Interviews
Face-to-face semi-structured interviews were conducted. The interviews were conducted by the research-interviewer who is not an employee of the clinic. The interviews were conducted in Cantonese and took place in an interview room at the MCHC. The room was a small private room, located away from the waiting hall, and a light indicating “interview in progress” was turned on to avoid being disturbed. This was done to provide comfort, privacy, and a quiet environment for conversation and clear audio-recording of the interviews.
Ethical considerations
Before conducting the study, ethical approval was obtained from the Ethical Review and Approval Committee, The Hong Kong Polytechnic University. Information related to the study was given to each informant. Those who were willing to take part in the study were interviewed immediately after their written consent to do so was obtained, or were scheduled for an interview according to the preference of the informants, usually within two weeks. As the audio recordings, notes, or interview transcripts contained sensitive and personal information about the informants, a pseudonym was assigned to each informant. All of the information was in a locked filing cabinet to assured confidentiality.
As the informants might recall the stressful experience of teenage pregnancy, measures were taken to safeguard their emotional well-being during the interview. The informants were informed about the voluntary nature of the research, that their decision on whether or not they agreed to be interviewed would not affect the treatment that they received from the clinic, and about the possibility of withdrawal at any stage, especially when feeling emotional discomfort. Support would be given during the interviews, and interviewees would be referred to counselling services if they needed further emotional support. None of the interviewees required emotional support after the interviews.
Data analysis
The informants’ demographic data were collected using a demographic sheet. The interviews were audio-recorded to “eliminate errors of memory”. The interviews were transcribed within two weeks to obtain the most comprehensive and accurate description. In order to maintain dependability, the researcher-interviewer repeatedly listened to the tape during transcription and proofread the verbatim transcription for accuracy. The transcriptions were typed in Chinese.
Conventional content analysis of qualitative data was used to handle the data [
15],[
16]. The researchers read the data repeatedly to obtain a sense of the whole; the data were read word-by-word and the text was highlighted. Codes were then derived, existing codes were revised if new codes emerged (further coding and recoding), and further analysis was conducted to develop themes that could authentically and accurately represent the topic being studied [
16].
Throughout the whole data analysis process, in order to maintain accuracy the language that was used in the transcription of data, with the highlighting of text, codes, and emergent themes, the language that was used was Chinese, the language with which the researcher are most familiar. It is only at the stage of writing up the manuscript that the themes were translated into English.
Rigor
The two researchers independently read through the interview transcripts of each informant several times so as to make sense of the data and obtain a sense of the whole. Significant statements pertaining to the situation, choices, and decision of the women were extracted and defined as phrases. The primary patterns were organized into themes, which were then compared with the original description. The two sets of analyzed themes were compared and discussed until a consensus was reached, and the themes were combined, summarized and classified accordingly. Study rigor was enhanced through a member check of the emerging clusters with the informants.
Study Results
In the months from August to October 2009, nurses who worked in the MCHC helped to review the records of current clients to identify and recruit those eligible as informants. A total of twelve women were considered eligible and invited for interviews. However, one repeatedly missed the appointments, one lost contact, and one was advised by her mother to refuse to be interviewed. A total of nine informants were successfully interviewed. The interviews lasted for 25 to 45 minutes.
All nine informants were Chinese women born in Hong Kong who had experienced an unintended first pregnancy when they were single in their teens. Seven informants were 17 years old when they first became pregnant, one was 18, and another 15. Four of them had been studying in secondary school, and one had been working as clerk, and one as a waitress. Three were not engaged in either school or work at the time of the pregnancy. All of the four who were in school discontinued their schooling after their pregnancy. Four were raised in single-parent families. GiGi, Helen, and Lucy moved out of their family home at the time of the pregnancy. Both GiGi and Lucy came from divorced families and described their families as uncaring.
Among the nine informants, four changed their initial choice of what to do about their pregnancy during the course of the pregnancy. Five informants finally chose to undergo an abortion (Candy, Helen, Ivy, Jenny, and Kitty), and four chose either co-parenting or single parenting (Daisy, GiGi, Lucy, and Fanny). However, Fanny, who had chosen to raise the baby together with the baby’s father, was placed in a halfway house for drug addiction treatment and had to place the baby in a foster family. She eventually signed away her baby what the infant was 4 months old, when she separated from the baby’s father.
Considerations involved in the pregnancy resolution decision
The process of pregnancy resolution began when informants realized that they were pregnant. An analysis of the interview transcripts revealed that to arrive at a decision on how to resolve their pregnancy, several categories for consideration emerged, including the interviewee’s relationship with the boyfriend, family’s advice or support, practical considerations, personal values in life, and views on adoption.
