Seeking safety and empathy: Adolescent health seeking behavior during pregnancy and early motherhood in central Uganda

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Study Justification:
– The purpose of this study was to explore adolescent health seeking behavior during pregnancy and early motherhood.
– The study aimed to contribute to health policy formulation and improved access to healthcare.
– The long-term goal was to reduce morbidity and mortality among adolescent mothers and their newborns.
Highlights:
– The study used qualitative methods, including focus group discussions and key informant interviews.
– Thirteen focus group discussions were conducted with a total of 92 adolescent girls.
– Two main themes emerged from the analysis: “feeling exposed and powerless” and “seeking safety and empathy.”
– The study found that pregnant adolescents seek healthcare in both modern and traditional health sectors.
– The traditional sector was more accessible in terms of distance, cost, and cultural context.
– Adolescent mothers faced challenges in decision making and felt disempowered due to their pregnancy state.
– The study recommended improving health systems, including the traditional sector, for adolescent girls.
– Key areas for improvement included infrastructure, attitudes of health workers, and training in delivering adolescent health services.
Recommendations:
– Policy makers should focus on improving maternal health services for adolescent girls.
– This includes improving infrastructure and attitudes of health workers.
– Training in delivering adolescent health services is critical.
– The traditional health sector should be integrated into the healthcare system to improve accessibility for adolescent mothers.
Key Role Players:
– Policy makers
– Health ministry officials
– Health facility managers
– Health workers
– Traditional healers
– Community leaders
– Adolescent girls and their families
Cost Items for Planning Recommendations:
– Infrastructure improvement (e.g., construction or renovation of health facilities)
– Training programs for health workers
– Awareness campaigns and community engagement activities
– Integration of traditional healers into the healthcare system
– Monitoring and evaluation of the implemented changes

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study that employed focus group discussions and key informant interviews. While this provides valuable insights into adolescent health seeking behavior during pregnancy and early motherhood, the sample size is relatively small (92 adolescent girls) and the study design does not allow for generalizability. To improve the strength of the evidence, future research could consider conducting a larger-scale quantitative study that includes a more diverse population of adolescent mothers. Additionally, incorporating longitudinal follow-up to assess the long-term impact of improved access to healthcare on morbidity and mortality outcomes would further strengthen the evidence.

Purpose: To explore adolescent health seeking behavior during pregnancy and early motherhood in order to contribute to health policy formulation and improved access to health care. This will in long-term have an impact on the reduction of morbidity and mortality among adolescent mothers and their newborns. Methods: This was a qualitative study that employed focus group discussions (FGDs) among adolescent girls (10-19 years) and key informant (KI) interviews with health workers. Age for FGD participants ranged from 16 to 19 years. The FGD participants were recruited while seeking antenatal care for their first pregnancy or immunization service for their first child, not being older than 6 months. Six health facilities were selected. Key informants were purposefully selected on the basis of being in-charge of maternity units. Thirteen FGDs comprising of a total of 92 adolescent girls were conducted. The FGDs were held with homogeneously constituted categories; married pregnant adolescents (5), unmarried pregnant adolescents (3) and married or not married adolescents with children (5). Semi structured interviews were held with six KIs who were in-charge of maternity units of health facilities. Latent content analysis technique was used for data analysis. Results: Two main themes emerged; ‘feeling exposed and powerless’, and ‘seeking safety and empathy’. The categories identified in the first theme were “the dilemma of becoming an adolescent mother” and “lack of decision power”. In the second theme the following categories were identified: “cultural practices and beliefs about birth”, “expectations and experiences”, “transport, a key determinant to health seeking”, and “dealing with constraints”. Adolescents felt exposed and powerless due to the dilemma of early motherhood and lack of decision making power. The adolescent mothers seemed to be in continuous quest for safety and empathy. In so doing they are part of cultural practices and beliefs about birth. They had expectations about the health care services but their experiences of the services were rather negative. Transport was a key determinant for health seeking and adolescents to some extent had learnt how to cope with constraints they face. Conclusion and implications: Pregnant adolescents seek health care in both modern and traditional health sectors in order to get safety and empathy. However, our findings indicate that they mostly utilize the traditional sector because it is most accessible in terms of distance, cost and cultural context. Adolescent mothers are disempowered in decision making because of their pregnancy state which often puts them in dilemma. We therefore suggest that policy makers need to improve health systems (including the traditional sector) especially maternal health services for adolescent girls. Improved infrastructure and attitudes of health worker as well as training in delivery of adolescent health services is critical. © 2008 The Association for Professionals in Services for Adolescents.

