Abstract
The idea that adolescence, an important developmental stage in human life is embodied in emotions is not new. However, the association between adolescence, unplanned motherhood, and HIV infection, which often lead to unanticipated transitions, may influence a rethink toward understanding the emotional and mental states of adolescent mothers. Using a sociological lens, this article draws on the concept of “emotionality” and the importance of paying attention to “emotions” in offering analysis of the new reality, which HIV-positive adolescent mothers find themselves in South Africa. Specifically, this article shifts the social research focus from behavioral (e.g. sexual behaviors) research to exploring HIV-positive adolescent mothers’ feelings, thus paying heed to a subjective emotional landscape. Through an inductive thematic analysis, the emotional accounts and unifying themes extracted from 13 (10 HIV-positive adolescent mothers and three key informants) semistructured in-depth interviews present an understanding of the various needs of an emerging youthful generation living with HIV, rather than a narrow, conventional focus on costs, risks, and impending mortality.
Developing an understanding of the concept of human emotions gives meanings to the complex nature of human experiences, and the world in general. To build insight into how emotions shape and influence human narratives in life, this article explores the emotional aspect of the experiences of HIV-positive adolescent mothers in South Africa. Consequently, the main goal of this article is to place primacy on the concept and place of emotions through the analysis of its impact on the lives of these mothers. This is to foster pertinent interventions that will enable positive emotional well-being while playing their roles as mothers. Based on the rich understanding of HIV-positive adolescent mothers’ emotional experiences, this study thus hopes to stimulate fresh research and promote overarching discussion, which will further contribute to the study of the concept of human emotions.
Selected Insights From the South African Context
Inevitably, in every human development, adolescence represents a distinct and evolving phase that involves the development from immaturity and social dependency into personal and social accountability with the clear ability to fulfill goals and expectations (Curtis, 2015; Steinberg, 2014). This significant transitional stage between childhood and adulthood includes the early substage of development to the middle and the late substage of development (Curtis, 2015; Neinstein et al., 2009; Steinberg, 2014). To encompass all these stages of development, this article engages with an expanded sequential formulation of adolescence between ages 10 and 24 years (Sawyer et al., 2018; United Nations Children’s Fund, 2009).
Continuously, adolescents are faced with wide fluctuating emotional experiences, and the capability to manage these emotions is paramount to their future relationships and existence, such as parenting and careers (Hartel et al., 2005; Larson & Brown, 2007). Understanding the daily fluctuating emotional development of adolescents is often viewed as difficult. This is because adolescents themselves are at the crossroad between subjective and objective reality—intensely personal emotions and the influence of their social world (Fisher et al., 1990; Haviland et al., 1994). Adolescence entails the integration of both the profound corporal growth and the matured existential essence, as they fit within the society (Curtis, 2015; Patton et al., 2018). If this relational process is however inappropriately comprehended and inadequately managed, this often leads to risky behaviors that have problematic consequences (Lerner & Steinberg, 2004; Sanci et al., 2018; Steinberg, 2014). Some of these consequences due to adolescents’ vulnerability include living with HIV and unplanned pregnancy.
Given the high rate of HIV infection and unintended pregnancy among adolescent girls in South Africa, which is generally driven by social, cultural, and risk behavioral issues such as inconsistent use of condoms, early sexual debut, transactional sex, and so on (Adeniyi et al., 2018; Fleischman & Peck, 2015; Mchunu et al., 2012), it is imperative to understand the emotional and social aspects of being an HIV-infected adolescent mother. Becoming an unplanned mother while living with HIV infection positions an adolescent and her child at a very vulnerable point. They are susceptible to a multiplicity of challenges and issues such as psychological and mental issues, financial hardship, stigma and discrimination, limited support structure, health needs, mother-to-child infection, and relationship tension (Adeagbo, 2019; Morrell et al., 2012; Mushwana et al., 2015).
To depict how these individuals are positioned within the interacting domains of adolescence, transition into adulthood, unplanned motherhood, and a life-threatening infection—HIV, an integrated conceptual model of HIV-positive adolescent mothers is presented below (see Figure 1). This model is presented to diagrammatically highlight the link between all the constituents that define the new reality of HIV-positive adolescent mothers.
Integrated conceptual model of HIV-positive adolescent mothers.
Comparatively, South Africa has the largest HIV epidemic in the world with an estimated 4.25 million to 7.52 million between 2002 and 2018 (Statistics South Africa, 2018). Despite the decline in HIV incidence among the youth, statistical analysis shows relatively high rates of new infections, especially among adolescent girls and young women (15–24 years) compared with young men in the same age group (Human Sciences Research Council, 2018). Living with HIV poses numerous emotional and social challenges. This is due to the effect on several levels of functioning especially during adolescence. In comparison with HIV-positive adults, adolescents living with HIV are faced with higher rates of psychological and emotional issues. Invariably, they often perceive living with HIV as physically, psychologically, and emotionally painful (Li et al., 2010). They are faced with issues such as mental and cognitive health, reproductive and sexual health, gender identity and socioeconomic status, medication adherence, disclosure, and stigma (Cervia, 2013; Dowshen & D’Angelo, 2011; Naidoo, 2015).
