Psychosocial challenges and individual strategies for coping with mental stress among pregnant and postpartum adolescents in Nairobi informal settlements: a qualitative investigation

Prevalence and correlates of depressive and anxiety symptoms among pregnant women from an urban informal settlement in Nairobi, Kenya: a community-based cross-sectional study

PURPOSE

Previous research, largely from the Global North, reports high rates of common mental health disorders among women in the antenatal period, but there is paucity of such data in contexts like Kenya. This study investigated the prevalence and correlates of depressive and anxiety symptoms among pregnant women in an urban informal settlement in Kenya's capital - Nairobi.

METHODS

An analysis of baseline cross-sectional data from a pilot cluster randomized trial of an integrated early childhood development programme. Participants were pregnant women in their third pregnancy trimester (N = 249), residing in an urban informal settlement in Nairobi County. Mental health measures [(Patient health questionnaire (PHQ-9) and generalized anxiety disorder scale (GAD-7)] were administered alongside other sociodemographic, pregnancy, and health-related questionnaires. Linear regression analysis was performed to investigate correlates of antenatal depressive and anxiety symptoms.

RESULTS

Participant's mean age was 27.5 years (SD = 5.6). The prevalence of antenatal depressive and anxiety symptoms was 26.9% (95%CI: 21.4-32.4) and 6.4% (95%CI: 3.4-9.4), based on the PHQ-9 and GAD-7 cut-off scores of ≥ 10 respectively. Being married was a significant correlate for decreased depressive and anxiety symptoms. Higher levels of education (secondary or tertiary), history of three or more previous pregnancies, and an experience of moderate-to-extreme pain were significant correlates for elevated depressive symptoms. Similarly, tertiary level of education, history of four or more previous pregnancies, and experiencing pain were significant correlates for elevated anxiety symptoms for the pregnant women. Participants reporting feeling unwell had significantly higher anxiety symptom scores.

CONCLUSION

In this setting, correlates of antenatal depressive and anxiety symptoms cut across demographic, pregnancy and health-related factors with implications for targeted interventions. Findings point to the need for screening of depression and anxiety as part of routine antenatal care. Further research is needed to understand these contextual correlates.

TRIAL REGISTRATION

This study was part of the integrated early childhood development pilot cluster randomised control trial, retrospectively registered in the Pan African Clinical Trial Registry on 26/03/2021, registration number PACTR202103514565914.

Examining the associations between social support and postpartum depression symptoms among adolescent mothers in Nairobi, Kenya

BACKGROUND

Globally, adolescent mothers are at increased risk for postpartum depression (PPD). In Kenya, 15% of adolescent girls become mothers before the age of 18. While social support can buffer a mother's risk of PPD, there are gaps in knowledge as to whether-and which types-of social support are protective for adolescent mothers in Kenya. Understanding the associations between support and postpartum depression symptoms among adolescent mothers can inform mental health interventions.

METHODS

Cross-sectional data of adolescent mothers ≤ 1 year postpartum (aged 14-19 years old) in an informal settlement in Nairobi, Kenya (N = 193) were used in analyses. Participants with scores ≥ 10 on the Patient Health Questionnaire-9 were classified as having postpartum depressive symptoms. To fully examine the different ways that social support might matter for adolescent mothers, we examined several domains of social support: child's father support during pregnancy, parental support during pregnancy, parental support of girl's education, membership in a social club, having a good female friend and having a supportive female adult one can turn to for help. We used bivariate and adjusted modified Poisson regression with robust standard errors to examine the associations between support measures and depressive symptoms, controlling for relevant covariates.

RESULTS

One-quarter of participants experienced postpartum depressive symptoms (24.9%). Adolescent mothers who reported their mothers or their fathers as being very supportive of girls' education had a lower risk of depressive symptoms (ARR 0.35, 95% CI 0.20-0.61; ARR:0.34, 95% CI 0.13-0.90, respectively) than those whose mothers or fathers were less supportive. Adolescent mothers who had a good female friend to confide in had decreased risk of depressive symptoms (ARR 0.61; 95% CI 0.37-0.99).

CONCLUSIONS

Having a mother or father being very supportive of girls' education and having a good female friend reduced risk of depressive symptoms. With the unique challenges of early childbearing and high adolescent birth rates in Kenya, interventions which increase parental and peer support during pregnancy and the postpartum period could improve adolescent mothers' mental health.

