The paradox of acceptance: A content analysis of Iranian married female adolescent in confronting pregnancy
The paradox of acceptance: A content analysis of Iranian married female adolescent in confronting pregnancy
Maryam Moridi 0 1
Farkhondeh Amin ShokraviID 0 1
Fazlollah Ahmadi 1
? These authors contributed equally to this work. 1
0 Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University , Tehran , Iran , 2 Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University , Tehran , Iran
1 Editor: Yeetey Akpe Kwesi Enuameh, Kwame Nkrumah University of Science and Technology , GHANA
Adolescent pregnancy is a major health problem significantly associated with adverse effects on the health of both adolescents and their newborns. However, there is a lack of clarity over adolescent pregnancy from adolescents' perspective, particularly in the low- and middle income countries including Iran. This study aimed to explore the experiences of Iranian married female adolescent in confronting pregnancy. This qualitative research was conducted using conventional content analysis approach. Unstructured interviews with 24 female adolescents (aged 14-18 years) were used for data collection, and data analysis was done simultaneously. In this study, the participants were recruited from urban and rural primary healthcare centers (PHCs). The PHCs were selected randomly from several towns and villages of Guilan Province, Iran. The participants were recruited through a purposive sampling method. After data analysis, four categories were extracted from 24 interviews, including "actively accepting pregnancy", "passively accepting pregnancy", "hope and satisfaction" and "frustration and regret". These categories formed the main theme of "paradox of acceptance" in confronting pregnancy. The concepts that have emerged based on the results of the study can potentially help develop comprehensive and age-tailored health promotion programs to confront pregnancy more successfully for female pregnant adolescents. Further research, particularly on the long-term effects of teenage motherhood is suggested.
Data Availability Statement: All relevant data are
within the manuscript.
Funding: Tarbiat Modares University provided
financial support for conducting the research. The
funders had no role in study design, data collection
and analysis, decision to publish, or preparation of
Competing interests: The authors have declared
that no competing interests exist.
Adolescent pregnancy is reported as a public health concern in many countries [
about 16 million female adolescents (aged 15?19 years) give birth globally [
]. Added to this,
approximately one million births occur to females younger than 15 years; 95% of these births
take place in the low- and middle-income countries [
]. The minimum legal age for males and
females to marry in Iran is 15 and 13 years old, respectively. However, if the three conditions
including the father?s permission, best interests of the child and confirmation of competent
court are met, the age of marriage will be lower. Iran?s population of adolescents is high, and
the age specific fertility rate in this group has been raised from 25 to 35 per 1000 adolescents
from 2010 to 2011 [
]. Iran?s population policy has shifted from a decrease to an increase in
the consequent decades [
]. Therefore, it is predicted that the fertility rate of Iranian
adolescents will be elevated by 2025. It is noteworthy to mention that, due to the cultural context
based on Islam in Iran, females give birth during the first year of marriage [
], so they are
confronted with simultaneous events such as marriage, pregnancy, and mothering in the
transition to adulthood.
Adolescent mothers and their children have higher rates of health problems and negative
outcomes, including medical complications, lower educational achievement, and
socio-economic consequences. In addition, adolescent pregnancy is perceived as an undesirable social
]. However, a number of quantitative studies on unmarried pregnant
adolescents have revealed that adolescents have positive attitudes toward early childbearing [
such as generating a connection to their parents and family, happiness, fulfilling gender roles
, accountability, maturity, autonomy, and a meaningful life [
]. Due to conflicting
perceptions about adolescent pregnancy, it is essential to investigate the consequences of
pregnancy from the perspective of adolescents with a special focus on the role of socio-cultural
factors influencing adolescents? feelings and choices. Understanding the adolescents?
perspectives on pregnancy, through qualitative approaches, can help gain better insight into the
challenges of adolescents in confronting pregnancy. However, while most pregnancies in Iran
occur within the marital relationship, a majority of qualitative studies are done with unmarried
female pregnant adolescents and indicate that these adolescents have mixed feelings about
their pregnancy. Furthermore, a phenomenological study from a southern city of Iran on
married female adolescents reported that pregnancy in adolescents resulted in the fast
development of physical, psychological, social, and spiritual aspects of these individuals [
Consequently, by considering the complexity and diversity of the phenomenon of adolescent
pregnancy in the context of time and place, the researchers aimed to explore how married
female adolescents living in Guilan, Iran confront and accept their pregnancy.
