Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana

The reasons for and influences of unintended teenage pregnancy in Kericho county, Kenya: a qualitative study

BACKGROUND

Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers' own experiences and perspectives is necessary to design appropriate interventions.

METHODS

A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022.

FINDINGS

Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as "infertility caused by FP," "freedom of sex by promoting FP," and "cultural taboos on having sex before marriage and talking about sexuality," were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences.

CONCLUSIONS

Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary.

The story of staying out of normal routine life in adolescent mothers in marginal areas in Urmia through the Lenz of conventional content analysis approach

BACKGROUND

Adolescent pregnancy is a main health concern in relation to adolescent mothers and their neonates especially in deprived areas.

AIM

This study aimed to explore the experiences of adolescent mothers who live in deprived marginal areas in Urmia in Iran.

METHODS

This qualitative study was conducted in 2022-2023 using the conventional content analysis approach. Participants were eighteen adolescent mothers purposefully selected from healthcare centers in marginal areas in Urmia. Data were gathered via semi-structured interviews and were analyzed by the conventional content analysis method proposed by Graneheim and Lundman.

FINDINGS

''Staying out of the life normal routine' was the main theme consisted of four categories 'forced early marriage', 'experience of abuse', 'learned helplessness', and 'impulses of hope under the shadow of motherhood' and five sub-categories role conflict, lifelong regret, attachment, reviving the lost self-value and the delight of family establishment.

CONCLUSION

Based on the results of the study health care providers, especially midwives, will be oriented to deal with adolescent mothers to help them to have successful transition to motherhood.

"My father insisted that I have the baby but not in his house": Adolescent pregnancy, social exclusion and (dis)empowerment of girls in an urban informal settlement in Kenya

While the drivers of adolescent pregnancy are widely studied, few studies have examined the social exclusions associated with early and unintended pregnancy. Drawing data from a larger mixed methods study on the lived experiences of pregnant and parenting adolescents and guided by Amatya Sen's social exclusion framework, this qualitative explanatory study examines how poverty and the contestation around girls' access to comprehensive sexuality education hinder them from preventing unintended pregnancy. It also examines why adolescent pregnancy further results in girls' social exclusion with implications for their health and socioeconomic (dis)empowerment. We drew on data from in-depth interviews with purposively selected pregnant and parenting adolescents aged 15 to 19 (n = 22) and parents (n = 10), and key informant interviews with teachers (n = 4), policymakers (n = 3), community leaders (n = 6) non-governmental organization representatives (n = 2), and health workers (n = 4). Through inductive and deductive thematic analysis, we found that poverty and lack of access to contraceptive information and services contributed to girls' vulnerability to early unintended pregnancies. Becoming pregnant exacerbated girls' social exclusion, which is characterized by self-isolation, being disowned by their families, or forced to drop out of school. Shame, stigma, and discrimination of girls made girls seek antenatal care late. They also failed to complete the recommended number of antenatal care visits. Marginalization of pregnant and parenting girls results in them being out of school, vocational training, and employment, as well as experiencing mental distress. The analysis shows the social exclusion of girls is cyclical, beginning before their pregnancy and continuing into pregnancy and post-pregnancy. Their social exclusion has negative implications for their health and socio-economic empowerment. Interventions to address adolescent childbearing should holistically address the social exclusion that predisposes girls to unintended pregnancy and that follows during and post-pregnancy, as tackling this exclusion is key to improving their health and socioeconomic well-being.

