The support and self-determination process surrounding pregnancy continuation of pregnant teenagers living on remote islands

Abstract

Purpose

To understand how young pregnant women living on remote islands made decisions about surrounding pregnancy continuation and to identify the self-determination process and support needed.

Methods

We interviewed women up to their early twenties living on the remote islands in Prefecture A who had previously become pregnant and given birth as teenagers. We conducted analysis using a combination of structural and thematic narrative analyses.

Results

The nine participants were between 15 and 19 years old at the time of pregnancy, when some were students, some had graduated and were employed, some had interrupted their studies due to pregnancy, and some had given up on their planned career at the time of pregnancy. A structural narrative analysis of the self-determination process revealed five types of structural element: “situation,” “action,” “evaluation,” “consequence,” and “conclusion.” In the “situation” phase, the pregnancy was first noticed. This occurred through noticing physical changes, such as hyperemesis gravidarum or an enlarged abdomen, the absence of menstruation, or irregular menstruation. In the self-determination process of the nine pregnant participants, six of the participants made their own decision to continue their pregnancies upon realizing that they were pregnant; three of the participants finally decided to have the baby while feeling upset or confused. In terms of “action,” five of the women's parents and partners were in favor of having the baby, while four were against it, but these four were eventually influenced by the strength of the participants' will and allowed the participants to have their baby. In terms of “evaluation,” all participants took actions, such as reporting to their partners and families, based on their strong will to have the baby. The thematic analysis revealed three patterns, after a participant had discovered that she was pregnant and decided to have the baby: 1) Their partners and family members agreed with and supported this decision; 2) Their partners agreed, but their parents opposed the decision; however, the parents were persuaded and eventually supported the decision; 3) Their partners and family members opposed the decision but were persuaded and eventually supported the decision.

Conclusion

In the self-determination process of young pregnant women giving birth on remote islands, the time spent on self-determination was short, as many of them had no doubts before deciding to keep the baby, and those involved in the decision making only included the participant, partner, and family members, as there were limits to interventions. It is important to create an environment where privacy is protected because of the small and tightly knit community. In addition, sex education based on life planning is essential, and support is required to enable self-determination in terms of the knowledge and information needed for teenage pregnancy and the options available for the future of the mother and child.