Public concern over adolescent sexual wellness and the declarations to these concerns has over the past three decennaries generated political argument and academic enquiry the universe over. At the nucleus of adolescent sexual wellness is the issue of adolescent gestation. South Africa has non been spared from the challenges teenage gestation nowadayss. Inquiry into adolescent gestation in South Africa began in the 1980s. In an attempt to command the prevalence of teenage gestation, faculty members and policy shapers likewise have developed assorted schemes and policies aiming adolescents. Yet three decennaries subsequently, teenage gestation still remains a topical issue in South Africa.
About 16 million adolescent misss between 15 and 19 old ages give birth each twelvemonth worldwide, and 80 % of these misss are found in developing states ( World Health Organisation, 2010 ) . In South Africa, 40 % of all births involve misss under the age of 19 old ages, and 35 % of these adolescents, give birth before making the age of 19 old ages ( Medical Research Council, 2009 ) .According to the Department of Basic Education ( 2009 ) , in South Africa, a sum of 45,000 adolescents were pregnant in 2008, while the figure increased to 49,000 in 2009.
This chapter examines literature on teenage gestation, and will help in supplying principle and context for this survey. This literature reappraisal will divert from the traditional Knowledge, Attitude and Perception ( KAP ) literature surveies that isolate persons from societal, cultural and economic contexts that influences and determine their lives. The failing of KAP surveies is that they do non admit the consequence of cultural, economic and social factors on human behaviour. Jewkes et Al. ( 2001 ) add that KAP surveies on teenage gestation in South Africa have chiefly been descriptive and do non do an attempt to account for the spread between cognition, attitude and perceptual experience. In attempt to account for these disagreements, and come up with spreads in adolescent gestation research, this literature reappraisal has been divided into the undermentioned two subdivisions ( I ) the effects of kid bearing on adolescents, and ( two ) factors lending to teenage gestation.
Consequences OF Childbirth FOR TEENAGERS
The challenge of unplanned and unwanted gestation for a adolescent has long-run effects, non merely for the female parent, but for society as a whole, with far-reaching deductions for economic and societal development. Mpanza ( 2010:66 ) puts frontward that “ adolescents who drop out of school due to pregnancy ne’er do good after they return from childbearing ” , this can be attributed to split truenesss between taking attention of the kid and continuance of school. Because of its normally unwanted and unplanned nature, adolescent gestation ever poses a wellness and societal hazard, a point farther supported by Edgardh ( 2000 ) , Genius and Genius ( 2004 ) , Santelli ( 2000 ) , and Petiffor et Al. ( 2004 ) . These surveies confirm that early sexual induction is a forecaster of hazardous sexual behavior and is more likely to be non-consensual, unprotected and to be later regretted, ensuing in unplanned and unwanted gestation.
While the effects of teenage gestation are varied, it is of import to admit that adolescent gestation is a consequence of a complex set of varied, but interconnected factors. An apprehension of these factors will enable a better apprehension of the cognition, attitudes and perceptual experiences of adolescents towards adolescent gestation.
Break of school
Teenage gestation has the potency of restricting a scholar ‘s future calling chances. For the pregnant scholar, impending maternity forces her to drop out of school as she is unable to go on analyzing ( Macleod & A ; Tracey, 2009 ) . Learners are forced to go forth school when their gestation has progressed as schools are “ considerate of their province ” ( Bhana & A ; Swartz, 2009 ) . The Department of Education ‘s ( DoE ) 2007 Measures for the Prevention and Management of Learner Pregnancy “ makes it possible for pedagogues to ‘request ‘ scholars take a leave of absence for up to two old ages ” ( Macleod & A ; Tracey, 2009:15 ) . Even with statute law in topographic point, pregnant adolescents are sent off from school earlier than they should ( ibid ) . This is likely due to the perceptual experience that pregnant scholars are a bad influence to other scholars.
Vagueness and ambiguity of the instruction guideline presents a challenge to the pedagogues who are left to construe it at their discretion. For case, the papers puts the duty of rearing steadfastly on the scholar, and states that a “ period of two old ages may be necessary for this intent. No scholar shall be should be re-admitted in the same twelvemonth that they left school due to gestation ” ( DoE, 2007:5 ) , pedagogues are left to make up one’s mind how long the scholar stays off from school. This opinion may be in struggle with the desires of the immature female parent who may hold sufficient support at place, which enables her to return to school before than expected ( Bhana & A ; Swartz, 2009 ) .
Young male parents are besides affected by gestation, albeit otherwise. It has been reported that impending paternity, cultural and social outlooks may coerce the immature male parent to go forth school and seek employment. This is conditional as it depends on whether the male child accepts duty or non ( Shefer & A ; Morrell, 2012 ; Bhana & A ; Swartz, 2009 ) .
However, Macleod and Tracey ( 2009 ) argue that the degree of break caused by gestation on scholars is problematic as scholars drop out of school for assorted grounds of which teenage gestation is one. Preston-WhyteA and Zondi ( 1992 ) concur with this averment. Manzini ‘s ( 2001 ) survey of adolescent gestation in KwaZulu-Natal ( KZN ) indicates that more than 20.6 % of pregnant adolescents had already dropped out of school before falling pregnant. Apart from falling pregnant, adolescents may go forth school due to defeats associated with the rawness of instructors, who frequently are required to learn in countries that are non their expertness, and a deficiency of relevancy of the course of study and instruction stuffs ( Human Science Research Council, 2007 ) . Among factors within the place that led to drop-out, scholars in this survey cited the absence of parents at place, fiscal troubles and the demand to care for siblings or ill household member.
Strassburg et Al. ( 2010 ) and Fleisch et Al. ( 2010 ) concur with the 2007 HRSC findings and assert that the grounds adolescents drop out of school are a combination of inter-related factors. As such, Fleisch et Al. ( 2010 ) note that poorness entirely can non outdo explain why adolescents drop out of school, because there are other factors such as academic ability of the adolescent, teacher-pupil relationship, support from place and school, intoxicant and drug maltreatment and household construction that contribute to school dropout.
Lloyd and Mensch ( 1995:85 ) summarize the assorted grounds why adolescents may drop out of school by saying that,
Rather than gestation doing misss to drop out, the deficiency of societal and economic chances for misss and adult females and the domestic demands placed on them, coupled with the gender unfairnesss of the instruction system, may ensue in unsatisfactory school experiences, hapless academic public presentation, and acquiescence in or indorsement of early maternity.
However, pregnancy ranks among the top subscribers to school dropout for misss in South Africa ( HRSC, 2009 ) .
