Struggling motherhood and coping fatherhood 1
ABSTRACT
Objective:To gain a deeper understanding of Thai teenage parents’ perspectives, experiences and reasoning about becoming and being a teenage parent from a gender perspective.
Design: An exploratory design using grounded theory methodology. Semi-structured interviews were used to collect data. An interview guide was developed, a pilot study was undertaken, and interviews were performed on two different occasions: once during the second trimester of pregnancy and again when the baby was 5–6 months old.
Setting:A province in the western part of Thailand.
Participants: The selection of a heterogeneous group of teenage parents-to-be continued until saturation was reached, as describe by Glaser and Strauss (1967), in all n = 50. Inclusion criteria for participants were that they were heterosexual couples, under 20 years of age, cohabiting, and expecting their first child.
Findings:The core category “struggling with motherhood and coping with fatherhood” comprises descriptions of the process from when the teenagers first learned about the pregnancy until the child was six months old. The teenagers had failed to use contraceptives which led to an unintended parenthood. Their parenthood became a turning point as the teenagers started to change their behaviours and lifestyle during pregnancy, and adapted their relationships to partner and family. Family commitments was a facilitator, through support given by their families. Finally, becoming a parent describes ways of dealing with the parental role, by engaging in parental activities and reestablishing goals in life. Most of the teenage parents reproduced traditional gender roles by being a caring mother or a breadwinning father respectively.
Key conclusions: “Struggling with motherhood and coping with fatherhood” referred to the parents’ stories about how they struggled and coped with life changes and their parental role when they became unintentionally pregnant, accepted their parenting, and finally became parents.After becoming parents, the main concerns of most of the teenage parents were being a caring mother and a breadwinning father.
Implications for practice: This study contributes a deeper understanding of Thai teenage parents’ experiences of becoming and being a parent and might improve health care professionals’ adaptation of care for teenage parents and inspire them to tailor their care specifically to teenager’s needs from early pregnancy to parenthood.
Key words: Coping with fatherhood, Grounded theory, Struggling with motherhood,
Teen parent, Thai teenagers
Introduction
Teenage parenthood continues to be a concern in many countries.In Thailand, the birth rate among teenagers increased dramatically from 31.1 to 53.8 per 1,000 teenage women during the years 2000–2012 (Termpittayapaisith & Peek, 2013).The proportion of both male and female students who reported always using a condom during intercourse was below 30% (n= 26,430) in 2011 (Bureau of Epidemiology, 2012). Pregnant teenagers also have an increased incidence of obstetric complications as well as poor neonatal outcomes for their babies
(Liabsuetrakul, 2012;Qazi, 2011).
Thai law approves requests for legal abortion only in cases of rape,serious complications for the mother, or expected physical deformity or mental retardation of the child. Many rural women remain fearful of the consequences of sin or “bap” if they were to undergo an abortion, and therefore choose to continue with an unintended pregnancy (Whitaker & Miller 2000).Since the end of 2014, legal medical abortion is possible under the strict control of the Ministry of Public Health, but teenagers under the age of 18 need parental consent.
Teenagers need a large amount of time for their education and social life, which are significant parts of their growth and development. Becoming a parent is a major developmental transition and brings an avalanche of both positive and negative experiences to a couple’s life together (Meleis, 2010). As parents, teenagers must devote time and effort to taking care of their child (Hockenberry & Wilson, 2011). Teenage parents thus experience conflicting needs. Teenage parents are often unemployed or have insufficient income, and therefore must rely on their families for basic necessities, such as food and housing (Chirawatkul et al., 2011). Moreover, 91.4% (n=879) of Thai teenage mothers felt an inner conflict and were frustrated because they had to act as daughter, mother and student at the same time. In addition, 7.4% (n= 3,114) of the teenage mothers reported being a single mother (Chirawatkul et al., 2011). Simultaneously, teenage fathers may be preoccupied with their own developmental issues relating to achieving independence from their parents (Logsdon, 2002). Consistency in parenthood provides the basis for the infant’s development and its sense of trust. Research indicates that positive experiences of becoming a teenage fatherenables the young father to express his sense of masculinity and identity. Being a father is described as a process of maturing (Premberg et al., 2008).
In Thailand, men are often referred to as “hua nah kropkrou” (leader of the household) (Coyle & Kwong, 2000). Asian men can be exemplified by the Philippines, where men are metaphorically referred to as “the pillar of the home” (Hoang & Yeoh, 2011). In Thailand, a good mother is expected to make personal sacrifices for her baby (Liuamputtong et al., 2004). Chirawatkul et al. (2011) reported that 68.7% (n=879) of Thai teenage mothers accepted that women were responsible for childrearing, and 78.5% agreed with the assertion that women are more sensitive and patient than men. Thus, Thai mothers have been subjects both internally and externally to expectations to do housework and take care of the children.