Prevalence of suicidal ideation and associated factors among perinatal women living with HIV: a systematic review and meta-analysis

Perinatal women living with HIV face increased susceptibility to mental health challenges, including suicidal ideation (SI). This study aimed to determine the prevalence of SI among perinatal women with HIV and identify associated factors. A systematic search was done across PubMed, Embase, Scopus, ScienceDirect, and Google Scholar. Data analysis was executed using R software. Publication bias was assessed via funnel plot and Egger's test, while heterogeneity was investigated using the I2 statistic. A total of 11 studies involving 4329 participants were included. The pooled prevalence of SI was 23.4% (95% CI: 16.3-32.4). Subgroup analysis showed higher prevalence in postnatal women (36.4%) than antenatal women (27.8%), although this difference was not statistically significant. Studies employing the Edinburgh Postnatal Depression Scale reported a higher prevalence (38.9%). Studies published between 2013-2017 showed a higher prevalence (37.6%) compared to those published between 2018-2022 (18.2%). Factors associated with SI included depression during pregnancy or postpartum, unplanned pregnancy, intimate partner violence, undisclosed HIV status, lack of social support, and recent diagnosis of sexually transmitted infections other than HIV. The high prevalence of SI emphasizes the need for mental health screening and interventions. Mental health assessments should be integrated into routine antenatal and postnatal care.

Transition to Motherhood and Lived Experiences of Teenage Mothers Delivering in Kasese and Bundibugyo Districts, Western Uganda

Introduction A large number of teenagers in low-resource settings experience pregnancy, with a significant number of these cases happening in sub-Saharan Africa. Teenage pregnancy is associated with unique physical and psychological experiences. Objective To explore the lived experiences of teenage mothers delivering at a tertiary referral hospital in southwestern Uganda. Methods This qualitative study used focus group discussions (FGDs) with teenage mothers in Kasese and Bundibugyo districts in Uganda. We purposively sampled 32 teenage mothers attending a tertiary referral hospital who had been pregnant at least once and had given birth. Sociodemographic information was obtained, and FGDs were conducted to capture the teenagers' experiences transitioning to motherhood. An inductive content analytic approach was used to analyze data.  Results The mean age of the participants was 18.4 (standard deviation [SD], 1.2) years, with the majority (22, 68.8%) being rural dwellers, married (23, 71.9%), unemployed (21, 65.6%), and having attained primary education (23, 71.9%). Teenage mothers' lived experiences were characterized by shattered dreams, concerns about changes in their body size and shape, abandonment and neglect by family members and spouses, considerations of terminating the pregnancy, forced early marriages, family stereotypes, and engaging in sex for survival. The process of transitioning to motherhood occurred along with resilience post-pregnancy and supportive environments from their loved ones, which enabled them to accept reality and care for their children. Conclusions The lived experiences of teenage mothers demonstrated social pressures, fear of abandonment, and poverty as major influences on their mindset and behavior. Further research to gain a comprehensive understanding of the challenges encountered by teenage mothers will aid the development of culturally appropriate strategies to reduce teenage pregnancy and improve perinatal outcomes.

MEASURING UNION FORMALIZATION FOR A NEW GENERATION OF FAMILY DEMOGRAPHY: A CASE STUDY FROM URBAN KENYA

Despite repeated calls for improved measures of marriage as a process in sub‐Saharan Africa, large‐scale surveys continue to rely on static marital status. As a result, there is an incomplete understanding of the effects of marriage on outcomes of interest. We use qualitative and survey data from a longitudinal study of 1,203 young mothers residing in informal settlements of Nairobi, Kenya, to (1) describe the development of an innovative measure of union formalization (UF) defined as the steps through which a union attains social legitimacy; (2) compare UF with a conventional current marital status measure; (3) examine the distribution of UF steps across union history; and (4) examine the sequence and timing of pregnancy and childbearing within the UF process. We find UF steps indicative of both increasing individualization of marriage and the ongoing importance of kin involvement hold meaning. We demonstrate extensive heterogeneity in the sequence and extent of UF steps completed and interrogate the classification of premarital childbearing using sequence analysis. We argue that measuring UF is feasible and necessary for the next generation of family demography in Africa; UF measures facilitate understanding the linkages among family dynamics, health, and social stratification within the context of ongoing socioeconomic change.

