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Facilitating the adolescent mother's transition to motherhood: A hermeneutical approach

Dissertation
Author: Akosua D. Eghan
Abstract:
The study explores the transition to motherhood for adolescent girls in a rural community in the Central Region of Ghana from the prenatal period to one year post partum. Theoretical assertions influential to the research are psychosocial development, transition experiences, and the concept of becoming a mother. Aims of the study were to explore and describe the adolescent girl's experience of the transition to motherhood and to use themes and categories identified in interviews to describe guidelines for interventions with young girls. In-depth interviews were conducted with 14 young mothers aged 14 to 18 at the time of first birth as well as 11 maternal grandmothers. Young mothers were asked about defining experiences in the pre and post natal periods. Additional questions included their views on motherhood and implications of the pregnancy for their personal goals, future plans, and purpose in life. Interviews with grandmothers began with the question: "Can you describe the decisions, events, and emotions surrounding the pregnancy, birth, and experience of the new mother?" A nurse midwife in a community health center was also interviewed to determine procedures for maternity care and reproductive health counseling for adolescents. Additionally, an elder in the community was interviewed for information on customary practices regarding courtship, marriage, and childbearing, as well as traditional penalties for paternal in-laws when fathers deny paternity. A seven-stage process for analysis of narrative texts guided the data analysis. Three themes emerged: pregnancy as disruption and loss, embracing the realities of motherhood, and deprivation of opportunity. Themes were used to infer guidelines for interventions with adolescent mothers. Interventions need to address fundamental antecedents of early sexual activity and childbearing, such as poverty, low educational attainment, and inadequate reproductive health information. Additional factors that hamper adolescent development in the community are limited opportunities for career advancement and other mainstream behaviors indicative of adult status. Though maternal grandmothers offered support for young mothers, community involvement is essential to foster positive outcomes of early childbearing. Communities need to enforce customary sanctions against absent fathers, provide childcare assistance, and reduce the stigma of off-time childbearing so mothers can maintain psychological well-being.

vi Table of Contents Acknowledgments iv List of Tables (if tables used) viii CHAPTER 1. INTRODUCTION 1 Introduction to the Problem 1 Background of the Study 5 Statement of the Problem 7 Purpose of the Study 8 Research Questions 9 Significance of the Study 9 Definition of Terms 11 Assumptions and Limitations 11 Nature of the Study 13 Conceptual Framework 15 Organization of the Remainder of the Study 19 CHAPTER 2. LITERATURE REVIEW 21 Introduction 21 Social Context of Adolescent Childbearing 22 Psychosocial Development 32 Adolescent Fertility Behavior 40 Outcomes of Adolescent Pregnancy 45 Adolescent Parenting 49 Social Support 53

vii Phenomenology 57 Summary 60 CHAPTER 3. METHODOLOGY 64 Heideggerian Hermeneutical Research 64 Participant Selection 67 Data Collection Procedures 71 Data Analysis 73 Limitations of Methodology 75 Expected Findings 77 CHAPTER 4. DATA COLLECTION AND ANALYSIS 78 Data Collection 78 The Setting and Participants 80 Results 83 Pregnancy as Disruption and Loss 83 Transcending Loss: Embracing the Realities of Motherhood 92 Deprivation of Opportunity 96 Research Questions 100 CHAPTER 5. RESULTS, CONCLUSIONS, AND RECOMMENDATIONS 105 Adolescent Development 106 Transition to Motherhood 110 Limitations of the Study 111 Guidelines for Practice 114 Conclusion 119

viii REFERENCES 120 APPENDIX. INTERVIEW GUIDE 132

ix

List of Tables

Table 1: Adolescent Mothers’ Transition to Motherhood 20 Table 2: Sample Description of Adolescent Mothers 82 Table 3: Themes and Sub-themes 100

