International Journal of Africa Nursing Sciences 13 (2020) 100251

Contents lists available at ScienceDirect

International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

Disconnections and exclusions of parents in the prevention of teenage

pregnancy: A phenomenological approach
Malebo Tryphina Skosana, Mmapheko Doriccah Peu *, Ramadimetja Shirley Mogale
Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa

A R T I C L E I N F O A B S T R A C T

Keywords: Teenage pregnancy is associated with poor maternal outcomes, as well as limited school attendance, which may
Teenage pregnancy have future financial implications for the family. This article explores and describes the disconnections and
Teenager exclusions of parents in the prevention of teenage pregnancy. We conducted a qualitative descriptive phenom­
Pregnancy prevention
enological study, purposively selecting and interviewing 20 parents of both boys and girls. After individually
Parent
Disconnections and exclusions
interviewing parents, we analysed the data using the Colaizzi method. Three overarching themes emerged from
the interviews, namely, the effects of teenage pregnancy on parents, the prevention strategies and the role of
parents in the prevention of teenage pregnancy. Parents emphasised the emotions of love and caring, frustration,
exploitation, anger and helplessness. Parents agreed that they should be actively involved in communicating with
their teenagers on sex education. They recommended that affordable and accessible youth-friendly services be
provided.

1. Introduction and background
Across the globe, sub-Saharan Africa has the highest prevalence of
teenage pregnancy, with approximately 105 in 1000 girls between the
ages of 15 and 19 giving birth (UNFPA, 2017). In these countries, more
than 30% of women between the ages of 20 and 24 gave birth before
they were 18 years old (Loaiza & Liang, 2013). A large disparity in
teenage pregnancies exists between developed and developing coun­
tries, for example in Korea, the teenage pregnancy rate is approximately
2.9 per 1000, and in sub-Saharan African countries the teenage preg­
nancy rate can be as high as 143 per 1000 (Thobejane, 2015). The sta­
tistics indicate that teenage pregnancy is a serious problem in sub-
Saharan Africa, with far-reaching implications for both adolescents
and their parents. Adolescents who fall pregnant often drop out of
school, preventing or delaying their entry in the workforce (United
Nations Population Fund, 2013). To avoid the burden of caring for the
adolescent and a new baby, parents need to assume joint responsibility
for preventing pregnancy in their adolescent children (United Nations
Children’s Fund, 2018).
On the other hand, teen pregnancy is not a troubling problem in
Nordic countries or the Netherlands because these countries have
powerful healthcare systems to warrant confidentiality, a non-
judgemental approach and support (Honig, 2012). The author further
articulated that within developed countries, the highest statistics of teen
pregnancy are in the United Kingdom and the United States of America
(USA) the lowest rate in Japan and South Korea. It was emphasised that
poverty is a leading factor for teen pregnancies followed by rape.
Therefore teen pregnancies may be contributed by multiple factors
irrespective of whether it is a developed or developing country.
Although media, peer and family have tremendous influence as risk
factors to teen pregnancy, parents can play a significant role in pre­
venting teenage pregnancy by guiding teenagers to make healthy,
responsible and value-based decisions about sex (Honig, 2012; Silk and
Romero, 2013). Children are known to benefit from positive, warm,
responsive, communicative, and authoritative parenting (Aparicio,
Vanidestine, Zhou, & Pecukonis, 2018; Cullen, Davis, Lindsay, & Davis,
2012) and adolescents who have secure relationships with their parents
are known to engage in sexual activity later, have fewer sexual partners,
and are more likely to use birth control (Honig, 2012). Parents are
ideally placed to be role models, educate their teenage boys and girls
about sex, and coach them on their sexual behaviour. Parents should
educate their teenagers on sexuality as early as possible within the
cultural context to prevent teenage pregnancy (Honig, 2012). Fostering
open communication often means that parents need to cross cultural
barriers to negotiate with their adolescents about sexuality education
(Mkhwanazi, 2010).

* Corresponding author at: Department of Nursing Science, Faculty of Health Sciences, Prinsh of campus, University of Pretoria, Pretoria 0007, South Africa.
E-mail address: Doriccah.peu@up.ac.za (M. Doriccah Peu).

https://doi.org/10.1016/j.ijans.2020.100251
Received 4 June 2019; Received in revised form 10 September 2020; Accepted 11 September 2020
Available online 17 September 2020
2214-1391/© 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
M. Tryphina Skosana et al.
Teenage pregnancy is more acceptable in some cultures than others.
In some cultures, early marriage and teenage pregnancy often go hand in
hand, or early childbearing is seen as a demonstration of fertility
(Winters & Winters, 2012). Despite being culturally acceptable in some
cases, teenage pregnancy has a long term negative economic effect
which impacts on a nation’s economy as a whole (Ressler, 2012; Winters
& Winters, 2012), and perpetuates social, health and economic
inequality (Macleod, 2016). Teenage pregnancy is associated with high
rates of school dropout and high unemployment (Mkhwanazi, 2010).