Similarly, the experiences during pregnancy and childbirth inform several transformative processes and adaptive responsibilities for any woman (Bhana et al., 2010; Hastings-Tolsma et al., 2018; Reisz et al., 2015). These life-changing experiences include grappling with conflicting developmental responsibilities, the simultaneous transition from girlhood into motherhood, and that of becoming a parent by nurturing and caring for both the physical and emotional needs of a child with a limited support system (Chigona & Chetty, 2008; Crugnola et al., 2014; Gyesaw & Ankomah, 2013; Patel & Sen, 2012; Seibold, 2004). This experience becomes complicated if the men who impregnated them are absent, intentionally or unintendedly (Chigona & Chetty, 2008). Moreover, the significant risk factors associated with motherhood in adolescence and early adulthood influence the subsequent developmental trajectories of both mother and child (Flaherty & Sadler, 2011; Mushwana et al., 2015). Both are at greater risk of psychological and physical abuse, insecurity, poor academic performance, unemployment, early parenthood, limited life chances, and general behavioral problems (Boden et al., 2008; Bolton, 1990; Flaherty & Sadler, 2011; Hoffman & Maynard, 2008; Mushwana et al., 2015; Rafferty et al., 2011).
With increased research on the interaction and connection between adolescent mothers and their children, studies have shown that early and unplanned motherhood subsequently affects the relationship, interaction, and in particular the responsiveness of adolescent mothers toward their children (Chohan & Langa, 2011; Mchunu et al., 2012; Morrell et al., 2012; Mushwana et al., 2015). A comparative report shows less affection from adolescent mothers compared with adult and planned parenthood, and this often results in both verbal and physical abuse (Krpan et al., 2005; Lee & Guterman, 2010). Due to their unplanned experiences, adolescent mothers are viewed as less expressive toward their children; rather than share positive emotions through care and love, they often transfer negative emotions (Barnard, 1997; Driscoll & Easterbrooks, 2007; Mushwana et al., 2015).
Imperatively, past research has focused on the social behavioral aspect of HIV-positive mothers and adolescents’ experiences, with limited discussions on their shifting emotions and feelings in South Africa (e.g., Bhana et al., 2010; Harrison et al., 2015; Lee & Guterman, 2010; Mushwana et al., 2015). There is, therefore, the need for more research into the emotional aspect of this subgroup of adolescent mothers’ subjective experiences in South Africa, to fully understand their needs.
The Present Study
Reiterated, there is a paucity of research on HIV-positive adolescent mothers’ subjective views of their psychological and emotional experiences, and the relevant interventions to promote their positive emotional well-being remain underresearched in South Africa. To address this gap in the extant literature, the key objective of this study is to provide relevant analysis of the impact and place of emotions in the lived experiences of HIV-positive adolescent mothers, so as to promote pertinent psychosocial interventions that will enable positive emotional well-being while playing their roles as mothers. Based on empirical research and related theory, this article, through the formulated model proposes a sociologically defined mechanism that will mediate between HIV-positive adolescent mothers, their children, and their mental/emotional stability, hence promoting positive overall outcomes.
A Closer Look at “Emotionality”
Across the disciplines, there are diverse ways of understanding the concept of human emotions, despite them being characterized by experiences and social occurrences. However, two major sociological and psychological redefined arguments on the understanding of human emotions conceptualized emotions as subjective feeling based, while the other advocated that emotions are thought and cognitive based (James, 1884; Schachter & Singer, 1962). Recent arguments have integrated these two dominant understandings of emotion, thereby presenting a broader conceptualization that encompasses key socially constructed natures of human emotion. Here, emotion is described in terms of “situation-directed” behaviors, which are delineated based on embodied interaction between the key player and the subjective setting (Colombetti, 2013; Heavey et al., 2017; Slaby & Von Scheve, 2019). These emotions are linguistically labeled and have culturally recognized categories, such as happiness, anger, regrets, fear, and sometimes mixed feelings (Colombetti, 2013; Heavey et al., 2017; Slaby, 2014; Slaby & Von Scheve, 2019). These categories upsurge the understanding of the concept of emotion as affective and cognitive processes. They are permeated by specific combinations of remarkable experiences, expressive attitudes, significant actions, and corporal changes.
Drawing from the range of empirical studies conducted by neuroscientists and psychologists in understanding these various emotional connections, social scientists have focused on how various identified emotions shape human knowledge, actions, and experiences (Burkitt, 2002; Demertzis, 2013; Goldie, 2002; Scheff, 2000). From a sociological viewpoint, emotions involve the labeling of human feelings based on cultural, interactive, and interpretive processes (Roach, 2016; Thoits, 1989; Turner & Stets, 2005). Emotions play a fundamental role that influence the comprehension of social occurrences through human experiences. It is through human feelings and thoughts that experiences are gathered and human life defined—I think (or feel), therefore I am (Descartes, 1637). Denzin (2009) defined emotion as a lived, believed-in, situated, temporally embodied experience that radiates through a person’s stream of consciousness, is felt in and runs through his (sic) body, and, in the process of being lived, plunges the person and his (sic) associates into a wholly new and transformed reality—the reality of a world that is being constituted by the emotional experience. (p. 66)
In other words, emotions are “essential for forming and perpetuating human societies” (Clack, 2002, p. 155). Therefore, considering the significant influence of emotions on human developmental outcomes, it is important to critically understand how the different or the combination of the categories of human emotions are related to the experiences of HIV-positive adolescent mothers.