CHAPTER 1. INTRODUCTION Introduction to the Problem Research studies indicate that the transition to parenthood is one of the most challenging developmental transitions in the family life cycle (Delmore Ko, Pancer, Humsberger, & Pratt, 2000; Nystrom & Ohrling, 2004; Wilson et al., 2000). Though the body of literature on pregnant and parenting adolescents is growing, much of the literature describes the transition to motherhood for adult women (Kaiser, 2004). The high incidence of childbearing among adolescents in Africa (Garenne, Tollman, Kahn, Collins, & Ngwenya, 2001; Mngandi, Thembi, Ransjo-Arvidson, & Ahlberg, 2002; Oppong, 1997; Otoo-Oyortey & Pobi, 2003) indicates a need for research that develops and refines theories and practices related to adolescent maternal roles and transitions. Transition to motherhood is a dynamic process that begins during pregnancy with parental-fetal attachment (Mercer, 2004). Mercer’s synthesis of literature describing the process of attaining a maternal identity focuses on adult mothers. In the months following the birth of the baby, a mother continues to incorporate motherhood into her self-concept and restructures existing relationships with family and significant others (Wilson et al., 2000). In an earlier study of adolescent mothers, Mercer (1986) identified maternal age as a variable that may disrupt successful achievement of maternal competence. Other factors potentially intrinsic in the adolescent mother’s situation are a lack of social support, low

Adolescent Mothers

2 educational attainment, and socioeconomic disadvantage. These contextual factors interact with the young mother’s psychosocial immaturity, putting her at greater risk than older mothers for poor maternal role adaptation and impaired maternal-child interaction. Research findings on the psychosocial outcomes of early childbearing are inconsistent (Koniak-Griffin & Turner-Pluta, 2001; Larson, 2004). On the one hand, adolescent motherhood is presented as a non-normative transition that hampers the process of identity formation for young mothers (Adams & Kocik, 1997). The adolescent mother has to simultaneously negotiate the developmental tasks of adolescence and motherhood. Major developmental challenges that are in conflict with motherhood are identity issues, individuation, cognitive development, and the development of sexual identity (Hulburt & MacDonald, 1997). While the development of a stable identity requires a period of moratorium in which adolescents experiment with different roles, childbearing restricts a mother to a specific, challenging role. The process of individuation, similarly, is often constrained by the need for the adolescent to negotiate with her family for childcare assistance (Spencer et al., 2002; Thompson & Peebles- Wilkins, 1992). Additionally, younger mothers lack the cognitive skills to anticipate their infants’ needs. Finally, the physical changes that accompany pregnancy and childbearing may exacerbate a young mother’s discomfort with her developing sexuality. On the other hand, childbearing may be normative for some adolescents and provide an alternative route to adulthood (Arendell, 2000). Adolescent childbearing occurs within socioeconomic, ideological, and family influences that may vary considerably with class, racial, ethnic, and cultural boundaries (Kaiser & Hays, 2004;

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3 Rhodes, 1993). Thus, a clear definition of the social and cultural context of marriage and sexuality in Ghana is required to determine the adolescent mother’s experience of childbearing. In rural areas in Ghana, family and community norms exert enormous pressure on women to begin childbearing early and maintain a fast tempo of childbearing (Akuffo, 1987; Mbugua, 1997; Otoo-Oyortey & Pobi, 2003). More than half of Ghanaian women marry while still in their teens (AGI, 2004). Motherhood rather than marital status or occupation may be the primary identity of women (Arendell, 2000). Thus, childbearing may fulfill important life goals and be an essential component of psychosocial development of adolescent mothers (SmithBattle, 2000). By enhancing the process of identity formation and self-esteem for young mothers, mothering may foster a sense of purpose and a meaningful future for themselves and their infants (Mercer, 2004). Sexuality and reproduction are often described as health issues or variables related to macroeconomic growth. However, they are also fundamental to individual identity and fulfillment, and effective family and social relationships (Bledsoe & Cohen, 1993; Larson, 2004). Studies have indicated that location and education create significant differences in adolescent mothers in Ghana (Bledsoe & Cohen, 1993; Gupta & Mahy, 2001; Kwankye, 2005). There are two categories of adolescent girls; some girls marry and give birth at early ages in rural areas with parental and community approval. Adolescent childbearing is normative in rural areas and there may be negative consequences for adolescents who do not bear children in contexts where it is expected (Buor, 1996; Otoo-Oyortey & Pobi, 2003). Often, pregnancy is a strategy for obtaining a husband, and can outweigh health