Thirty-four per cent of young teenage mothers earn neither a college
degree nor a high school diploma, and fewer than two per cent of
teenage mothers earn a degree by the time they turn thirty (Ressler,
2012).
Previous studies from rural South Africa have highlighted the un­
desirability of teenage pregnancy, both from the perspectives of the
adolescents and adult community members (Richter & Mlambo, 2005).
Despite the negative associations with teenage pregnancy, teenagers still
had little knowledge of contraceptives, poor knowledge of the physi­
ology of conception and little or no access to sex education (Richter &
Mlambo, 2005). In addition to the statement, many teens receive
inconsistent messages about sex, pregnancy, contraception, and abor­
tion from schools, peers, and family members (Mollborn, Dominique &
Boardman, 2014). These messages influence teenagers either negatively
or positively to take full responsibility.
Despite the availability of contraceptives, recent studies have shown
that many of the same barriers to contraceptive use still exist (Tabane &
Peu, 2015; Honig, 2012). Teenagers who fall pregnant blame lack of
education, lack of role models and, an overarching lack of parental
guidance (Mkhwanazi, 2010; Tabane & Peu, 2015). Parents of adoles­
cent boys and girls do not offer relevant information on safe sex issues,
including appropriate contraceptive use, because they find it difficult to
talk about sexuality education (Mudhovozi, Ramarumo, & Sodi, 2012;
Rouvier, Campero, Walker, & Caballero, 2011). Culturally, within some
of the South African context, mothers are not encouraged to talk about
sexual issues with their teenagers (Mkhwanazi, 2010; Mudhovozi et al.,
2012), resulting in teenagers being deprived of their most important
source of information and guidance (Deaton, 2012). Teenage pregnancy
prevention strategies and policies need to account for the role of parents
in their teenagers’ lives, especially the role of the mother. In this
research study, we qualitatively assess the perceptions of parents, living
in a rural area, towards the prevention of teenage pregnancy.
2. Methods
2.1. Study area
We conducted this study in a selected village, which is situated in Dr
J.S. Moroka subdistrict, within the Nkangala district, Mpumalanga
Province in South Africa. Mpumalanga Province has a population of
approximately 4.4 million (Mpumulanga, 2017). In 2011–2012, the
available statistics indicated that the teenage pregnancy rate in this
village was around 2.5%; however, for 2012–2013, it reportedly grew to
5.5%. In 2014, the Mpumalanga Department of Education (2014) re­
ported that more than 3000 girls fell pregnant, indicating a significant
public health problem. In the year 2018, it was reported that teenage
pregnancy was escalating with the public health facilities reporting 78%
within just one year (SABC, 2018). In 2018–2019, 97 145 teenagers gave
birth increasing the number of teenagers who dropped out from school
(Department of Health, 2018; Mpumulanga, 2018). We conducted this
study between 1st May 2014 and 30th August 2014 in response to the
escalating statistics. Therefore the village was chosen as research setting
based on its proximity and background information.
2.2. Research design
We conducted a qualitative descriptive phenomenological study to
2
International Journal of Africa Nursing Sciences 13 (2020) 100251
explore and describe parental perspectives in the prevention of teenage
pregnancy (Polit & Beck, 2017). The purpose of choosing phenome­
nology is to understand the subjective nature of lived experiences from
the perspective of those who experienced it (Cope, 2005). The descrip­
tive design acted as a theoretical framework and as a design. In this
paper, the researcher looked for essential and universal structures of
parental perspectives and experiences in the prevention of teenage
pregnancy (Holloway & Galvin, 2016; Martins (2008) cited in Peu,
2014). The researcher carefully insisted on describing the perspectives
of parents regarding the prevention of pregnancy (Peu, 2016; Polit &
Beck, 2017).
The researcher applied four elements found within descriptive phe­
nomenology. These elements included bracketing, intuiting, analysing
and describing. The researcher put aside all pre-conceived mentality and
opinions about the phenomenon, enabling the researcher to view the
participants’ perceptions in a pure form (Polit & Beck, 2017). The
researcher kept a diary for reflection. The researcher was totally
immersed in the collected data (Speziale, Streubert, & Carpenter, 2011).
The researcher discovered the essence of the phenomenon during
analysis (Speziale et al., 2011). The researcher dwelt in the generated
data and analysed each piece of information to identify significant
statements, categorise them and extract meaning. During the fourth
step, the researcher described the critical elements of the phenomenon
(Speziale et al., 2011).
2.3. Population and sampling
The study population included parents of teenage boys and girls, who
had a previous pregnancy or who were pregnant during the research
process. Parents were included in the study if they resided in the village,
spoke English and volunteered to participate. Parents whose teenagers
were not pregnant were excluded. The participating parents were pur­
posefully selected to explore their perspectives and knowledge
regarding the prevention of teenage pregnancy. The researcher reques­
ted permission to gain entry through traditional authorities and gate­
keepers of the village.