Experiences of Food Insecurity Among Pregnant Adolescents and Adolescent Mothers in Ghana: A Photovoice Method

Objectives: Food insecurity (FI) remains a major public health problem globally. However, there is limited information about adolescents' experiences. The current study explored FI experiences of pregnant adolescents and adolescent mothers in Cape Coast, Ghana using a Photovoice method. Methods: This study recruited 34 pregnant adolescents and adolescent mothers from communities in Cape Coast, Ghana. Each participated in a training session then was provided prompts to take photos that portrayed food access barriers, facilitators and coping strategies. In a debrief session, each participant selected two pictures they took and explained the image, followed by a group discussion of the selected photos. Debrief sessions were audio recorded and transcribed verbatim to develop themes using a theory-driven approach. Results: Most participants reported several or many experiences with FI (64.7%) in the previous month. Participants discussed money, unwanted pregnancy, and unstable work as barriers to obtaining food and working, selling goods, and family support as facilitators to obtaining food. Coping strategies mentioned include providing services to others, borrowing food and goods, meal stretching, pawning personal items and trading. Conclusion: The FI experience of this population is complex; interventions, including trade training or school retention, should be multifaceted.

« Éloigne cette honte de moi! »: une étude qualitative des normes sociales entourant les expériences d’avortement chez les adolescentes et jeunes femmes au Bénin

In Africa, the rights of adolescent girls and young women in terms of sexual and reproductive health are strongly influenced by social norms. This article delves into the pivotal role these norms play in the abortion decisions and experiences of young women aged 15-24 in Benin. An ethnographic approach was adopted for data collection among young women who have undergone abortion, their confidants, and other community members. The findings reveal that these young women face a threefold normative burden in their social environment. They juggle contradictory norms that simultaneously stigmatise early pregnancies, hinder proper sexual education, and strongly condemn abortion. These normative pressures often drive their resort to abortions, typically carried out under unsafe conditions. The study also highlights the significant role parents play in the abortion decisions and processes of teenagers under 20. When men are involved in seeking care for abortion, adolescents and young women usually access safer procedures. However, their access to aftercare and contraception following an abortion is hindered by the social norms of healthcare professionals. In addition to broadening the conditions of access to abortion in Benin in October 2021, it is imperative to implement interventions centred on value clarification, raising awareness of adolescents' rights, combating obstetric violence, and social stigmatisation. These measures are crucial to alleviate the weight of social norms bearing down on these young women. DOI: 10.1080/26410397.2023.2294793.

'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.

"I felt I needed help, but I did not get any": A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi

Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January-March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: "psychosocial risk and protective factors" (potential causes of common mental health problems among adolescents); and "health care services" (maternal and mental health services available, and adolescents' experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.

Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana

Background

Adolescence, a transition period from childhood to adulthood forms the foundation of health in later life. The adolescence period which should have been characterised by good health is often marred with life-threatening and irreparable consequences of public health concern. Teen pregnancy is problematic because it could jeopardise adolescents’ safe transition to adulthood which does not only affect adolescents, but also their families, babies and society. There is ample evidence about the determinants and effects of teen pregnancy, but it is fragmented and incomplete, especially in Sub-Sahara Africa. This study presents pregnant adolescents’ voices to explain significant gaps in understanding their lived experiences and coping strategies.

Methods

This narrative inquiry, involved in-depth interviews with 16 pregnant adolescents, who were recruited from a peri-urban district in Southern Ghana using purposive and snowball techniques in health facilities and communities respectively. The audio recorded interviews were transcribed verbatim and analysed manually using content analysis.

Results

Many pregnant adolescents are silent victims of a hash socio-economic environment, in which they experience significant financial deprivation, parental neglect and sexual abuse. Also, negative experiences of some adolescent girls such as scolding, flogging by parents, stigmatisation and rejection by peers and neighbors result in grieve, stress and contemplation of abortion and or suicide. However, adolescents did not consider abortion as the best option with regard to their pregnancy. Rather, family members provided adolescents with critical support as they devise strategies such as avoiding people, depending on God and praying to cope with their pregnancy.

Conclusion

Adolescent pregnancy occurred through consensual sex, transactional sex and sexual abuse. While parents provide support, pregnant adolescents self-isolate, depend on God and pray to cope with pregnancy and drop out of school. We recommend that the Ministries of Education and Health, and law enforcement agencies should engage community leaders and members, religious groups, non-governmental organisations and other key stakeholders to develop interventions aimed at supporting girls to complete at least Senior High School. While doing this, it is also important to provide support to victims of sexual abuse and punish perpetrators accordingly.