Social support among HIV-positive and HIV-negative adolescents in Umlazi, South Africa: changes in family and partner relationships during pregnancy and the postpartum period.

Lauren M Hill,Allison K Groves,Suzanne Maman,Dhayendre Moodley

doi:10.1186/s12884-015-0542-z

Abstract

BackgroundPregnancy is common among adolescents in South Africa, yet the social experiences of adolescents during the pregnancy and postpartum period remain understudied in this context. We aimed to explore how adolescent women’s discovery and disclosure of both their pregnancy and HIV status affected their relationships with family members and sexual partners, with a particular focus on whether and how support changed throughout this time period.MethodsWe conducted in-depth semi-structured interviews with 15 HIV-positive and HIV-negative adolescent women who were either pregnant or had delivered in the last 18 months from one urban clinic in Umlazi, South Africa. Interviews were audiotaped, transcribed, translated, and coded for analysis.ResultsYoung women described stress and instability in their relationships with family and partners during pregnancy and the postpartum period, though prior to and during HIV-status disclosure women generally experienced less stress than in disclosing their pregnancy to family members and partners. After a destabilizing period immediately following pregnancy disclosure, families became and remained the primary source of material and emotional support for the young women. Women discussed heightened closeness with their partners during pregnancy, but few women had close relationships with their partners postpartum. Support experiences did not differ by HIV status.ConclusionPrograms should be aware of the relative importance of pregnancy-related concerns over HIV-related concerns in this population of young women. Engaging family members is critical in ensuring social support for this population of young pregnant women, and in encouraging timely initiation of antenatal care.

Highlights

Pregnancy is common among adolescents in South Africa, yet the social experiences of adolescents during the pregnancy and postpartum period remain understudied in this context
Social support confers further benefits for Human Immunodeficiency virus (HIV)-infected pregnant and postpartum adolescents, promoting adherence to antiretroviral therapy (ART) regimens which promote the health of the mother and protect against mother-to-child transmission of HIV [27,28]
We describe the relationships that young women have with family and partners during pregnancy and the postpartum period, how these relationships differ for HIV-positive and HIVnegative women, and discuss the implications of these social support patterns for the care of young women during this critical period

Summary

Introduction

Pregnancy is common among adolescents in South Africa, yet the social experiences of adolescents during the pregnancy and postpartum period remain understudied in this context. Thirty-five percent of young women in South Africa under 21 years of age have been pregnant, and the majority (54%) of these pregnancies are unintended [1]. The stigmatization of adolescent pregnancy may cause weakening of social support [15], which during pregnancy and postpartum is integral to the health of both the adolescent mother and her child. Lack of social support has been linked to poor mental and physical health outcomes among young pregnant women [16,17,18,19,20,21,22,23,24]. Social support confers further benefits for HIV-infected pregnant and postpartum adolescents, promoting adherence to antiretroviral therapy (ART) regimens which promote the health of the mother and protect against mother-to-child transmission of HIV [27,28]

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