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4 risks and the loss of education and career opportunities (Akuffo, 1987; Awusubo-Asare, Abane, & Kemu-Kyereme, 2004). Further, in some ethnic groups, marriage is incidental to a woman’s reproductive career (Gupta & Mahy, 2001). A second category of adolescent mothers is made up of unmarried schoolgirls in urban areas whose pregnancies are socially condemned. However, these are not two, neat, mutually exclusive groups. The availability of traditional methods of abortion suggests that pregnancy was unwanted in some circumstances. The timing of entry into marriage and childbearing depends on decisions that parents or other relatives make about child betrothal, immediate marriage offers, or training opportunities (Otoo-Oyortey & Pobi, 2003). To explain the sexual decision making of adolescent girls in Ghana, particularly in rural areas, researchers need to search for variables in their individual backgrounds as well as the influence of adults in their lives. Similarly, the traditional sequence of training/formal education, marriage, and childbearing is determined by the social context. Thus, “social contexts shape the consequences of physiological and demographic events in subtle yet profound ways.” (Bledsoe & Cohen, 1993, p. 144). Traditionally, preparation for adulthood followed an elaborate sequence of ritual practices that symbolized the child’s development. These practices clearly defined the particular stage in the life cycle where pregnancy and childbearing were acceptable (Ahlberg, 2001). Adolescents were offered reproductive health information as part of formal rituals. Currently, traditional rites of passage are not consistently practiced, leaving adolescents without the customary support of kin groups and community

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5 institutions. Though the incidence of adolescent marriage and childbearing remains high, young mothers are negotiating the transition to adulthood without the customary support of kinship groups and community institutions (Awusabo-Asare et al., 2004). Furthermore, economic hardship constrains the family from offering traditional financial resources to its members. The wellbeing of adolescent mothers depends on the health system, families, and community members (Mngadi et al., 2003). It is therefore important to identify the unique features of young mothers’ transition processes and coping responses that assist them to successfully confront the challenges of motherhood.

Background of the Study Demographic heath survey data suggest that 20 to 30% of all births in sub- Saharan Africa are to teenagers (Mbugua, 1997). Adolescent reproductive health is an issue that is receiving increasing attention in Ghana. One in ten births in Ghana occurs to adolescent mothers. Twelve percent of girls and 1% of boys between the ages of 15 and 19 have had one child or more (Allan Guttmacher Institute [AGI], 2004), with more than half of adolescent girls aged between 15 and 19 marrying in their teens. There are significant regional variations: girls in rural areas are twice as likely to have children in their teens as their counterparts in urban areas (Awusobo-Asare et al., 2004). Available data from the Ghana Social Marketing Foundation [GSMF, 2001] indicated a declining age at first menarche from 14.9 in 1980 to 12.5 in 1993 and a corresponding decrease in age at first sex. A survey (GSMF, 2001) showed that mean age at sexual debut is 16.8 for females and 17.3 for males. By age 15, 21% of males and 25%

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6 of females are sexually active. By age 19, 84% of males and 87% of females are sexually active; however, only 22% of women aged 15-49 use contraceptives is 22%, with only 13% using modern methods (GSMF). Empirical research focuses on evidence that adolescent childbearing is detrimental to mother and child rather than reporting evidence of successful outcomes (SmithBattle, 2000). More recently, researchers are increasingly taking a more complex view of teen childbearing (As-Sanie, Gantt, & Rosenthal, 2004; Manlove, Terry, Gitelson, Papillo, & Russell, 2000). The supposed adverse consequences either do not occur or may be more correlates resulting from antecedents of pregnancy such as poor social and economic circumstances. Additionally, there are significant individual differences between women that need to be taken into account in examining the consequences of adolescent childbearing (Kaiser & Hays, 2004). Finally, some of the studies on adolescent motherhood have methodological problems that limit the credibility of their findings (Rhodes, 1993). Empirical evidence refuted the predominantly negative impression of adolescent motherhood (Kaiser & Hays, 2004). Studies demonstrated that increased health risks of adolescent mothers may be due more to inadequate prenatal care and socioeconomic disadvantage than their age (Larson, 2004; Phoenix, 1993). The typical teenager mother is biologically ready for pregnancy. In fact, in the US the majority of women under 20 giving birth are 18 or 19, the age generally considered optimal for childbearing (Phoenix; Reynolds, Wong, & Tucker, 2006). Furthermore, older mothers may also have obstetric complications. Childbearing for adolescents is no more hazardous than pregnancy in