While gestation may non be the ground for go forthing school, kid attention is a ground for non returning to school. Manzini ( 2001 ) indicates that immature female parents, who have to take attention of their babes, and happen it hard to beguile pupil life and being a female parent, finally drop out. Assorted grounds for non returning to school have been explored, among them being a deficiency of a support construction, fiscal challenges and entree to a Child Support Grant ( CSG ) . Research in South Africa indicates that adolescents who do non hold support from their households and battle financially one time the babe is born, normally dropout of school so as to supply for the babe and themselves ( Bhana & A ; Swartz, 2009 ) . On the other manus, surveies in Brazil and Guatemala indicate that misss are forced to look for occupations to supplement household income and take attention of the new household member ( Hallman et al. , 2005 ) .
Young female parents who have support constructions in the signifier of parents and grandparents have an chance of returning to school ( Grant & A ; Hallman, 2006 ) . Matthews et Al. ( 2008 ) concur and maintain that the presence of an older female in the household enables scholars to return to school, while the absence of the same forces them to look for alternate ways of doing a life. This is the same with teenage male parents who have accepted duty and have household that is prepared to back up the kid ( Bhana & A ; Swartz, 2009 ) . The return to school in South Africa is motivated by a desire for a better life. Anecdotal grounds suggests that parents of African teenage female parents normally send the adolescent back to school, since she has a higher opportunity of bringing high bride monetary value in the event that she gets married. In the African belief system, an educated adult female is bound to bring a higher monetary value than that of an uneducated one ( Macleod, 2009 ; Mkwananzi, 2011 ; Bhana, Swartz & A ; Morrell, 2012 ) . Kaufman, de Wet and Stadler ( 2000 ) concur, adding that the fact that the adolescent has proven her birthrate really increases her opportunities of matrimony in future. Interestingly, adolescents in Hlabangana ‘s 2012 survey in Soweto ( South Africa ) indicated that falling pregnant before matrimony decreases the bride monetary value, as prospective grooms consider the teenage female parents as ‘used goods ‘ . Reasons for returning to school after gestation may change for both sexes, but the of import portion is that the adolescent is back in school.
Clearly the effects of adolescent gestation on the adolescent vary for the immature parents, the difference may lie in the fiscal fortunes of the adolescents ‘ household and on the portion of the immature male parent whether or non he accepts duty of the gestation. The effects of dropping out of school for teenage misss due to pregnancy can non be overestimated, particularly in a continent where the proverb ‘when you educate a adult female, you educate a state holds true ( Hubbard, 2009: 223 ) . The chief push of the survey is to understand why adolescents continue falling pregnant in the face of attempts by the South African authorities in seeking to pull off adolescent gestation. In an attempt to command and pull off adolescent gestation, the authorities has provided youth-friendly clinics, life accomplishments programmes in schools and is presently on a much opposed thrust to provide rubbers in schools. Resistance for administering rubbers in schools comes from parents who fear that by administering rubbers in schools, adolescents are given indirect permission to indulge in sexual activities.
In visible radiation of the attempts made by the South African authorities and a decennary of disbursement on adolescent gestation direction, figures still indicate that teenage gestation rates are on the addition countrywide. Break of school, as a effect of adolescent gestation virtues scrutiny in this survey, as it will enable an apprehension of their sensed consequence of teenage gestation on immature misss who are pregnant.
Research on wellness hazards associated with early childbearing in adolescents is chiefly divided into two chief cantonments. One cantonment argues that adolescents are at hazard of wellness jobs due to their socio-economic position. The other cantonment, which is scientific, argues that age at first childbearing puts immature adult females at hazard of wellness jobs as she is non mature plenty to force the babe, and this proves fatal to both female parent and kid. Some immature female parents who have assisted births end up holding obstetric complications such as hemorrhaging and harm to the uterus. Macleod ( 2009 ) identifies dearth of research in South Africa in footings of wellness hazards associated with early childbearing.
Age at first kid birth contributes to a scope of complications, including pregnancy-induced high blood pressure, anaemia, obstructed and prolonged labors, low birth weight, preterm labour and bringing, perinatal and infant mortality, and maternal mortality ( WHO, 2007 ) . These complications are normally associated with the physical immatureness of adolescents, an averment that Cameron ( 1996 ) supports and adds that limited entree to wellness attention services is another lending factor to the scope of complications. He suggests that “ complications become more marked when the adolescent decides to end gestation ” ( Cameroon, 1996:83 ) .
In South Africa, the Choice on Termination of Pregnancy Act ( No. 92 of 1996 ) allows bush leagues under the age of 18 old ages to end a gestation without the consent of either parents or defenders. Manzini ( 2001 ) suggests that due to wellness forces attitudes, adolescents are forced to hold insecure abortions, which may take to decease. Lack of support construction before and after expiration possibly the ground for adolescents fall backing to ‘self-administered expirations ‘ and this normally leads to irreversible harm to the uterus or even decease ( Petiffor et al. , 2005 ) .
Sexually active immature male parents face different wellness challenges from those of the immature female parent and kid. Bhana and Swartz ( 2009 ) indicate that immature male parents in Cape Town ( South Africa ) , frequently have multiple and coincident spouses ( MCP ) , and this puts them at great hazard of undertaking and distributing HIV. However, they are speedy to advert that impending paternity for those that have accepted duty is cause for behaviour alteration. MCPs are one of the chief drivers of the spread of HIV ( Halperin & A ; Epstein, 2007 ) . Young work forces put themselves at hazard by practising unprotected sex with multiple spouses who themselves may be portion of a potentially sexual web.
Geronimus and Sanders ( 1992 ) observe that immature African American adult females who live in conditions of poorness are more prone to jobs as they are unable to entree pre- and post-natal attention. They note that this is different for white teenage female parents who are the majority of teenage female parents in America. Geronimus and Sanders ( 1992 ) suggest that this may be due to the differences in economic position of the adolescents. Macleod ( 1999 ) points out that despite their socio-economic position, teenage female parents barely of all time entree pre- and post-natal services. This may be due to the ‘stigma ‘ associated with teenage gestation, and may besides be due to the attitudes of service suppliers. While surveies may site negative attitudes of staff towards adolescents ( Wood & A ; Jewkes, 2003 ) , Ehlers ( 2003 ) paints a more positive image, reasoning that youth-friendly services initiated by South Africa ‘s Department of Health ( DoH ) have made great paces in turn toing the stigma attached to adolescent gender.
The Child Support Grant ( CSG )
Social grants or aid can outdo be described as non-contributory hard currency transportation programmes set up by the authorities for the under privileged, aged or vulnerable ( Grosh et al. , 2008 ) . Social grants are really of import as they assist in relieving poorness, cut downing the degree of exposure of vulnerable groups in society and supplying societal insurance to the vulnerable groups in society ( Neves et al. , 2009 ) .
The CSG was foremost introduced in South Africa in April 1998 as a poorness relief scheme for the poorest kids ( Parliamentary Liaison Office, 2007 ) . Initially restricted to kids under the age of seven old ages, it was subsequently extended to include 14 twelvemonth olds in 2003. Harmonizing to Hall ( 2011 ) , the CSG pay-out in 2011 was R275 per month per kid.