In Thailand, studies in the area of teenage motherhood have explored female experiences during pregnancy, early motherhood and childrearing (Muangpin et al., 2010; Neamsakul, 2008; Phoodaangau et al., 2013; Pungbangkadee, 2008; Sriyasak et al., 2013). The knowledge about teenage parenthood is limited in the existing literature. With this study we intend to contribute to the understanding in this area. The objective was to gain a deeper understandingof Thai teenage parents’ perspectives, experiences and reasoning about becoming and being a teenage parent, from a gender perspective.
Methods
An exploratory design was chosen and grounded theory methodology was employed. Grounded theory explores social processes and is helpful when developing a preliminary model to explain human interactions in society (Glaser & Strauss, 1967).
Participants and Setting
Inclusion criteria for participants were that they were heterosexual couples under 20 years of age expecting their first child. The selectionof teenage parents-to-be (n=50) continued until saturation was reached (Glaser & Strauss, 1967). This means, the researcher compared sequentially events until no new concepts or properties of categories were obtained (Charmaz, 2006). One teenage couple dropped out in the second interview due to the baby’s death.Participants were selected from cohabiting, pregnant couples who resided in a province in western part of Thailand,who visited the district hospitals and Primary Health Care Centres in this province. This rural area was chosen since it has one of the highest adolescent birth rates in Thailand (Ministry of Social Development and Human Security, 2014).
Data collectionand analysis
The interview guide was developed based on our research objective (Table 1).Three pilot interviews were undertaken to test and, if necessary, modify the questions in the interview guide, in a group similar to the sample. At all interviews, conducted by the first author in Thai, the researcher initiated a conversation with a general question such as: “Could you please tell me the story of how you became a teenage parent?” All the semi-structured interviews were digitally recorded and transcribed verbatim. Names and places were changed. Taking theoretical sensitivity into consideration (Glaser & Strauss, 1967), the interview questions were modified throughout the study according to the emerging concepts(Table 1). Examining the data from different angles enabled us more easily to develop a preliminary model. To gain richer data, some new questions were added to the interview guide based on the findings from the pilot interviews, such as questions about preparing for parenthood, and support from other people, friends or teachers.
The first author origins from a rural area of Thailand and has extensive experience as a nursing instructor. To enhance self-awareness and minimize bias, a reflective journal was used throughout the data collecting process and analysis to remind the researcher of bias and to enhance the study’s rigor (Charmaz, 2006). Being a woman, interviewing male participants could imply difficulties in taking the other’s perspective. The first author has undertaken research within the area of teenagers and has lead parental classes, with both men and women. These experiences were beneficial for the ability to listen and talk with men becoming or being teenage parents. Further, all the co-authors have earlier experience of doing and publishing research on families, using grounded theory. These experiences have led to an awareness of the importance of data variation and an open mind when analysing the empirically generated findings.
Data were collected from the same participants on two different occasions. The first interview was conducted during the second trimester of the mother-to-be’s pregnancy. The participants decided on the location of the interview, with most choosing to be interviewed in a separate room in their own home. Six couples were interviewed in a quiet place in the antenatal ward for the first interview. The second interview was undertaken when the child was around 5–6 months old. For the second interview, all of the participants were interviewed in their own homes.The interviews were held separately with the teenage mother and the teenage father, and lasted around 45–60 minutes.
The processes of collecting and coding data took place in parallel, as is characteristic of grounded theory (Strauss & Corbin, 1998). The theoretical sampling (Glaser & Strauss, 1967) took place after every open coding; a new couple who had some different demographic characteristics was interviewed in order to gain more varied data. Interview data were transcribed verbatim in Thai to preserve the subtleties and meaning of the Thai teenage parents’ narratives as accurately as possible. A professional interpreter translated the coded data from Thai into English. The non-Thai-speaking authors(author 2, 5)read and commented on part of the interviews. The process of coding was double-checked by both Thai co-authors(author 3, 4)to reduce the risk of translation distortion (Squires, 2008). The procedures for data analysis followed the work of Strauss and Corbin (1990), and NVivo 10 qualitative software (QSR International, 2010) was used.
The first step in the analysis was open-coding; the first authorand the third authorreviewed all transcripts independently and read and reread the transcript several times in order to understand the meaning of the whole text, after which the line-by-line coding began(Strauss & Corbin, 1990).The second step was axial coding, which is a procedure of relating subcategories to a category in a new way through the coding paradigm of causal conditions, actions, intervening conditions, and consequences (Strauss & Corbin, 1990), summarizing the content (Table 2). The third step, selective coding, was done to identify a core category and to link categories to each other. The last step was to form a preliminary model, which is a theoretical model constructed to link the categories together (Figure 1). Both memos and the constant comparative method were useful in all stages of the analytic process. Saturation was decided on when answers, wordings and emerging concepts among participants tended to be repeated in the interviews.