In studying the emotions of HIV-positive adolescent mothers in South Africa, there is a revelation as to the persistent dynamics of the complexities they encounter and the possibilities of ameliorating or altering the narratives that are based on their experiences as unplanned mothers while living with HIV (Adeagbo, 2019). For example, institutionalized stigma may have been understood as a tool to discourage adolescents from high-risk behavioral activities that often lead to unplanned negative consequences (Sidibe & Goosby, 2013). Although several adolescents may have fallen prey to this situation, an understanding of the raging emotions—such as fear and regret—of these mothers can motivate the society to address the root causes of unplanned parenthood. This may especially proffer constructive assistance that will promote general psychosocial well-being of affected adolescents.
Studies have highlighted different intensive emotions that can both be negative and positive, such as satisfaction, delight, frustration, depression, simultaneous feelings of love and hate toward one’s child, and even regret (Dew & Wilcox, 2011; Nelson et al., 2014). Regret, as one of the various human emotions, is often regarded as a taboo in most cultural arguments on childbirth. The feeling of regret is associated with the outcome of choices made that could have been made differently (Zeelenberg et al., 2000). Having children, as advocated through pronatalist ideology celebrates parenthood, which is believed to be the essential fulfillment of the key purpose of adulthood and life in general (Carroll, 2012; Moore & Abetz, 2019). Expressing regret due to maternal experience is generally frowned at and as such, regret as a unique emotion remains underresearched. In order not to be socially stigmatized or labeled a “bad mother,” most women would rather remain silent, thus limiting empirical research on regret, in relation to motherhood/parenthood.
Studies on motherhood often pay tribute to the resilience of mothers, their tenacity and self-sacrificing, multitasking attributes (O’Reilly, 2016; Oyewumi, 2016). It could be argued that although such narratives are empowering, they could exaggerate the strengths of those who are HIV-positive by neglecting their emotional and psychological needs, and other mental health–related issues. To avoid and to further prevent negative strategies of coping (e.g., drug abuse, high-risk behaviors, suicide), which may negatively affect their mental health, it is important to probe the state of their emotions. This is to promote robust emotional and physical health so that both HIV-positive adolescent mothers and their children are better equipped with the necessary skills to face their challenges in life (Bacon et al., 2010). This need to understand and acknowledge women’s subjective emotions and the connection between their emotional life and gender relations of power is portrayed through feminist and transformative ideology and practices of “personal is political” (Hanisch, 2006). Whether infected perinatally or behaviorally acquired, adolescent mothers living with HIV are faced with daily and numerous challenges of being a mother, an adolescent, and living with HIV. They have unique and urgent psychosocial and emotional needs.
Theorizing Emotions: Why Is It Important in HIV Research?
Feminist and social constructionist thoughts guided this study. These theories are used to explain the importance of the understanding of the concept of human emotions based on the social or cultural influence on the lived experiences of HIV-positive adolescent mothers in South Africa. They are important in this study because they highlight the unmet emotional needs of HIV-positive adolescent mothers in South Africa. For instance, poverty, lack of access to quality health services, and the struggle to implement the basic mental and emotional support that are need specific and tailored for HIV-positive adolescents persist.
Given the exclusive characteristic of feminism that continuously demands and persistently advocates for social transformation of the economic and political spaces, placing the emotional experiences of these Black HIV-positive adolescent mothers at the center of analysis offers important insights on their prevailing emotional needs and the comprehensive view of their world (Collins, 1990, 2009; Pillow & Mayo, 2007). Developing an understanding of the concept of emotions of HIV-positive adolescent mothers in South Africa imperatively reveals and gives relevant meaning to their lived experiences. In South Africa, limited research has been conducted on the emotions of adolescents and HIV-positive individuals, not to mention HIV-positive adolescent mothers, hence the incapacity of most public health facilities and the society, in meeting their unmet emotional needs. This group of individuals are at the intersection of complex emotions: catering for their personal health needs, negotiating the transition to unplanned motherhood and adulthood, care for the physical and emotional needs of their children, economic and financial instability, and more. This implies that there is a possibility of impending danger that may encourage dysfunctionality of these adolescents and their children, if these complex emotions are not adequately catered for.
The feminist and social constructionist theories, therefore, offer three important insights toward the link between the understanding of the emotions of HIV-positive adolescent mothers in the prevention and management of the HIV epidemic and the reduction of unplanned parenthood among adolescents in South Africa. First, it fosters consciousness and fundamental mind shift in how society views HIV-positive adolescent mothers. Second, it highlights the mental and emotional needs of both the adolescent mothers and their children and the urgent need for the building and implementation of relevant policies and strategies. This will aim at alleviating the circumstances and the relationship between the mothers and their children. Finally, the two theories contribute to continuing epistemological discussions that enable the unheard or socially unseen individual/groups to define their new reality. These theories present an avenue that facilitates and promotes the inclusion of HIV-positive adolescent mothers’ narratives in prevalent discourses on motherhood. Such discourses will enable the society to view these mothers’ emotionality as an important tool that can help understand their agency, as they travel through their unknown/unplanned journey.
Research Data: Reflecting on Emotional Circumstances
To facilitate a supplementary and robust understanding of the roles of emotions based on the intersectional identities and agency of HIV-positive adolescent mothers in South Africa, this study adopted qualitative research method and draws on the feminist paradigm. The choice of qualitative feminist methods was to overcome simplification and grasp the complexities of participants’ experiences, as the fusion of qualitative methodology and feminist research eliminates the simplification of positivism through the acknowledgment that psychological phenomena differ based on subjective experiences and cultures (Devault & Gross, 2012). The combination of a variety of methods within this framework also provides participants with the power and ability to express, identify, question, and analyze their difficulties, through their lived experiences as adolescents, young women, mothers, and HIV-positive individuals, thus incorporating and giving recognition to the multiple intersections of their identity (Marshall & Rossman, 2016).