2.4. Data collection
Data were collected through in-depth individual interviews which
were recorded with an audio recorder. Data were collected from the 1st
May 2014 to 30th August 2020. A field worker took field notes during
the individual interviews (Polit & Beck, 2017). The researcher con­
ducted the interviews in the village, at a venue of the participants’
choice, e.g. their home, community hall, church, or hospital. The in­
terviews lasted approximately one hour, depending on the participants’
responses. Before fieldwork began, the aim, nature, benefits and confi­
dentiality of the study were deliberated (Polit & Beck, 2017).
The researcher conducted a pilot study with the first four parents,
who were not included in the main study, to ascertain if the questions
were clear or too complex. The pilot study checked if the probing
questions could be clearly answered.
The venues for the interviews were prepared according to the pref­
erences of the participants. The researcher offered a warm welcome to
allay anxiety. The researcher explained that an audio recorder would be
used to gather information accurately. The researcher ensured that the
audio recorder was switched on. The researcher posed a question: “What
are your (the parental) perspectives on the prevention of teenage
pregnancy?”
The researcher used communication skills such as good listening,
probing questions and paraphrasing to cover the events of interest
(Bowling, 2014). The probing questions assisted in understanding the
events, attitudes, experiences, motives and reactions of interviewees.
The research clarified answers by asking probing questions, listening
attentively and providing feedback. The researcher paraphrased state­
ments and focused on issues that were important to the study. The
M. Tryphina Skosana et al.
interviews were largely unstructured and focused on discussions be­
tween the researcher and the interviewee. Data saturation was reached
at the 15th participant, but the researcher added five participants for
confirmation and ensuring the confirmability of the study. In total, 20
individual interviews were conducted. The researcher thanked and
appreciated all the participants at the end of the interviews.
2.5. Data analysis
The researcher used the Colaizzi (1978) (cited in Polit & Beck, 2017)
method to analyse the data. The Colaizzi method ensured that the
researcher used member checking to validate the results (Polit & Beck,
2017). We chose Colaizzi method of data analysis because it is holistic,
contextual and involve interpreting the narrative data within the context
of the whole (Polit & Beck, 2017). The researcher reviewed all the
transcripts and identified significant statements. The researcher identi­
fied the meaning of each statement, which was then organised into
clusters. The researcher merged the results into an exhaustive descrip­
tion; the final product was later validated by the participants.
Ethical considerations
The University of Pretoria Research Ethics Committee (no: 42/2014)
approved the study. The researcher adhered to ethical principles such as
beneficence, justice and respect for human dignity (Polit & Beck, 2017).
All personal information remained confidential, and each participant
was assigned a code number. The participants could withdraw from the
study at any phase of the research.
2.6. Rigour
To ensure trustworthiness in the qualitative findings, the researcher
practised reflexivity, bracketing, credibility, transferability, depend­
ability and conformability (Lincoln & Guba, 1985 cited in Polit & Beck,
2017). The researcher demonstrated reflexivity by remaining self-aware
and critically examining her interactions during data collection and
analysis. The researcher acknowledged that her personal feelings and
experiences could influence the study (Creswell, 2003), and she with­
held or bracketed all her preconceptions. The researcher ensured cred­
ibility through member checking, prolonged engagement and peer
examination. After analysing and interpreting the data, the researcher
asked the participants for their input, to ensure accuracy and faithful
interpretation. The researcher asked the participants to listen to the
taped interviews and gave them a chance to comment. The researcher
held a debriefing session with a colleague to discuss problems, findings
and the research process. Peer examination increased the researcher’s
honesty and credibility. The researcher ensured transferability by
keeping a dense description of the data while dependability was ach­
ieved through a dependability audit.
In this study, the audit of the research gave another researcher a clear
direction to follow. The researcher conducted a confirmability audit,
including someone who was not directly involved with the participants.
3. Results
Three overarching themes emerged from the results, namely, effects
of teenage pregnancy on parents, the prevention strategies and the role
of parents in preventing teenage pregnancy.
3.1. Effects of teenage pregnancy on parents
Parents strongly emphasised the effects of teenage pregnancy on
themselves. Parents felt excluded from the problem. Parents felt that
they did not have adequate communication skills, and they felt pres­
sured by societal and cultural norms.
3.1.1. Feeling excluded from the problem
Parents felt excluded from the problem by teenagers when they were
3
International Journal of Africa Nursing Sciences 13 (2020) 100251
supposed to be empowered. The participants dissociated themselves
from teenage pregnancy and referred “them” not “we” in their dis­
courses. The participants felt that most parents are not prepared to share
their knowledge and experiences with their children. Parents were
reluctant to debate issues of sexuality. Parents pushed the responsibility
of sex education to the teachers, claiming that they lacked communi­
cation skills. These were mentioned as follows:
“We are reluctant to talk about sexuality with our children. If we
were invited to participate in meetings with other parents, we could
learn how to interact and to talk about these issues.”
