Millennium Development Goal 5 and adolescents: looking back, moving forward

Exploring pregnancy-related stigma experiences among adolescents in rural Uganda

INTRODUCTION

Pregnant adolescents face multiple adverse experiences that vary by context due to pregnancy-related stigma. We explored experiences of pregnancy-related stigma and psychosocial issues among adolescents living in rural eastern Uganda.

METHODS

We conducted in-depth semi-structured interviews with 15 adolescents (15-19 years old) who were pregnant (>3 months) or had recently given birth (<3 months) at Tororo District Hospital in Uganda. All interviews were translated from Dhopadhola to English. Thematic analysis was conducted to identify major themes, which were interpreted using the Health Stigma and Discrimination Framework.

RESULTS

Six key themes were identified and were organized under the Health Stigma and Discrimination Framework. Social and gender norms for adolescent women and their lack of autonomy were identified as drivers and facilitators of pregnancy-related stigma. Results show how stigma is experienced by adolescents through the lack of social support, multiple forms of abuse, and negative judgement. Such manifested stigma negatively impacted their psychosocial wellbeing and resulted in limited access to socioeconomic resources and educational opportunities.

CONCLUSION

This study acknowledges the multilevel nature of pregnancy-related stigma among adolescents in the context of existing policy and programming. Recognizing the impact of pregnancy-related stigma on the health and wellbeing of adolescent girls necessitates prioritizing comprehensive stigma reduction interventions that address main drivers and facilitators, and that are rooted in the communities to harness support.

A community-based mentoring scheme for pregnant and parenting adolescents in Sierra Leone: Protocol for a hybrid pilot cluster randomised controlled trial

BACKGROUND

Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention '2YoungLives' (2YLs) for adolescent girls in Eastern Freetown. We aim to formally assess the feasibility and implementation of the 2YL mentorship scheme in new communities in Sierra Leone.

METHODS

A hybrid type 2 pilot cluster randomised controlled trial of the 2YL mentoring scheme in urban and rural communities living around twelve peripheral health units (PHU) across five districts in Sierra Leone. Clusters will be matched into pairs and randomisation will be determined by computer-generated random numbers via a secure web-based system hosted by MedSciNet. All under-eighteen adolescents identified as pregnant in the community and/or the PHU are included. Feasibility (recruitment, retention, and attrition rates; data collection and completeness; sample calculation) and primary clinical outcome data (composite of maternal deaths, stillbirths, neonatal deaths) will be collected. A mixed-methods process evaluation will explore implementation outcomes, mechanisms of change, contextual factors, experiences of care, and health and wellbeing. A concurrent cost-consequence analysis will be undertaken. Main trial analysis will be pragmatic, by intention to treat, and a complementary per protocol analysis will also be included.

DISCUSSION

Improving health and wellbeing for adolescent girls (including sexual and reproductive health) remains a top priority in Sierra Leone indicated by several government policies targeted to this group, in which maternal and infant mortality are still persistently high. Supporting these girls and facilitating their wellbeing is imperative, along with sensitisation of communities, strengthening of youth friendly services and collaboration with stakeholders at all levels (government, regional, community, family). We believe 2YL supports the global holistic agenda to integrate and implement interventions across health, education, and social systems in order to protect, nurture, and support the health and development potential of every adolescent girl, and thus become a model of good practice for adolescent pregnancy, to be adopted more widely in Sierra Leone and elsewhere.

TRIAL REGISTRATION

ISRCTN registry ISRCTN32414369. Prospectively registered on 14/03/2022.

Knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care services at Thai community hospital

BACKGROUND

To decrease preventable maternal mortality, providing health education to all parties is mandatory. Good knowledge, including awareness of pregnant women regarding obstetric danger signs (ODS), leads to appropriate practices and services. The knowledge of ODS varies among countries and regions. Since the data in rural regions of Thailand remains unavailable, this study aimed to identify the prevalence of good ODS knowledge and associated factors among pregnant women attending antenatal services at a Thai community hospital.

METHODS

We performed a cross-sectional, analytical study in 415 singleton pregnant women who visited the antenatal clinic at Wang Saphung Hospital, Loei, Thailand. A well-trained research assistant interviewed all participants using the data record form containing twenty items on the demographic and obstetric data and sixteen items on ODS knowledge. An ODS score of at least 75% (12 points) was considered a good level of knowledge.

RESULTS

A total of 275 participants (66.27%) had good knowledge of ODS. The most recognized ODS was vaginal bleeding whereas the least recognized ODS during pregnancy was convulsion; the least recognized ODS during labor and delivery was retained placenta. Multivariate regression analysis showed that the predictive factors of good OBS knowledge included a higher education level, maternal age of at least 20 years, and having medical personnel as a source of knowledge.

CONCLUSIONS

In a rural setting of Thailand, two-thirds of pregnant women had good ODS knowledge. Identifying those at risk for fair and poor ODS knowledge and prompt management for the vulnerable subgroups might help decrease maternal mortality.

Barriers to vulnerable adolescent girls’ access to sexual and reproductive health

Background

Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health.

Methods

In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis.

Results

Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society.

Conclusion

Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies.

Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies

Background

Fertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published.

Aim

To synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.

Methods

An extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument.

Results

After screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents’ relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services.

Conclusions

Adolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05022-1.

Sexual-Related Knowledge, School and Family Sexuality Education and Its Association with Experience of Sexual Intercourse among Vocational Secondary School Students in China

Objectives: To investigate the associations between sexual-related knowledge, access to school and family sexuality education, and the experience of sexual intercourse, in order to make recommendations on sexuality education for vocational secondary school students in China. Methods: A cross-sectional study was conducted among 3180 vocational secondary school students in the Shanghai municipality and the Shaanxi province, China. Data were collected through an online, electronic questionnaire, which included socio-demographics, sexual-related knowledge, sources of information, and sexual-related behaviors. Results: The score on sexual-related knowledge among girls (53.8) is higher than that of boys (48.8), and that of participants from Shanghai (55.2) is higher than their counterparts from Shaanxi (47.6). The proportions of girls (70% and 41.7%, respectively) and participants from Shanghai (65% and 35.7%, respectively) who reported acquiring sexual information from their schools/teachers and parents are higher than that of boys (54.3% and 21.0%, respectively) and their counterparts from Shaanxi (59.7% and 27.4%, respectively). About 6% of participants had experienced sexual intercourse and 10% had watched porn actively. Experience of sexual intercourse was associated with higher sexual-related knowledge scores (OR = 1.01, 95% CI: 1.00–1.02) and active porn watching (OR = 2.63, 95% CI: 1.79–3.84) but was not associated with school and family sexuality education. Conclusions: Vocational secondary school students had poor sexual knowledge and inadequate school and family sexuality education. School and family-based comprehensive sexuality education should be promoted among vocational secondary school students.

Factors Related to Sexual Intercourse Among Korean Middle and High School Students

Background

Social interest in sexual intercourse among teenagers is increasing in Korea. This study aimed to identify factors related to sexual intercourse among adolescents.

Methods

This is a secondary analysis study using data from the 2020 Korea Youth Risk Behavior Survey, with information regarding 54,948 middle school and high school students in Korea having been analyzed. Demographics, health behavior, and mental health characteristics were included. Data evaluation involved chi-square test and binary multivariable logistic regression analysis.

Results

For middle school students, sexual intercourse was related to their housing type [Odds Ratio (OR) = 10.698], smoking (OR = 5.165) and drinking (OR = 2.229) experience, suicide attempt (OR = 1.920), gender (OR = 1.632), loneliness (OR = 1.501), sadness and despair (OR = 1.493), year level (OR = 1.457), happiness (OR = 0.772), sleep status (OR = 0.716), economic status (OR = 0.705). For high school students, sexual intercourse was related to their smoking experience (OR = 4.746), housing type (OR = 3.661), drinking experience (OR = 2.840), drug use (OR = 2.511), suicide attempt (OR = 2.071), year level (OR = 1.989), sadness and despair (OR = 1.506), gender (OR = 1.429), suicide plan (OR = 1.402), loneliness (OR = 1.270), academic performance (OR = 1.165), happiness (OR = 0.865), subjective health status (OR = 0.814), and economic status (OR = 0.727). However, sleep status was statistically significant for middle school students, but not for high school students. Academic performance, drug use, suicide plan, and subjective health status were statistically significant in high school students, but not in middle school students.

Conclusion

A program that can directly mediate these factors must be prepared. When conducting sex education for adolescents, mental health-related factors must also be considered.

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

Background

Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania.

Methods

The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences among the three groups in the sociodemographic characteristics were analyzed by using chi-square test for categorical variables, independent-sample t-test for continuous variables and Mann–Whitney U test for ordinal or skewed continuous data. The independent sample t-test was used to determine the effect of the intervention by comparing the computed self-reported performance on RMNH services between the intervention and control groups. The paired-samples t-test was used to measure the differences between before and after intervention groups. Significance was set at a 95% confidence interval with p ≤ 0.05.

Results

The study included a sample of 216 participants with before and after intervention groups comprising of 95 (44.0%) and 121 (56.0%) in the control group. The comparison between before and after intervention groups revealed a statistically significant difference (p ≤ 0.05) in all the dimensions of the self-reported performance scores. However, the comparison between intervention groups and controls indicated a statistical significant difference on intra-operative care (t = 3.10, df = 216, p = 0.002), leadership skills (t = 1.85, df = 216, p = 0.050), Comprehensive emergency obstetric and newborn care (CEMONC) (t = 34.35, df = 216, p ≤ 0.001), and overall self-reported performance in RMNH (t = 3.15, df = 216, p = 0.002).

Conclusions

This study revealed that the training and onsite clinical mentorship to have significant positive changes in self-reported performance in a wide range of RMNH services especially on intra-operative care, leadership skills and CEMONC. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.