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7 older women provided they receive adequate prenatal care and nutrition (Koniak-Griffin &Pluta-Turner, 2004). Unfortunately, negative perceptions of teen mothers make it difficult to meet these conditions. Age may however be a significant factor in determining obstetric hazards for younger adolescents. The literature indicates that teens under 15 and their infants face greater health risks than older adolescents in spite of early, risk-appropriate ante-natal care (Airede & Ekele, 2003; Otoo-Oyortey & Pobi, 2003).

Statement of the Problem This study reframes adolescent childbearing by focusing on adolescent childbearing as a life stage transition that may include both negative and positive experiences and outcomes (SmithBattle & Leonard, 1998). It examines adolescent parenting as a process that relates to the adolescent stage of development of girls in an Akan, matrilineal community where early marriage and childbearing may still be normative and not bearing children may place girls at social and economic disadvantage (Bledsoe & Cohen, 1993; Reynolds, Wong, & Tucker, 2006). Theoretical assertions influential to the research are psychosocial development, transition models, and the concept of becoming a mother (Erikson, 1968; Meleis et al., 2000; Mercer, 2004). Significant parallels in these models include their descriptions of major developmental life events that involve constructing new self-definitions. To cope successfully with the transition process, individuals use strategies such as information- seeking, seeking expert role models, and testing mastery of the new role. Additionally,

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8 demographic and environmental variables facilitate or inhibit the individual in successfully completing the process. The study will identify both factors that enhance and hinder adolescent mothers’ transition to the maternal role through interviews of their experiences from the prenatal period to one year postpartum (Mercer, 2004). It will elicit understanding of the adolescent girl’s transition to motherhood in the Ghanaian cultural context.

Purpose of the Study Rather than confirming the link between adolescent childbearing and negative psychosocial outcomes, the study takes an approach that highlights the resilience of adolescent mothers. Though there are potential problems with adolescent pregnancy and parenting, adolescent sexual activity is part of the normal transition into adult life (Scott- Jones, 1999). Against this background, the study seeks to explore factors that lead to positive developmental outcomes for adolescent mothers. It seeks to answer the question: “When adolescent childbearing occurs, what variables and processes explain successful transition to motherhood?” Two research aims are formulated for this study. The first is to explore and describe the adolescent mother’s experience of the transition to motherhood. The second is to use themes and categories identified in interviews with adolescent mothers to describe guidelines for interventions with young mothers.

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9 Research Questions The study will answer the following questions: 1. What are the unique dimensions of the transition to motherhood for adolescent girls in a rural community in the Central Region of Ghana? 2. What variables constrain or support young mothers in this community at different stages in the transition to motherhood?

Significance of the Study The study is significant from the point of view of existing conceptual and empirical knowledge of adolescent fertility (As- Sanie et al., 2004; Hogun, Sun, & Cornwell, 2000). The majority of these studies test theories within mainstream European or American contexts and may not generalize to adolescents in other sociocultural contexts (SmithBattle, 2000). Teens’ perceptions of pregnancy risk-taking, nonmarital childbearing, and the impact sex and pregnancy may have on their lives determine their decisions to engage in sexual activity (Caldwell, 1999). Additionally, existing theoretical studies employ behavioral theories to explore adolescent sexual and pregnancy risk- taking focus on the individual and are not adequate for exploring the interplay of individual, family, and contextual factors in adolescent fertility behavior (Sugland et al.). Furthermore, the focus of current research is not on young mothers’ development and views of identity, but on lifelong negative socioeconomic effects of early motherhood (Larson, 2004; Rhodes, 1993). Research needs to focus less on the difficulties associated with early childbearing and more on adolescent sexual decision