2.1 Study design
Due to the nature of the study, the qualitative content analysis method was used. Content
analysis is a systematic approach that provides new insight into a particular phenomenon. It leads
to valid deduction from data and is appropriate for exploring the experiences and views of
people towards the issue of interest [
]. The current study was conducted from November 2015
to October 2016 in Guilan Province (in the north of Iran).
2.2 Study settings
In this study, the participants were recruited from urban and rural primary healthcare centers
(PHCs). All PHCs and all available eligible females were selected from several towns and
villages of the Guilan Province using census method.
2.3 Study population
The inclusion criteria were married females aged 14?18 years, being pregnant, living in the
Guilan Province, registered to the PHCs or study hospital, speaking and understanding the
Persian language, and willing to participate in the study.
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2.4 Sampling approach
At first, 24 female adolescents who met the inclusion criteria and had been registered in the
antenatal clinics of PHCs or the referral obstetric hospital in Rasht City (the capital of Guilan
Province) were recruited using a purposeful sampling method. For this purpose, the telephone
numbers of potential participants were selected from registry lists. Next, potential participants
were contacted and provided with information about study. As soon as the female adolescents
agreed to participate, the place, time and date of the interview were determined at their
2.5 Data collection
In total, from all the PHC?s, 30 female pregnant adolescents were eligible to participate in the
study. Of these 30 females, three were reluctant to participate, two did not have their family?s
consent, and one could not speak Farsi. Individuals who were interested in participation were
then provided with details about the objectives of the study. The informed consent was
obtained from the adolescents and legally acceptable representative or adult separately. The
data for the present research was collected using unstructured, in-depth and one on one
faceto-face interviews with 24 participants conducted by the first researcher who was supervised
by two other experts. Duration of the interview sessions varied from 30 to 90 minutes. The
interviews were conducted in PHCs and/or in more convenient locations such as the
participants? homes at their request.
At the beginning of the interview, the participants were asked a general question: "Would
you please explain your experiences of pregnancy?" or "Please tell me how you felt when you
found out you are pregnant?". These questions were then followed by probing questions (e.g.
"What do you mean exactly?" or "Would you please explain more?") for more clarity and
insight into each response.
2.6 Data analysis
All interviews were audio-recorded in mp3 format and transcribed verbatim in Persian
immediately after each interview prior to the next interview. Each transcript was imported to
MAXQDA 10 software for data analysis. Concurrent with data collection, data analysis was
done using Graneheim and Lundman?s method (2004) including, reading the entire
transcription of the interview to achieve an overall understanding of its content, specifying semantic
units and basic codes, classifying initial similar codes in more comprehensive categories, and
ultimately, extracting more abstract themes from the categories [
]. Data saturation was
obtained after interviewing 21 participants when no new concepts or categories were
developed thereafter. We elevated the sample size to assure the data saturation.
All processes of conducting interviews, coding, extracting primary codes, sub-categories,
categories and theme, writing interpretations and writing the manuscript were done in Persian
language by the authors. The manuscript was translated to English in four steps. First the
authors wrote the primary first draft of the manuscript, then the draft with the Persian version
was sent to an academic English institute for professional translation, next it was sent to an
academic English editor. Finally it was reviewed and revised by an American native English
editor living in Iran. After that, it was again sent to a native English editor living in the USA.
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Four criteria (credibility, confirmability, transferability and reflexivity) are used to evaluate
trustworthiness or rigor in a qualitative study [
]. The following strategies were used to
ensure trustworthiness in this study. First, according to the study question, the conventional
content analysis method was employed under careful supervision of the research team.