A batch of argument surrounds the CSG and adolescent gestation in South Africa with the media fuelling the sentiment that adolescents fall pregnant to entree the CSG. Popular sentiment provinces that the CSG has led to a perverse inducement for adolescents to gestate and travel on to pass the money on personal goods ( Macleod, 2006 ) . In response to the media call, the Department of Social Development ( DSD ) commissioned research into the affair in 2006. The research concluded that there was no direct relationship between CSG and adolescent gestation ( Kesho Consulting, 2006 ) . Other research by Makiwane and Udjo ( 2006 ) concluded that there is no grounds that the CSG leads to an addition in public assistance dependence in South Africa. Furthermore, during the period in which the CSG has been offered, rates of expiration of gestation have increased ( Macleod, 2009 ) . In 1998, when the CSG was introduced, abortion rates were at 4.1 % , a decennary subsequently abortion rates were at their all-time high of 8.1 % , and in 2011 they were at 6.3 % . Macleod ( 2009 ) suggests that the high rate of abortion amongst adolescents, in the face of the CSG, is grounds that there is no relationship between the CSG and adolescent gestation.
Matsidiso Nehemia Naong ( 2011 ) concurs with research that indicates that there is no nexus between the CSG and adolescent gestation. In her survey of three of South Africa ‘s states ( Free State, Mpumalanga and Eastern Cape ) , Naong ‘s sample of 302 school principals and 225 Grade 12 scholars indicated that there was no relationship between the CSG and adolescent gestation. Alternatively, the survey concluded that poorness, peer force per unit area and substance maltreatment contributed to teenage gestation. Naong concludes that teenage gestation and CSG are divorced and any influence between the two is negligible.
Interestingly plenty, anecdotal grounds suggests that more and more adolescent misss are falling pregnant in an attempt to entree the CSG so as to complement family earning or in some cases the CSG is the chief beginning of income. In such instances teenage gestation ceases to be unplanned and becomes planned and unwanted. In a 2005 survey of CSG usage in KZN, Case, Hosegood and Lund ( 2005 ) showed that 12.1 % of pregnant adolescents who had conceived cited the CSG as the ground. Tyali ( 2012 ) in his survey of HIV and AIDS communicating in Platfontein ( South Africa ) found that adolescents were intentionally falling pregnant so as to entree the CSG, while others wanted to entree the HIV and AIDS grant.
Marsh and Kau ‘s ( 2010 ) survey of adolescents ‘ perceptual experiences and apprehension of adolescent gestation, gender and abortion concurs with Tyali ‘s ( 2012 ) decision that adolescents intentionally fall pregnant to entree the CSG. Using a population sample of 35 adolescents ( 24 misss and 11 male childs ) , Marsh and Kau ( 2010 ) discovered that the CSG was perceived as agencies of increasing household income, by holding a babe, the adolescent so contributes towards the family income through entree of the CSG. Interestingly, Marsh and Kau ‘s research population indicated that the influence or force per unit area to bear kids in order to entree the CSG came from household. On the other manus other adolescents viewed the CSG as a manner of increasing the pocket money for apparels and cell phones.
On the other manus, the CSG has been credited with enabling adolescent female parents to return to school. “ The CSG is associated with an addition in school attending and improved child wellness and nutrition. Therefore, the grant can be associated with an betterment in the lives of kids whose health professionals receive the CSG on their behalf ” ( Macleod, 2009:24 ) .
It will be interesting to happen out how adolescents perceive the relationship between the CSG and adolescent gestation. Their attitudes sing the grant will besides be of import in the preparation of a communicating intercession, and finally contribute towards attempts to pull off adolescent gestation rates.
CONTRIBUTING FACTORS TO TEENAGE PREGNANCY
The present survey does non look at pregnant adolescent ‘s cognition, attitudes and perceptual experiences towards adolescent gestation ; alternatively it focuses on non-pregnant adolescents ‘ cognition attitudes and perceptual experiences towards adolescent gestation. Having said that, lending factors to teenage gestation virtue geographic expedition as these factors will cast visible radiation on cognition, attitudes and perceptual experiences towards adolescent gestation. Understanding how adolescents make significance of teenage gestation through their cognition, attitudes and accomplishments is of import in peculiar if this apprehension is viewed through the contributory factors to teenage gestation.
Lending factors to teenage gestation are of import for this survey as they will set the survey in context and enable the research worker non to take the revisionist and reductionist attack towards adolescent gestation. The reductionist and revisionist attacks to teenage gestation ignore other non-sexual factors that contribute to teenage gestation. The undermentioned contributing factors were evident in this reappraisal of the literature and will be dealt with in the undermentioned subdivisions:
Family is an of import unit for socialization as it enables the sharing of beliefs and ideals that lead to social norms. Research indicates that household dealingss are an of import facet in adolescent gestation rates. Eaton ( 2003 ) and Bhana ( 2004 ) found that adolescents with individual parents were prone to risky sexual behavior, and gestation compared to those with both parents. This may be attributed to issues to make with shared control and duty of both parents, whereas in individual household parents control is vested in one parent. Family form becomes a protective status to immature people. Muchuruza ( 2000 ) concurs and puts forward that in Tanzania adolescents coming from individual parent households have hazardous sexual behavior and are more likely to go immature parents. Where the individual parent struggles to supply for the miss kid, the miss is at greater hazard of gestation as she has to look for agencies of endurance and normally this is achieved through intergenerational relationships. The major ground why adolescents engage in intergenerational relationships with older work forces and adult females is that they see them as suppliers of societal position symbols such as brassy cell phones and jewelry, while at the same clip taking attention of their basic demands. Such relationships jeopardize the wellness of the two people involved as the adolescent is unable to negociate for safe sex because of fright of losing their economic ends ( Leclerc-Madlala, 2008 ) . Most documented research on intergenerational relationships is between misss and ‘sugar dadas ‘ . These ‘sugar dadas ‘ feel that such relationships are transactional hence there is no demand for them to utilize protection ( ibid ) . Such relationships leave the adolescent vulnerable to HIV and AIDS, gestation, Sexually Transmitted Infections ( STIs ) and to sexual use.
Bhana ‘s ( 2004 ) Cape Town ( South Africa ) survey found that 66 % of the adolescents reported that household norms enabled them to hold people to rede them on how to populate a constructive life, while 55 % said that handiness of household members acted as beginning of control for their sexual behavior. This is grounds that household dealingss play an of import portion in the behavior of adolescents and most significantly their sexual behavior.
The presence of a responsible biological male parent encourages misss to detain their sexual introduction and instils in male childs a sense of sexual duty. Blum and Mmari ( 2005 ) point out that the presence of a male figure in a family and their attitude to sexual behavior dramas an of import portion in act uponing adolescents ‘ sexual behavior. They found that misss with male parent figures who were against prenuptial sex were less likely to prosecute in prenuptial sex and experience unplanned gestation, compared to those with father figures who had sexually permissive attitudes and those without male parents. In the same context, Loving ‘s ( 1993 ) probe into the connexion between household relationships and teenage gestation in Durban ( South Africa ) , established that warm relationships between male parents and their girls played an of import function in detaining immature misss ‘ sexual induction.
