LOSING A PREGNANCY INCENTIVE TOWARD RAPID REPEAT PREGNANCY

‘LOSING’ A PREGNANCY: INCENTIVE TOWARD RAPID REPEAT PREGNANCY? Sarah Bekaert Lecturer Child Health, City University CASH Nurse Specialist, OUH Foundation Trust

Aims • To explore the influencing factors on pregnancy decision- making in relation to becoming a mother soon after an abortion in the teenage years • To consider these factors in relation to the legacy of the Teenage Pregnancy Strategy (SEU 1999) and societal expectations for motherhood and childhood • To explore these ‘normalised’ expectations in relation to a ‘lost’ pregnancy (Clarke 2002) and a situated context of poverty and violence.

Methods • 8 in-depth interviews with teenaged mothers, or mothers to be, who had previously had an abortion • Using a narrative framework and the Listening Guide as both methodological tool and data analysis method (Gilligan et al 2003, Mauthner and Doucet 2008) • Readings for plot, voice of I, reader response, relationships, social structures and cultural contexts

Results - disempowerment • A decision to abort an early unexpected pregnancy due to expectations for academic achievement prior to childbearing • Normalised technologies for the teenage years may affect how the young women narrate their stories and expectations for the future

Results - agency • A ‘lost’ pregnancy through abortion or miscarriage might be an incentive to rapid repeat pregnancy • A context of poverty and violence can also push toward earlier pregnancy to ensure family support is available • The young women employ creative strategies to maintain the young father’s involvement in their new family

A ‘lost’ pregnancy through abortion or miscarriage might be an incentive to rapid repeat pregnancy

Miscarriage • High rate of miscarriage • 18 pregnancies, 7 ended in miscarriage (40%) • 5 of 8 first pregnancies (60%) • Miscarriage more common <14 yrs and >40 yrs • Abortion referral but miscarried before • More acceptable story? (Mojapelo-Bakta and Schoeman 2003, Dahlbeck et al 2010, Mitchell et al 2006)

Miscarriage • Anxiety and depression (Rai and Ryan 2006) • Anxiety regarding infertility ‘…I still thought like maybe later on in my pregnancy something would happen to the placenta, or something so I wouldn’t actually have a baby born and have to bury her or whatever, God forbid. But it didn’t think I’d hae a baby at the end of it. ’ (Danielle)

• Self-blame, guilt ‘I’m worried about future pregnancies…but I don’t know…here could have been several things like I was working too hard, and there was stuff I didn’t know…’ (Susannah) ‘I felt like I’d done something wrong…I couldn’t carry the baby’. (Danielle)

Abortion • Positive and negative consequences (Ekstrand et al 2005) • Relief and grief (Brady et al 2008) ‘…that day it made me feel sad a little bit but at the same time it made me feel happy…’ (Sandra)

• Negative outcomes greater when there are negative attitudes from family and friends (Broen et al 2003) ‘He told me I’m a murderer, he said that’s what I am a murderer and I won’t get pregnant ever again’. (Angelique) ‘…he cant put up with me doing terminations like that, I have to know what I’m doing with myself…’ (Sandra) ‘I told my nan, my nan was disappointed but then with my nan being a Christian she’s against abortion…’ (Susannah)

Trauma • Incomplete miscarriage • Several trips to hospital • Alone • Ptsd (Maker and Ogden 2003, Brier 2004) ‘but big huge clots and I was thinking what’s going on? I was in pain I couldn’t even walk…I was crying and I went to hospital and they done another scan and they’re like oh there’s still products remaining so they gave me some pill and I had to go through the same process again. Um yeah and that was the end of that and that went on for a long time. ’ (Danielle)

Rapid repeat pregnancy • ‘pregnancy loss, a powerful incentive toward pregnancy (Clarke 2002) • Decision out of their control, decision imposed: plan a new pregnancy (Ribiero da Fonseca Dominges et al 2013) • Ways to ‘move on’; try for another pregnancy (Maker and Ogden 2003)

Motherhood identity • Pregnancy loss, challenges motherhood identity (Hutti 1986) • Reassess past and future experiences (Maker and Ogden 2003) • Possibility of infertiltity; try again sooner rather than later (Brady et al 2008)

Education • Completed education; motherhood rite of passage, identity (Geronimus 1996, Burton 1995, Phoenix 1981) ‘…and then I didn’t go back (on the contraceptive injection) cos I thought what’s the point, I’ve done my GCSEs. I’m a big girl now, and you know, make my own decisions. ’ (Sandra)

Men’s experience of pregnancy loss Largely ignored (Murphy 1998, Serrano and Lima 2006) No difference between men and women’s reaction (Beutal et al 1996) Shock, surprise, sense of loss, frusration, anger. . Also alienation and marginalisation (Rinehart and Kiselica 2010) Gendered expectations (Brady et al 2008, Rinehart and Kiselica 2010) Anger and violence (Long 1987, Rinehart and Kiselica 2010)

Effect on relationship • Maker and Ogden (2003) miscarriage made relationship stronger • Loss in direction of relationship ‘went downhill from there’ (Mai) ‘We weren’t together for about 6 months. Cause after I had the miscarriage things were a bit rocky and I thinks that’s where it all kicked off from. So we weren’t talking as much…’ (Susannah) ‘…but after that we still had a relationship but it was like, like he was violent’ (Angelique)

Summary • While there is a strengthening of desire for family formation for the young women as a consequence of a pregnancy loss…for the young men it may result in a distancing from the relationship • This appears to result in the young women employing creative strategies to keep their men close, forging family for the future….