Staying on track or falling behind? Factors associated with pre- and post-pregnancy schooling among adolescent mothers in South Africa

Background: Adolescent birth rates remain high in Sub-Saharan Africa where about 20% of women under the age of 20 have had their first pregnancy. Despite global concerns about adolescent mothers’ impaired school outcomes, few interventions exist that effectively support girls’ continued schooling throughout pregnancy and thereafter. As education is a modifiable social determinant of health, supporting adolescent mothers’ continued schooling might provide opportunities to strengthen the long-term health for them and their children. In South Africa, laws and policies that support pregnant girls and adolescent mothers’ right to education have been implemented. Yet, early pregnancies remain a major reason for girls’ school discontinuation and young mothers still face barriers in the process of returning to school. The research to inform programmes to combat school withdrawal among girls has been limited, with little empirical evidence on the factors that enable or hinder continued schooling throughout pregnancy and motherhood. This is especially true for key pre- and post-pregnancy factors, such as medical problems during pregnancy or available childcare postpartum, which have not yet been quantitatively explored in the context of adolescent mothers and schooling within South Africa.
Objectives: This DPhil aimed to: (1) Estimate the associations between school withdrawal during pregnancy and hypothesised structural, family, individual, and pregnancy-related correlates, and examine school discontinuation patterns over the course of pregnancy. (2) Investigate the associations between adolescent mothers’ postpartum return to school and hypothesised structural, individual, family, pregnancy, and postnatal factors, and examine the mediating mechanisms through which socioeconomic hardship affects school return after birth. (3) Assess adolescent mothers’ timing of school return after birth. (4) Identify subpopulations of adolescent mothers which are characterised by similar patterns of structural and relational characteristics and compare the probabilities for school enrolment across these identified profiles.
Method: This thesis addresses its objectives using data from the study Helping Empower Youth Brought up in Adversity with their Babies and Young children (HEY BABY), a cross-sectional survey which was completed by 1,046 adolescent mothers living in the Eastern Cape province of South Africa between 2017 and 2019. Within this sample, pre- and post-pregnancy school enrolment were assessed and a variety of quantitative methods were deployed across four sets of analyses: The first paper analysed the associations between school discontinuation during pregnancy and hypothesised correlates. Patterns of discontinuation over the course of pregnancy were further tested with a Cox proportional hazards model and examined through visualisations of adjusted survival curves. In the second paper, logistic regression was used to investigate the associations between adolescent mothers’ postpartum return to school and hypothesised pre- and post-pregnancy factors. In addition, mediation analyses tested the pathways from economic hardship towards school return. The third paper further investigated adolescent mothers’ timing of school return after birth. In the fourth paper, a latent profile analysis was used to further interrogate which structural and parenting patterns place adolescent mothers at risk for negative school outcomes. Specifically, this paper characterised latent profiles of adolescent mothers and compared the probabilities for school enrolment across these identified profiles.
Results: A large proportion of mothers were enrolled in school at the time of the pregnancy (91%), continued schooling throughout pregnancy (75%), had returned to school after birth (69%), and were still enrolled at the time of the study (59%). Withdrawal from school during pregnancy was associated with being able to afford fewer necessities, grade-delay at the onset of the pregnancy, an unplanned and unwanted pregnancy, and having received less information about the pregnancy from the caregiver. Complementary time-to-event analyses showed that some girls discontinue schooling relatively early on during pregnancy, namely the first trimester. In addition, returning to school after birth was associated with access to more necessities, fewer repeated grades before the pregnancy, continued schooling during pregnancy, the use of formal childcare and childcare provided by the family, and not exclusively breastfeeding in the first six months after birth. Mediation analyses showed that lower levels of poverty were not associated with school return directly but via two indirect pathways, namely continued schooling during pregnancy and the use of formal childcare, respectively. Complementary analyses also showed that many mothers returned to school soon after birth. That is, about 70% of returned mothers have gone back to school within the first two months after birth. Lastly, a latent class analysis showed that three distinct subgroups of adolescent mothers emerged based on their similarities in family and household-, school-, and community-level variables. Compared to the “most deprived” subgroup which experienced food insecurity and lack positive relationships with their caregiver (39%), mothers who are free from most structural and caregiver risks (18%) showed the highest probability of being enrolled in school (i.e., the probably for school enrolment was 72% for the least deprived mothers and 49% for the most deprived mothers).
Conclusions: Many girls become mothers during the adolescent years in South Africa. A sizable proportion of these girls are at risk of permanently discontinuing their education, limiting their progress towards several international development goals. This study showed that more than 90% of adolescent mothers were enrolled in school at the onset of their pregnancy, but schools might be losing a quarter and more of these girls due to pregnancy and motherhood. However, the high level of engagement with schools at the onset of the pregnancy might provide the opportunity to expand existing school-based services to prevent pregnant girls' school withdrawal during pregnancy. Such services do not necessarily have to target adolescent mothers, but should be aware that a group of school-going girls might be at a higher risk to withdraw from school once a pregnancy occurs, such as girls whose school trajectories are characterised by grade-repetition. At the same time, the access to affordable or free childcare opportunities might increase adolescent mothers' ability to return to school once the child is born. Even though childcare support is frequently provided by family networks and might help with girls' return to school, the improving access to formal childcare services could be a more sustainable solution which simultaneously alleviates the burden of childcare for other female family members. Any of these efforts must be coupled with the development of aligned national educational and health policies which protect the girls' right to education whilst considering their infant's health and development (e.g., by considering how school re-entry policies match breastfeeding recommendations and practices). Specifically, there appears to be scope to improve policies for pregnant learners and learners with children which do not currently lead to uniform return patterns, nor reflect the needs of the high number of girls who return to school very early after their pregnancy.
Prior to this thesis, there were no known studies which examined the breadth of modifiable factors which could affect pregnant girls and adolescent mothers' continued school enrolment. Despite the cross-sectional nature of the data and the reliance on self-reports, this study provides large-scale evidence that will be valuable for future research on adolescent mothers’ support needs and how to address them. Fellow researchers and policy makers aiming to adapt and test existing intervention packages to promote adolescent mothers’ schooling will be able to leverage the present results which suggest girls’ unmet needs for childcare, information, family-strengthening, and financial support. In addition, future research should further interrogate which potential clusters of risk factors, especially those beyond the individual-level, place adolescent mothers at the greatest risk for an incomplete education. Building on the presented evidence, longitudinal research designs, natural experiments, or carefully constructed randomised controlled trials are needed to cement the causal impact of the factors identified within this thesis. Overall, this thesis has generated evidence on several pre- and post-pregnancy factors and, therefore, addressed an important gap in the available research to inform programmes to combat school withdrawal among adolescent girls who begin childbearing early.

Keywords: education
South Africa
school return
school dropout
adolescent pregnancy
schooling
adolescent girls and young women
adolescent mothers
Advisor: Cluver, L
Meinck, F