(Participant 12).
“I think that teachers are the people who are responsible for teaching
teenagers about prevention of pregnancy” (Participant 13).
3.1.2. Lack of parental communication skills
Parents play a pivotal role in the sexual socialisation of children and
adolescents. The information and messages that are not communicated
between parents and children have the potential to shape sexual
decision-making during adolescence.
One participant indicated that teenagers might be advised on absti­
nence. This was expressed as:
“We must apply communication skills educate teenagers about their
responsibility as teenagers in preventing teenage pregnancy”
(Participant 2).
“Teenagers must be advised by their parents to go for family plan­
ning and to use dual protection that is contraceptives and condoms”
(Participant 3).
3.1.3. Societal and cultural pressures
Parents indicated that some cultural beliefs inhibit free-flowing
communication. In a male-headed family, fathers may feel unable to
share their sexual experiences with a girl child, and the same applies to a
female-headed family, where mothers cannot share sexual information
with a boy child. The participants felt that many members in their cul­
tural community believed that women needed to have a child to prove
their femininity and suitability for marriage. Adolescents thus competed
amongst their peer group to prove their suitability for marriage.
The societal and cultural pressures were expressed as:
“Culturally as a male I cannot communicate with the girls about
sexuality and a woman also cannot communicate with boy child”
(Participant 16)
“Many parents find talking with their teenagers about sexuality is­
sues as a taboo and very uncomfortable” (Participant 14).
“We believe that every woman must have a child to prove fertility
then the woman will be married” (Participant 11).
3.2. The prevention strategies
Prevention strategies mentioned were parent-to-child education on
sexuality and contraceptives and including sex education in the educa­
tion curriculum from an early age.
3.2.1. Parent to child education on sexuality and contraceptives
Parents in this study perceived that parent to child education on
sexuality and contraceptives was the most important strategy in the
prevention of pregnancy. Parents felt that their relationships with their
adolescents should have promoted the sharing of information on sexu­
ality and contraceptives. Parents also mentioned that teenage pregnancy
prevention strategies should mirror the needs of a specific community.
Parents felt that their decisions about teenage pregnancy prevention
strategies should have been made in a reflective and not in a reactive
M. Tryphina Skosana et al.
manner. This reflective process should involve both parents and their
teenagers.
This was addressed as:
“There should be an open communication between parent and child
allowing teenagers to raise their concerns, giving love at home is
vital” (Participant 15).
“Teenagers need to be encouraged by parents on dual protection that
can prevent pregnancy as well as sexually transmitted diseases”
(Participant 8).
“We also need to be role models, avoid arguments that will drive
teenagers from home to peers who will mislead them” (Participant
15).
Parents, as primary sex educators need to disseminate sexual infor­
mation in a non-judgmental way. Above all, good interpersonal re­
lationships and role modelling promote compliance in the teenager’s
sexual decisions.
3.2.2. Include sex education in education curriculum from an early age
Parents strongly emphasised that sex education for young teenagers
should be included in the education curriculum. Parents were less
motivated to communicate with their teenagers because most schools do
not create an environment that allows for free discussion of sexual is­
sues. Parents felt that educating their teenagers was an important
strategy for empowering teenagers about sexuality education. Knowl­
edge enhances informed decisions. Therefore, both parents and teen­
agers do not know enough about sexual education. This is a major
challenge and a public health concern.
Participants attested that:
“We need to educate teenagers about sex education and stages
starting from puberty until adulthood, also the issue of menstruation
and erection” (Participant 16).
“Girls and boys must know that penetration of the penis into the
vagina not using any protection expose one to pregnancy” (Partici­
pant 5).
“Knowledge on menstrual cycle is also imperative to know the safe
period” (Participant 6).
3.3. The role of parents in preventing teenage pregnancy
Parents felt that they should play an important role in preventing
teenage pregnancy since they were ideally placed to coach their teen­
agers regarding precautionary measures such as prevention of unwanted
pregnancy and promotion of abstinence. Parents felt that it was their
responsibility to reinforce the negative impacts of the early initiation of
sexual activity. Parents identified various ways to empower adolescents,
such as sharing information, becoming role models for their own chil­
dren and coaching their children on dress code.
3.3.1. Share information with children from an early age
Parents identified that sharing information with children from an
early age was one of the significant roles of parents in preventing
teenage pregnancy. Parents felt that it was important to talk to teenagers
at a younger age about sexuality. In addition, parents felt that there was
a need for a platform of open and free communication for both parents
and teenagers, which would instil a sense of responsibility and clarify
any misconception related to sexuality education.
Participants conveyed that: “We have to communicate with our teen­
agers and be honest and educate them about sex” (Participant 9).
“I think it will help them to gain knowledge and to become confident
to protect themselves when they become sexually active, they should
abstain, be faithful and condomise” (Participant 4).
