Introduction: Globally, the World Health Organisation (WHO) have reported approximately 16 million adolescent pregnancies per year, of which 95% are reported to occur in low-lower and middle-upper middle income countries. Indonesia, is one of the low-lower and middle-upper middle income countries; and data indicates that during 2012, 48 per 1,000 pregnancies occurred at the aged 15-19, of these 0.02% were aged 15 or less. This study is the first research of its kind in Indonesia to explore, illuminate and understand Indonesian adolescents’ reproductive practices and their experiences during pregnancy and early parenthood.
Methods: This is an exploratory qualitative research conducted over a period of three years, consisting of three studies, a qualitative systematic review (study 1), an in-depth study of adolescents during pregnancy (study 2) and an in-depth study of young parents (study 3). Four couples participated in study 2 and twelve young parents participated in study 3 (including eight young mothers and four young fathers). One-to-one in-depth interviews were used for data collection, thematic analysis was used for data analysis and N Vivo was employed for data management.
Findings: This study revealed that adolescents engaged in premarital sexual relationship due to a loving relationship, whilst knowledge related to preventing pregnancy and Sexual Reproductive Health (SRH) services was limited and resulted in unplanned pregnancies. When unplanned pregnancy occurred, the couples were forced by their parents to get married to ’fit in’ with cultural and societal norms of not having children outside of marriage. However, it brought life difficulties within adolescents’ marriage relationships i.e. coping with stress, stigma, judgement, social exclusion, education termination, financial difficulties, jobs, role divisions, breastfeeding and children care. Foucault's theory of power is used to interpret findings.
Conclusions and recommendations: Power of culture and religion within Indonesian society played a critical role in adolescents’ complex experiences through their unplanned pregnancy, marriage and parenthood. Indonesian adolescents require timely and accessible SRH education and services to increase their knowledge and understanding around SRH practices so that they can make informed decisions about sexual reproductive practices and prevent unplanned pregnancies. Evidence based care pathways are essential to support and empower young parents during their journeys that they can undertake their parenting role effectively. Future research is invaluable which might evaluate service models initiated to meet the health and social needs of the adolescents during pregnancy and early parenthood.