Second, all interviews were conducted with a trained interviewer in conducting qualitative
research and interviewing techniques. Third, the interviewer had a prolonged engagement
with the data. The researcher developed trust and connected with the participants, considering
a variety of perspectives, and co-constructing the meaning of adolescence. The first eight
interviews were coded independently by each author, after which the interpretations were
compared. If the interpretations differed, they were discussed until consensus was obtained. At the
end of the study, member checking and peer check methods were used. In the member check
method, the printed transcribed file was returned to participants to match the accuracy of the
data with their experiences. In the peer check method, the transcripts, codes and categories
were sent to four impartial professors in nursing, public health and social sciences to review
the credibility of the extracted categories and sub-categories. Fourth, the researcher tried to
choose participants with maximum variation in females? age, from extended and nuclear
families and urban and rural settings. Finally, in addition to audio-records and transcripts, multiple
data sources, including field notes, observation, memo, and diaries were used.
This study was a part of a doctoral dissertation, which was approved by the Ethics Committee
of the Research Deputy at Tarbiat Modares University. In addition to this approval, each
participant and her spouse or her family member signed a written informed consent letter before
Most of the participants were in the age range of 17?18 years (n = 13); three of them were 14
years old and eight were 15?16 years old. All of the participants were housewives with primary
school to high school education and all of them were Muslim; most of them were pregnant for
the first time during the interview (Table 1).
In total, 980 primary codes were extracted from 24 interviews, and were then compared to
one another and categorized in 12 sub-categories. Next, the 4 categories, which included the
active acceptance of pregnancy, the passive acceptance of pregnancy, feelings of hope and
satisfaction, and feelings of frustration and regret, emerged from them and formed a main theme
of "paradox of pregnancy acceptance". The categories and sub-categories are depicted in Fig 1.
The paradox of accepting pregnancy is the early response of young female to pregnancy.
Usually, the decision for planned childbearing was established before pregnancy and for
unplanned ones after the pregnancy in active or passive forms. In the active form, it is regarded
as deciding to accept and undertake the responsibilities of pregnancy egocentrically, and in the
passive form, it is characterized by the family?s and husband?s compulsion and insistence
without regard to the females? desire for a child. Based on the kind of acceptance (active or passive),
female adolescents are exposed to the dual feelings of hope and satisfaction, and frustration
and regret when it comes to their experience of pregnancy. Generally speaking while these
conflicting feelings exist simultaneously in both groups, hope and satisfaction were
predominant in the teens who accepted pregnancy actively and frustration and feelings of regret were
predominant in those who accepted it more passively. The degree of dominance of each of
them was determined by either an egocentric (thinking only about herself and what is good for
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Table 1. Characteristics of the participants.
Partcicoidpeant?s Age Gestaagteional Gravidity Parity
1 1y7r 41 wk 1 0
2 1y6r 28 wk, 4d 1 0
3 1y5r 39 wk 1 0
4 1y6r 40wk+2d 1 0
5 1y7r 38 wk 1 0
6 1y4r 36 wk 1 0
7 1y7r 37 wk 1 0
8 1y7r 39 wk, 2d 1 0
9 1y7r 38 wk. 1d 2 0
10 1y5r 27 wk, 2d 1 0
11 1y6r 16w, 5d 1 0
12 1y8r 14 wk 1 0
13 1y8r 18 wk 1 0
14 1y7r 29 wk 2 1
15 1y6r 36, 4d 1 0
16 1y6r 32 wk, 3 d 2 1
17 1y4r 22 wk 1 0
18 1y7r 13 wk, 2d 1 0
19 1y7r 19 wk, 4d 1 0
20 1y6r 35wk, 6d 1 0
21 1y8r 31wk, 2d 1 0
22 1y8r 26 wk, 3d 2 0
23 1y7r 8 wk 1 0
24 1y4r 21 wk 1 0
her) or an allocentric (having one?s interest and attention centered on other people) decision
PLOS ONE | https://doi.org/10.1371/journal.pone.0216649
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Fig 1. The categories and sub-categories of the paradox of pregnancy acceptance.