It has been emphasised that parents should be honest and should
4
International Journal of Africa Nursing Sciences 13 (2020) 100251
educate their children about teenage pregnancy. Lack of knowledge
among parents may lead to poor judgment. Therefore sexuality educa­
tion is crucial for teenagers to make informed decisions.
3.3.2. Become a role model for your own child
Parents believed that being a role model for your own child was
critical in preventing teenage pregnancy. The parents in this study felt
that teaching and living with good behaviour would encourage their
teenagers to do the same. Teenagers observe their parents on a daily
basis and follow their actions. Teenagers tend to say like mother, like
daughter and like father, like son. Therefore it is crucial to practice what
you preach at all times. In addition, participants felt that parents as role
models lay a concrete foundation for their teenagers.
The expressions were highlighted as:
“As a parent I have to lead by example in my family so that the
children can copy the right thing” (Participant 12).
One participant further mentioned that:
“We must be role models with good behaviour to our children and
avoid promiscuity, as it is said that one has to practice what he
preaches” (Participant 15).
“Both boys and girls must be taught by parents as role models about
means of preventing unwanted pregnancy and protection of sexual
transmitted diseases” (Participant 16).
3.3.3. Coach children on their dress code
Parents emphasised that parents should coach their children on their
dress code to prevent teenage pregnancy. Parents felt that the way
teenagers dress determines their outcome. Parents felt that dressing in a
certain way drew men’s attention, thus leading to sexual desire.
Therefore parents need to coach teenagers appropriately on their dress
code to prevent negative outcomes.
This was indicated that:
“At times older men are looking at the teenager’s dress code, looking
sexy they would like to experience what younger kids can give them”
(Participant 8).
“We are faced with fashion trends there are crop tops and miniskirts
thus exposing one
unnecessarily” (Participant 8).
4. Discussion
4.1. Effects of teenage pregnancyon parents
In this study, we explored the lived experiences of parents, living in a
rural area, who had adolescents that fell pregnant. We asked the parents
what their perceptions were on the prevention of teenage pregnancy.
Parents in this study felt excluded from the problem of teenage preg­
nancy. Presently, parents thought that they did not have the commu­
nication skills or knowledge to talk to their adolescents about pregnancy
prevention. This is not an uncommon occurrence in South African
communities, as previous studies have expressed that parents do not
share sexuality education information with their teenagers (Mkhwanazi,
2010; Mudhovozi et al., 2012). Therefore, teenagers do not receive
adequate information on contraception or sexuality education. It is
imperative that teenagers should receive this information before
engaging in risky behaviours and away from peer influences (Aujoulat,
Libion, Berrewaerts, Noirhomme-Renard, & Deccache, 2010). Health
education messages should be addressed to both teenagers and their
parents, opening up avenues for communication. Teenage mothers often
express regret that they never had the opportunity to discuss sexual and
reproductive health issues with their parents (Aujoulat et al., 2010;
Mkhwanazi, 2010).
M. Tryphina Skosana et al.
Lack of parental communication skills is a barrier to the personal
development of any adolescent. Parent-child connectedness; including
support, closeness and parental warmth decreases the risk of teenage
pregnancy by influencing teenage sexual and contraceptive behaviours
(Manlove, Logan, Moore, & Ikramullah, 2008; Miller, Benson, & Gal­
braith, 2001; Panday, Makiwane, Ranchod, & Letsoalo, 2009). When
parents fail to openly communicate with their teenagers, teenagers are
more likely to be influenced by their peers and teenagers who do not
have a close relationship with their parents are more likely to be
involved with deviant peer groups. Studies have shown that parental
regulation, in a loving environment, through house rules, supervision
and monitoring can delay sexual engagement, reduce the number of
partners, increase contraceptive use and decrease the risk of pregnancy
(Honig, 2012; Manlove et al., 2008).
Effective communication about sexual behaviour between parents
and teenagers depends on timing, frequency, content, developmental
appropriateness and quality. Teenagers in South Africa report poor
communication with their parents about sexual matters and they indi­
cated that parents refuse to hold conversations with them about sex
(Eaton, Flisher, & Aarø, 2003). Often parents only provide vague in­
dications rather than direct and correct information, and some parents
may even punish their children for raising the topic (Silk and Romero,
2013). Ideally, parents and children should start communicating about
sex at a young age, and their conversations should adapt to their teen­
agers’ needs as time goes on (Grossman, Jenkins, & Richer, 2018).
Societal and cultural pressures are the influences emanating from
society and cultural beliefs. Sociocultural factors are associated with the
escalation of teenage pregnancy in sub-Saharan Africa (Yakubu & Salisu,
2018). In our study, parents perceived that socio-cultural norms affected
their ability to communicate with their teenager, especially if their
teenager belonged to the opposite sex. Social cohesion within commu­
nities should be promoted to protect teenagers from engaging in risky
behaviour, or from the consequences of risky behaviour. If community
members perceive teenage pregnancy as a problem, then interactive
action and social control of community members should effectively
guide teenage behaviour. For example, if contraceptive use is seen as a
part of responsible, healthy sexuality rather than associated with fear,
shame and poor morality, more teenagers may be inclined to learn about
healthy sexual behaviours (Deaton, 2012).