Mfono ( 2008 ) holds the position that teenage misss whose female parents were adolescent female parents themselves have a greater opportunity of being adolescent female parents. Arai ( 2008 ) observed that in Britain and America, the girl of a teenage female parent is one and a half more likely to go a adolescent female parent herself than the girl of an older female parent. This, harmonizing to Hlabangana ( 2012 ) is due to the fact that these adolescents come from communities where it is ‘normal ‘ to be a teenage female parent, since about everyone has been or is a teenage female parent. The HRSC ‘s 2008 survey of perceptual experiences towards adolescent gestation in Johannesburg, Cape Town and Durban ( South Africa ) coincides with Hlabangana ‘s averment that teenage gestation has been normalised. Harmonizing to the respondents of the HRSC survey, non-pregnant adolescents are viewed as the ‘other ‘ , and are asked when they excessively will be pregnant. Such attitudes make adolescent gestation a manner of life, and adolescents themselves view adolescent gestation as a world that forms a portion of mundane life instead than an foreign happening ( HRSC, 2008 ) .
This rhythm self-perpetuates from one coevals to another until it becomes ‘acceptable and normal ‘ for adolescents to fall pregnant. The intergenerational rhythm is a consequence of a deficiency of upward mobility ; upward mobility is an person ‘s ability to lift above their current societal or economic place ( Hlabangana, 2012 ) . Arai ( 2008 ) considers this ‘low outlook ‘ on the portion of adolescents, as one of the grounds that perpetuates the intergenerational rhythm of adolescent gestation. This she attributes to structural factors in disadvantaged communities such as schools that fail to give adolescents a ground to experience entitled to anything. Knowledge, attitudes and perceptual experiences of adolescents towards adolescent gestation may be rooted in the ‘lack of upward mobility ‘ that Arai refers to.
Arai ( 2008 ) notes that in Britain, the low outlook statement for teenage gestation is a powerful one as evidenced by many British research workers ( Garlick et al. , 1993 ; Rosato, 1999 ; Selman, 1998 ; Smith, 1993 ; Wilson, 1991 ) . She puts frontward that in Britain, teenage gestation is really high amongst adolescents who do non hold household support, come from broken places, are raised by individual parents, have trouble with school and who come from socially disadvantaged backgrounds. Harmonizing to Arai ( 2008 ) , adolescents from such backgrounds have entree to contraceptive method and sexual wellness information, but display a lack in their cognition of sexual wellness, proper preventive usage, are diffident to prosecute in sexual wellness communicating and are wary to entree services for sexual wellness.
In a 1999 survey in Northumberland, Britain, it was discovered that teenage parents had low educational accomplishment and low outlooks of their hereafter prior to their parentage Arai ( 2009 ) . She notes that these adolescents went on to hold low paying occupations where they had to work long hours. In another Scots survey, ( Smith,1993 in Arai, 2009 ) observed that adolescents from deprived backgrounds were six times likely to fall pregnant and so abort than their counter parts from good to make countries. These surveies, validate Arai ( 2009 ) and Hlabangana ‘s ( 2009 ) impression of upward mobility and entitlement for more on the portion of the adolescents.
Interestingly, Rutenberg et Al. ( 2003:5 ) in their survey of attitudes towards HIV and AIDS and adolescent gestation in KZN ( South Africa ) discovered that “ for some striplings, increasing chances and aspirations for instruction and employment, in add-on to the perceived hazard of HIV and gestation, consequences in many striplings non desiring an early gestation ” . Rutenberg et Al. ‘s survey, validates Arai ‘s ( 2008 ) and Hlabangana ‘s ( 2009 ) averment that adolescents with a low sense of upward mobility are most likely to happen themselves as teenage parents while those with a high degree of upward mobility are most likely to forestall themselves from early parentage. This survey will seek to unearth these changing kineticss in an attempt to understand adolescents ‘ attitudes towards other adolescents who fall pregnant.
Pregnancies among adolescents are related to societal jobs, and this is prevailing in developing states and in peculiar poorness afflicted communities. Hazardous sexual behavior among adolescents are more likely to happen in hapless households and those with individual households. Lack of resources forces misss to go sexually involved in an attempt to acquire material additions ( Jewkes, Morrell & A ; Christofides, 2009 ) . Hallman ( 2004 ) found that in South Africa low income households contributed to risky sexual behavior among immature people in both rural and urban countries. The survey argues that low income histories for misss ‘ determination to prosecute in hazardous sexual behavior in seeking to do ends meet. Macleod ( 2009 ) and Manzini ( 2009 ) concur with Hallman, and farther add that immature people from low economic positions are most likely non to utilize rubbers. This is attributed to deficiency of entree to wellness services, generative wellness information and proper support constructions from other societal establishments.
Adolescents who find themselves in intergenerational relationships find themselves unable to negociate safe sex patterns in fright of endangering their economic ends ( Panday et al. , 2009 ; Leclerc-Madlala, 2008 ) . Many immature adult females non merely prosecute in hazardous sexual activities to run into their basic ‘needs ‘ such as money, nutrient and vesture, but besides to fulfill ‘wants ‘ such as expensive cell phones, high-toned jewelry and drives in luxury autos ( Hunter, 2002 ; Leclerc-Madlala, 2004 ) . Opportunities of teenage gestation become high when the adolescent comes from a place without big supervising and most likely hapless economic standing. Mfono ( 2003 ) confirms these statements saying that adolescents are at high hazard of gestation if they come from financially disadvantaged backgrounds, or if they succumb to peer force per unit area to prosecute in sexual activities for economic addition.
On the other manus, teenage misss reject the transactional sex talk and province that they are able to do make with what is available without holding to prosecute in intergenerational and transactional relationships with older spouses. Sathiparsad and Taylor ‘s ( 2011 ) survey of 335 misss and male childs in eThekwini Secondary Schools in Durban ( South Africa ) revealed that misss view themselves as independent and rational minds. These misss suggested that they do non believe that sex is synonymous with love, and assert their power as persons by their ability to state no to unprotected sex. This is declarative of misss defying use and normative entry ( ibid ) . For the intents of this survey, it will be interesting to happen out how adolescents perceive economic position as a lending factor to teenage gestation.
The South African DoH ‘s Policy Guidelines for Youth and Adolescent Health ( 2001 ) locates gender considerations as cardinal to the wellness of immature people. The policy guidelines identify sexual wellness and sexual development, sexual maltreatment, gender-based force, coercive sex and pack colzas as countries of concern that put immature adult females in peculiar at hazard of HIV and AIDS and adolescent gestation.