Reproductive maternal and newborn health (RMNH) in low- and middle-income countries continue to face critical challenges. Training healthcare workers especially using a combined approach (training followed by immediate clinical mentorship) in RMNH have been documented as an essential strategy to reduce maternal and neonatal mortality in low-and middle-income countries closer to those in high-income countries. This study investigated the effectiveness of a Continuous Professional Development (CPD) trainings on performance among healthcare workers in Mwanza Region. The study included a sample of 216 participants with before and after intervention groups comprising of 95 participants and control group comprising of 121 participants. The findings revealed that in comparison between before and after intervention groups all dimensions of the self-reported TNA questionnaire had a statistically significant difference. However, the comparison between intervention and controls groups indicated a statistical significant difference on leadership skills, intra-operative care, Comprehensive emergency obstetric and newborn care (CEMONC) and overall RMNH self-reported performance. In conclusion, the findings demonstrated that healthcare workers’ self-identified and prioritized training needs that are supported with clinical mentorship results in significant positive changes in performance across a wide range of RMNH tasks. Therefore, conducting TNA that is followed by training and mentorship according to the identified needs among healthcare workers plays a significant role in improving performance on RMNH services among healthcare workers.

Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies

BACKGROUND

Despite the existence of preventive policies across sub-Saharan Africa, countries within the sub-region lead global rankings for rates of adolescent pregnancy. The aim of this scoping review was to identify and review national policies on the prevention of adolescent pregnancy in Anglophone sub-Saharan Africa.

METHODS

Relevant policies were identified from searches of national government websites and the search engine Google. Recognised screening and data extraction processes were used; data were subjected to content analysis using a published Framework for Evaluating Program and Policy Design on Adolescent Reproductive Health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines was used in reporting the review.

RESULTS

In line with the inclusion criteria that guided the selection of relevant policies in this study, 17 of 75 national policies were suitable for the analysis. All were backed by political recognition, were government and public initiatives, acknowledged a range of determinants of adolescent pregnancy and allocated human resources to policy activities. Few specified financial resourcing. Most policies acknowledged the importance of coordination and collaboration among public and private actors. All policies had objectives that addressed adolescent pregnancy but none were measurable or included timeframes. Provision of comprehensive sexuality education and adolescent reproductive health services were the most common recommendations. Monitoring and evaluation plans were present in all the policies. However, youth involvement in policy formulation, and plans for implementation, monitoring and evaluation was scarce.

CONCLUSION

Overall, national policy strengths were seen in relation to their political recognition, and all aspects of policy formulation. Policy implementation strengths and weaknesses were identified, the latter in relation to clear descriptions of financial resources. Importantly, the absence of measurable and time-bound objectives or formal evaluation of policy effectiveness confounds demonstration of what has been delivered and achieved. Youth involvement was notably absent in many policies. For future policy-setting, governments and policy-makers should make efforts to engage young people in policy development and to be transparent, realistic and address the necessary financial resourcing. They should set quantifiable policy objectives that provide a basis for assessing the adoption, uptake and effectiveness of policies in relation to measurable objectives.

An explorative study of beliefs in two groups of community health promoters of adolescent reproductive health in Indonesia: informed by theory of planned behavior

OBJECTIVE

To explore beliefs in specific social context and potential individual-level behavioral strategies used by two groups of community health promoters to foster their participation of promoting ARH.

DESIGN

Two phases of formative studies based on the Theory of Planned Behavior (TPB) was conducted with community health promoters in the integrated service center (pos pelayanan terpadu/posyandu), posyandu cadres and peer educators of three villages in Tengger, East Java, Indonesia.

RESULT

The phase one, conducted with posyandu cadres (n = 20) and peer educators (n = 21). A survey using open-ended questions and focus group discussion was carry out to elicit accessible behavioral (advantages and disadvantages), normative (references of who have significant roles for promoters) and control (personal or situational factors) beliefs related to ARH promotion. The content analysis, elicited 15 salient beliefs for posyandu cadre and 21 for the peer educators. In phase two, the participants who previously participated in phase 1 (posyandu cadres (n = 14 and peer educators (n = 21))), completed two questionnaires to measure the belief strength and evaluation of the beliefs.

CONCLUSIONS

The result showed that each group has different characteristic in the strength of their beliefs in promoting reproductive health. The findings highlight the social context underlying beliefs associated with ARH promotion and opportunities to enhance engagement with the different groups of community health promoters.

Differences in perinatal outcomes in teenage mothers with their first and third pregnancies and predictors of adverse neonatal events: A cross-sectional study

Background

Repeated teenage pregnancy is a major burden on the healthcare system worldwide.

Objective

We aimed to compare teenagers with their first and third pregnancies and to evaluate the likelihood of neonatal complications.

Materials and Methods

This cross-sectional study was performed on female teenagers (aged ≤ 19 yr) with singleton pregnancies. The subjects (n = 298) were screened over 12 months. Ninety-six women were excluded, based on the exclusion criteria. The remaining subjects (n = 202) were divided into two groups: teenagers with first pregnancy (n = 96) and teenagers with third pregnancy (n = 47). The subjects were observed throughout pregnancy and delivery. The final sample size of the first and third pregnancy groups was 96 and 47, respectively.