3.1 Actively accepting pregnancy
The majority of the participants expressed that they decided to become pregnant completely
egocentrically. The reason for this decision was a desire to experience motherhood and an
interest in parenting which led the teen to persuade her husband to accept her decision about
becoming pregnant. This category includes three sub-categories: Females? negotiation and
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persistence to convince their husbands, Interest in parenting, and Tendency to experience
3.1.1 Females? negotiation and persistence to convince their husbands. Some of the
participants mentioned using indirect negotiations as they tried to prepare their husbands to
accept the pregnancy and its responsibilities. In other words, if the females were inclined to
have a child but theirs husbands seemed reluctant, they tried to convince them otherwise using
different approaches. Ultimately, these negotiations involved the cooperation and agreement
of the couple regarding this decision:
?I really wanted to have a child. However, once I saw that my husband was not interested, I
tried to speak with him about the issue. I said that we have been married for a few years and
we currently have a house and a car and can take care of the expenses related to the child.
With this, I was able to convince him and he agreed to have a child.? (Participant 13)
"At first, my husband did not accept my pregnancy, so he pushed me to abort the baby . . .; so I
tried to satisfy him and told him that all of your friends have two babies, I want just one! I
repeated my words several times and ultimately convinced him." (Participant 23)
3.1.2 Interest in parenting. Some participants mentioned that they accepted the
pregnancy because of personal interest in childbearing and parenting. They also expressed that this
interest existed even before their marriage and they were inclined to experience parenting
again as a result of taking care of their younger siblings. These adolescents recognized the
desire and interest in having a child as the axiom of life and believed that every human would
subconsciously love and protect his/her child. In this respect, some participants said:
"As both my husband and I would love to have a child, I just wanted to get pregnant . . .; I
have really loved children since my childhood." (Participant 4)
"I love babies, I took care of my brother myself. A child is sweet." (Participant 17)
"When my sister was born I cared for her myself. When I look at a child, I have a good feeling;
kids are cute, like my sister."(Participant 6)
3.1.3 Tendency to experience motherhood. Based on the data collected, the desire to
experience motherhood was one that was shared among all the participants:
"I felt so happy about the fact that I was pregnant and that I would give birth to a child and
become a mother soon. When I hear other mothers talking about their children, I always want
to be able to experience the same feelings. For example, when they talk about buying their
children clothes, or the fact that they miss them when they aren't around." (Participant 18)
"I like my pregnancy so much. When my friend was pregnant and her baby was born and she
hugged him, I was jealous of her child." (Participant 3)
3.2 Passive acceptance of pregnancy
Some participants mentioned that, while being pregnant was against their personal desires,
they accepted it due to the pressure they felt from their families. This category included the
two subcategories of compulsory acceptance of childbearing, and child as a factor for
stabilizing the marital life.
3.2.1 Compulsory acceptance of childbearing. Some participants stated that they had to
accept the pregnancy and fight the desire to abort the child, despite their unwillingness to do
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so. The reasons for this compulsory acceptance includes their religious beliefs that forbids
abortion, and a fear of the consequences that the abortion may have on their fertility in the
future, as well as their family?s insistence on having the child.
"When I found I'm pregnant, I did not believe it at all but I did not have any choice . . . At
first, I did not want to be pregnant, but after pregnancy, I could not abort the child because
(according to Islamic law) it is a sin."(Participant 17)
"My father loves boys and asked me not to abort. Though I was determined to abort him, I had
to keep him because of my parents and especially my husband's insistence." (Participant 21)
3.2.2 Child as a factor for stabilizing the marital life. The adolescents in this study
believe that having a child plays an important role in stabilizing and strengthening their
marital life. Therefore, at times, despite their own personal unwillingness to have a child, they agree
to do so in order to have a healthier marriage:
"I have been married for two years, and a child is necessary for marital life."(Participant 15)
"I want a child for my life, and every marital life needs a child."(Participant 18)
3.3 Hope and satisfaction
Most of the females expressed that accepting pregnancy brings about feelings of satisfaction
and hope especially the females who accepted pregnancy actively; meanwhile others who
accepted the pregnancy passively stated that they felt frustration and regret.
