Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders

  • Global Social Welfare, Volume 5, No. 1, Year 2018

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Study Justification:
– The study aims to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers in Kenya.
– It explores the role of social support and the absence of empathy in depression among pregnant adolescents.
– The study also examines the caregiving environment of the adolescents, including their mothers, partners, community, and healthcare workers.
– It aims to identify barriers to accessing mental health services and pregnancy care for pregnant adolescents.
Highlights:
– Pregnant and parenting adolescents face adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments.
– Primary social support for pregnant and parenting teens comes from the adolescent’s mother, while external family and male partners provide negligible support.
– Adolescent mothers have multiple needs, but there is a lack of a holistic approach to service delivery in the maternal and child health primary care setting.
– Health care workers and community health workers have limited training and capacities to address the needs of pregnant adolescents.
Recommendations:
– Address the individual stakeholder-related and system-level barriers in the maternal and child health primary care setting that affect the delivery of psychosocial support for pregnant adolescents.
– Improve knowledge, practice, and institutional gaps through community and health service staff engagement using effective implementation strategies.
– Enhance understanding of mental health services for pregnant adolescents and develop appropriate interventions.
Key Role Players:
– Researchers
– Health care workers
– Community health workers
– Adolescent mothers
– Adolescent mothers’ mothers
– Partners of adolescent mothers
Cost Items for Planning Recommendations:
– Research funding
– Training and capacity-building for health care workers and community health workers
– Community engagement activities
– Implementation strategies
– Intervention development and implementation

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a grounded theory approach and conducted interviews with multiple stakeholders, including pregnant adolescents, caregivers, and healthcare workers. The findings highlight several challenges faced by pregnant and parenting adolescents, such as social stigma, lack of emotional support, and poor healthcare access. However, the abstract does not provide specific details about the methodology, sample size, or data analysis techniques. To improve the strength of the evidence, the authors could provide more information on the sampling strategy, data saturation, and the process of analysis. Additionally, including specific recommendations for addressing the identified barriers and improving mental health services for pregnant adolescents would enhance the actionable steps.

Objective: The key objective of this paper is to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers. We explore the role of social support and the absence of empathy plays in depression among pregnant adolescents. The project also collected data on the adolescents’ caregiving environment which includes the adolescents’ mothers, their partners, the community, and health care workers, as well as feedback from staff nurses at the maternal and child health centers. The caregivers provide additional insight into some of the barriers to access of mental health services and pregnancy care, and the etiology of adolescents’ distress. Methods: The interviews were conducted in two health facilities of Kariobangi and Kangemi’s maternal and child health (MCH) centers that cover a huge low-income and low-middle-income formal and informal settlements of Nairobi. A grounded theory approach provided a unique methodology to facilitate discussion around adolescent pregnancy and depression among the adolescents and their caregivers. Our interviews were cut across four samples with 36 participants in total. The sample 1 comprised of eight pregnant adolescents who screened positive for depression in Kariobangi, sample 2 were six caregivers from both sites, and sample 3 were 22 new adolescent mothers from both sites. After individual interviews, we carried out one focused group discussion (FDG) in order to understand the cross-cutting issues and to gather some consensus on key issues, and the sample 4 were 20 community health workers, health workers, and nurses from both sites. We had one FGD with all health facility-based workers to understand the cross-cutting issues. The interviews in sample 1 and 2 were individual interviews with pregnant and parenting adolescents, and their caregivers. All our adolescent participants interviewed in sample 1 were screened for depression. Individual interviews followed the FGD. Findings: Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments. We highlighted a few useful coping mechanisms and strategies that these adolescents were thinking to reduce their stress. Primary social support for pregnant and parenting teens comes from the adolescent’s mother. The external family and male partners provide negligible support in the rearing of the child. While the mother’s reactions to the daughters’ pregnancy were empathetic sometimes, absence of food and resources made the mother distant and constraint in lending support. For those adolescents who were living with partners, in their new mother role, they had to negotiate additional challenges such as solutions to everyday childcare responsibilities and other family duties. The health care workers and community health workers confirmed that adolescent mothers have multiple needs, but there is a lack of holistic approach of service, and that their own training and capacities were very limited. Conclusions: Our paper highlights several individual stakeholder-related and system-level barriers in the MCH primary care setting that affect delivery of psychosocial support for pregnant adolescent. We have identified these knowledge, practice, and institutional gaps that need addressing through careful community and health service staff engagement using implementation strategies that are effective in low-resource settings. Pregnant adolescents are highly vulnerable group and mental health services needs to be understood better.

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Based on the description provided, here are some innovations that can be developed to improve access to maternal health for pregnant adolescents:

1. Comprehensive and integrated approach: Develop a comprehensive and integrated approach to maternal health services that addresses the physical, mental, and social needs of pregnant adolescents. This can include providing comprehensive prenatal care, mental health support, and social support services all in one location or through coordinated care.