Results

There was a significant risk of preeclampsia in the first pregnancy group (p = 0.01). Low birth weight, five-min Apgar score < 7, and neonatal intensive care unit admission were the most significant neonatal outcomes in the first pregnancy group. In the third pregnancy group, significant predictors of neonatal complications included very young age in the first pregnancy ( ≤ 15 yr), an inter-pregnancy interval < 2 yr, current anemia, and history of obstetric and/or neonatal complications in previous pregnancies.

Conclusion

Based on the results, teenagers with their first pregnancy had comparable obstetric outcomes (except for preeclampsia) as teenagers with their third pregnancy, whereas neonatal complications occurred more frequently in the first pregnancy group. Overall, we can predict high-risk neonates in the third pregnancy, based on the abovementioned parameters.

Maternal healthcare coverage for first pregnancies in adolescent girls: a systematic comparison with adult mothers in household surveys across 105 countries, 2000-2019

Background

Effective maternal service delivery for adolescent mothers is essential in achieving the targets for maternal mortality under the Sustainable Development Goals. Yet little is known about levels of maternal service coverage in adolescents compared with adult mothers.

Method

We used data from 283 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 105 countries between 2000 and 2019 to estimate the levels and trends of inequality in coverage of five maternal health services between adolescent girls (aged 15–19) and adult mothers (aged 20–34), including receiving four or more antenatal care visits, delivering with skilled birth attendants and receiving a postnatal check-up within 24 hours of delivery.

Results

We analysed data from 0.9 million adolescent girls and 2.4 million adult mothers. Using the most recent data, we found adolescent girls had poorer coverage across all indicators, with receipt of four or more antenatal care visits 6.5 (95% CI 6.3 to 6.7) percentage points lower than adult mothers, delivery with skilled birth attendants 3.6 (95% CI 3.4 to 3.8) lower and having a postnatal check-up within 24 hours of delivery 3.2 (95% CI 2.8 to 3.6) lower. The coverage was 54.2% (95% CI 53.9 to 54.5) among adolescents for four or more antenatal care visits, 69.7% (95% CI 69.4 to 70.0) for delivery with skilled birth attendants and only 30.0% (95% CI 29.3 to 30.7) for receiving a postnatal check-up within 24 hours of delivery. Country-specific coverage of the maternal services increased over time in most countries, but age-related differences persisted and even worsened in some, particularly in the Western Pacific (eg, Vietnam, Lao, Cambodia and Philippines).

Conclusion

Even though their pregnancies are of higher risk, adolescent girls continue to lag behind adult mothers in maternal service coverage, suggesting a need for age-appropriate strategies to engage adolescents in maternal care.

Individual and Contextual Factors Associated with Teenage Pregnancy in Colombia: A Multilevel Analysis

OBJECTIVE

To analyze municipal- and individual-level factors related to the prevalence of teenage pregnancy in Colombia during 2015.

METHODS

We analyzed 660,767 births registers, of which 21.5% recorded adolescent women. At an individual level, marital status, educational level, area of residence, and access to health services were included in the analysis. At the contextual level, Colombian municipal socioeconomic characteristics and proxies of violence and poverty were analyzed. A multilevel logistic regression model was generated with a Markov Chain Monte Carlo estimation method using 100,000 simulations in MLwiN 2.32 software.

RESULTS

Multilevel modeling revealed an increased risk of teenage pregnancy in municipalities with the highest numbers of people expelled by forced displacement (OR 1.21; CI 95%, 1.13-1.29) and with unsatisfied basic needs (OR 1.09; CI 95%, 1.02-1.17). At an individual level, the majority of the teenage women were unmarried and/or had an unstable partnership, a low level of educational, a subsidized health regimen, and resided in the municipal seat.

CONCLUSIONS

Municipal contextual variables related to poverty, violence, and social inequity contribute to an increase in teenage pregnancy in Colombia. At the individual level, marital status, educational level, and area of residence is associated with teenage pregnancy. It is therefore imperative to include municipal contextual characteristics in the design of the national political agenda.

Contribution of researchers in the Arab region to peer-reviewed literature on mental health and well-being of university students

OBJECTIVE

The current study aimed at investigating the contribution of researchers in the Arab region to the field of mental health and well-being of university students using bibliometric tools.

METHOD

Relevant literature was obtained from the Scopus database for the period from 2001-2020. Examples of keywords used in the query included "college student", "university student", and undergraduate student" combined with keywords such as wellbeing, wellness, suicide, and anxiety. No language restriction was used. Only research articles were considered. The search query was validated. Bibliometric indicators and mappings such as active countries, institutions, authors, highly cited documents, and the most frequently encountered topics were identified and discussed to shed light on research gaps in the Arab region. Research gaps were also identified. The analysis was carried out on February 12, 2021.

RESULTS

The search query returned 309 research articles published by authors from 17 different Arab countries. Less than one-third (n = 97, 31.4%) of the retrieved articles were carried out in collaboration with authors from 39 non-Arab countries, mainly from the United Kingdom and the United States. The overall contribution of researchers from the Arab region to global research in the field was 5.6%. In total, 1212 authors from 791 different institutions participated in publishing the retrieved research articles. At the country level, Saudi Arabia (n = 125, 40.5%) ranked first, followed by Jordan, Egypt, and Lebanon. At the institutional level, The University of Jordan (n = 25, 8.1%) ranked first, followed by King Saud University, and Kuwait University. The retrieved articles included 132 (42.7%) articles on stress/distress, 95 (30.7%) on anxiety, 61 (19.7%) on depression. Knowledge gaps on suicide, eating disorders, substance use, and happiness were identified. The retrieved articles appeared in 193 different journals and approximately two-thirds of the active journal were in general medicine, public health, and education.