Developing the concept of maternal in teenage mothers: a hybrid model

Objectives

Maternal transition is a challenging developmental process requiring physical, mental, social, and cognitive preparedness. Therefore, the transition to motherhood is even more challenging for teenagers who are exposed to both the maturation process and adaptation to the parenting role. Therefore, the present study was conducted to provide a deeper understanding of the maternal role in Iranian teenage mothers.

Methods

A three-phase hybrid model was adopted for concept analysis. In the theoretical phase, 50 articles were analyzed. In the fieldwork phase, 10 participants were interviewed. In the final phase, the findings of the previous two stages were analyzed. This study was conducted between October 2021 and November 2022. After determining the attributes, antecedents, and consequences, a final definition was presented for parenting in teenage mothers.

Results

The concept of motherhood for teenage mothers was described as "a process-oriented phenomenon in nature," "complex, challenging and multidimensional," "development with immature transition," "a turning point in life," "a stressful event," "affected by several factors," and "bidirectional effects on life" according to antecedents, including "the level of received social support," "reaction to teenage motherhood," "teenage mother's characteristics," and "family structure" leading to "positive psychological consequences," "negative psychological consequences," and "loss of educational and career opportunities."

Conclusion

This study provides a suitable ground for evaluating the concept of motherhood in teenage mothers and employing it in nursing care of teenage mothers and children by identifying this concept.

Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach

In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.

'I have to pretend that I don't care': Stigma management among unmarried young mothers in South-Western Nigeria

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women's difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse.

Diverse policy maker perspectives on the mental health of pregnant and parenting adolescent girls in Kenya: Considerations for comprehensive, adolescent-centered policies and programs

The pregnancy rate in Kenya among adolescent girls is among the highest in the world. Adolescent girls experience increased risk of anxiety and depression during pregnancy and postpartum which can result in poor health outcomes for both mother and baby, and negatively influence their life course. Mental health is often given low priority in health policy planning, particularly in Sub-Saharan Africa (SSA). There is an urgent need to address the treatment gap and provide timely mental health promotion and preventative services, there is a need to focus on the shifting demographic of SSA-the young people. To understand perspectives on policymakers on the mental health prevention and promotion needs of pregnant and parenting adolescent girls, we carried out a series of interviews as part of UNICEF funded helping pregnant and parenting adolescents thrive project in Kenya. We interviewed 13 diverse health and social policy makers in Kenya to understand their perspectives on the mental health experiences of pregnant and parenting adolescent girls and their ideas for optimizing mental health promotion. Six principal themes emerged including the mental health situation for adolescent girls, risk factors for poor mental health and barriers to accessing services for adolescent girls, health seeking behavior effect on maternal and child health outcomes, mental health promotion, protective factors for good mental health, and policy level issues. Examination of existing policies is required to determine how they can fully and effectively be implemented to support the mental health of pregnant and parenting adolescent girls.

What to expect when girls are expecting: psychosocial support challenges and opportunities in the context and aftermath of teenage pregnancy in Kenya

BACKGROUND

An understanding of the psychosocial support challenges and opportunities in the context of teenage pregnancy is important for developing appropriate interventions for pregnant and parenting girls. This qualitative study was conducted in Homa Bay County, Kenya, to examine the experience of teenage pregnancy and the resultant psychosocial support needs from the perspectives of both pregnant/parenting girls and their own parents, who are typically expected to provide various forms of support.

METHODS

The study used a descriptive case study design, drawing on counseling case notes documented by psychologists who held counseling sessions with 20 pregnant or parenting girls and 6 of their parents as part of a psychosocial support intervention. The counseling case notes formed a qualitative data set, which was analyzed thematically.

RESULTS

Emerging master themes were related to pregnant and parenting girls' experience of sexual violence and adverse childbirth outcomes; psychological trauma confronted by girls and their parents alike; parental need for support in communicating with pregnant/parenting girls about sex and sexuality; and the availability of family support as a resource for teenage mothers.

CONCLUSION

Pregnant and parenting teenage girls require a range of psychosocial support responses that recognize the realities of sexual violence and other challenges in the lives of the girls themselves, as well as in the lives of their parents and caregivers. While parents and other caregivers can serve as an important resource for supporting affected girls, they often need assistance as well, in order to support pregnant/parenting girls effectively. These realities need to be taken into account to maximize the effectiveness of health and development programs for pregnant and parenting girls. Furthermore, emerging themes from actual counseling sessions with affected girls and parents can provide important insights into the potential psychosocial support needs of the broader population of pregnant and parenting girls.