In African communities, the role of male dominance also influences
attitudes towards healthy sexual behaviours. Mavhandu-Mudzusi,
Sandy, and Francis (2014) confirmed that young women’s ability to
negotiate safe sexual practices is strongly characterized by their power
in a relationship. In Africa, gender power inequalities inhibit teenagers’
sexual choices (Bhana, Morrell, Shefer, & Ngabaza, 2010). These power
inequalities are often exacerbated by intergenerational relationships,
where young teenage girls are unable to negotiate condom use due to
male pressure from older partners. Young women and men are also
pressured by the cultural belief that childbearing proves fertility and
virility (Jewkes, Vundule, Maforah, & Jordaan, 2001). In this study,
parents did not mention power imbalances affecting their children, but
we propose that the isolation experienced by parents, is as a result of
cultural pressure which prevents parents from communicating with
their teenagers.
4.2. Prevention strategies
Parent to child health education on sexuality and contraceptive use is
a participatory learning process enabling teenagers to make informed
decisions about their health (Clark, 2015). In this study, parents
acknowledged the importance of this communication, but this was
overshadowed by their feelings of isolation and inadequate communi­
cation strategies. The inability of parents to discuss relationships and
sexual activity with their teenagers, especially sons, is a common
problem (Harris, Sutherland, & Hutchinson, 2013). Family-based in­
terventions to improve positive parent to child communication about
5
International Journal of Africa Nursing Sciences 13 (2020) 100251
sex and relationships have been proposed to prevent or reduce risky
sexual behaviour in teenagers (Cullen et al., 2012).
The timing of exposure to sexuality education is important. Rouvier
et al. (2011) identified schools as an effective setting for education about
the prevention of early sexual debut. Often, teenagers believe that they
do not need additional information from their parents because they get it
all at school, but parents need to reinforce these messages and encourage
reflection which is not always possible in a school setting. There is no
doubt that sexual education is the responsibility of both the school and
the parent, and the issue is too important to be ignored by either party.
Sexual education needs to form part of the school curriculum; contra­
ceptives need to be freely distributed and accepted by the community.
Parents can provide individual counselling that can help to reduce
pregnancy and early sexual debut.
4.3. Role of parents in preventing teenage pregnancy
In this study, parents were aware of their multiple roles in preventing
pregnancy among teenagers. Parents agreed that significant roles
included sharing information, being a role model and coaching. Silk and
Romero (2013) commented that parents and families should use
evidenced-based programs to advocate policies in the upliftment of
sexual health. In this study, parents indicated a need to learn to share
with their male and female teenagers on how to prevent teenage preg­
nancy. The conversation between parents and teenagers is mainly
influenced by parents and their ability to initiate the conversation. The
ability depends on the parent’s knowledge of sexual and reproductive
health (Rouvier et al., 2011). Rouvier et al. (2011) added that some
parents face a conflict between considering information as a risk to
promote early sexual debut or alternatively as a preventative measure to
teenage pregnancy and sexually transmitted diseases. If parents believe
that sharing information promote early sexual debut, teenagers may be
left with a knowledge deficit. These teenagers often seek out their peers
for accurate information, which may be inaccurate and fraught with
urban myths.
Minnick and Shandler (2011) indicated that teenage pregnancies are
a public concern because of their socio-economic burden. This burden
often extends across generations, as the children of teenage parents are
more likely to have their children at a teenage age (Minnick & Shandler,
2011). Some teenagers believe that being pregnant will secure re­
lationships and provide love. Similar studies confirmed that parents play
an important role in shaping their teenagers’ attitudes towards sexual
issues and that parents are the primary sex educators of their teenagers
(Yakubu & Salisu, 2018). Parental involvement in sexual education is
crucial, but teenagers report that parents mostly stress the negative
impact of sexual activity.
Herrman and Waterhouse (2011) confirmed role modelling as an
indicator for teenage pregnancy, as teenagers with a parent or a sibling
who were teenage parents had positive perceptions of teenage
parenting. The importance of familial interactions underscores the value
of open, free, respectful and honest discussion about sexual behaviour.
According to Welles (2005), today’s sexualised dress code for teen­
agers is sending various messages. The styles are made to display an
ideal image of femininity, but teenagers receive messages that their
bodies are the passport to happiness. Teenage girls learn to entice men
through their dress code and bodies. Teenagers also associate this sex­
ualised dress code with feeling confident and in control of their bodies
and sexuality. Most teenagers choose to follow the fashions seen in
television and movies, which presents a challenge for socialising in a
hyper-sexualised era (Rahimi & Liston, 2009).
4.3. Recommendations
Based on our findings, we recommend that:
M. Tryphina Skosana et al.
Youth-friendly awareness campaigns related to healthy lifestyles and
reproductive health should be launched.