Relationship with the boyfriend
All of the women had approached their boyfriend, the putative father of the baby, about their pregnancy resolution. The boyfriend was the usually the first person whom the pregnant teenager approached. The relationship with the putative father greatly influenced their pregnancy decision. Four out of the five informants who chose to undergo an abortion had a poor relationship with their boyfriend. They explained:
He was never concerned about my feelings: instead of comforting me, he grumbled. He denied that the baby was his, and said that I had other men. We then separated. (Candy)
As he thought the baby was not his, and he insisted on an abortion. I was afraid that he would beat me, so I said nothing. (Helen)
After I told him I was pregnant, he complained, stopped talking to me, and left me a few days later. (Ivy)
We dated each other for only a short time, about one month; our relationship was not strong enough. (Kitty)
The three informants who chose to co-parent were those who had a good relationship with their boyfriend (the putative father) and received support from him. They reported that their boyfriend was affectionate and supportive. They said:
I was going to abort the baby. But we considered our relationship: since it was stable, he insisted that we keep the baby and did not want me to have an abortion. So we decided to keep the baby. (Daisy)
We were together and loved each other, so after discussion, we both decided to keep the baby. (Fanny)
I love my husband (then my boyfriend), and he was good to me. I told him that I wanted to keep the baby, and he didn’t object. (GiGi)
Lucy was the only one who chose to become a single parent. She said that she had separated with her boyfriend before she realized that she was pregnant. When she called him to tell him the news, her boyfriend told her to get an abortion. She said:
He said something nasty to me, and that he would stay with me just because I am pregnant. We had already separated then. He told me to go and get an abortion because he already had another girlfriend. I did not want to abort the baby, so I decided to have the baby myself. (Lucy)
Fanny initially chose to co-parent, but finally gave the baby up for adoption when the baby was 4 months old. She said:
I was in a drug treatment program. I surely would have taken care of the baby even though we were separated, but I had no choice: I had to put the baby up for adoption. (Fanny)
Family’s advice and support
When the informants did not gain support from their boyfriend, they would turn to their mother for advice. Three informants followed the advice of their mother and had an abortion. They said:
Mom advised me definitely not to keep the fetus. She said that I would not be able to raise a baby, and that it is a responsibility for life. (Candy)
I followed my mother’s advice and chose to get an abortion. My mom said that I was still too young to look after a baby, so I aborted the fetus. (Ivy)
Jenny and her boyfriend wanted to keep the baby. However, her parents advised her to get an abortion because she was only 15 and did not want her boyfriend to be prosecuted for having sexual intercourse with a girl under the age of 16. She explained:
I had no other choice, as I hadn’t reached the age of consent. My parents told me that since I was not of age, if I delivered the baby, my boyfriend would be put in jail. So I agreed to abort the fetus. (Jenny)
Helen had a poor relationship with her family and had left home at the time of her pregnancy, so she did not discuss it with her family. However, her boyfriend suspected that the baby was not his and forced Helen to undergo an abortion at around five months gestation. Gi Gi, Lucy, and Kitty aborted the fetus soon after getting pregnant, without discussing the matter with anyone. Kitty had only known her boyfriend for a short time, and feared being reprimanded by her parents.