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The study recommends the following strategies to improve access to maternal health for adolescent girls:

1. Enhancing infrastructure: Upgrading health facilities, including maternity units, and ensuring the availability of necessary medical equipment and supplies.

2. Training health workers: Providing training to health workers, especially those in charge of maternity units, on delivering adolescent-friendly health services and creating a supportive environment.

3. Promoting cultural sensitivity: Integrating traditional health sectors with modern healthcare systems by collaborating with traditional birth attendants and community leaders.

4. Addressing transportation barriers: Improving transportation infrastructure and accessibility to health facilities, such as providing transportation subsidies or establishing mobile health clinics.

5. Empowering adolescent mothers: Providing comprehensive information about rights, options, and available healthcare services through targeted education and counseling programs.

Implementing these recommendations can help improve access to maternal health for adolescent girls, reducing morbidity and mortality among adolescent mothers and their newborns.
AI Innovations Description
The recommendation to improve access to maternal health based on the study is to focus on improving health systems, particularly maternal health services, for adolescent girls. This can be achieved through the following strategies:

1. Enhancing infrastructure: Improving the physical infrastructure of health facilities, including maternity units, can help ensure that they are adequately equipped to provide quality maternal health services. This may involve upgrading facilities, ensuring the availability of necessary medical equipment and supplies, and creating a conducive environment for adolescent mothers.

2. Training health workers: Providing training to health workers, especially those in charge of maternity units, is crucial. This training should focus on delivering adolescent-friendly health services, including addressing the specific needs and concerns of adolescent mothers. It should also emphasize the importance of empathy and sensitivity towards adolescent mothers to create a supportive and non-judgmental environment.

3. Promoting cultural sensitivity: Recognizing and respecting cultural practices and beliefs about birth is essential in improving access to maternal health for adolescent girls. Health policies and programs should take into account the cultural context and work towards integrating traditional health sectors with modern healthcare systems. This can be achieved through collaboration and partnerships with traditional birth attendants and community leaders.

4. Addressing transportation barriers: Transport is identified as a key determinant for health-seeking behavior among adolescent mothers. Efforts should be made to improve transportation infrastructure and accessibility to health facilities. This may involve providing transportation subsidies or establishing mobile health clinics to reach remote areas where transportation is a challenge.

5. Empowering adolescent mothers: Adolescents often feel disempowered in decision-making due to their pregnancy status. Policies and programs should aim to empower adolescent mothers by providing them with comprehensive information about their rights, options, and available healthcare services. This can be done through targeted education and counseling programs that empower adolescent mothers to make informed decisions about their health.

By implementing these recommendations, policymakers can work towards improving access to maternal health for adolescent girls, ultimately reducing morbidity and mortality among adolescent mothers and their newborns.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Study Design: Conduct a mixed-methods study that combines quantitative and qualitative approaches to gather comprehensive data on the impact of the recommendations. This could involve surveys, interviews, and focus group discussions.

2. Sample Selection: Select a representative sample of adolescent girls (10-19 years) who are pregnant or have recently given birth in central Uganda. Ensure that the sample includes both married and unmarried adolescents to capture a diverse range of experiences.

3. Intervention Implementation: Implement the recommended strategies in selected health facilities. This could involve enhancing infrastructure, providing training to health workers, promoting cultural sensitivity, addressing transportation barriers, and empowering adolescent mothers.

4. Data Collection: Collect data before and after the implementation of the interventions to assess the impact. This could include collecting information on health-seeking behavior, access to maternal health services, satisfaction with services, and health outcomes for both adolescent mothers and their newborns.

5. Quantitative Analysis: Analyze the quantitative data using statistical methods to measure changes in health-seeking behavior, access to maternal health services, and health outcomes. This could involve comparing pre- and post-intervention data to determine the effectiveness of the recommendations.

6. Qualitative Analysis: Analyze the qualitative data using thematic analysis to gain insights into the experiences and perceptions of adolescent mothers regarding the implemented interventions. This could involve identifying themes related to the impact of the recommendations on access to maternal health.

7. Integration of Findings: Integrate the quantitative and qualitative findings to provide a comprehensive understanding of the impact of the recommendations. This could involve triangulating the data to validate the results and identify any discrepancies.

8. Policy Recommendations: Based on the findings, develop policy recommendations to improve access to maternal health for adolescent girls in central Uganda. These recommendations should be evidence-based and consider the specific context and needs of the target population.

By following this methodology, researchers can assess the effectiveness of the recommendations in improving access to maternal health for adolescent girls and provide valuable insights for policy formulation and implementation.

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