Dunkle et Al. ( 2004 ) in their survey of immature adult females go toing ante-natal clinics in Soweto ( South Africa ) discovered that over half of the adult females aged between 15 and 30 old ages had been exposed to sexual force. Another study, conducted by the Planned Parenthood Association of South Africa ( PPASA ) in six of South Africa ‘s states, found that 20 % of misss reported forced sexual brushs or were sexually assaulted ( PPASA, 2003 ) . Similarly, Vundule et Al. ( 2001 ) found that 33 % of misss in South Africa have their first intercourse as a consequence of force, including colza. Where there is unequal power distribution and deficiency of dialogue accomplishments, gestation ceases to be a affair of pick.
Sexual force alters the power dealingss in any relationship, and in most instances adult females are vulnerable and unable to negociate safe sex. Adolescents may avoid negociating prophylactic use, in peculiar rubbers, for fright non merely of violent reactions, but besides of emotional rejection, of being labelled unfaithful or HIV positive ( Wood, Maforah & A ; Jewkes, 1998 ) . Furthermore, adult females trying to utilize other ‘invisible ‘ prophylactic methods, such as the injection, may be accused by their spouses of doing ‘infertility, ‘disabled babes ‘ and vaginal ‘wetness ‘ , which diminishes male sexual pleasance ( ibid ) . Clearly, work forces have the upper manus on sexual affairs as adult females are constrained by their low-level place in gender and societal hierarchy, forced and coerced sex and unavailability of contraceptive method ( Jewkes et al. , 2001 ; Wood & A ; Jewkes, 2006 and Macleod, 1999 ) . Sexual force is more marked between immature misss and their older spouses, where the relationship is founded on stuff addition on the portion of the adolescent ( ibid ) .
In visible radiation of prophylactic dialogue, adolescents are coerced into holding sexual dealingss with their spouses, go forthing them vulnerable, non merely to gestation, but to HIV. The work forces have control over gender, and as Wood and Jewkes ( 2006 ) put frontward, some adolescents view coercive sex as an look of love and as an inevitable portion of relationships. Sexual force besides increases the opportunities of repetition gestation. In Sweden, Ekstrand ( 2008 ) notes that rubber dialogue is besides peculiarly hard between adolescents and older spouses and between adolescents themselves. Ironically, Swedish adolescents agree that contraceptive method is the duty of both spouses, though some misss want the duty to be borne by the male childs entirely.
Bhana et Al. ( 2008 ) challenge misss ‘ submissiveness when it comes to sexual intercourse. They put frontward that misss are non ever the victims of male childs ‘ behavior towards prophylactic usage. Bhana et Al. ( 2008 ) note that misss are besides sexual agents, who engage with male childs on a sexual degree, make determinations and picks consensually and sometimes coercively. Bhana et Al. ‘s averment seems to formalize Bhana and Swatz ‘s ( 2009 ) decision that male childs are besides victims of misss who refuse to utilize rubbers and even lie to acquire their ain manner when it comes to unprotected sex. Clearly rubber dialogue is a contested terrain and virtues geographic expedition in this survey.
Sathiparsad and Taylor ( 2011 ) in their survey of 335 adolescents in eThekwini secondary schools in Durban ( South Africa ) found that boys deliberately impregnated misss so as to ‘mark ‘ these misss as their ain and guarantee ownership. This ‘ownership ‘ ritual is perceived as a method of guarding off other male childs and likely older work forces who are viewed as menaces since they have more economic power than the adolescents. Harmonizing to Sathiparsad and Taylor ( 2011 ) these male childs construct themselves as in control of the determination doing associating to when sex take topographic points and what happens afterwards. These immature work forces ‘s positions on maleness may be a merchandise of socialization, where immature work forces are brought up to believe that they are better than their female opposite numbers, and that a adult male is ever in control. As Arai ( 2009 ) and Jewkes and Wood ( 2008 ) put it, adolescent gestation is best understood within the context in which it takes topographic point. This means that for teenage gestation to be understood at that place needs to be an apprehension of the background from which these immature male childs are coming from. One such background is where they are considered as the ‘other ‘ in the discourse around adolescent gestation.
While South African male adolescents may infuse misss as a mark of ownership and a mark of maleness, Australian teenage boys perceive holding babes as a mark of beef uping dealingss. In their survey of 350 Australian teenage male childs, Corkindale et Al. ( 2009 ) found that Australian male childs perceive holding babes as a manner of adhering with their spouses though they are speedy to hold that babes are a large duty that needs money, money these adolescents do non hold. Corkindale et Al. ‘s survey is really interesting as these adolescent male childs deviate from the ‘norm ‘ where misss want to hold babes to beef up relationships and non the other manner unit of ammunition. It will be interesting to happen out the perceptual experience and attitudes of adolescents under survey in this research towards holding babes as a manner of jumping in peculiar from the male childs.
Much discourse on teenage gestation focuses on the misss who bear and suffer the effects of teenage parentage. Very small is said about the males who go on with their lives with small or no break at all. Disregarding male childs and work forces as portion of the job is retrograde to the cause of pull offing adolescent gestation degrees ( Masuku, 1998 ) . Some schools in KZN make certain that if the male parent is a pupil at the same school, he is sent off together with the pregnant miss and come back when the miss besides comes back after giving birth ( Mpanza, 2010 ) . While this may at base seem as ‘justice ‘ , there is a impudent side to it being youth delinquency. Mpanza ( 2010 ) contends that this truly does non work out the job at manus, but instead creates a new one, which is societal delinquency. Bhana and Swartz ( 2009 ) concur though they argue that teenage male parents feel a moral duty to take attention of the new household though they are unable to make so.
Age at first sex/ Sexual introduction
Age at first sex has been identified as another lending factor to teenage gestation. For misss, early age at oncoming of catamenial rhythm increases the possibility of gestation at an early age and the hazard of undertaking HIV. The average age of oncoming of catamenial rhythm in South Africa is 13 old ages, and the average age at first sex is 17 old ages for misss and 16 old ages for male childs ( Reproductive Health Research Unit, 2003 ) . The 2003 RHRU study on HIV and sexual behavior among immature people in South Africa explored sexual behavior and perceived hazard towards HIV infection. The study concluded that South African immature people are at hazard of HIV infection, and perchance teenage gestation because they have low self-efficacy and under estimate their hazard to HIV and other STIs. It was besides found out in the study that age at sexual introduction increased opportunities of adolescent gestation.
Age at sexual introduction is affected and influenced by assorted protective and hazard factors. A positive relationship with parents and instructors, keeping religious beliefs and go toing school is associated with a lessening in the likeliness of early sexual introduction. In contrast hazardous sexual behavior, deficiency of equal information on sexual wellness, low economic position and holding sexually active friends is associated with early sexual introduction ( WHO, 2008 ) .