2. Mobile health clinics: Implement mobile health clinics that can reach remote or underserved areas where pregnant adolescents may have limited access to healthcare facilities. These clinics can provide prenatal care, mental health support, and education on pregnancy and parenting.

3. Peer support programs: Establish peer support programs where pregnant adolescents can connect with and receive support from other young mothers who have gone through similar experiences. This can help reduce feelings of isolation and provide a safe space for sharing concerns and seeking advice.

4. Telemedicine services: Utilize telemedicine services to provide remote consultations and support for pregnant adolescents. This can include virtual prenatal visits, mental health counseling, and educational resources that can be accessed from home or other convenient locations.

5. Training and capacity-building: Provide comprehensive training and capacity-building programs for healthcare providers, community health workers, and other stakeholders involved in maternal health services. This can include training on adolescent-specific care, mental health support, and culturally sensitive approaches to care.

6. Community engagement: Engage the community in the development and implementation of maternal health programs. This can involve community awareness campaigns, community-based participatory research, and involving community members in decision-making processes to ensure that programs are culturally appropriate and meet the specific needs of pregnant adolescents.

By implementing these innovations, it is possible to improve access to maternal health services for pregnant adolescents and address the mental health challenges they face. This will ultimately contribute to better maternal and child health outcomes.
AI Innovations Description
Based on the description provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Implement a comprehensive and integrated approach to maternal health services: Develop a holistic approach to maternal health services that addresses the physical, mental, and social needs of pregnant adolescents. This approach should involve collaboration between healthcare providers, community health workers, and other stakeholders to ensure that pregnant adolescents receive the necessary support and care throughout their pregnancy and postpartum period.

2. Enhance social support networks: Recognize the importance of social support in the well-being of pregnant adolescents. Develop programs and interventions that aim to strengthen social support networks for pregnant adolescents, particularly from their mothers and partners. This can be achieved through education, counseling, and community-based support groups that provide emotional support, practical assistance, and resources to pregnant adolescents.

3. Improve healthcare access and quality: Address the barriers to accessing maternal healthcare services by improving the availability, affordability, and quality of care. This can be done by increasing the number of healthcare facilities in low-income and low-middle-income areas, ensuring that healthcare providers are adequately trained to address the specific needs of pregnant adolescents, and implementing strategies to reduce stigma and discrimination in healthcare settings.

4. Enhance training and capacity-building: Provide comprehensive training and capacity-building programs for healthcare workers and community health workers to improve their knowledge and skills in providing psychosocial support to pregnant adolescents. This should include training on adolescent mental health, effective communication, and culturally sensitive care.

5. Engage the community: Involve the community in the development and implementation of maternal health programs. This can be done through community mobilization, awareness campaigns, and community-based participatory research. Engaging the community will help to address community-level barriers and ensure that the programs are culturally appropriate and sustainable.

By implementing these recommendations, it is possible to improve access to maternal health services for pregnant adolescents and address the mental health challenges they face. This will ultimately contribute to better maternal and child health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Baseline assessment: Conduct a comprehensive assessment to establish the current state of access to maternal health services for pregnant adolescents in the target area. This assessment should include data on healthcare facilities, availability of services, healthcare provider capacity, social support networks, and barriers to access.

2. Intervention design: Based on the recommendations outlined in the abstract, design an intervention that addresses the identified barriers and aims to improve access to maternal health services. This intervention should include components such as comprehensive and integrated maternal health services, enhanced social support networks, improved healthcare access and quality, training and capacity-building for healthcare workers, and community engagement.

3. Implementation: Implement the designed intervention in the target area. This may involve collaborating with local healthcare facilities, community organizations, and stakeholders to ensure the successful implementation of the intervention. Monitor the implementation process to identify any challenges or modifications needed.

4. Data collection: Collect data throughout the implementation process to assess the impact of the intervention on improving access to maternal health services. This can include data on the number of pregnant adolescents accessing services, changes in healthcare provider knowledge and skills, improvements in social support networks, and feedback from pregnant adolescents and healthcare providers.

5. Analysis: Analyze the collected data to evaluate the impact of the intervention. Compare the data to the baseline assessment to determine the extent of improvement in access to maternal health services. Identify any gaps or areas for further improvement.

6. Recommendations: Based on the analysis, provide recommendations for further actions or modifications to sustain and enhance the impact of the intervention. These recommendations should consider the specific context and needs of the target area.

By following this methodology, it is possible to simulate the impact of the main recommendations outlined in the abstract on improving access to maternal health services for pregnant adolescents. This will provide valuable insights for policymakers, healthcare providers, and community stakeholders to develop effective strategies and interventions to address the challenges faced by pregnant adolescents in accessing maternal health services.

Statistics:
Citations: 46
Authors: 9
Identifiers:
DOI: 10.1007/s40609-017-0102-8
Research Areas:
Community Interventions, Disparities, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Kenya
Study Design:
Grounded Theory, Phenomenological Study
Study Approach:
Qualitative
Participants Gender:
Male
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