Understanding the health-related and everyday lived experiences of young mothers in Rexdale

139 Pages·2017·1.99 MB·English

Western University
“Being Stuck”:
Understanding the health-related and everyday lived experiences of young mothers in
Rexdale, Ontario through a social determinants framework

(Thesis format: Monograph)

by

Jaspreet Kaur

Graduate Program in Health and Rehabilitation Sciences

A thesis submitted in partial fulfillment
of the requirements for the degree of
Master of Science

The School of Graduate and Postdoctoral Studies
The University of Western Ontario
London, Ontario, Canada

© Jaspreet Kaur 2013
Abstract
The purpose of this study was to gain an understanding of the ways the health-related and
everyday lived experiences of young mothers are shaped by various social determinants, and in
the context of their neighbourhood. Using a critical qualitative methodology, five mothers
between the ages of 17 to 19 were interviewed from Rexdale, a neighbourhood in the City of
Toronto characterized by a number of social risk factors (e.g., high rates of visible minorities,
unemployment, and teen mothers). In-depth thematic analysis led to the emergence of four
themes: 1) Living in Rexdale: Representations and realities; 2) Leaving Rexdale and wanting
something better; 3) Being stuck: Between desire and constraint and; 4) Isolation and support.
The results demonstrate the complex ways in which determinants such as gender, class, violence
and stigmatizing representations of teen mothers intersect to shape the health-related and
everyday lived experiences of young mothers in Rexdale.

Keywords
teen mothers; social determinants of health; qualitative; violence; stigma; neighbourhood; malls;
Rexdale; socioeconomic status; gender
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Acknowledgments
I would like to begin my acknowledgements by thanking my supervisor, Dr. Jessica Polzer. To
have a thesis supervisor that provides guidance and encouragement along your academic path is
reassuring. But to have a thesis supervisor who helps you challenge your way of thinking, and
critically question what you know is invaluable. Thank you for helping me discover my voice
and myself through this process. I will forever be grateful.
I would like to thank Dr. Erica Lawson and Dr. Treena Orchard for their roles on my advisory
committee. Your trust, support and excitement about the importance and progress of my study
always kept me going during the times when I was unsure. Thank you.
Thank you to the five wonderful young women that took the time to participate in this study. I
have learned so much from meeting you and hearing your stories. I hope I have done justice to
them.
To the community partners that supported me during the early stages of this study (First Stage
daycare, Rexdale Community Health Centre): Thank you for your support and believing in the
importance of my research for our neighbourhood.
On a personal note, I would like to thank those closest to me for their behind-the-scenes support.
To my parents and sisters: I know understanding what I did and why I did it was not always easy,
but thank you for all the little and big ways that you made life easier. Thank you for giving me
space when I needed it; for the ready-made lunches and dinners; for your forgiveness when I did
not always have time to play; for letting me have my “5 more minutes” of sleep and; for your
encouragement to just keep going.
To my significant other: thank you for being there every step of the way through this process.
When I could not see past the obstacles, you showed me the bigger picture and how things will
always fall into place. Thank you for understanding when I did not have time, but always being
there when I had the time to spend. I am always in awe and grateful for your patience with me.
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Table of Contents
Abstract .............................................................................................................................. iii
Acknowledgments............................................................................................................. iiii
Table of Contents ............................................................................................................. ivv
List of Tables .................................................................................................................... vii
List of Appendices ........................................................................................................... viii
1 Introduction .................................................................................................................... 1
1.1 Teen pregnancy as a social problem ....................................................................... 1
1.2 Rexdale as a “priority”neighbourhood.................................................................... 3
1.3 Purpose and significanceof study............................................................................ 4
1.4 Outline of thesis ...................................................................................................... 5
2 Literature Review ........................................................................................................... 6
2.1 Social determinants of health .................................................................................. 6
2.1.1 Socioeconomic status and health ................................................................ 7
2.1.2 “Race” as a determinant of health ............................................................... 8
2.1.3 Gender as a determinant of health .............................................................. 9
2.1.4 Neighbourhood as a determinant of health ............................................... 11
2.2 Intersectionality and health ................................................................................... 21
2.2.1 Intersectionality and teen mothers ............................................................ 23
2.3 Conclusion ............................................................................................................ 26
3 Methodology ................................................................................................................ 27
3.1 Research Goal and Objectives .............................................................................. 27
3.2 A critical qualitative approach .............................................................................. 27
3.3 Participant Recruitment ........................................................................................ 31
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3.3.1 Study Sample ............................................................................................ 32
3.3.2 Participant profiles .................................................................................... 33
3.3.3 Study Site: Rexdale ................................................................................... 37
3.4 Ethical Considerations .......................................................................................... 39
3.5 Data Collection Methods ...................................................................................... 40
3.5.1 Interview 1: Semi-structured interviews ................................................... 40
3.5.2 Interview 2: Walking Interview ................................................................ 41
3.5.3 Journals ..................................................................................................... 42
3.5.4 Reflexivity................................................................................................. 45
3.6 Data Analysis ........................................................................................................ 48
3.7 Quality Criteria ..................................................................................................... 51
3.7.1 Credibility ................................................................................................. 51
3.7.2 Confirmability ........................................................................................... 52
3.8 Conclusion ............................................................................................................ 53
4 Results .......................................................................................................................... 55
4.1 Living in Rexdale: Representations and Realities ................................................ 56
4.1.1 Resisting the Stigma of Being a Young Mother in Rexdale ..................... 56
4.1.2 Negotiating Negative Representationsof Rexdale .................................... 58
4.1.3 Rexdale as a place of violence and street-level harassment ..................... 62
4.1.4 Rexdale as a place of familiarity and comfort .......................................... 66
4.2 Leaving Rexdale and wanting something better ................................................... 68
4.2.1 Motherhood and new expectations ........................................................... 68
4.2.2 Moving out and moving up ....................................................................... 70
4.3 Being stuck: Between desire and constraint ......................................................... 72
4.3.1 The Mall .................................................................................................... 73
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4.3.2 The Guys ................................................................................................... 77
4.4 Isolation and Support ............................................................................................ 80
4.5 Conclusion ............................................................................................................ 83
5 Discussion .................................................................................................................... 85
5.1 Summary of Findings ............................................................................................ 85
5.2 Relationship of Findings to Previous Research .................................................... 87
5.3 Methodological Reflections .................................................................................. 94
5.4 Implications for research, practice, policy ............................................................ 98
References ....................................................................................................................... 101
Appendices ...................................................................................................................... 112
Curriculum Vitae ............................................................................................................ 130
vi
List of Tables