The adolescent females who felt satisfaction and hope expressed happiness at the prospect
of motherhood and felt as if they were creating a purposeful and motivated life for themselves.
This category included the following sub-categories:
3.3.1 Hope to provide a better future for children. Some adolescents had lost life
opportunities such as education and employment, due to an early marriage and pregnancy.
Therefore, they hoped to compensate for this loss by providing a better future for their children.
"I neglect myself and I just attempt to provide everything for my child. I would like to provide
a better future for my child." (Participant 1)
"I try to provide the things for my child that I did not have in my childhood. I would like my
child to be more educated with a better job; I always think about these things." (Participant 22)
3.3.2 Creating hope and motivation for life. Some adolescents mentioned that they have
hope and motivation for their life as a child can eliminate their loneliness in the future:
"When I wake up in the morning, from his kicking, I become more hopeful for the future of my
life . . .; my life will become sweet by his birth. I am now busy with him, and the home is full of
the baby?s sweet sound; all of them make life enjoyable." (Participant 5)
3.3.3 Waiting for child birth and child care. Waiting for childbirth and caring for him/
her was another theme, that emerged from the interviews. The participants considered this
enjoyable, and stated that they felt motivated in their day to day life and anticipated the joys of
childcare. After pregnancy, most of them have planned for child care:
"I have a good feeling and I am in a hurry for the child?s birth. I am counting the days"
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"I'm glad and I'm enthusiastically waiting for his/her birth, I think of his/her face; when I see
a child, I say when will my child be born, when will he/she walk or talk." (Participant 19)
3.3.4 Happiness and satisfaction with the experience of motherhood. Most participants
associate pregnancy with the feeling of motherhood. They stated that they even began
experiencing these feelings by observing the passion and satisfaction of other mothers.
Therefore, this led to the belief that their willingness and desire to experience motherhood for
themselves motivated them to tolerate the difficulties of pregnancy.
"I was happy because I wanted to be a mother and give birth to a baby. When I heard other
mothers talking about their babies, I became interested in experiencing the same feeling."
"Well, it was a good feeling when I was informed that I am pregnant. This good feeling helps
you tolerate the problems and difficulties of pregnancy." (Participant 9)
3.4 Frustration and regret
This category discusses the feelings of uncertainty and frustration, as well as the shock and regret
some females feel with regard to their pregnancy. In other words, while feeling a general sense of
happiness and satisfaction, these females also begin feeling frustrated due to the financial problems
they begin to face as well as their lack of readiness to accept the role of motherhood, being too
young for their first child, or being unable to take care of two children if they already have one.
3.4.1 Feeling of uncertainty and desperation. Some participants experienced a sense of
uncertainty and desperation as they felt that they are unprepared to take on and accept their
maternal responsibilities due to a lack of information about child care. These feelings created a
sense of doubt in these females and some even began considering abortion as an option:
"Because my first child was so young, I wanted to abort the second one, but my family did not
allow me.? (Participant 12)
"At first, I did not know; after two months, I felt I am pregnant. At first, I was happy, but later
I was upset why did I listen to my husband and accept to get pregnant at this age. As I
regretted it, I said "now how can I raise my baby?" It would have been better to get pregnant at least
two years after marriage." (Participant 13)
3.4.2 A sense of shock and regret. Some participants claimed that they were shocked and
felt regret due to the unexpected nature of the pregnancy. They mentioned that this regret was
as a result of the fear they felt at the prospect of being pregnant and the difficulties that came
with it. Other females who were pregnant due to an egocentric decision, felt regret as they saw
their husbands? reluctance with regard to having a child:
"I could not believe it; I did not think of it at all, I was pregnant! (Surprised) . . .; pregnancy is
good, but it has its own difficulties, too . . ., I tolerated a lot of problems and I felt regret. I did
not want a child." (Participant 5)
"It was unexpected and we were shocked . . . my husband did not believe it at all . . ., at first,
my husband was confused and said it was a bit early but I said whatever God wants."