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10 making as a valid response within a particular social context (SmithBattle & Leonard, 1998). The net effect of the lack of contextual research on adolescent mothers is that their voices are silenced, though they may have priorities that challenge dominant middle class views of self and mothering (Arendell, 2000). An approach that is respectful of the perceptions adolescents have of motherhood recognizes sexual activity as a normative aspect of adolescent development and affirms young mothers’ priorities and accomplishments. Finally, research on adolescent mothers in rural areas can inform the design of interventions. Theory influences how professionals approach sexuality research, practice, education, and policy formulation (Arendell, 2000). Public debate about adolescent sexuality is often based on assumptions with little factual evidence (Rhode, 1993). Adolescent mothers are not a homogeneous group. Furthermore, the challenges of adolescent childbearing may provide the impetus for emotional growth and a successful resolution of adolescent developmental tasks (SmithBattle, 2000). Much of the disadvantage of adolescent childbearing may be due to demographic and socioeconomic factors rather than the age of young mothers (Hayes, 1987; Reynolds, Wong, & Tucker, 2006). Additionally, it is not yet known what individual coping strategies and interventions are most effective in minimizing the negative effects of early childbearing (Spear, 2004). Research can contribute to understanding how communities can provide safe adolescent transitions within their developmental contexts (Kaiser & Hays, 2004).

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11 Definition of Terms The literature identifies several challenges in addressing this topic adequately. One challenge in defining premarital childbearing is the lack of clarity about when marriage starts and is completed and what constitutes a premarital birth in the African context (Garene, Tollman, Kahn, Collins, & Ngwenya, 2001). Marriage is a dynamic institution that takes diverse forms and meanings in different ethnic groups. For the purposes of the study, marriage was defined as celebration of customary rites in the Fante tradition. Secondly, the concept of an intended pregnancy itself is complex (Bledsoe & Cohen, 1993). Where young mothers responded that their pregnancies were unplanned, they were described as such, regardless of the processes involved (Macintyre & Cunningham-Burley, 1993). A final challenge is that the definition of adolescence varies from one study to another (Bledsoe & Cohen, 1993). Adolescent mothers, for the purposes of this study, were girls aged between 12 and 19 at the time of their first birth.

Assumptions and Limitations An underlying assumption of the study was that early childbearing is accepted in rural areas in light of the preference for large families and the likelihood that adolescent girls have little or no formal education (Bleek, 1987; Gupta & Mahy, 2003; Otoo- Oyortey & Pobi, 2003). For these girls, motherhood is the primary identity. The study explored the assumption that motherhood contributes towards adolescent development. A second was that adolescent mothers are embedded in a network of extended family

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12 relationships and have access to support that promotes their adjustment to motherhood (Thompson & Peebles-Wilkins, 1992). Limitations of the study included challenges intrinsic to research in the qualitative tradition. Though a number of strategies can be used to enhance the rigor of a phenomenological study, the credibility of a qualitative study is dependent on the expertise of the researcher who has a major role in data collection and analysis. An inexperienced researcher working with an emergent design within time and financial constraints will be hard put to conduct research that meets the highest standards (Priest, 2001). Closely related to this is the issue of transferability of the research. The strength of qualitative research is that it captures the distinctive experiences of a population within its own setting (Patton, 2000). Its weakness is that it may not generalize to other settings and populations. Secondly, becoming a mother is a dynamic, evolving, and interactional process that continues over a lifetime (Mercer, 2004). The research limited its focus to two years beginning from the prenatal period to one year post partum. Similarly, although the focal role of the infant’s father in enhancing maternal well being has been observed (Furstenberg & Harris, 1993; Mngandi et al., 2003), the study did not include interviews of male partners. Finally, the study investigated the transition experiences of young mothers during their first pregnancy. Since memories are reconstructed, to some extent, participant recall of events and interactional processes may have been biased by their current experiences.

