Rebecca Lewinsohn1, Tamaryn Crankshaw2, Mark Tomlinson3, Andrew Gibbs4, Lisa Butler5, Jenni Smit6. 1. Haverford College, Pennsylvania, United States. Electronic address: rebecca.lewinsohn@gmail.com. 2. Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, South Africa. Electronic address: crankshaw@ukzn.ac.za. 3. Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. Electronic address: markt@sun.ac.za. 4. Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, South Africa; Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa. Electronic address: andrew.gibbs@mrc.ac.za. 5. Institute for Collaboration on Health, Intervention, and Policy (InCHIP),University of Connecticut, Storrs, Connecticut, United States. Electronic address: lisa.butler@uconn.edu. 6. Maternal Adolescent and Child Health (MatCH) Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa; School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. Electronic address: jsmit@matchresearch.co.za.
Abstract
BACKGROUND: Unintended pregnancy is associated with poor maternal and child health outcomes. To improve the health and wellbeing of women during the antenatal period, additional research in settings where unintended pregnancies are common is required to better understand the impact of the pregnancy on women's emotional health, relationships, and support structures. OBJECTIVE: To examine the personal, social and economic factors shaping the antenatal experiences of women in a resource-constrained setting with high rates of unintended pregnancy and HIV. RESEARCH DESIGN AND SETTING: Qualitative, semi-structured interviews were conducted with 30 women from an urban informal settlement in KwaZulu-Natal, South Africa, who had given birth within the last six weeks. FINDINGS: Most participants (n = 27, 90%) reported that their pregnancy had not been planned. Unintended pregnancy marked a period of heightened stress and vulnerability for many participants due to increased financial strain, HIV status, and trauma associated with past or current violence. Family members and sexual partners could mitigate financial stress and be sources of emotional and material support during the antenatal period. However, participants frequently experienced increased instability and conflict in sexual partner and family relationships due to the unintended pregnancy, exacerbating women's stress. KEY CONCLUSIONS: A nuanced understanding of the factors shaping women's emotional responses to an unintended pregnancy may aid in identification of women who are most likely to experience high levels of antenatal stress and to prioritize these women for intervention in order to prevent associated poor maternal and child health outcomes.
BACKGROUND: Unintended pregnancy is associated with poor maternal and child health outcomes. To improve the health and wellbeing of women during the antenatal period, additional research in settings where unintended pregnancies are common is required to better understand the impact of the pregnancy on women's emotional health, relationships, and support structures. OBJECTIVE: To examine the personal, social and economic factors shaping the antenatal experiences of women in a resource-constrained setting with high rates of unintended pregnancy and HIV. RESEARCH DESIGN AND SETTING: Qualitative, semi-structured interviews were conducted with 30 women from an urban informal settlement in KwaZulu-Natal, South Africa, who had given birth within the last six weeks. FINDINGS: Most participants (n = 27, 90%) reported that their pregnancy had not been planned. Unintended pregnancy marked a period of heightened stress and vulnerability for many participants due to increased financial strain, HIV status, and trauma associated with past or current violence. Family members and sexual partners could mitigate financial stress and be sources of emotional and material support during the antenatal period. However, participants frequently experienced increased instability and conflict in sexual partner and family relationships due to the unintended pregnancy, exacerbating women's stress. KEY CONCLUSIONS: A nuanced understanding of the factors shaping women's emotional responses to an unintended pregnancy may aid in identification of women who are most likely to experience high levels of antenatal stress and to prioritize these women for intervention in order to prevent associated poor maternal and child health outcomes.