Parents and healthcare workers should collaborate to facilitate
knowledge and new developments.
Youth-friendly services should be accessible and available to all
communities.
Technology should be established to ensure 24 h online services for
sexuality education.
4.4. Limitations
The study was conducted in a selected rural area and was limited to
parents of teenage boys and girls. Therefore the results cannot be
generalized to all parents from various areas such as urban areas or other
rural areas. The sample size used in Dr J.S. Moroka sub-district was
limited, excluding parents from other sub-districts and the broader
province.
5. Conclusion
In this study, we explored and described parental perspectives in the
prevention of teenage pregnancy in a selected rural community. The
perspectives of the parents were highlighted, debated and confirmed
particularly on the lack of knowledge and skills they possess of sexual
and reproductive information. It is important to note that parents felt
excluded from the problem of teenage pregnancy and they are unable to
communicate with their teenagers about it. It is, therefore, necessary
that parent-to-child education platforms be established between parents
and teenagers to prevent teenage pregnancy. These platforms should be
established to prepare teenagers at an early age as part of ensuring good
health and well being.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
References
Aparicio, E. M., Vanidestine, T., Zhou, K., & Pecukonis, E. V. (2018). Teenage Pregnancy
in Latino Communities: Young Adult Experiences and Perspectives of Sociocultural
Factors. Families in Society, 97(1), 50–57.
Aujoulat, I., Libion, F., Berrewaerts, J., Noirhomme-Renard, F., & Deccache, A. (2010).
Adolescent mothers’ perspectives regarding their own psychosocial and health
needs: A qualitative exploratory study in Belgium. Patient Education and Counseling,
81(3), 448–453.
Bhana, D., Morrell, R., Shefer, T., & Ngabaza, S. (2010). South African teachers’
responses to teenage pregnancy and teenage mothers in schools. Culture, Health &
Sexuality, 12(8), 871–883.
A. Bowling Research methods in health: Investigating health and health services 2014
McGraw-Hill Education (UK).
M.J. Clark Community health nursing 2015 Prentice-Hall.
Cope, J. (2005). Researching Entrepreneurship through Phenomenological Inquiry:
Philosophical and Methodological Issues. International Small Business Journal, 23(2),
163–189.
Cullen, M. A., Davis, L., Lindsay, G., & Davis, H. (2012). Engaging Parents in Parentline
Plus’ Time to Talk Community Programme as Part of England’s Teenage Pregnancy
Strategy: Lessons for Policy and Practice: Engaging Parents in Time to Talk
Community Programme. Children and Society, 26(6), 443–455.
Deaton, D. L. (2012). Amy T. Schalet: Not Under My Roof: Parents, Teens, and the
Culture of Sex: University of Chicago Press, Chicago, Illinois, 312 pp, ISBN:
9780226736198. Journal of Youth and Adolescence, 42(1), 157–163.
Department of Health. (2018). Teenage pregnancy statistics. Government Printers,
Witbank.
Eaton, L., Flisher, A. J., & Aarø, L. E. (2003). Unsafe sexual behaviour in South African
youth. Social Science and Medicine, 56(1), 149–165.
Grossman, J. M., Jenkins, L. J., & Richer, A. M. (2018). Parents’ Perspectives on Family
Sexuality Communication from Middle School to High School. International Journal
of Environmental Research and Public Health, 15(1). doi: 10.3390/ijerph15010107.
Harris, A. L., Sutherland, M. A., & Hutchinson, M. K. (2013). Parental Influences of
Sexual Risk Among Urban African American Adolescent Males: Parental Influences
of Sexual Risk. Journal of Nursing Scholarship, 45(2), 141–150.
International Journal of Africa Nursing Sciences 13 (2020) 100251
Herrman, J. W., & Waterhouse, J. K. (2011). What Do Adolescents Think About Teen
Parenting? Western Journal of Nursing Research, 33(4), 577–592.
Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare: John
Wiley & Sons.
Honig, A. S. (2012). Teen pregnancy. International Journal of Adolescence and Youth, 17
(4), 181–187.
Jewkes, R., Vundule, C., Maforah, F., & Jordaan, E. (2001). Relationship dynamics and
teenage pregnancy in South Africa. Social Science and Medicine, 52(5), 733–744.
Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. London, Sage.
Loaiza, E., & Liang, M. (2013). Adolescent pregnancy: a review of the evidence. New
York: UNFPA.
Macleod, C. (2016). Economic Security and the Social Science Literature on Teenage
Pregnancy in South Africa. Gender & Society, 16(5), 647-664. doi: 10.1177/
089124302236990.
Manlove, J., Logan, C., Moore, K. A., & Ikramullah, E. (2008). Pathways from family
religiosity to adolescent sexual activity and contraceptive use. Perspectives on Sexual
and Reproductive Health, 40(2), 105–117. https://doi.org/10.1363/4010508
Mavhandu-Mudzusi, A. H., Sandy, P. T., & Francis, T. K. (2014). Factors Contributing to
Intergenerational Sexual Relationships among Refugee Girls in the City of Tshwane,
South Africa. Mediterranean Journal of Social Sciences, 5(20), 2876.