Early on sexual introduction is a hazard factor for unwanted and unplanned teenage gestation. Macleod ( 2009 ) suggests that this has to make with unequal power dealingss in the relationships immature adult females find themselves in. Timing of adolescent sexual introduction is an of import variable in the adolescent gestation discourse as it affords adolescents an chance to at least have information on sexual wellness ( Crockett, 2004:2 ) . Crockett concludes that at sexual introduction adolescents do non utilize protection due to miss of information. Bhana and Swartz ( 2009 ) add that adolescents at first sex do non cognize the effects of prosecuting in sexual activities and are ‘saddened ‘ when they have to cover with the consequences.
Peer force per unit area is a important variable in age at first sex. Adolescents with allegedly sexually active friends find themselves giving in to coerce to prosecute in sexual activities. Pressure is increased where the miss comes from an destitute background, and is driven by the desire to ‘change ‘ their fortunes and tantrum in the circles. Dlamini et Al. ( 2009 ) put forward that friends act upon the determination to prosecute in sex. Teenage old ages are a critical period in the geographic expedition and development of gender individuality. For this ground, Wood and Jewkes ( 2009 ) province that in the context of poorness and limited options, procuring and keeping sexual dealingss is critical to both misss and male childs.
Delaying sexual introduction has been proposed as a agency of controling unwanted and unplanned gestations. However, as indicated earlier on this is complex adolescents ‘ gender is affected by assorted grounds “ runing from, peer group ini¬‚uences which may lend to credence of sexual aggression and the male dominant civilization ” ( Dlamini et al. , 2009: three ) . Given the desire to pull off and cut down teenage gestation prevalence, bring outing factors associated with sexual introduction hold virtues geographic expedition in the survey.
Research grounds indicates that adolescents are cognizant of preventives in all their assorted signifiers ( Rasch et al. , 2000 ; Jewkes et al. , 2001 ; Manzini, 2001 ; Dunkle et al. , 2007 ; Mfono, 2008 ; and Macleod, 2010 ) . However, statistics on preventive usage, teenage gestation and HIV infection rates indicate that preventive usage is fickle ( RHRU, 2003 ) . Knowledge, harmonizing to Macleod ( 2009 ) is an indispensable, but non sufficient, component for effectual prophylactic use. As discussed earlier, cognition besides does non interpret to wellness confirming behavior. This will besides deserve look intoing in the survey utilizing a broader theory that does non disregard non-sexual factors that may act upon teenage gestation.
Contraceptive usage is a extremely contested sphere for most striplings, and as a consequence forestalling an unwanted gestation that may ensue in abortion is non that easy. This is chiefly due to factors such as schools, churches, non-governmental administrations, nurses, adolescent misss ‘ female parents and male sexual spouses who may play a polar function in the determination devising procedure, and may direct contradictory messages to striplings such as preventives can ‘completely barricade the tubings ‘ ( Warenuis et al. , 2006 ; Woods & A ; Jewkes, 2006 ) .
Emphasis has been placed on rubber instruction since the rubber serves a double intent as it protects against gestation and contraction of STIs.Rutenberg et Al. ‘s ( 2001 ) family study in Durban and Mtunzini ( South Africa ) measuring immature people ‘s apprehension of gestation hazards, found that 8 % were cognizant of the catamenial rhythm and the times adult females are most fertile for gestation during this period. The research sample comprised of Blacks, Indians and Whites. Knowledge increased with age, with the white population holding more cognition than other races. At least 80 % of the sample ( both misss and male childs ) knew that a adult female could acquire pregnant if she had sex merely one time. Most of the sample ( 99 % ) knew of at least one method of household planning, and 72 % could call more than two types of preventives. The pill, rubber and injectable preventives were most often cited, and abstention, non-penetrative sex and backdown method were mentioned by less than 6 % of the respondents ( Rutenberg et al. , 2001 ) . Although adolescents might hold knowledge on preventives, the quality of apprehension and degree of consciousness varies well ( ibid ) .
Harmonizing to Arai ( 2009 ) , in Britain, teenage gestation and adolescents ‘ attitudes towards contraceptive method is best explained by mention to the consequence of sexual attitudes and cognition on sexual behavior. Arai maintains that even in the developed universe, adolescent gestation is a consequence of contraceptive method ignorance, service supplier attitudes, equal force per unit area and sexual embarrassment. She argues that the reply to teenage gestation lies with improved sexual wellness service, greater usage of contraceptive method and increased sexual wellness cognition. She nevertheless cautiousnesss that “ the factors would non on their ain, cut down teenage gestation ” ( 2009:6 ) . Arai advocates for a more comprehensive and holistic attack to the handling of teenage gestation because a “ additive solution does nil at all at covering with the job ” ( Arai, 2009:9 ) .
Maria Ekstrand ( 2008 ) studied perceptual experience of teenage gestation, abortion and prophylactic usage among Swedish adolescents and her consequences concur with those Arai ( 2008 ) got from her survey of Britain adolescents. Ekstrand ( 2008 ) found that adolescent gestation in Sweden was a consequence of inconsistent usage of preventives despite the fact that they are readily available, Swedish adolescents besides had a healthy misgiving of rubbers as they are associated with unfaithfulness. She concludes that adolescents have negative attitudes towards adolescent gestation as they acknowledge that adolescent gestation affects future chances. However, misss have a misgiving of the pill as a prophylactic method as they fear the side effects of the pill. Harmonizing to Ekstrand, there are still some lingering misconceptions towards contraceptive method as some adolescents believe that they can take interruptions from taking preventives but still remain protected against gestation.
Like in Sweden, misconceptions environing preventive usage still abound in South Africa as evidenced by Oni et Al. ‘s ( 2005 ) research on high school pupils ‘ attitudes, patterns and cognition of contraceptive method in KwaZulu-Natal. At least 21 % of the misss in Oni et Al. ‘s survey knew that they could fall pregnant after losing their preventive pill, while another 12 % believed they could non fall pregnant on their first sexual brush. Clearly, there are some misconceptions, and it is these misconceptions that give rise to unwanted and unplanned gestations. Richter and Mlambo ( 2005 ) concur and point out those adolescents are exposed to ‘sexual myths ‘ such as non falling pregnant the first clip they have sexual intercourse, holding sex standing and backdown before interjection prevents construct.
CONTRACEPTIVE USE AMONG Adolescents
The South African DoH provides free rubbers and a societal selling programme, Society for Health ( SFH ) provides Lovers Plus rubbers at a extremely subsidised rate ( MacPhail & A ; Campbell, 2001 ) . In South Africa, dedicated condom distribution new waves that dispense outside of clinic scenes have, nevertheless, been discontinued, and it is possible that this has lowered entree to the service ( Macleod, 2001 ) . Oral and injectable preventives are besides available, as are exigency preventives, free of charge, at authorities run household planning clinics. At the same clip, female rubbers are non widely available – an inaccessibility that, harmonizing to Macleod ( 1999b ) , has the possible to decrease the ability of misss to negociate safe sex as the power is taken off from them by mere inaccessibility of the Femidom. The Femidom is a female rubber, worn as a preventive to forestall unwanted gestation and to cut down hazard of infection of STIs. Indeed, entree to the femidom seems particularly hard for immature adult females who have to negociate the negative attitudes of nurses at local clinics, and societal norms prevent them from transporting rubbers ( Macleod, 2010 ) .