The research data in the article are drawn from in-depth interviews with 10 HIV-positive adolescent mothers, resident in Johannesburg, South Africa. Their children’s ages ranged from 2 months to 7 years at the time of the study. The goal of the in-depth interviews was to enhance the understanding of emotion in the life of “women” (HIV-positive adolescent mothers) as they transition into an unplanned reality. Also, three key informants—two representatives from nongovernmental organizations (NGOs) and an experienced clinical nurse—were interviewed. These key informant interviews generated insightful information from frontrunners and experienced personnel working with adolescents, and they provided relevant supportive insights to the interviews conducted with HIV-positive adolescent mothers. Before the commencement of data collection, the ethical clearance for the research was obtained from the Faculty of Humanities Research and Ethics Committee at the University of Johannesburg (reference number 02-091-2016), Helen Joseph Hospital, and the Department of Health in Gauteng, South Africa.
The recruitment of participants involved purposive sampling (Bryman, 2004; Creswell, 2012; Darlington & Scott, 2002). Specifically, the first author approached and recruited all participants from a clinic within Helen Joseph Hospital in Johannesburg. The clinic facility caters for tuberculosis patients and HIV-positive individuals in Gauteng, South Africa. Majority of the adolescents receiving treatment at the clinic were approached to participate in the study to know whether they met the criteria of the study, namely, race (Black African), age (10–24), gender (female), marital status (unmarried), health status (HIV-positive), and whether they were already mothers. Despite all efforts to recruit and interview younger adolescents aged 10 to 15 years, only 10 participants between the ages of 16 and 24 years willingly granted interviews due to the sensitive nature of the research. As the sample size in qualitative research is determined purposively to generate richly textured data, with depth and most especially provide the pertinent answers to the phenomenon that is investigated, the sample size for this study was thus determined based on pragmatic considerations (Guest et al., 2006; Morse, 2000; Safman & Sobal, 2004; van Rijnsoever, 2017) such as the nature and complexity of the topic and the accessibility of participants. Despite these pragmatic considerations, the in-depth interviews generated richer information that is based on “information power,” saturation (the reoccurrence of data patterns), and usability of data collected (Charmaz, 2006; Malterud et al., 2015; Morse, 2000).
All participants reported their race as young Black women living with children who were reported to be Black or colored (biracial). The highest educational level of each participant varied from Grade 11 in high school to second year at tertiary level. The ages of participants presented in the study are “as at the delivery” of their children. None were married at the time of the interviews but two were in a committed partnership while the remaining eight participants reported that they were single. Semistructured in-depth interviews were conducted in English with consented participants between May and December 2017 and it lasted approximately 60 minutes. Although the interviews were conducted in the English language, participants were also encouraged to communicate in their native languages to enable them to share their experiences easily. None was pressured to partake in the study as information sheets were offered explaining the nature of the research, and informed consent was signed by each participant. Most of the interviews were conducted on the Helen Joseph Hospital premises, while a few were conducted at participants’ place of choice. The main questions centered on participants’ feelings and thoughts when they learnt about their HIV status and pregnancy, means of support and survival strategies, coping with the responsibilities of motherhood, living with HIV, and unplanned transition. All the interviews were digitally recorded with the consent of the participants. To protect all participants’ identity and to ensure anonymity, pseudonyms were used for all the HIV-positive adolescent mothers and key informants in the research. Below are the self-reported characteristics of the participants (see Table 1).
Participants’ Self-Reported Details.
Data Analysis
The overall objective of the analysis of all generated data was to explore and understand the relevance and impact of emotions in the experiences of adolescent mothers living with HIV infection in South Africa. All data were generated from participants’ individual interviews and were transcribed by the first author. With the assistance of an independent translator, the native languages were translated where appropriate. The first author then verified the data after numerous readings for validity and accuracy. The transcripts were further reviewed to allow familiarization with the entire data and to identify pertinent themes. To adequately represent participants’ subjective narratives and experiences, the transcribed text from the in-depth interviews were inductively, systematically, and thematically analyzed by the first author (Braun & Clarke, 2012; Fslick, 2009). The analysis was guided by an interpretivist approach in a two-stage process. First. the data were coded by identifying all the quotations in the interviews that were closely related to the concept of emotions and how each participant expressed them (Elliot, 2018). These were then primarily categorized based on consistent patterns. Similarly, the transcripts from the key informants’ interviews were read and pertinent passages were also identified to back up themes that were generated. To reduce the possibility of researcher’s bias and promote trustworthiness, an independent consultant and the second author verified the codes and the process. All disagreements were resolved by negotiation toward consensus in an unmoderated setting. This further demonstrated credibility in the qualitative analysis. Some of the identified codes that were constructed include negative emotions, positive emotions, complex emotions, support, fear, and rejection. The subsequent stage involved the organization of themes that were formed from relevant and representative transcripts. The key themes were identified based on their relevance to the main objective of the study, and each theme was adequately and generally represented across most of the narratives of the participants. The representation and descriptive analysis of one of the themes are outlined in Table 2 to demonstrate the transferability of data (Lincoln & Guba, 1985). This shows that themes are drawn across the rich narratives and quotes of the majority of the participants.