CONCLUSIONS

The contribution of researchers in the Arab region to the field showed a noticeable increase with time. However, important research gaps were identified. The contribution was confined to authors from a limited number of Arab countries. Funding and international research collaboration for the mental health and well-being of students need to be strengthened.

Digital Educational Support Groups Administered through WhatsApp Messenger Improve Health-Related Knowledge and Health Behaviors of New Adolescent Mothers in the Dominican Republic: A Multi-Method Study

Background:

In limited-resource settings such as the Dominican Republic, many factors contribute to poor health outcomes experienced by adolescent mothers, including insufficient support and/or health knowledge. In response, we designed a digital educational support group, administered through WhatsApp Messenger, for new adolescent mothers. The purpose of this study was to assess if participation in this digital support group could improve health outcomes and health behaviors.

Methods:

Participants completed questionnaires with a health literacy screener, demographic items, knowledge questions, the Index of Autonomous Functioning, and five Patient Reported Outcomes Measurement Information System scales before and after the moderator-led intervention. Differences between pre- and post-intervention scores were calculated and perceptions of the intervention were explored through in-depth interviews analyzed with content analysis. Participants’ well-baby visit attendance and contraceptive use were compared to that of controls and a national sample.

Results:

Participants’ (N = 58) knowledge scores increased (p < 0.05). Participants were 6.58 times more likely to attend well-baby visits than controls (95% CI: 2.23–19.4) and their contraceptive use was higher than that of the national sample (p < 0.05). Participants indicated the intervention was enjoyable and beneficial.

Conclusion:

This adolescent-centered digital intervention is a promising method to improve health outcomes and health behaviors of young mothers in limited-resource settings.

Establishing content for a digital educational support group for new adolescent mothers in the Dominican Republic: a user-centered design approach

Background As digital interventions to improve health become widespread globally, it is critical to include target end-users in their design. This can help ensure interventions are maximally beneficial among intended populations. Objectives To generate the content of a digital educational support group, administered through WhatsApp, for new adolescent mothers and establish participants' cellular access and WhatsApp use. Participants Adolescent mothers with new babies. Methods We completed a two-phase user-centered design process. In phase I design sessions, participants discussed their postpartum experiences and completed an activity to elucidate their health and wellbeing information needs. In phase II sessions, participants individually identified which health information topics were important to them, then all topics were prioritized as a group. Phase II participants also completed a brief survey on cell phone access and WhatsApp use. Results Phase I included 24 participants, 21 of whom completed phase II. Priority health and wellbeing information topics in the postpartum period were identified as: child growth and development, understanding your baby, common childhood illnesses, breastfeeding, childhood nutrition, family planning, and self-care. Of phase II participants, 45% had cellular phone access and none had a data plan. Cellular service was inconsistently obtained with data packages or Wi-Fi. 30% of participants had no experience using WhatsApp. Conclusions Participants identified numerous health information needs, which will serve as the content for our planned digital support group and provides valuable insight for health care providers globally. Less than half of participants had consistent cellular phone access, and none had reliable access to cellular service.

Contraceptive Use in Adolescent Girls and Adult Women in Low- and Middle-Income Countries

IMPORTANCE

Preventing unwanted pregnancy through adequate use of contraceptives among adolescent girls is essential for improving maternal and child health and social well-being.

OBJECTIVE

To estimate the levels and trends of contraceptive use in adolescent girls (age 15-19 years) compared with adult women (age 20-34 years).

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data from 261 Demographic and Health Surveys or Multiple Cluster Indicator Surveys conducted in 103 low- and middle-income countries between 2000 and 2017. Modern contraceptive use in 90 countries and unmet need for family planning in 73 countries for adolescent girls and adult women were assessed at country and aggregate levels. Data analyses for this study were conducted between March 2019 and December 2019.

MAIN OUTCOMES AND MEASURES

Modern contraceptive use and unmet need for family planning, estimated between adolescent girls and adult women for absolute inequality and relative inequality (defined as the ratio in service use between adult women and adolescent girls). Inequalities by wealth and place of residence in each age group were also assessed.

