: 1) Being a bachelor’s student in health sciences, 2) Reside in the metropolitan area of Guadalajara, Jalisco, Mexico at the time of the study, 3) Being between 18 and 21 years of age, and 4) Agreeing to participate anonymously in the study by responding to the requested instruments. A sample size of at least 17 informants was determined, in accordance with the proposal of Weller and Romney ¹⁴ , who indicated that this was the minimum size required to meet the criteria of sufficiency and saturation of the information needed to adequately develop the theoretical assumptions of cognitive anthropology. The women who met the inclusion criteria were personally invited to the University Center of Health Sciences of the University of Guadalajara in December 2015. Each participant took a maximum of 15 minutes to respond to each questionnaire, including resolving any doubts about their respective questionnaire. Data collection was carried out in two phases using semi-structured questionnaires. In the first phase, the free listing technique ¹³ was used , which allows for responses free from elaborate terms to be thought of as rationalized responses. This method is motivated by social acceptance, which consists of offering participants an induction sentence and asking them to write the first five words or phrases that come to mind when reading it, as well as the reason why they thought of them. Participants were given two free lists, one for the term “unplanned pregnancy” and another for “unwanted pregnancy”. Once the data from this first instrument were obtained, through frequency distribution, the ten most frequent responses for each induction term were identified, with which the pairwise comparison technique ¹³ was used , which aims to show prominent elements of the social representation sought and indicate the relationship they have. In this phase, participants associated the words according to their idea of the terms “unplanned pregnancy” or “unwanted pregnancy”. They were asked to first mark the two words or phrases with the strongest association and then the two that were less strongly associated, and they were asked to repeat this procedure with the remaining words or phrases. To obtain the social representations, the data collected with the pair comparison questionnaire were used, analyzing the intensity of the association between the terms with respect to their similarity or antagonism, assigning a value based on the level of association established by the participant, in such a way that the values were 2, 1, 0, -1 and -2, according to what was proposed by Abric ¹¹ . The words and phrases were ordered from highest to lowest according to these values, where a graph was subsequently constructed according to the theory described by Doise et al. ^{15 . Finally, a thematic analysis of the explanations related to the terms recalled in the free lists}¹⁶ was performed , reading, rereading and coding the responses to categorize them by themes and, finally, triangulating this information among the researchers to obtain a consensus on the coding. The study was considered risk-free for the participants in accordance with the regulations of the general health law on health research in Mexico17, due to the survey-type data collection methods, and no psychological variables of the participants were modified nor was sensitive information collected. Consequently, the protocol did not require approval by an ethics committee, and the women’s participation was not subject to written informed consent, other than their acceptance to participate by completing the instruments. Likewise, in accordance with Mexican legislation17, since no sensitive information was collected, understood as potentially generating social segregation, no privacy notice was issued. RESULTS Seventy-nine women participated in the study, 40 in the first phase and 39 in the second, and none of them were pregnant. Five of the participants in the first phase and six in the second phase reported being married when asked about their marital status. Figures 1 and 2 show the graphs corresponding to the social representations of the terms “unplanned pregnancy” and “unwanted pregnancy”, respectively. In these, the highlighted lines indicate the concepts or meanings that constituted the central core of each social representation according to Abric’s theory ¹¹ . These corresponded to “fear”, “problem” and “family conflict” for “unplanned pregnancy” (Figure 1), and to “unprotected sex”, “unplanned” and “irresponsibility” for “unwanted pregnancy” (Figure 2).

Figure 1. Social representation of the term “unplanned pregnancy” according to young women in the Guadalajara Metropolitan Area, Jalisco, Mexico. Figure 2. Social representation of the term “unwanted pregnancy” according to young women in the Guadalajara Metropolitan Area, Jalisco, Mexico.

Tables 1 and 2 show the results of the thematic analysis performed with the explanations provided by the participants about the terms remembered in the free lists for the terms “unplanned pregnancy” and “unwanted pregnancy”, respectively. In both cases, three categories were identified: facilitators, consequences and expectations; whose characteristics and frequency distributions are shown in the aforementioned tables.