Condoms can be sourced from a assortment of topographic points, including friends, retail shops, clinics, and nines and even in schools. This was confirmed by participants in MacPhail and Campbell ‘s ( 2001 ) focal point group treatment in Khutsong ( South Africa ) reported having male rubbers from a assortment of beginnings, including friends, schools and retail shops. The research sample comprised of 44 adolescents in the 13-25 age group. However, the bulk made usage of the free rubbers from the local clinic. Despite the seemingly ready handiness of rubbers, participants still reported holding unprotected sex because they had non been able to entree rubbers. While free rubbers are readily available, the lower economic degree of immature people in general prevents them from buying rubbers should liberate rubbers non be on manus. Interestingly, adolescents in the HRSC 2008 survey on perceptual experiences towards teenage gestation said they did non swear the free preventives from authorities and preferred to utilize the commercial rubbers like Durex, Lifestyle and Crown. Of involvement in such scenarios is that these adolescents do non hold the fiscal means to afford commercial rubbers and yet they do non swear the subsidized rubbers provided by authorities. The cost of rubbers is a barrier to entree to condom and misgiving of subsidized authorities rubbers is a barrier to rubber usage, it will be interesting to happen out how adolescents perceive this moral force in the survey.
Wood and Jewkes ( 2006 ) , describing on South African research conducted in the late 1990s, cite the chiding, stigmatizing and rough intervention of immature adult females at governmental household be aftering clinics as a ground for the hapless entree of these services by immature people. The negative attitudes of clinic nurses toward immature adult females were besides noted by MacPhail and Campbell ( 2001 ) in their survey of Khutsong adolescents ‘ attitudes towards HIV and contraceptive method. The stigma attached to youth gender may besides lend to immature people ‘s involuntariness to entree these services. While the 2008 HRSC survey on perceptual experiences towards adolescent gestation in Johannesburg, Cape Town and Durban concurs with MacPhail and Campbell ( 2001 ) , the survey notes that it is non that preventives are non accessible, they are everyplace, but the attitudes of nurses and fright of being seen by community members who might judge these adolescents and study to their several household members. It is these frights and the attitudes of the nurses that basically make preventives unaccessible to adolescents.
However, Ehlers ( 2003 ) paints a more positive image of wellness service proviso by South African clinic nurse staff. In a Praetorian sample of adolescent female parents, Ehlers ( 2003 ) found that the bulk waited merely 30 proceedingss to have aid at a household planning clinic, and 86 % experient nurses as really helpful. Merely 6.4 % waited two hours or longer, and merely 15 % reported dissatisfaction at the services they had received. Given that the youth-friendly inaugural by the DoH was launched in 1999, it is possible that this enterprise has had some positive effects in some countries.
While preventives are available from many beginnings, Mfono ( 1998 ) found that Gauteng adolescents patronizing urban household planning Centres had merely visited the Centres after several sexual brushs. While these immature people do finally entree preventives, it is merely after a period of sexual activity that puts them at hazard for gestation and STIs. There are barriers against immature people freely accessing services, perchance including fiscal resource restraints, stigmatization by service suppliers, trouble in going long distances to make a clinic, and trouble in acquiring to the clinic during school hours.
High teenage gestation rates despite the usage of preventives may be a mark that there may still be unmet prophylactic demands, including intermittent usage of preventives and break in supply ( Rasch et al. , 2000 ) . Hickley ( 1997 ) and Palamuleni ( 2002 ) study that the non-availability of and reluctance to utilize preventives are lending factors towards the addition in adolescent gestation. Reluctance to utilize preventives may be attributed to miss of proper information on preventive usage, every bit good as perceptual experiences and attitudes towards preventives. Reasons for non-contraceptive usage include, spiritual and cultural beliefs, hapless quality of services, including the negative attitude of service suppliers, fright of exposure of their organic structures, holding grownups at the same services and inability to negociate prophylactic usage with sexual spouses. Furthermore, misconceptions, fright of side effects and stigma associated with the usage of preventives as striplings may be labelled as being promiscuous can besides be considered as lending factors for non-contraceptive usage ( Chonzi, 2000 ; Paz Soldan, 2004 ) . There are many misconceptions associated with the deficiency of information sing sexual generative wellness. Some of these include unwritten preventives and intrauterine device causes malignant neoplastic disease, usage of preventives before childbearing taking to sterility, and rubbers vanishing in the adult female ‘s organic structure ( Chonzi, 2000 ) .
Bhana and Swartz ( 2009 ) in their survey on teenage male parents in Cape Town ( South Africa ) indicated that male childs tend to believe information from their girlfriends about contraceptive method usage. Girls in bend harmonizing to Mfono ( 1998 ) tend to lie to their fellows about their preventive usage for fright of rejection. The prevarications that abound in the treatment about contraceptive method among adolescents are a testimony to the complexness of teenage gender as these beliefs and ‘lies ‘ are a merchandise of other factors.
Conscious non-contraceptive usage has been another factor impacting prophylactic usage and in peculiar the rubber. The usage of rubbers is viewed with reluctance as adolescents prefer to hold “ skin to clamber ” or “ meat to meat ” sex ( Bhana & A ; Swartz, 2009 ) . Condomless sex additions sexual pleasance harmonizing to adolescents in Bhana and Swartz ‘s interviews. They equate holding sex with rubbers to “ eating a Sweet in its negligee ” ( ibid ) .
In their survey of adolescents ‘ attitudes towards HIV, preventive usage and teenage gestation, in Durban ( South Africa ) Sathiparsad and Taylor ( 2011 ) found that at least 44 % of the 335 teenage male childs and misss agreed that desire and merriment clouded their ability to believe rationally when it comes to protection. Sathiparsad and Taylor ‘s survey besides revealed that 72 % of the males and 55 % of the females had negative perceptual experiences towards rubbers as they interfered with ‘pleasure ‘ . Harmonizing to Sathiparsad and Taylor ( 2011 ) , adolescents opt to hold unprotected sex inspite of the high hazard of HIV infection and gestation. The gender differences in perceptual experiences towards rubbers in Sathiparsad and Taylor ‘s ( 2011 ) survey are really important, bespeaking that male childs have more negative attitudes towards the rubber more than the misss. Such attitudes may lend to the gender kineticss of rubber usage where misss are unable to negociate safe sex. Attitudes towards the male rubber may besides stem from the fact that the male rubber is ‘readily available ‘ compared to the female rubber. Attitudes towards rubber usage in general may besides stem from trust issues with in adolescent relationships.