3.4.3 Economic barriers. Economic barriers and limited financial resources caused a
sense of frustration and regret about the pregnancy for some of the participants. This type of
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financial regret was mostly seen among the mothers who were less religious compared to the
other participants, or those who at the time, had other children:
"I did not want to get pregnant at all because of financial problems. . .; I would like to give
birth to several children if our financial situation was good because I love kids." (Participant
"In general, I love little kids; however, because of my condition, I wanted to abort the child,
but I could not do that." (Participant 12)
The aim of the present study was to explore the perceptions of Iranian married female
adolescents in confronting pregnancy. "Paradox of acceptance" emerged as the main theme of female
adolescents in confronting pregnancy. During their pregnancy, teens experience ambivalent
feelings that oscillate between a sense of willingness and unwillingness to remain pregnancy.
One reason for these conflicting feelings is as a result of them defying the common social
expectations of female adolescents, such as going to school and finding an income-generating
job. Sadler, Novick and Oliver (2016) in a qualitative study on 30 Latina and African-American
female pregnant adolescents (aged 14?25 years with different marital statuses) indicated that
adolescents experience a range of paradoxical feelings (happiness to despair) when faced with
pregnancy. For example, even though some adolescent mothers accepted their pregnancy after
learning about their condition, their initial reaction was one of shock and confusion. A few
female adolescents were discontent, experienced doubt, and feelings of desperation in
confronting the maternal challenges [
]. Macutkiewicz & MacBeth (2017), in their review study
of adolescent pregnancy intentions, identified that both positive and negative attitudes existed
in adolescents. However, the positive feelings were predominant. Also, they suggested that
adolescents display contradictory and incoherent attitudes towards their pregnancy that is in
line with their developmental stage which is characterized by variability in their identity and
]. In other words, the adolescents in the study exhibited dual perceptions when it
came to accepting their pregnancy as a result of the stage of life they are currently in and the
changeable attitude they have towards various events. The participants in the current study
exhibit similar responses in that, even the adolescents that had accepted their pregnancy
willingly still felt feelings of frustration and regret, and on the other hand, those who had accepted
the pregnancy as a result of the influence of others also felt satisfaction and hope along with
their negative feelings. In addition, one category of a phenomenological study (2016) from
Iran on 11 married female pregnant adolescents (aged 14?19 years) was similar to the main
theme of the present study. That phenomenological study showed that female adolescents had
dual self-perceptions regarding pregnancy. Although the participants had positive
self-perceptions? on becoming pregnant most of the time, they also experienced negative self-perceptions
about their own pregnancy [
Actively accepting pregnancy is one of the common experiences of young females in
confronting pregnancy at adolescence. The active and egocentric acceptance of pregnancy is
related to the feelings of responsibility they have for their children which in and of itself is as a
result of these females? desire to experience the feelings of motherhood and child rearing. In a
phenomenological study (2016) from Iran on married female pregnant adolescents
demonstrated that the participants? egocentric perceptions were intensified after becoming pregnant
] which is in line with the findings in this study.
In the present study, some adolescents mentioned that they were forced to accept their
pregnancy despite their unwillingness to have a child. They felt the role of motherhood was
10 / 15
imposed on them as a result of their inability to decide freely, current social, religious, and
family situations, as well as the guilt they faced if they aborted the child and the feeling that
they had to submit to the will of God. Some studies reported similar results [
Unintended pregnancy is a common finding among adolescents [
]. According to the World
Health Organization, every year more than 82 million unplanned adolescent pregnancies
occur in low- and middle income countries . Mohammadi, Montazeri, Alaghband-Rad,
Ardabili & Gharacheh, (2016), in a phenomenological study from Iran, declared that all
married female pregnant adolescents participating in the study considered pregnancy as a way to
enter adulthood and grow up. Most of the young females believed that they were not ready to
accept the roles and responsibilities of early pregnancy and motherhood physically,
emotionally, and mentally, and that they were forced to accept pregnancy due to their family members?