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13 Nature of the Study Creative methods of research are required for studies of marginalized populations and diverse groups (Henderson, 1998). Hermeneutic phenomenology provided the philosophical and methodological background for this study (Laverty, 2003). With the study’s emphasis on analyzing young mother’s experience of the transition to motherhood, a phenomenological approach as described by Heidegger was an appropriate method of inquiry.It sought multiple perspectives on phenomena to capture the diversity of people’s experiences. Subjects were studied in their natural settings recognizing how language defines interaction and reflects the meanings people assign to objects and events (Draucker, 1999). Conventional survey methods are inappropriate for non-literate populations, particularly women, who are not used to responding freely (Bamberger, 1999). Survey methods may be used with such populations, but additional researchers have to be recruited to assist with administering questionnaires (Nabila & Fayorsey, 1996). Further, concerns of accurate translation of questionnaires into the local language increase costs of the research. For these reasons, in-depth interviews will be conducted with young mothers in the local language. Qualitative research is appropriate for research on subjects that are not clearly defined. Despite the amount of research on the topic, no well-accepted theory of adolescent pregnancy and childbearing has been formulated (Moore et al., 1996; Spear, 2004). On the one hand, it is conceptualized as part of a constellation of deviant behaviors among high-risk youth. On the other hand, some studies suggest that

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14 adolescent childbearing is a result of rational choice to achieve adult status, demonstrate love or commitment to a partner, or replace a real or threatened loss of a significant person (Moore et al.). Conventional survey methods are inappropriate for non-literate populations, particularly women, who are not used to responding freely (Bamberger, 1999). A preference for a qualitative as opposed to a quantitative approach is also determined by the multifactorial, multidimensional nature of adolescent development and childbearing. Quantitative designs can investigate the affect of multiple predictor variables on different dimension of adolescent development using multivariate statistics (Corcoran et al., 2001). A phenomenological study, however, allows participants to express their self-understanding of their maternal role as well as the various factors that impinge on their life courses. Similarly, understanding context is essential to a holistic perspective. Adolescent sexual behavior cannot be separated from adolescents’ reproductive options and sexual roles within a cultural context (Rhode, 1993). Feminist constructionism defines motherhood as more than biological activities of “conception, gestation, and lactating” (Arendell, 2000, p.1194). Mothering takes place within a particular social context that gives it meaning. Furthermore, it is dynamic, as a woman’s maternal practices are influenced by her beliefs about family, childhood in general and her infant in particular, and the process of interaction with her infant (Arendell). Teen mothers often live with their families of origin (Spencer et al., 2000). Thus, their parenting practices reflect family and cultural meanings and practices: "Rather, parenting is fundamentally a highly relational, situated, and arational practice in which parents nonreflectively take up and

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15 modify family and cultural norms and practices." (SmithBattle, 2000, p. 34). Additionally, constructs that guide individual choices in specific situations may be very different from constructs in the public domain (Coyle et al., 1991). Research strategies need to elicit the personal meanings young mothers ascribe to sexual behaviors and the maternal role. Conceptual Framework Erikson’s model of psychosocial development, the concept of becoming a mother (Mercer, 2004), and transition theory (Meleis et al., 2000) form the framework of the study) see Table 1). Erikson (1968) stated that the growing child moves from non ego identity to ego identity through a series of inner and outer conflicts. Erikson emphasizes the complex relationship between individual development and societal expectations. According to Erikson, the social environment defines psychosocial tasks and standards of successful mastery. Although Erikson classified each stage in terms of conflicting personality characteristics, stages form gradated scales (Santrock, 2001). Damage done at one stage can be repaired partly in subsequent periods of growth. Adolescence is a period of rapid physical growth, attaining puberty, and attempts at consolidating social roles (Owen, 2002). Additionally, during adolescence children are cognitively, physically, and socially mature enough to synthesize values and goals learnt in childhood to pursue a viable path toward adulthood (Santrock, 2001). After a period of experimentation, adolescents selectively reject goals and values of their parents and