A Theme With Descriptive Data Extracts.
Findings and Discussion: Narratives, Feelings, and Subjectivities
As many women walk the path of motherhood, it is important to understand that these shared results should not negatively override the diverse meanings of the process because most construction and sometimes reconstruction of motherhood are based on subjective experiences, circumstances, and the negotiation of agency as the individual becomes a mother (Glenn et al., 1994; McMahon, 1995). Linking up with this, the following sections highlight the diverse but connected emotional paths to motherhood that were apparent from the analyzed data. These results emphasize that the adolescents’ experiences of motherhood (a motherhood status constrained by the reality of HIV) are not limited to their unpreparedness and traumatic childbirth but are entrenched in the entire emotional whirlpool of transitioning into motherhood while facing a multitude of uncertainties and insecurities. Drawing on these subjective narratives, the findings are divided under a unifying umbrella described below.
Emotionality, Adolescence, Unplanned Motherhood, and Living With HIV
As indicated above, the following subheadings grapple with the emotional state of adolescent mothers living with HIV and they are presented as follows.
Tensions between the states of “happiness” and “sadness.”
Although it is often believed that the birth of a child brings happiness to a mother, participants’ accounts reveal the difficulty encountered as they negotiate the dual realities of becoming a mother, its responsibilities and living with HIV. From this theme, the intense and complex emotions enabled the understanding of the impact of the intersectional identities, agencies, and unplanned new reality. Conversely, this theme highlights and corroborates previous discourse on the difficulties, intensely personal and fluctuating emotions that may inevitably define the parenting and reality of adolescents (Curtis, 2015; Larson & Brown, 2007; Steinberg, 2014). For instance, all participants expressed they had conflicting dyadic emotions on their path to motherhood. The emotions of (a) extreme and overwhelming sadness due to the unintended transition to motherhood, coupled with their health status; and (b) the joy of becoming a mother. First, the emotions experienced at the discovery of their pregnancy and health status was painted with extreme pain. Most of them described an extremely emotional picture of their pregnancy knowledge, as some participants also became aware of their HIV status on the same day (except for the perinatally infected participants). Reiterated, all the participants reported their pregnancies as unplanned, hence the expression of emotional distress upon discovering their pregnancy and health status. Violet (17 years, with a 5-year-old child) narrated her extreme distress after being told that she was HIV-positive and expecting a baby: Whao . . . I wanted to kill myself . . . I wanted to run away from home as my mum is a very strict parent . . . I didn’t know how to deal with the situation . . . (Sighs) It felt like a death sentence . . . Like I punished myself like so badly . . . every day I would cry . . . every day I would feel like drinking pills and just commit suicide.
Violet’s narratives and emotions present the picture of a young lady who is at the crossroad between her fluctuating emotional development and an unplanned and scary new reality (Haviland et al., 1994; Li et al., 2010). The effect of being confronted with an unanticipated mental and emotionally painful challenge was generally expressed by the participants. For Jasmine (19 years old, with a 7-month-old baby), her emotional pain was presented through her anger and frustration when she discovered that she was pregnant and infected by her first sexual partner: I was so angry . . . I was so angry, and I was ashamed . . . Angry with myself and my partner. Why was he (her partner) not honest and tell me the truth because I know . . . you know I was virgin by that time . . . virgin and got pregnant and HIV . . . I was angry with him
The frustration of nondisclosure and deception despite “late” sexual debut added to the pain and anger she felt toward the man who impregnated her. Her sense of anger was aggravated by the feeling that she had “waited,” as related studies in South Africa claim that it is not uncommon for adolescents to engage in sexual activities in their early teens (Morrell et al., 2012). In general, the participants’ narratives revealed their struggles in negotiating the unexpected transition and dual responsibilities of unplanned motherhood while living with HIV. They not only enunciated complex emotions surrounding their pregnancy and postnatal but also revealed how some are able to balance their new statuses. Mixed emotions are highlighted in Daisy’s (17 years, with a 5-year-old child) narratives, as it unveiled the joy motherhood brings and concurrently the pain that comes with the experience: It’s awesome to be a mother . . . it’s a joy to be a mother because they (children) are like a blessing to me . . . you know . . . There are times when things get a bit like . . . get a bit hard . . . you know and then I will cry . . . oh . . . that bad . . . times when we don’t have money . . .
There were also some somber, though optimistic narratives from the adolescent mothers who appeared to be grappling with their new situations manageably, largely because of their support structures (Atuyambe et al., 2008; Gyesaw & Ankomah, 2013; Maputle et al., 2015; Morrell et al., 2012). This optimism is reflected in Holly’s (24 years, with a 4-month-old child) narrative of her experience as an unplanned adolescent mother: at first I was scared, but now I am happy because I look at her and she inspires me a lot . . . now I am seeing life in another way . . . with the support of my aunt and friends, I feel better . . .
However, generally in the narratives of the participants, the variability of their emotional experiences portrayed the ebbs and flows of their contexts, situations, and the relationships that are related to the everyday negotiations of their motherhood roles. The narratives highlighted both the subjective differences and similarities in the adolescents’ reactions to related problematic positions and their ability to manage and reconcile this new reality, emotionally and psychologically. Even though some participants acknowledged the joy they experienced after the birth of their child, retrospectively, some also expressed guilt and the fear of the possibility of mother-to-child infection. Violet (17 years, with a 5-year-old child) explained that . . . when I was pregnant, I always had this guilt like maybe I might infect my child or something.
