Experiences of repeat pregnancy in Thai adolescent mothers

Aims: The study aims to increase the understanding of the experiences of repeat adolescent mothers in the context in which they live.Objective: To explore the experiences of adolescent mothers who have at least one living child and are at least 6 months pregnant on a subsequent occasion as adolescents (a repeat pregnancy).Sample: Purposive sampling was used to identify a sample of 15 adolescent mothers experiencing a repeat pregnancy at the time of interview.Methods: Individual semi-structured qualitative interviews were used to gather in-depth data from participants who discussed their experiences of a repeat pregnancy. Thematic analysis (Braun and Clarke, 2006) was used to develop an analytic framework; this analysis was further organised using Bronfenbrenner’s ecological theory (1979, 1986,1994) to understand and conceptualise the relationship between individual experiencesand related contexts.Findings: The findings of this study are classified into four main themes: Contraceptive decision-making, Relationships, Education and Employment and A Transformational Experience. This analytic framework, when considered in relation to Bronfenbrenner’s ecological theory (1979, 1986, 1994), raises five main issues, namely: the experience of repeat pregnancy at the microsystemic level, interaction and relationships at the mesosystemic level, disruption from others at the exosystemic level, trying within constraints at a macrosystemic level and the life journey at the chronosystemic level.Conclusion: Although adolescent mothers experiencing a repeat pregnancy exercise some agency in relation to decision-making around sexual health, contraception, and family-building, they are heavily constrained by their structural context. That is, the agency available to pregnant adolescent mothers is impacted by partner behaviour, the influence of family and peers, cultural expectations and the structured function of policy and law. The organisation of education, including sexual health and relationships education itself, and the structure of employment disadvantage young mothers when they are most vulnerable. This is further evident in the lack of active enactment of protective policies and laws, including adequate, timely and confidential sexual health provision and protection from child marriage. The acknowledgment of the impact of these structures to limit the ability of young mothers to exercise agency in a Thai context is unique to this study and central to the project to reduce repeat adolescent pregnancy in Thailand