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16 establish their own priorities. Youth acquire fidelity, and an ability to abide by the values, ethical standards, and ideologies of their societies (Erikson). A psychosocial developmental framework provides an empirical basis for investigating outcomes of adolescent childbearing. Current literature frequently presents the adverse outcomes of adolescent pregnancy from a psychosocial perspective (Myors, Johnson, & Langdon, 2001). Similarly, studies affirming the assets, latent strengths, and capacities of young mothers emphasize the interaction of demographic and environmental influences in the transition to motherhood (SmithBattle, 2000). Successful identity formation is experienced as allegiance to the values of the community, recognition of oneself as a productive member, and a growing sense of self-efficacy (Erikson, 1968). In some social contexts, early childbearing enhances a girl’s social and economic prospects (Bledsoe & Cohen, 1993). Motherhood may be a primary role that enhances a young girls’ status and provides an alternative trajectory to adulthood. The concept of becoming a mother (Mercer, 2004) evolved from Rubin’s (1967) work on maternal role attainment (MRA). The process of MRA is expressed prenatally in the mothers’ acceptance of the pregnancy and attachment to her unborn child. Progressive stages involve fantasizing about motherhood and her infant’s future, information seeking, and imitation of mothering practices with the mother as the most significant role model. Postpartum, it is expressed by the new mother as the development of her personal style of mothering, satisfaction in the mothering role, competent mothering behavior, and affectionate communication between mother and infant. MRA is the result of maternal role taking and assimilation of the maternal role into the self-

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17 concept. Rubin stressed that a woman’s maternal identity develops in interaction with her infant’s developmental stage, gender, health status, and behavior. Further, strategies of maternal role attainment are repeated with each successive birth as each childbearing experience is unique. Mercer (1985) identified four stages of acquisition of maternal identity: anticipatory, formal, informal, and personal identity. In the final stage, a mother has a sense of fulfillment and self-efficacy in her performance of care taking tasks as she receives validation from significant others and interacts with her infant. Mercer extended her investigation of MRA from four months post-partum to one year. In subsequent research, Mercer (2004) argued that the concept of MRA needs to be replaced by becoming a mother (BAM). From a summary of research findings in recent studies, Mercer described BAM and variables influencing this transition. The literature corroborated descriptions of the transition in MRA and described the importance of prenatal attachment to baby for maternal competence and fulfillment in the mothering role. Mothers with more complex differentiated expectations and positive relationships with their own mothers adapt more successfully to mothering. The process of adjustment is accomplished around four months post-partum. Finally, social support, including paternal support is related to the mother’s satisfaction with her role. Becoming a mother, additionally, stresses the growth and transformation of a mother as she increases her adaptive functioning, redefines her roles and relationships within the family to incorporate the infant, and assimilates motherhood into her self-concept. Mercer defines the concept of BAM as:

Full document contains 147 pages
Abstract: The study explores the transition to motherhood for adolescent girls in a rural community in the Central Region of Ghana from the prenatal period to one year post partum. Theoretical assertions influential to the research are psychosocial development, transition experiences, and the concept of becoming a mother. Aims of the study were to explore and describe the adolescent girl's experience of the transition to motherhood and to use themes and categories identified in interviews to describe guidelines for interventions with young girls. In-depth interviews were conducted with 14 young mothers aged 14 to 18 at the time of first birth as well as 11 maternal grandmothers. Young mothers were asked about defining experiences in the pre and post natal periods. Additional questions included their views on motherhood and implications of the pregnancy for their personal goals, future plans, and purpose in life. Interviews with grandmothers began with the question: "Can you describe the decisions, events, and emotions surrounding the pregnancy, birth, and experience of the new mother?" A nurse midwife in a community health center was also interviewed to determine procedures for maternity care and reproductive health counseling for adolescents. Additionally, an elder in the community was interviewed for information on customary practices regarding courtship, marriage, and childbearing, as well as traditional penalties for paternal in-laws when fathers deny paternity. A seven-stage process for analysis of narrative texts guided the data analysis. Three themes emerged: pregnancy as disruption and loss, embracing the realities of motherhood, and deprivation of opportunity. Themes were used to infer guidelines for interventions with adolescent mothers. Interventions need to address fundamental antecedents of early sexual activity and childbearing, such as poverty, low educational attainment, and inadequate reproductive health information. Additional factors that hamper adolescent development in the community are limited opportunities for career advancement and other mainstream behaviors indicative of adult status. Though maternal grandmothers offered support for young mothers, community involvement is essential to foster positive outcomes of early childbearing. Communities need to enforce customary sanctions against absent fathers, provide childcare assistance, and reduce the stigma of off-time childbearing so mothers can maintain psychological well-being.