Guilt and fear are complex emotions that resonated with most of these mothers. The complex feelings and emotions were stirred largely because of the unpredictability and the uncertainty of their future and that of their children. As presented in previous research, these adolescent mothers expressed their fear and insecurity based on their experience and new social reality (Mushwana et al., 2015). Ironically, Poppy (17 years old, with 7- and 2-year-old children) presented another type of mixed emotion as she was more concerned and seemed unwilling to trade her adolescence and freedom for the responsibilities that accompany motherhood.
I was only worried about a baby that was gonna cry at night, give me sleepless night (laughing) and you have to be waking up all the time, feeding a baby, not knowing how to do it and all that things . . .
This experience highlighted evidence of the tensions between the states of adolescence and that of unplanned motherhood, which corroborates other studies (see Driscoll & Easterbrooks, 2007; Krpan et al., 2005; Lee & Guterman, 2010). This account highlighted the struggle to come to terms with the responsibilities that are generally inevitable for mothers. Narratives such as these were common for many of the adolescent mothers interviewed. The negotiation of their conflicting realities presented the need for intervention that is based on differential strategies.
Resentment: The father, the child
Findings from analyzed data highlighted resentments from most participants toward the father of their child, the child, or even both simultaneously. As all participants were unmarried and the majority were not in committed partnerships, the anger toward the father of their children was expressed with strong emotions. For many of them, the sadness and anger go beyond the nondisclosure of their partners’ HIV status or the discovery of their own during pregnancy. Much of the resentment was due to the fathers’ unresponsiveness and inability to accept their parental responsibilities even postnatal. At least three participants narrated their experience with the father of their children as stressful because they (the young fathers) were literally forced to see the babies after delivery. Alyssum’s (22 years, with a 7-months-old baby) experience is described below: When he (the child) was born, we took him to his (the father’s) house, he was so . . . so angry, he did not want to touch his kid uhmm . . . here in South Africa, the birth certificate has to have both parent’s details . . . but I did that without him because he wasn’t there, he doesn’t care . . . even now he doesn’t wanna be part of it, so why force him . . .
Likewise, Iris (19 years old, with a 3-year-old child) recounted that she had to coerce the father of her baby to come to Home Affairs for the signing of the birth certificate, as it is one of the prerequisites for the issuance of birth certificate in order to access social grants for the child. This was the first time he saw the baby and he has since not bothered about the welfare of the baby.
. . . that one (father of the baby) even made my life hell . . . so I gave birth he didn’t come to see the child, but they told him at home that I put to bed . . . So he didn’t come to see the child then. Oh, I gave birth with a C-section (sobbing) . . . it was so painful . . . so painful. For you to make a certificate for your baby there must be a father that is present and me and the father we are not like united. So I had to like force him to come and then do the certificate for the baby and that was the first time he actually saw the child (nervous laugh) then he never came back just came that day did the certificate and then went back home . . .
This stressful experience resulted in more anger and resentment due to the treatment received from their partners. Despite this experience, these adolescent mothers solely took care of other responsibilities such as the physical and emotional needs of their children. However, this resentment was not limited to the father of their children but also extended to their unborn babies while they were pregnant and even postnatal. This is largely due to the limited social, financial, and emotional support. Iris, who at the age of 19 became pregnant described her hatred for her unborn baby because of the embarrassment and shame she thought her pregnancy would bring to her family. Growing up in one of the small towns in KwaZulu-Natal where teenage pregnancy was frequent, she had been accorded the respect due to her dedication to her studies. She was the second individual to have ever gained admission into a higher institution of learning in her community; thus, after falling pregnant, she held deep anger toward her baby. Iris (19 years, with a 3-year-old child) said, . . . I resented the baby in me like I do not wanna be pregnant at the time, I did not want anything . . . I do not wanna lie, I hated my baby, I hated him so much . . .
This simple yet complicated response portrays a traumatized and frustrated adolescent who is forced by unanticipated circumstances to become a mother.
Silent emotion: Regret
Another significant component of human emotion, also negative and mostly silenced around discourses on motherhood, is regret. From participants’ narratives, some portrayed regrets that were influenced by their circumstance while others narrated absolute regret of becoming a mother. Violet (17 years, with a 5-year-old child) painted a very emotional picture of absolute regret when she became pregnant: . . . I will always feel like I robbed myself of my childhood and at times I will resent my child, I would hit my child so badly and even though she couldn’t hear what I was saying but I will always tell her that I regret being with her . . .
This retrospective account corroborates the argument that due to the psychological effect of being a young mother, adolescent mothers radiate negative emotions and sometimes abuse their children (Driscoll & Easterbrooks, 2007; Krpan et al., 2005; Lee & Guterman, 2010). Although Violet also recounted the joy she experienced several years after, this account, similar to others’ narratives presented a vulnerable young mother who would rather be free from the overwhelming responsibilities of motherhood. Circumstantially, most of the participants wished they had delayed childbirth till later or when they were older and ready with necessary resources. For these adolescent mothers, the timing was wrong. When asked whether the baby was worth the pain and stress of motherhood, Iris (19 years, with a 3-year-old child) responded that, I won’t say . . . I don’t know whether it was worth it but I know maybe I could have prevented it but what I went through maybe someone, the people of my age they are not or have never been exposed to such a thing . . . I wish I had known how difficult it was to actually be a mother (nervous laugh) . . .
