‘LOSING’ A PREGNANCY: INCENTIVE TOWARD RAPID REPEAT PREGNANCY?

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

2. 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.

3. 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

4. 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

5. 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

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

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

8. 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)

9. 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)

10. 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)

11. 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)

12. 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)

13. 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)

14. 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)

15. 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)

16. 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)

17. 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)

18. 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….