Practical considerations
The ability to raise a baby and financial considerations were the major concerns for most of the informants. Two informants, Daisy and GiGi, obtained such childcare support from their boyfriend and financial support from their mother or mother-in-law. They said:
I believed that my boyfriend was able to earn the money needed to support the baby. His mom could help me to take care of the baby. It was even better that my mom said that she would help me care for the baby. (Daisy)
I had concerns about our ability to cope financially, but my boyfriend had a stable income, so I was not worried. My mother-in-law to be would help with child care. (GiGi)
Lucy could not receive any support from her boyfriend or her own family, but she chose to become a single parent. She moved into a hostel for pregnant girls during her pregnancy and obtained a social security allowance from the government. She said:
A friend of mine gave me the phone number of a social worker at the girls’ hostel; the social worker then arranged for me to move into the hostel. Then, she helped me to apply for a government allowance. (Lucy)
Fanny gave birth to the baby, but later separated from her boyfriend. She could not take care of the baby as she was in drug rehabilitation treatment and had no financial support. She was left with no other choice but to give the baby up for adoption. She said:
I thought about becoming a single parent, but realized that I did not have the ability to do so. I didn’t have the ability to earn money, so I decided to give the baby up for adoption. I wish I had had an abortion. (Fanny)
Two informants were not ready to be mothers. Neither of them received any support from the putative father or their family members, and so they decided to abort the fetus. Ivy and Kitty said:
My boyfriend ran away when he found out about my pregnancy. I was still studying and had no job. I was unable to take care of the baby myself. (Ivy)
I had only known him for a short time, so we could not stay together just for the baby. I was also too young, and could not manage to care for the baby and to assume the burden of the family finances. No one was there to help. (Kitty)
Personal values in life
Three other informants were against the option of adoption, and chose parenting instead of abortion as they regarded the fetus as a “living being with life”. Daisy and GiGi initially preferred to undergo an abortion, but changed their minds due to the “existence” of the baby. They said that it was not only because they could receive support from their boyfriends but also due to their feelings about the life of the fetus. They explained:
All of my family and friends suggested that I have an abortion. They were concerned about me, but not about the fetus. I felt “life” inside me; I didn’t want to “kill” it. I thought that since I had made it happen, I had to keep and give birth to the baby. (Daisy)
I had thought of abortion in the first month, but as the baby grew gradually in my belly, I didn’t want an abortion any more. When I felt unhappy, the fetus kicked me as if it was comforting me. (GiGi)
Lucy separated from her boyfriend before she realized that she was pregnant, but still chose to become a parent as she considered it wrong to take the life of a fetus by abortion. She remarked that she respected life and that a fetus has a right to live. She said:
Previously, I was prejudiced against single mothers; however, I also strongly believed that the fetus has a right to live, and I respect life. I would have felt sorrow if I had given the baby up for adoption. It is also irresponsible. I understood that I had made a mistake, so I told myself that I would be a good mother. (Lucy)
Even those who chose to get an abortion generally viewed the fetus as having “life”, but they felt that they had no other choice but to scarify the fetus, that they had weighed their other choices and that there were other more important considerations. They explained:
The baby was innocent and had life. I didn’t really agree with abortion. But if I could not give a good life to my baby, and a father, then it was better that the baby should not suffer. (Candy)
I didn’t want an abortion, as the baby was mine and had life. My boyfriend insisted on an abortion, threatening to leave me if I did not get one. Since I didn’t want to lose him, I complied with his request. (Helen)
Abortion is like killing. But my boyfriend disappeared; I needed to continue with my life, either study or work, and could not wait to settle the pregnancy before it was too late. (Ivy)
I felt bad about the abortion. But I had no other choice as I hadn’t reached the legal age of consent, and my boyfriend would get into trouble, so I had an abortion. (Jenny)
Views on adoption
None of the informants chose to give birth to a baby for adoption. Candy, Ivy, and Kitty held a negative view of adoption. They rejected the idea of giving the baby to others, and worried whether or not their baby would be treated nicely by his/her adoptive parents. They said:
I wondered how someone could place their baby in an orphanage or put it up for adoption; I would regret not knowing whether the baby was leading a good life, and would keep worrying about whether they were not being treated well. (Candy)
The social workers only told me that I could surrender the baby for adoption immediately after delivery, but they wouldn’t tell me anything more about the adoption process and to whom the baby would be given. I just could not see how I could keep thinking that my child was somewhere in this world, but I wouldn’t know how s/he was being treated, and if s/he would blame me for not taking care of him/her. It was better not to give birth than to have to worry about all of these things. (Ivy)
Daisy, GiGi, and Lucy also held negative views on adoption, in that they believed it would cause psychological distress to the baby. They also believed that they had a responsibility to the baby. They would rather terminate the pregnancy than surrender the baby for adoption. They explained:
I would rather abort the fetus than give birth to the baby for others to adopt. Adoption would greatly impact the baby’s psychological health, and the baby would grow up to wonder why they had been abandoned by their mother. I am not dead, and I am the baby’s mom: why would I want to abandon my child? If I didn’t want the baby, then I would not give birth to the baby. (Daisy)
It is better to terminate the pregnancy than to abandon the baby after bringing it into this world. If I could not take care of my baby, I would prefer to put him/her in an orphanage and visit regularly; there is no need to give the baby up for adoption. (GiGi)
I didn’t want my baby to be adopted. I would be sorry and heartbroken; it seemed so irresponsible. (Lucy)
Fanny was the only one who finally placed her baby for adoption when she separated from her boyfriend. She also had a negative view of adoption. She regretted giving birth to the baby. She explained:
Adoption meant I would never see my baby again. I would not have delivered the baby had known that I could not keep the baby. Why did I continue the pregnancy? (Fanny)