Similarly, Jasmine (19, with a 7-month-old baby) narrated her regret: I sacrifice my own time because if I do not have a baby now, I would go and look for things that I can do for me to become a better person.
From the foregoing, the effects of cognitive and emotional structure that unintendedly affect the behavior of a mother and the interaction between a mother and her child lead to socially constructed feelings of self-condemnation, and states of confusion. This is as a result of the internal conflicting emotions as she considers the roles, responsibilities, and difficulties that await her. These participants’ expressions of regret negate the views suggesting that the moment a woman becomes a mother, she has access to authoritative knowledge systems enabling her to maintain the image of “the good mother” (Collins, 2009; Hooks, 2007). Many in this group of mothers felt this emotion and were able to express this feeling without self-regulated actions that are often guided by cultural beliefs and settings (Hochschild, 1979). Their experiences highlighted the depth of each mother’s wide spectrum of felt emotions and this significantly shifted the common assumption and social construction of emotion that silence regrets. Despite some denial, silence, or limited exploration of regret around motherhood, it is important to present significant findings from this study, which culturally frames and presents relevant insight into both the negative emotions (e.g., regret, anger) and positive emotions as the participants transition to their unexpected new reality.
Looking through the eyes of the experts
The findings, through the analysis of the narratives of these adolescent mothers, highlighted the emotional challenges and psychological needs of these HIV-positive adolescent mothers in South Africa. Based on their experiences and unplanned new reality, the relevance and impact of emotions are highlighted. To buttress these findings and show the limited attention given to the emotional aspect of these mothers’ experiences, the discussion with the key informants are presented in this section.
As previously highlighted, the emotional aspect or needs of adolescent mothers is paramount and should be given utmost attention as it influences their mental health, self-esteem, and general well-being in the society (Flaherty & Sadler, 2011; Mushwana et al., 2015; Rafferty et al., 2011). This emotional and psychological need was unanimously confirmed by all three key informants. However, they confirmed that there are limited attention and services that cater to the emotional needs of adolescents, most especially those with special and specific needs, such as those living with HIV infection and those who are young new mothers. For instance, Ms. Gold, an experienced senior clinical nurse, who has worked with adolescents and young women (including HIV-positive adolescents) opined that, I do not think so . . . I do not think we (society/public) are doing enough justice to do that . . . it is something that has to go back also on the community side. By the time these adolescents link to care or go to the health facilities, most of the time they have been exposed and are traumatised in many ways, it is their last resort. Normally when you see a young person come to the clinic with all those issues it is their last resort because they do not have anywhere to go.
According to her, most of these adolescents often resort to community clinics for solutions to all their medical and sometimes personal needs because they are left with limited choices. Consequently, public hospitals and health professionals (society) are saddled with the important responsibilities of paying more attention to their emotional and psychological needs to provide the needed solutions and relevant interventions. Due to various challenges, these needs remain inadequately met by health professionals. Dr. Diamond, with vast years of experience researching adolescent girls and young women, noted that, Although there are counsellors in clinics, they are faced with some challenges, as well as the facilities . . . I do not think their (adolescents) care and emotion are taken into total consideration because thousands of people want to access care and there is limited time. If you want to talk about people’s emotions, if you want to sit with them, then you must have that time to do that. Some health care workers especially the nurses, are not patient enough . . . some of them are even cruel and even some of these adolescent girls and young women are afraid to go . . . There is no time to counsel, there is no proper counselling, especially for adolescent girls who are living with HIV. I would not say there is no counselling service but in most of the facilities, there is no proper counselling and we are still struggling with youth-friendly services, which I think is the best.
As the mental and emotional well-being of adolescents is crucial in South Africa, and to find consistent and sustainable solutions to the limited attention given to this important issue, relevant interventions were recommended by these experts. Ms. Gold suggested some possible medium of connecting and catering for the emotional privations of these adolescent mothers: I feel by the time they (adolescents) get to the clinics, they are getting to a nurse who is only trained in a very limited way to cater for social ills of a community, who is very clinical, just like any doctor. Nurses are not well trained in social and mental wellbeing. The training of nurses should be orientated more on social and psychological wellbeing as well as the clinical aspect of illness. It should compromise the social part where they have to nurture and listen to this person and have more time because, at the end of the day, they need to diagnose this patient and treat this patient. So, it is too much in one plate to be able to say they have catered for this individual who is sitting next to me (a nurse) completely. There is a need to have social workers, psychologists and social (behavioural) scientists at the clinics . . . we need to beef up our (public) clinics, not only in private clinics.
The above suggestion highlights the need for redirection and more focus on the mental and social needs of individuals. This can be achieved by more engagement and involvement of social or behavioral scientists, who are able to identify subjective needs in order to provide tailored solutions based on social interaction rather than absolute focus on clinical aspects and needs of HIV-positive adolescents. Furthermore, Dr. Diamond explained that, When you put youth-friendly services in place, a part of it should be counselling, thorough counselling about their emotions, as some of them are HIV-positive and some of them could be single mothers. They have diverse needs. So, if there are youth-friendly services, it will cater to the diverse needs of each individual. Some are orphans, some were raped . . . Orphans who were perinatally infected differ from a rape victim and a rape victim who is HIV-positive and at the same time pregnant or becomes a mother . . . it must be youth-friendly to accommodate good rapport with service providers like the initiation of peer group . . . because adolescent girls and young women tend to talk more about their feelings and their emotions to their peers than even their parents or older people.