Ethical considerations
The study was approved by the Ethical Committee of the Public Health Office in a province in western Thailand (PB0027.005/3539) and by the Swedish Ethical Board in Uppsala (Dnr. 2012/556). Participants took part voluntarily and were informed that they could withdraw at any time without giving an explanation.
Findings
Twenty-five teenage mothers aged 14 to 19 years and twenty-five teenage fathers aged 16 to 19 years participated in this study (Table 3). Most of the teenage mothers had had a normal labour and had given birth to a healthy, normal-weight baby (Table 4).
Core category
The core category labelled “struggling with motherhood and coping with fatherhood” includes a description of the teenagers’ experiences from when they first learned about the pregnancy until the child was six months old. The teenage mothers expressed how they struggled with physical and social changes, such as for example bodily changes, breastfeeding and having to leave school, whilst the teenage fathers gave examples of coping with their future responsibility by working hard in order to save money for future family needs. The teenagers had in most cases failed to use contraceptives, which led to their unintended parenthood. Their parenthood became a turning point, as the teenagers started to change their behaviours and lifestyle during pregnancy, and adapted them to improve their relationships to partner and family. Family commitments were a facilitator, through support given by their families. Finally, being a parent explores their ways to manage the parental role by engaging in parental activities and re-establishing goals in life. Most of the teenage parents reproduced traditional gender roles by being a caring mother and a breadwinning father (Figure 1).
Unintended parenthood
Most of the teenage parents-to-be described feelings of unreadiness to be parents, but at the time of the first interview, they had accepted the unintended future parental role and took responsibility as a parent before the child was born. The decision to keep the baby was related to religious beliefs called “bap”, which caused them to fear the future consequences of attempting abortion, and to the acceptance they received from their families.
Unconcerned about risk and failing to use contraceptives Most of the teenage parents were unconcerned about the risk of becoming pregnant and had not used contraceptives or had used them only sporadically, due to the fact that they had had sexual intercourse many times without getting pregnant. This counted for most respondents, as one father-to-be stated:
…We had sex many times; I randomly used a condom and I didn’t think that she would get pregnant. Now,I have to keep the baby. The baby is our flesh and blood and I didn’t think of doing an abortion; it’s sinful or “bap”. (Father05)
Most of the pregnancies were unintended, however three teenage couples intended to get pregnant and needed a baby to be a family. As one mother-to-be expressed it:
We didn’t use birth control; we really wanted a child. Having a baby is common and helps us to become a family because we had finished school and already had a job. They performed a family ceremony for us and we lived together on our own beforegetting pregnant. (Mother 16)
Fear of performing an illegal abortion Teenage mothers and fathers had similar feelings of fear about getting an abortion, as they realized it meant going through a physical operation and was against the law. The teenage parents also expressed concerns about religious beliefs. They believed in a Buddhist sin called “bap”, and feared the consequences of this sin, especially losing the prospect of a successful life in the future. As one mother-to-be said:
I didn’t attempt to have an abortion because I was afraid of sin or “bap”. I feared negative consequences in the future. I also feared the haemorrhage from an abortion, I heard that my friend, who had an abortion, bled heavily. (Mother 09)
Acceptance from their families Acceptance from the teenagers’ families of their continuing the pregnancy included positive responses from both families. Most of the teenagers were hesitant to reveal they were pregnant, and therefore waited about 2–3 months to tell their families about their condition. One teenage mother revealed that she thought it was shameful to be a pregnant teenager:
I didn’t dare to talk with her [mum]; I told my aunt first. She [aunt] was afraid that my boyfriend would not take his responsibility. She called my mum and made her understand. After that she [aunt] told me to call my boyfriend and tell him to tell his parents to talk with my parents, then she [her mum] accepted [the pregnancy and boyfriend]. (Mother 10)
Parenthood as a turning point
The teenage parents reflected on the adjustments involved in becoming a parent. A social tradition in Thailand is the “family ceremony”, which is performed for a couple when a teenage girl gets pregnant. The couples had to adapt their behaviours and lifestyle; by changing their relationships with their families and partner, they helped prepare themselves to become parents. Moreover, the young couples were concerned about childrearing.
A societal wedding tradition in Thailand A societal tradition is to organize a family ceremony for the couple. This is a part of a wedding ceremony, and it helped the young couples and their families to maintain their status in society. For instance, a father-to-be reported: “My father talked with my partner’s family, then they let my partner live with me before we made the traditional and informal Thai engagement, ‘the nuptial bed’ (Father 05). Observing this tradition helped other people to accept the pregnancy as well as to forgive the pregnant teenagers for the mistake they had made.