]. Furthermore, some young females viewed pregnancy as a contributing factor to
a stable and strong marital life. Loke & Lam (2014) found that stability in marital relations is
the most effective factor in acceptance of pregnancy [
], which was confirmed by other
studies too [
]. However, this finding is inconsistent with the findings of Williams & Vines
(1999); in the phenomenological study on pregnant female adolescents, they reported five
themes including poor performance in the past, the disintegration of relationships, emotional
separation, problem fixing, and reconnection. According to their findings, pregnancy was as a
repackage for a new life for adolescents because early pregnancy has led to the disintegration
of the marital life, and created an opportunity for reconnection . In the current study,
while not a dominant theme among the adolescents, one of the adolescents who had gotten
pregnant despite the reluctance of her husband stated that her pregnancy created a distance
between herself and her partner therefore negatively impacting her marriage. The reason for
this difference is that in Iran, pregnancies occur within the marital relationship in accordance
with the social and Islamic religion norms within the country. On the other hand, in the
Williams and Vines study, most females were pregnant without being married to their partners.
As these adolescents experience pregnancy within the context of the marriage, their perception
of their success or failure as parents depends on the status of their relationship with their
]. Another advantage of becoming pregnant while married is that married mothers
receive social rewards for their pregnancy while unmarried mothers face many problems such
as loneliness, poverty, and social isolation.
The paradox of acceptance is a theme that frames the experience of dealing with pregnancy
in female adolescents and provides a better understanding of the inner struggle as well as the
threats and opportunities that these adolescents experience. Generally, these adolescents
viewed pregnancy as an opportunity for growth, stabilizing their marital life, and
compensating for childhood and adolescent deficiencies, leading to a satisfying life in the future. At the
same time, due to untimely pregnancy and an early undertaking of the maternal
responsibilities, they had lost many occupational and educational opportunities, which play a major role
in ensuring a good future for them. Some studies indicate that, while some mothers view their
pregnancy as the beginning of a new and exciting chapter in their life, the pregnancy still
presents several challenges for adolescents which leads these mothers to feel both happiness and
]. For some adolescents, early pregnancy is viewed as a chance to mature
and grow which contributes to their feelings of satisfaction and hope for the future. On the
other hand, some adolescents feel frustrated and regretful due to their lack of access to material
resources, family support, and sexual partners. . Smith Battle & Leonard (1998) examined
US adolescents experiences 4 years after the birth of their first child using a phenomenological
approach and concluded that for some adolescents, early pregnancy means situating in a
positive direction that reassures them about stability and a future full of hope; however, others feel
reluctant and ambivalent about the pregnancy and parental acceptance [
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(2004) conducted a study by using the phenomenological approach to investigate the
experiences of young females who had planned their pregnancy and found that planned pregnancy
creates motivation for better and efficient performance [
]. The young females believed that
their lives are difficult with pregnancy but they had decided to provide a better life for
themselves and their child. Some adolescents emphasized the plans for the future of their child like
buying clothes and opening a bank account.
Based on the current study, although some adolescents considered their pregnancy and
their new found identity as a mother a positive event, due to a lack of preparation with regard
to undertaking the responsibilities of child care, some adolescents found this event to be
unexpected and difficult as well. The simultaneous occurrence and the challenges of events such as
the transition to adulthood, marrying young, and an early pregnancy contributed to making
the acceptance of pregnancy more difficult for these teens.