DISCUSSION The results showed the view of a group of women on the terms “unplanned pregnancy” and “unwanted pregnancy”, in which it is possible to distinguish, by describing the process they experienced, the elements that facilitate the pregnancy event, the respective implications in the life of the mother, the couple, their parents and the child born, and the expectations of pregnant women with respect to their future. When comparing the results obtained with the existing literature on the facilitators, risky sexual practices and being an adolescent, the results corroborated those of the present study, which describes adolescence as a period characterized by a lack of awareness of the implications of the beginning of sexual life, and the compromised responsibility for pregnancy, with attitudes of neglect being common ¹⁸ . However, it was noteworthy that these types of pregnancy were considered only in adolescence and that other facilitators were not mentioned, since there are references to cases of unplanned and unwanted pregnancy in women over 40 years of age ⁹ . Just as the consequences of acts of sexual violence ¹⁹ , marital status, educational and work expectations and needs, spirituality, appreciation of autonomy ²⁰ and poverty ²¹ were not stated as facilitators of these types of pregnancy. In this sense, it was reflected that there may be a limitation to this result due to the fact that the questionnaire was designed to remember the most latent meanings when listening to or reading the proposed terms ¹³ , restricting the possibility of participants accessing other, more specific meanings. On the other hand, regarding the perception that misinformation about contraceptive methods is not a facilitator, this was in agreement with the reports carried out three decades ago by the National Institute of Statistics and Geography ² on the increase in knowledge and use of these methods among the young population, indicating the existence of other elements such as, for example, failures in the use of contraceptives by adolescents. Other resulting coincidences were: the view that unplanned and unwanted pregnancies affect the mental health of adolescent women ^4,9,19,20 , that the term “unwanted child” is associated with events such as child abuse and problems with the birth and development of the child ^{21, 22} , that there are fewer employment and educational opportunities for young parents, and that the interference in the mother’s physical health was not seen by the participants ²². Such risks can be resolved and eliminated with a good diet and adequate prenatal care, with the real danger being the stress generated by changes in one’s life plan and the risks of a lower probability of access to an adequate quality of life ²² . As limitations of the study, negligent attitudes towards the use of contraceptives could not be explained, probably due to the evocative methodology. However, Winkler ²³ describes that the non-use of contraceptive methods may be due to beliefs such as that pregnancy will not occur, that there is no control over sexual desire or that contraceptives are not requested out of pity. Oviedo argues that the meanings associated with pregnancy during the transition from childhood to adulthood are the reason for this negligence, and explains that the consolidation of femininity is based on learning and exercising motherhood, and that, since this is a discourse learned and gradually naturalized over the years, negligence results from an unconscious impulse to consolidate one’s role as a woman ²² . Regarding the results, as Álvarez-Neto mentions, the motivations for unplanned and unwanted pregnancies are uncertain ¹⁸ . Although it is clear that they depend on sociocultural aspects and the socialization of these ideas among women, elements that were able to be described for the group addressed in this study, while other elements were identified, although subtle, were useful for understanding the differences between the terms unplanned and unwanted pregnancy. This allows us to glimpse that there is a mainly negative value to unwanted pregnancy, in which it is assumed that the child will need well-being, while unplanned pregnancy has a more positive value, in which it is expected that it can benefit the mother in some way by overcoming the obstacles that it represents. It is concluded that the social representations of unplanned and unwanted pregnancy focused on adolescent women, students and economically dependent on their parents, which demonstrates a clear stereotype around the two terms mentioned, although it can generate stigmatization and hinder the possibilities of intervention and education in this population. In this sense, it is recommended to further study this phenomenon of the subjectivities of adolescents themselves, also including the perspective of adolescent men. CONSIDERATIONS Authorship contributions: All authors participated equally in the project design, data collection, information analysis, writing of the article and approval of the final version of the manuscript. Conflicts of interest: None to declare. Acknowledgements:The researchers would like to thank the young participants for making the research possible, as well as the anonymous reviewers assigned to the manuscript for their valuable contributions to improving its quality.

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