Table 1. Participant Information ................................................................................................... 33
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List of Appendices

Appendix A: Study Poster ........................................................................................................ 112
Appendix B: Letter of Information ......................................................................................... 113
Appendix C: Ethics Approval Notice ...................................................................................... 117
Appendix D: Consent Form ..................................................................................................... 118
Appendix E: Resource Sheet .................................................................................................... 119
Appendix F: Demographic Survey .......................................................................................... 121
Appendix G: E-mail Script ...................................................................................................... 123
Appendix H: Telephone Script ................................................................................................ 124
Appendix I: Contact Information............................................................................................ 127
Appendix J: Interview guide .................................................................................................... 128

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1 Introduction
1.1 Teen pregnancy as a social problem
In January 2013, the Globe and Mail announced that the national rate of teen pregnancy (defined
as pregnancy for women aged 15 to 19) rose from 27.9 to 28.2 per 1,000 teens, between 2006 to
2010. While this increase seems slight, four provinces were reported as having a staggering
increase (Bielski, 2013, January 29). Teen pregnancy rates jumped approximately 40 per cent in
New Brunswick, 36 per cent in Newfoundland, 17 per cent in Nova Scotia, and 15 per cent in
Manitoba (Bielski, 2013, January 29). Within Ontario, in 2006, based on data from 36 public
health units, the highest teen pregnancy rate was 60.8, and the lowest rate was 9.5 per 1,000
women (Ministry of Health and Long-term Care, 2009). However, prior to the release of these
statistics, teen pregnancy rates in Canada have been on the decline over the last 25 years, with
the availability of contraceptives and increased awareness of the risks of unprotected sex credited
as major contributors to this decline. Canada's rates of teen pregnancies between 1996 and 2006
declined 36.9%, as compared with a 25% decrease in the United States, a 4.75% fall in England
and a 19.1% increase in Sweden (Statistics Canada, 2008).

Despite these declines, the publication of increasing rates of teen pregnancy frames it as an
urgent social and health problem that must be immediately addressed. The revival of teen
pregnancy as a social problem has reignited the issue of teen pregnancy as a public health
concern. Public health interventions tend to focus on the risks of serious health consequences for
babies born to mothers in their teens (e.g., low birth weights, premature birth, sudden infant
death syndrome)(Gibbs, Wendt, Peters & Hogue, 2012; Malamitsi-Puchner & Boutsikou, 2006;
Roth, Hendrickson, Schilling & Stowell, 1998). There are also health concerns for the teenage
mother (e.g., higher risk of postpartum depression, eclampsia, anaemia) (Boath, Henshaw &
Bradley, 2013; Gibbs, Wendt, Peters & Hogue, 2012).From a public health perspective, the
initiatives to address teen pregnancy include strategies targeted towards individual behaviours
and pregnancy prevention; healthy sexuality education and counselling; the provision of low cost
birth control supplies; confidential and free sexual health clinic services and; building
community partnerships with schools, hospitals, and community-based organizations to deliver
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