Miller, B. C., Benson, B., & Galbraith, K. A. (2001). Family Relationships and Adolescent
Pregnancy Risk: A Research Synthesis. Developmental Review, 21(1).
Minnick, D. J., & Shandler, L. (2011). Changing Adolescent Perceptions on Teenage
Pregnancy. Children & Schools, 33(4), 241–248.
Mkhwanazi, N. (2010). Understanding teenage pregnancy in a post-apartheid South
African township. Culture, Health & Sexuality, 12(4), 347–358.
Mollborn, S., Domingue, B. W., & Boardman, J. D. (2014). Understanding multiple levels
of norms about teen pregnancy and their relationships to teens’ sexual behaviours.
PMC, 20, 1–15. https://doi.org/10.1016/j.alcer.2013.12.004
Mpumulanga, D. o. H. P. o. (2017). Annual Report. Nelspruit: Department of Health,
Province of Mpumulanga.
Mpumulanga, D. o. H. P. o. (2018). Annual Report. Nelspruit: Department of Health,
Province of Mpumulanga.
Mudhovozi, P., Ramarumo, M., & Sodi, T. (2012). Adolescent sexuality and culture:
South African mothers’ perspective. African Sociological Review, 16(2), 119–138.
Panday, S., Makiwane, M., Ranchod, C., & Letsoalo, T. (2009). Teenage pregnancy in
South Africa: with a specific focus on school-going learners. South Africa: Human
Sciences Research Council.
Peu, D. (2016). Health promoters’ contribution regarding health promotion for families
with adolescents within the HIV and Aids context. The Social Work Practitioner-
Researcher, 28(3), 303–315.
Peu, M. D. (2014). Health promotion strategies for families with adolescents orphaned by
HIV and AIDS: Health promotion evaluation strategies. International Nursing Review,
61(2), 228–236.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for
nursing practice: Wilters Kluwer/Lippincott Williams & Wilkins: Philadelphia.
Rahimi, Regina, & Liston, Delores D. (2009). What Does She Expect When She Dresses
Like That? Teacher Interpretation of Emerging Adolescent Female Sexuality.
Educational Studies, 45(6), 512–533.
Ressler, T. C. (2012). Teenage pregnancy negatively impacts the national economy
Retrieved 29/08/2018, 2018, from http://thinkprogress.org.health.
Richter, M. S., & Mlambo, G. T. (2005). Perceptions of rural teenagers on teenage
pregnancy. Health SA Gesondheid, 10(2), 61–69.
Rouvier, Mariel, Campero, Lourdes, Walker, Dilys, & Caballero, Marta (2011). Factors
that influence communication about sexuality between parents and adolescents in
the cultural context of Mexican families. Sex Education, 11(02), 175–191.
SABC. (2018). Teenage pregnancy on the rise in Mpumalanga, SABC NEWS, at 9.39 PM.
Accessed on the 11 August 2020:https://www.sabcnews.com/sabcnews/teenage-
pregnancy-on-the-rise-in-mpumalanga/.
Silk, Jessica, & Romero, Diana (2013). The Role of Parents and Families in Teen
Pregnancy Prevention: An Analysis of Programs and Policies. Journal of Family Issues,
35(10), 1339–1362.
Speziale, H. S., Streubert, H. J., & Carpenter, D. R. (2011). Qualitative research in
nursing: Advancing the humanistic imperative: Wolters Kluwer/ Lippincott Williams
& Wilkins: Philadelphia.
Tabane, N. S., & Peu, M. D. (2015). Perceptions of female teenagers in the Tshwane
District on the use of contraceptives in South Africa. Curationis, 38(2), 1528. https://
doi.org/10.4102/curationis.v38i2.1528
Thobejane, Tsoaledi Daniel (2015). Factors Contributing to Teenage Pregnancy in South
Africa: The Case of Matjitjileng Village. Journal of Sociology and Social Anthropology,
6(2), 273–277.
United Nations Children’s Fund. (2018). UNICEF programme Guidance for the Second
Decade: Programming with and for adolescent. Geneva: Switzerland.
UNFPA. (2017). The State of the World Population 2017: Worlds Apart.
UNFPA. (2013). Motherhood in childhood: Facing the challenge of adolescent
pregnancy. South Africa: Government Printers.
Welles, Caitlin E. (2005). Breaking the Silence Surrounding Female Adolescent Sexual
Desire. Women & Therapy, 28(2), 31–45.
Winters, L. I., & Winters, P. C. (2012). Black Teenage Pregnancy. SAGE Open, 2(1). doi:
10.1177/2158244012436563.
Yakubu, I., & Salisu, W. J. (2018). Determinants of adolescent pregnancy in sub-Saharan
Africa: a systematic review. Reproductive Health, 15(1), 15.