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Jochim J, Meinck F, Toska E, Roberts K, Wittesaele C, Langwenya N, Cluver L. Who goes back to school after birth? Factors associated with postpartum school return among adolescent mothers in the Eastern Cape, South Africa. Glob Public Health 2023; 18:2049846. [PMID: 35388739 DOI: 10.1080/17441692.2022.2049846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/19/2022] [Indexed: 11/04/2022]
Abstract
Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high . This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Optentia, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Elona Toska
- Department of Sociology, University of Cape Town, Cape Town, South Africa
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Kathryn Roberts
- Institute for Global Health, University College London, London, United Kingdom
| | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Jochim J, Cluver L, Sidloyi L, Kelly J, Ornellas A, Mangqalaza H, Coakley C, Nogoduka C, Pillay M, Nokama B, George G, Toska E, Eastern Cape TAG. Improving educational and reproductive outcomes for adolescent mothers in South Africa: A cross-sectional analysis towards realising policy goals. Glob Public Health 2023; 18:2206465. [PMID: 37158293 DOI: 10.1080/17441692.2023.2206465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12-24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017-2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lulama Sidloyi
- Oxford Research South Africa, University of Oxford, Oxford, UK
| | - Jane Kelly
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Abigail Ornellas
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Hlokoma Mangqalaza
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Chelsea Coakley
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Coceka Nogoduka
- National Department of Basic Education, Pretoria, South Africa
| | - Managa Pillay
- National Department of Basic Education, Pretoria, South Africa
| | - Busisa Nokama
- National Department of Basic Education, Pretoria, South Africa
| | - Gavin George
- Health Economic and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Sociology, University of Cape Town, Cape Town, South Africa
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Gray NJ, Desmond NA, Ganapathee DS, Beadle S, Bundy DAP. Breaking down silos between health and education to improve adolescent wellbeing. BMJ : BRITISH MEDICAL JOURNAL 2022; 379:e067683. [PMCID: PMC9600159 DOI: 10.1136/bmj-2021-067683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicola J Gray
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Danalaxshmi Shanen Ganapathee
- International Youth Alliance for Family Planning, Mauritius,Mastercard Scholars Foundation Programme, University of Edinburgh, Edinburgh, UK
| | - Sally Beadle
- Section for Health and Education, Unesco, Paris, France
| | - Donald AP Bundy
- London School of Hygiene and Tropical Medicine, London, UK,Research Consortium for School Health and Nutrition of the Global School Meals Coalition of the UN Food System Summit, London
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Infant Outcomes among Teenage and Young Mothers: Racial Inequities and the Role of Educational Attainment. J Pediatr 2022; 247:87-94.e2. [PMID: 35364098 DOI: 10.1016/j.jpeds.2022.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association of age-appropriate maternal educational attainment in teenage and young mothers on infant health outcomes across racial/ethnic groups. STUDY DESIGN In this retrospective, cross-sectional study using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Natality data (2016-2017), we included live births comparing 14- to 19- year-old mothers with 20- to 24-year-old mothers. To analyze the association of maternal age-appropriate education (≥8th grade for 15-18 years of age, 9th-12th grade/completed high school for 19-24 years of age), we conducted multivariable regression adjusting for mothers' demographics, reporting adjusted incidence rate ratios with 95% CI for infant mortality rate, and logistic regression for extreme prematurity and low birth weight, reporting aORs with 95% CI. RESULTS From 2016 to 2017, there were 1 976 334 live births among women 14-24 years of age; 407 576 (20.6%) were in 14- to 19-year-olds. In the multivariable model, increased term infant mortality rate was associated with age 14-19 years (adjusted incidence rate ratio 1.18, 95% 1.10, 1.27), age-inappropriate education (adjusted incidence rate ratio 1.38, 95% CI 1.28, 1.48), and non-Hispanic Black mothers (adjusted incidence rate ratio 1.21, 95% CI 1.12, 1.30). Extreme prematurity was associated with women age 14-19 years (aOR 1.35, 95% CI 1.30, 1.40), non-Hispanic Black (aOR 2.50, 95% CI 2.39, 2.61), and Hispanic mothers (aOR 1.09, 95% CI 1.04, 1.15). Term infant low birth weight was associated with age 14-19 years (aOR 1.14, 95% CI 1.12, 1.16), age-inappropriate education for non-Hispanic White (aOR 1.16, 95% CI 1.11, 1.21), and non-Hispanic Black (aOR 1.08, 1.04, 1.12) mothers. CONCLUSIONS Inadequate maternal educational attainment, which is influenced by modifiable social policies, is associated with increased adverse infant outcomes in mothers 14-24 years of age.
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Jochim J, Meinck F, Steventon Roberts KJ, Wittesaele C, Langwenya N, Toska E, Cluver L. Which factors affect postpartum educational enrollment of adolescent mothers in South Africa? A latent class analysis. PSYCHOL HEALTH MED 2022; 27:138-154. [PMID: 35934947 DOI: 10.1080/13548506.2022.2108085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interrupted education of adolescent mothers remains a major concern, but limited evidence-based programming exists to support postpartum schooling of this group. This study aimed to better understand the factors that render some adolescent mothers vulnerable to school non-enrollment, and how to reduce these risks. Data from 1,046 adolescent and young mothers (10-24 years) from rural and urban communities in South Africa's Eastern Cape was obtained through a questionnaire containing validated and study-specific measures relating to sociodemographic characteristics, schooling, relationships, violence exposure, and health. Using latent class analysis, we explored emerging latent groups and their relationship to mothers' enrollment in school, college, or tertiary education. The analyses revealed three distinct groups of mothers: The 'most disadvantaged' subgroup (39%) experienced multiple risks, including food insecurity, living in informal housing, lacking positive relationships with their caregiver, and the highest distance to school; The 'disadvantaged' subgroup (44%) did not experience food insecurity whilst reporting better caregiver relationships and lower distance to school. However, this group still showed high probabilities of residing in informal housing and in communities that expose them to violence; A 'least disadvantaged' subgroup (17%) was largely unaffected by economic and community risks and experienced good caregiver relationships. Compared to the most disadvantaged mothers, the least disadvantaged mothers showed the highest probability of being enrolled in education (65% versus 45%). Adolescent motherhood can impede continued enrollment in education and individual-centered interventions alone might not be sufficient to mitigate the risks for non-enrollment. Services and provisions that address severe poverty and improve family relationships might provide an opportunity to positively influence schooling among adolescent mothers.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,Optentia, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Kathryn J Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Institute for Global Health, University College London, London, UK
| | - Camille Wittesaele
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa.,Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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