Similarly, Ms. Ruby, an NGO representative, also advocated for the need for adolescent/youth-friendly environment and services that will encourage and enable comfortable rapport between service providers and adolescents: . . . AYFS (adolescent and youth-friendly services), it is an idea, a very good idea that needs to be implemented, but there is a need to create more of such structure and services in bigger communities to accommodate more adolescents . . .
The sequences of unexpected new realities inevitably trigger multifaceted emotions. The examination of these multifaceted emotional responses from both the subjective viewpoints of affected adolescent mothers presents vital insights into understanding the concept of emotions. By lending relevant support and insight into their emotions, an understanding of how to develop and implement suitable policies and interventions can be sensitively achieved. Despite some similarities, there existed few variabilities of experiences that highlighted the struggles and daily navigation of adolescents’ lived realities. Their accounts highlighted individual differences to analogous problematic experiences and the personal coping strategies employed. Following the different accounts that comprise of joy, distress, and regret, the article suggests that the in-depth focus on emotions may offer a lens through which the interplay between unplanned realities, agency, and subjectivity can be more sharply probed. Examining “emotions” also assisted with identifying the feelings and the impact on this subgroup of adolescent mothers as they navigate unplanned motherhood.
Due to the paucity of empirical and theoretical work on interrogating the emotions of HIV-positive adolescent mothers in South Africa, this article explored and facilitated understanding of the concept of emotions through their experiences. It especially suggested relevant interventions that can be implemented in South Africa (and Africa in general) to provide the needed support for HIV-positive adolescent mothers. Given the link between poor emotional outcomes and other social and health-related problems such as poor sexual and reproductive health decisions, poor medication adherence, continuous risky sexual attitudes, drug and alcohol abuse, low educational attainment, and unemployment (Campos et al., 2010; Grossman & Gordon, 2010; Sikkema et al., 2010; Smit et al., 2006), it is imperative to develop manageable and sustainable adolescent-tailored interventions in South Africa.
Limitations and Strength of the Study
The major limitations of this study are the sample size and generalizability of the research results. Despite all attempts to recruit and interview the younger HIV-positive adolescent mothers for the research, they all declined outrightly based on the psychological and mental effect of their experience. The majority have not come to terms with their new reality and would rather not discuss such an experience. However, those who agreed to be interviewed willingly participated despite the emotional and sensitive nature of the research. Even though the research participants were not the representatives of all HIV-positive adolescent mothers in South Africa, the research findings and recommendations presented in this article highlighted the usefulness of the study. It provided valuable insights into HIV-positive adolescent mothers’ experiences and contributes to the understanding of the impact of emotions on these experiences, hence empowering and enabling adolescents to make better and informed decisions on their emotional and psychological needs, and sexual and reproductive health rights.
Conclusion
Being an adolescent, living with HIV, and becoming an unintended parent inevitably shape and influence the lives of affected individuals and their children. The findings of this study have provided important pointers toward the need to redirect, plan, and implement effective and sustainable mental and emotional support programs for HIV-positive adolescent mothers and their children. Presented in this article is a narrative on emotionality and motherhood based on the analysis of the HIV-positive adolescent mothers’ emotional, subjective, and retrospective interpretations of motherhood. Understanding the emotions of this group of mothers will promote insightful social responses that will enable relevant support-based actions. Although this article has been able to present empirically and theoretically based findings, it also highlights the urgent need to build and meticulously examine sustainable strategies that are based on subjective need and that are culturally appropriate for this vulnerable group. This is because there are tendencies and later risks of mental health–related disorders such as depression, anxiety, and despair.
This article advocates for positive social supports that will contribute to self-developmental processes at an interpersonal level. Addressing individual emotional and social needs is an important strategy in understanding collective needs, thereby fostering wider social engagement and future advancement. There is a need for an intervention that supports HIV-positive adolescent mothers on how to cope with the pre- and postnatal effects of pregnancy and motherhood simultaneously. The intervention should focus on supporting HIV-positive mothers in adjusting and regulating their emotions, especially the negative feelings of inadequacy and unpreparedness. The intervention that promotes their self-development, self-esteem, communication, and interpersonal skills is strongly recommended. Moreover, it should incorporate mental health–related components that will facilitate HIV management and intervention, which will help strengthen social and emotional coping skills, promote resilience, and advocate general well-being of both mother and child. Specifically, interventions should address mental health challenges postnatal, enhance the adherence to antiretroviral therapy (ART), and provide the needed psychosocial support that will promote adequacy, connection, and interaction between HIV-positive adolescent mothers and their children in order to build a better, more equitable, and emotionally stable future and society.
Footnotes
Acknowledgements
Our sincere gratitude is first extended to the wonderful adolescent mothers who willingly agreed to participate in this research. Thank you for sharing your personal and important stories. To all the key informants, who despite their busy schedule accommodated our interviews, we are also thankful. We also extend our appreciation to Dr. Mashamaite Sello and some members of staff at Helen Joseph Hospital for their assistance before and during the data collection of the research. We also acknowledge the support from the University of Johannesburg Commonwealth Scholarships. Thank you all.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