Trust issues between twosomes are another factor that significantly affects condom usage among adolescents. Varga ( 2000 ) notes an overarching perceptual experience that rubbers endanger trust and familiarity between spouses. Indeed, non utilizing rubbers may besides be taken as a mark of earnestness and trust within a relationship, while the desire to utilize one is viewed as a mark of unfaithfulness ( Varga, 2000 ; Bhana & A ; Swartz, 2009 ; Ekstrand, 2008 ; Wood & A ; Jewkes, 2009 ) . In kernel adolescents find themselves caught between a desire to keep and keep a relationship by holding condomless sex, while on the other manus there is a echt desire to protect themselves from STI infection and gestation.
Inconsistent prophylactic usage among adolescents has been identified as one of the grounds for teenage gestation ( Varga, 2000 ; Bhana & A ; Swartz, 2009 ; Wood & A ; Jewkes, 2009 ) . However, grounds for inconsistent preventive usage are diverse and complex hence they are non easy to characterize. Harmonizing to Arai ( 2009:12 ) the ‘ ideal ‘ preventive for adolescents is the 1 that is “ safe, provides equal protection, is reversible, carries minimum side effects, is cheap, convenient and can be obtained and used in a private mode ” .
Negative perceptual experiences of teenage gestation are most likely to actuate adolescents to utilize contraceptive method systematically, while the antonym is besides true ( Varga, 2000 ; Wood & A ; Jewkes, 2009 ) . That being said, analysis cognition, attitudes and perceptual experiences towards preventive is of import as prophylactic splay an of import function in gestation bar.
Beginnings of information on sexual behavior and preventive usage
Cardinal to undertaking bing spreads in adolescent gestations and entree to preventives is instruction and information airing ( Brooke, 2006 ) . Adolescents are exposed to information sing gender and contraceptive method through assorted beginnings. Beginnings of information include parents, friends, the media, and institutional beginnings such as school and church. Since 2002, South Africa has had a publicised and well-coordinated sex instruction programme, though it still struggles with high teenage gestation rates. Parents and defenders are encouraged to talk openly to their kids approximately gender as they are the primary beginnings of information. However, Macleod ( 2009 ) argues that this is an unrealistic outlook as parents are unable to make so because of assorted grounds, one of them being civilization, and issue which will be discussed subsequently on in the chapter.
“ Certain issues including gestation, prenuptial sexual intercourse, contraceptive method, sexual torment and molestation are forbidden household topics in certain civilizations in South Africa ” ( Madu, Kropiunigg & A ; Weckenmann, 2002:88 ) . The drape of silence drawn over these issues consequences in anxiousness, fright and misconceptions finally taking to unplanned and unwanted gestations. However, Macleod paints a rose-colored image and notes that there are programmes that have been put in topographic point to guarantee that there is blunt treatment between parents and adolescents refering gender. These programmes include the Planned Parenthood Association of South Africa and Love Life ‘s Born Free duologues.
Adolescents province that they have treatments on gender with their parents, though there is no lucidity on certain issues and no room for farther audiences ( MacPhail & A ; Campbell, 2001 ) . Female participants of MacPhail and Campbell ‘s ( 2001 ) Khutsong focal point group treatments indicated that they were informed to protect themselves from and to remain off from male childs, and many did non understand that sexual intercourse could ensue in gestation, intending that abstention instead than contraceptive method was emphasised. The perceptual experience that speaking about preventives gives adolescents the licence to prosecute in sexual activities is cited as one of the grounds seniors are loath to speak about gender. MacPhail and Campbell ( 2001 ) further suggest that grownup surveillance impinges on preventive usage and cognition. Harmonizing to MacPhail and Campbell, ( 2001 ) grownups in the Khutsong country base on balls on information to relevant others about immature people ‘s visits to household planning clinics, and about these immature people ‘s suspected relationships and other indexs of suspected sexual activities. Parents may so censure adolescents over their sexual behavior. Adults ‘ attitude towards adolescents ‘ sexual behavior prevents immature people from accessing clinics for preventives and sexual wellness information.
Where immature people can non entree information from their parents, they tend to turn to their friends for information. Peer information is regarded as a dual edged blade. Some information from equals is good meant and placed as they encourage each other to utilize preventives. On the other manus, equal information is fatal as they are misinformed themselves, and tend to go through on the same information to their equals. Peers bar immature misss who are non sexually active from conversations of a sexual nature, perpetuating the bewilderment and silence environing sex ( Wood, Maepa & A ; Jewkes, 1997 ) . They contend that this mounts force per unit area on the naive to hold sex so they can besides be included in these ‘circles ‘ . Male spouses may take advantage of the information oversight and stress impressions of female handiness and male sexual entitlement ( Jewkes et al. , 2001 ) .
Mass media, including magazines, wireless and telecasting broadcasts, provide utile sexual and prophylactic information to immature male childs and misss. Rutenberg et Al. ‘s 2001 study in Durban and Mtunzini showed that 52 % of the respondents had heard their information on preventives from the mass media. Oni et Al. ‘s ( 2005 ) smaller study on high school scholars ‘ attitudes, cognition and patterns of contraceptive method in Jozini, KwaZulu-Natal ( South Africa ) , suggests that the response of such messages may be gendered, with 54.2 % of male and merely 21.5 % of female respondents describing that they had received a telecasting or wireless message about contraceptive method.
Institutional beginnings, such as life accomplishment instruction in schools has besides been slightly effectual in advancing sexual and generative wellness cognition and sensed rubber self-efficacy in South Africa ( Magnani et al. , 2005 ) . They nevertheless note that effectivity of life accomplishments instruction is non unvarying across board with some countries holding non received life accomplishments bundles ( ibid ) . This non-uniformity affects adolescents who are coming from countries where sexual wellness information is already limited, the lessening in beginnings of information may somewhat increase misconceptions and myths refering sexual wellness and in peculiar gestation bar.
Health attention Centres are other beginnings of information on gender. However, they have been under the limelight for their attitude towards immature adult females who visit clinics in hunt for preventives and any other information. Macleod ( 2010:29 ) affirms “ so, entree to contraceptives seems particularly hard for immature adult females who have to negociate the negative attitudes of nurses at local clinics, and societal norms prevent them from transporting rubbers ” . However, Mkwananzi ( 2010 ) disputes this, reasoning alternatively that adolescents do non travel to clinics with an unfastened head. In fact, harmonizing to Mkwananzi, adolescents are the 1s who have negative attitudes towards contraceptive method. It is such attitudes, purportedly, that put adolescents at hazard of gestation. Wood and Jewkes ( 2006 ) and MacPhail and Campbell ( 2001 ) concur with Macleod ( 2010 ) on negative attitudes of nursing staff. While surveies may site negative attitudes of staff towards adolescents, Ehlers ( 2003 ) paints a more positive image, reasoning that youth-friendly services initiated by the South Africa ‘s DoH have made great paces in deciding the animus between wellness attention su