RESULTS

A total of 832 673 adolescent girls and 2 156 268 adult women were included in the analysis. Adolescent girls were significantly less likely to use modern contraceptives (31.6% [95% CI, 30.3% to 32.8%] vs 43.5% [95% CI, 42.4% to 44.7%]; absolute inequality, 11.9 percentage points [PPs] [95% CI, 11.7 to 12.1 PPs]; relative inequality, 1.38 PPs [95% CI, 1.36 to 1.40 PPs]) and more likely to have an unmet need for family planning (50.8% [95% CI, 49.0% to 52.5%] vs 36.4% [95% CI, 34.9% to 35.8%]; absolute inequality, -14.4 PPs [95% CI, -15.8 to -15.0 PPs]; relative inequality, 0.72 PPs [95% CI, 0.69 to 0.75 PPs]). Contraceptive use generally improved over time (aggregate-level use of contraceptives increased from 17.8% [95% CI, 16.6% to 19.0%] in 2000-2006 to 27.2% [95% CI, 26.6% to 27.8%] in 2013-2017 for adolescents and from 30.9% [95% CI, 29.8% to 32.0%] in 2000-2006 to 40.3% [95% CI, 39.8% to 40.8%] in 2013-2017 for adult women), but inequalities between adolescents and adult women persisted. Aggregate-level prevalence of unmet need for family planning decreased only among adult women (from 45.8% [95% CI, 44.9% to 46.7%] in 2000-2006 to 38.0% [95% CI, 37.3% to 38.7%] in 2013-2017). For adolescents, the prevalence remained at approximately 52% over time. The inequality between the 2 age groups therefore significantly increased from 7.5 PPs (95% CI, 6.5 to 8.4 PPs) in 2000 to 2006 to 14.0 PPs (95% CI, 13.4 to 14.6 PPs) in 2013 to 2017. An increasing gap between adolescent girls and adult women was found in 18 countries for modern contraceptive use and in 20 countries for unmet need for family planning. In India, for example, both age groups had increased percentage of unmet need for family planning over time, from 16.2% (95% CI, 15.9% to 16.6%) in 2006 to 29.8% (95% CI, 29.6% to 30.1%) in 2015 for adult women and from 23.9% (95% CI, 23.0% to 24.9%) to 64.5% (95% CI, 63.3% to 65.7%) among adolescents. Thus, inequality increased from 7.7 PPs (95% CI, 7.2 to 8.2 PPs) in 2006 to 34.7 PPs (95% CI, 34.2 to 35.1 PPs) in 2015.

CONCLUSIONS AND RELEVANCE

Despite a growing focus on contraception in the past decade with initiatives such as Family Planning 2020, adolescent girls continue to lag behind adult women in contraceptive use. There is a pressing need to develop age-appropriate strategies for increasing access and maintaining contraceptive use in sexually active adolescent girls.

A comprehensive reproductive health program for vulnerable adolescent girls

Background

Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls’ reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls.

Methods

The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members.

Discussion

Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

The State of Adolescent Sexual and Reproductive Health

In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies

AIM OF THE STUDY

We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016.

METHODS

A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models.

RESULTS

The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94).

CONCLUSIONS

Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.

School-Based Sexual and Reproductive Health Services for Prevention of Adolescent Pregnancy in the Hoima District, Uganda: Cluster Randomized Controlled Trial

Uganda has persistently had high adolescent pregnancy prevalence; 25% for the last 10 years. This protocol presents the design of a Cluster Randomized Controlled Trial (CRCT) to investigate the effectiveness of School-Based Sexual and Reproductive Health (SBSRH) interventions on prevention of pregnancy among school girls aged 15-19 years in the Hoima District, Uganda. 18 secondary schools (clusters) will be selected using cluster sampling and allocated 1:1 into control or intervention group stratified by geographical location. 1080 (60 each cluster) participants/girls aged 15-19 years will be selected using simple random sampling. The intervention group will receive tailored SRH information, in-school medical care and referral over 12 months. The control group will receive no intervention from the research team; however, they can access alternative services elsewhere if they wish. Data will be obtained at baseline, 6 months and 12 months. The outcomes are reduction in occurrence of pregnancy, utilization of SRH services and sexual behavioral change. To our knowledge, this is the first CRCT providing combined SRH interventions for prevention of adolescent pregnancy in Uganda. If effective, it could have great potential in preventing adolescent pregnancy. Trial Registration: Pan African Clinical Trial Registry (PACTR201810882140200) Registered on 16 October 2018.

Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review

Introduction

Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model.

Methods

A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were retrieved for analysis.

Results

Thematic analysis revealed that early marriage, sexual risk behaviors, substance use, family experience of adolescent birth, peer pressure, and lack of sex education and health service increased the hazards of adolescent pregnancy. Communication with parents, school activities, community meetings, laws, and government policies protected adolescents from pregnancy.

Conclusions

Results of this study suggests that the background of adolescents and complex interactions among various factors should be considered for pregnancy. In future research, mixed-method that supplements the methodological weaknesses of previous studies is also recommended.

'You just have to learn to keep moving on': young women's experiences with unplanned pregnancy in the Cook Islands

The Cook Islands is one of several countries in the Pacific region that has high rates of teenage pregnancy and birth. While the social determinants of pregnancy and early motherhood are well established in the global context, little is known about how Cook Islands young women who become pregnant before age 20 make sense of their experiences. Drawing on individual interviews with a purposive sample of 10 young mothers, this paper examines the phenomenology of early pregnancy from their perspectives. Structural, cultural and individual factors emerged as salient themes in participants' accounts. Qualitative analysis revealed that nearly all the pregnancies were unplanned and every participant reacted negatively when she learned she was pregnant. While some participants wanted to terminate their pregnancies, lack of access to safe, legal and affordable abortion care limited their options. Ultimately, while nearly all participants wished they had been able to delay motherhood, they expressed happiness and pride about their new-found status as mothers. These findings allow for a fuller understanding of factors shaping young women's experiences of pregnancy in the Cook Islands, which have policy implications for reproductive health and rights.