The adolescents in the current study mentioned that they felt frustrated as a result of the
economic barriers they faced even though they had a personal desire and interest to become
pregnant and experience motherhood. The results are congruent with the qualitative study in
Maryland done by Tanner et al. (2013), in which the preparation of young females to accept
pregnancy and childbearing was highly associated with their economic status rather than their
emotional maturity and intellectual readiness [
]. Additionally, in the present study, the
adolescents with strong religious beliefs were faced with a lesser paradox in relation to the
acceptance of pregnancy. They controlled their frustration and regret by their belief that a child is a
blessing. In other words, in Islam and the Persian culture in general, having a child is viewed
as have several positive outcomes in one?s life, some of which include continuing the path of
the parents and helping them in time of need. Furthermore, in Islam a child is viewed as a
blessing and as such the parents will be provided with a way to care for the child from God.
Additionally, a good child will have lasting positive results for the parents in the after-life.
Therefore, even adolescents who may not feel prepared to accept their pregnancy, eventually
do so as a result of their religious belief system. A study showed that personal opinions and
experiences related to childbearing, sexual experiences, and the social environment could
create the paradox [
Adolescents who had a history of pregnancy and parenting were further faced with this
paradox as a result of the additional financial strain and parenting responsibilities that this new
child would bring. Yoo, Guzzo & Hayford (2014), using data from a nationally representative
survey of unmarried young adults in Arizona, concluded that personal characteristics and
experiences might influence the experience of this paradox as it may change the individual?s
perception of the positive and negative consequences of childbearing [
Finally, the results of this study indicated that the contrast between active and egocentric
acceptance and passive and allocentric acceptance as well as the struggle between the sense of
satisfaction and hope and frustration and regret resulted in creating the paradox of accepting
pregnancy. In general, the adolescent mothers in this study had positive feelings toward
pregnancy, and having a child was valuable for them despite the fact that the pregnancy might have
created some problems for them. Therefore, due to the existing conflicting emotions, the
adolescents never experienced a full rejection or acceptance of their pregnancy and the paradox of
acceptance was consistently observed among them.
The main limitation of this study was that the participants were selected from among
adolescents visiting PHCs or the selected hospital, meaning that the voices of adolescents who did
not have antenatal care visits or chose not to participate are not represented. Also, this
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qualitative study was conducted in Rasht (Guilan Province, Iran). Therefore, like other
qualitative studies, generalization of the results is limited; these studies should be repeated in different
locations with different cultural and social conditions.
The experience of pregnancy in adolescence is a phenomenon that is strongly influenced by
the cultural, social, political, and religious contexts of every community. Generally speaking, as
most studies focus on the experience of adolescent pregnancy outside the marital relationship,
this study offers a new perspective on this phenomenon with regard to female pregnant
married adolescents. These results can contribute to developing future mental and physical health
programs tailored to the needs of adolescents.
According to the results of the study, given the dual-perceptions these adolescents have
about their pregnancy acceptance, it is important that they have strong cognitive, emotional,
and instrumental social support. This support should come from their families, husbands,
health system, and government. Therefore, it is important that policy makers and health care
providers design health promotion programs and develop mental and physical health
promotion strategies tailored to the needs of adolescents. It is important to note, that this study was
done with 24 married, female pregnant adolescents in only one city within a province in Iran
making it a non-representative sample. Therefore similar studies should be done in the context
of other cultures and religions to truly gain insight into this phenomenon.
This study was a part of a doctoral dissertation, which was approved by the Ethics Committee
of the Research Deputy at Tarbiat Modares University. We would like to thank the deputy of
Tarbiat Modares University and the University of Medical Sciences in Rasht for their
cooperation, and all the participants who gave us their valuable experiences. It needs to be noted that
this article is part of a larger qualitative study and presents a part of the study findings.
Conceptualization: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Data curation: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Formal analysis: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Funding acquisition: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Investigation: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Methodology: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Project administration: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Resources: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Software: Maryam Moridi, Fazlollah Ahmadi.
Supervision: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Validation: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Visualization: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Writing ? original draft: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
Writing ? review & editing: Maryam Moridi, Farkhondeh Amin Shokravi, Fazlollah Ahmadi.
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