Age at reproductive debut: Developmental predictors and consequences for lactation, infant mass, and subsequent reproduction in rhesus macaques (Macaca mulatta)

OBJECTIVES

The age at which females initiate their reproductive career is a critical life-history parameter with potential consequences on their residual reproductive value and lifetime fitness. The age at reproductive debut may be intimately tied to the somatic capacity of the mother to rear her young, but relatively little is known about the influence of age of first birth on milk synthesis within a broader framework of reproductive scheduling, infant outcomes, and other life-history tradeoffs.

MATERIAL AND METHODS

Our study investigated the predictors of age at first reproduction among 108 captive rhesus macaque (Macaca mulatta) females, and associations with their milk synthesis at peak lactation, infant mass, and ability to subsequently conceive and reproduce.

RESULTS

The majority of females reproduced in their fourth year (typical breeders); far fewer initiated their reproductive career one year earlier or one year later (respectively early and late breeders). Early breeders (3-year-old) benefited from highly favorable early life development (better juvenile growth, high dominance rank) to accelerate reproduction, but were impaired in milk synthesis due to lower somatic resources and their own continued growth. Comparatively, late breeders suffered from poor developmental conditions, only partially compensated by their delayed reproduction, and evinced compromised milk synthesis. Typical breeders not only produced higher available milk energy but also had best reproductive performance during the breeding and birth seasons following primiparity.

DISCUSSION

Here, we refine and extend our understanding of how life-history tradeoffs manifest in the magnitude, sources, and consequences of variation in age of reproductive debut. These findings provide insight into primate reproductive flexibility in the context of constraints and opportunities.

Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes

Background

Adolescent deliveries remain a global public health concern especially in low- and middle-income countries where 95% of these deliveries occur. In Cameroon, adolescent pregnancies have a high disease burden due to their association with adverse pregnancy outcomes. We sought to evaluate the prevalence, trend and adverse maternofoetal outcomes of adolescent deliveries in a rural community in Cameroon.

Method

We carried out a retrospective register analysis of 1803 singleton deliveries in two health facilities located in the Oku sub-division over an 8-year period (2009 to 2016). We excluded: records without maternal age, babies born before arrival, birthweights less than 1000 g, multiple deliveries and deliveries before 28 weeks gestation. Data analysis was done using Epi info 7.0.8.3. The Fisher’s exact test was used to compare categorical variables, while the chi-square test for trends was used to determine time trends. P-values below 5% were considered statistically significant.

Results

The 8-year prevalence of adolescent deliveries was 20.4% (95% CI = 18.6–22.4) with a significant, downward trend between 2009 and 2016 (P trend = 0.05). Second-fourth degree perineal tears were more likely to complicate adolescent (Age < 20 years) deliveries compared with their adult (Age ≥ 20 years) counterparts (OR = 2.9; 95% CI = 1.8–4.7; p < 0.001). Also, babies born to adolescent mothers were more likely to have a low birthweight (OR = 1.7; 95% CI = 1.1–2.6; p = 0.009) and be asphyxiated at the fifth minute of life (OR = 3.2; 95% CI = 1.9–5.5; p < 0.001). Over an eight-year period, the downward trend in the prevalence of adolescent deliveries was associated with a significant decrease in the trend of neonatal asphyxia at the fifth minute. Married adolescents and their babies were as likely to develop the complications of adolescent delivery such as second-fourth degree perineal tears (OR = 0.8; 95% CI = 0.4–1.6; p = 0.456), low birthweight (OR = 2.1; 95% CI = 0.9–4.7; p = 0.070) and fifth minute neonatal asphyxia (OR = 0.9; 95% CI = 0.4–2.0; p = 0.832) as single adolescents and their babies.

Conclusion

The prevalence of adolescent deliveries in this rural community is high with one of every five babies born to an adolescent mother. Despite the downward trend indicating a decrease in adolescent deliveries, our study demonstrates the need to reinforce and effectively apply existing government-based public health programme to target key indicators of adolescent pregnancy in Cameroon.

Pregnant teenagers' group: contributions to prenatal care

Objective

To describe changes in nurses' care following the implementation of a group of pregnant teenagers in prenatal care based on the expectations and experiences of pregnant teenagers.

Method

Qualitative and descriptive study conducted from February to November 2013 at a Primary Care Unit in Fortaleza, Ceará, Brazil, through focus groups with 16 adolescents from the group of pregnant women in the second or third trimester of pregnancy. The analysis identified central ideas and units of meanings that formed the categories.

Results

The strategy of a group of pregnant teenagers, which provides a space for coexistence and the establishment of ties encourages these individuals to talk about their needs, re-signifying their ties. Educational strategies to promote self-care of pregnant teenagers and care for their babies involve the sharing of experiences, doubts and beliefs.

Conclusion

Considerations and suggestions of the adolescents contributed to guide nurses' practice and provide a strategic space of care and support for pregnant adolescents in primary care.

[Contraception and maternity: Findings of a quali-quantitative study with 18- and 19-year-olds in four provinces of Argentina]

The article analyzes the factors that facilitate or hinder access and effective use of contraception by 18- and 19-year-olds living in the cities of Resistencia (province of Chaco), Posadas (province of Misiones) and Santiago del Estero (province of Santiago del Estero) as well as the health regions V and VII of the province of Buenos Aires. Data comes from a survey applied to a purposeful sample of 480 adolescent females (including respondents without children, with one child, and with more than one child) and 21 semi-structured interviews with a population of the same profile. In response to the survey, 74.2% reported using contraception "always" and 12.2% "most of the time." The pill and condoms were the most widely used methods (41.7% and 37.0% respectively). Only 13.2% used a mid- to long-term method (intrauterine device or injectable contraceptive). The main reasons reported by those who "never" use a method (13.6%) were: wanting to become pregnant (27.6%) and partner refusal (27.6%). The interviews revealed difficulties in the use of contraception methods and deficits in contraception counseling.

Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review

BACKGROUND

Adolescent mothers aged 15-19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20-24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes.

METHODS

We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation.

RESULTS

Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered.

CONCLUSIONS

Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Opportunities that have adolescents engaging with health providers also need to be seized. These will be critical in improving adolescent MHS utilisation. However, policy and programmatic choices need to be based on recent, relevant and robust datasets. Innovative approaches that leverage new media to generate context-specific dis-aggregated data may provide a way forward.

Newborn Care Practices among Adolescent Mothers in Hoima District, Western Uganda

INTRODUCTION

Adolescent childbearing remains a major challenge to improving neonatal mortality especially in Sub Saharan countries which are still struggling with high neonatal mortality rates. We explored essential newborn care practices and associated factors among adolescent mothers in Western Uganda.

METHODS

Data were collected among 410 adolescent mothers with children aged one to six months in Hoima district. Three composite variables (appropriate neonatal breastfeeding, cord care and thermal protection) were derived by combining related practices from a list of recommended newborn care practices. Logistic regression analysis was conducted to identify factors independently associated with practice of essential newborn care.

RESULTS

Appropriate newborn feeding, optimal thermal protection and dry cord care were practiced by 60.5%, 67.2% and 31% of adolescent mothers respectively. Independent predictors' of cord care were: knowledge of cord care (AOR 5.34, 95% CI (1.51-18.84) and having delivered twins (AOR 0.04, 95% CI (0.01-0.22). The only predictor of thermal care was knowledge (AOR 25.15, 95% CI (7.01-90.20). Staying in a hospital for more than one day postpartum (AOR 2.45, 95%CI (1.23-4.86), knowledge of the correct time of breastfeeding initiation (AOR 14.71, 95% CI (5.20-41.58), predicted appropriate neonatal feeding, whereas; adolescent mothers who had had a caesarean delivery (AOR 0.19, 95% CI (I 0.04-0.96) and a male caretaker in the postnatal period (AOR 0.18, 95% CI (0.07-0.49) were less likely to practice the recommended newborn feeding.

CONCLUSION

Sub optimal essential newborn care practice was noted especially suboptimal cord care. Adolescent mothers should be a focus of strategies to improve maternal and neonatal health.

Utilisation of maternal health services by adolescent mothers in Kenya: analysis of the demographic health survey 2008-2009

BACKGROUND

Many Kenyan adolescents die following pregnancy and childbirth complications. Maternal health services (MHS) utilisation is key to averting such poor outcomes. Our objectives were to understand the characteristics of adolescent mothers in Kenya, describe their MHS utilisation pattern and explore factors that influence this pattern.

METHODS

We collected demographic and MHS utilisation data of all 301 adolescent mothers aged 15-19 years included in the Kenya Demographic Health Survey 2008/2009 (KDHS). Descriptive statistics were used to characterise them and their MHS utilisation patterns. Bivariate and multivariate analyses were used to test associations between selected predictor variables and MHS utilisation.

FINDINGS

Eighty-six percent, 48% and 86% of adolescent mothers used ante-natal care (ANC), skilled birth attendance (SBA) and post-natal care (PNC), respectively. Adolescent mothers from the richest quintile were nine (CI=2.00-81.24, p=0.001) and seven (CI=3.22-16.22, p<0.001) times more likely to use ANC and SBA, respectively, compared to those from the poorest. Those with primary education were four (CI=1.68-9.64, p<0.001) and two (CI=0.97-4.81, p=0.043) times more likely to receive ANC and SBA, respectively, compared to uneducated mothers, with similar significant findings amongst their partners. Urban adolescent mothers were six (CI=1.89-32.45, p=0.001) and four (CI=2.00-6.20, p<0.001) times more likely to use ANC and SBA, respectively, compared to their rural counterparts. The odds of Maasai adolescent mothers using ANC was 90% (CI=0.02-0.93, p=0.010) lower than that of Kalenjin mothers.

CONCLUSIONS

Adolescent MHS utilisation in Kenya is an inequality issue. To address this, focus should be on the poorest, least educated, rural-dwelling adolescent mothers living in the most disadvantaged communities.