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Background: Adolescent reproductive health is still a challenge in Low and Middle Income Come Countries (LMICs). However, the reasons for the inability of most pregnant adolescent girls to access and utilize maternal and child health information (MCHI) are not well-documented. This is despite the policy guidelines promoting the provision of this necessary information to pregnant adolescents in order to prepare them for delivery. This provision is one of the strategies envisaged to improve their attendance of ANC visits and their maternal and child health. Method: Data were generated from 12 adolescent pregnant girls aged 15 to 19 years and eight nurses from four different health centres in the Ohangwena Region of Namibia, using semi-structured in-depth interviews. The study was conducted over the period of three months (December 2018 to March 2019). The data were grouped into clusters aided by NVivo computer software version 12. Data were organized and condensed in small units, prior to being coded, categorized, and finally grouped into main themes and sub-themes. Results: Results revealed that long travel hours to reach the nearest clinics was amongst the leading challenges affecting accessibility and utilization of MCHI for pregnant adolescent girls. This was exacerbated by poor support with transport fare, poor road infrastructure and non-availability of transport, and these factors were key barriers to accessibility and utilization of clinic services. Other barriers pertained to the family dynamics, such as disclosing the pregnancy to the family members prior to commencing antenatal care (ANC) visits and harsh treatment from family members after the disclosure. Conclusion: The pregnant adolescent girls were concerned about their inability to access and utilize MCHI, thereby making them susceptible to maternal complications. Health educational interventions should prioritize both the adolescent girls and their families for proper support, especially since the reactions of families on the pregnancy of their adolescent girls often negatively affect accessibility and utilization of maternal and child health services. Moreover, further research on adolescents’ needs during pregnancy should be expanded to include their parents, in order to better inform policymakers.
This study was guided by the interpretive paradigm due to its ability to explore the phenomenon from the perspectives of the service users (adolescent girls) and service providers (nurses) [23, 24]. By applying an interpretive paradigm, the researchers had a chance to view the world through the lenses and experiences of those participating in the provision and use of MCHI in their region. An exploratory qualitative design was applied to explore the experiences of service users and service providers pertaining to the accessibility and utilization of MCHI during pregnancy in the Ohangwena Region in Namibia. The study was conducted in the Ohangwena Region, which is one of the 14 political regions in Namibia. It shares international boundaries with Angola to the north and regional boundaries with the Kavango region to the east, Omusati region to the west, and Oshana and Oshikoto regions to the south. It is the second-highest populated region in Namibia with a population of 274 650 [25]. Ohangwena is a rural region and one of the most poverty-stricken areas in the country [26]. In 2017, Ohangwena was rated as one of the regions with the highest prevalence of teenage pregnancy [26]. The major diseases in the region are pneumonia, malaria, diarrhoea, and HIV/AIDS [26]. The total population of pregnant women between the target ages of 15 and 19 was 693. The total number of registered nurses and enrolled nurses and midwives working at the selected health centres and clinics was 57. The study participants included twelve (12) pregnant adolescents from different villages across Ohangwena Region and eight (8) Nurses from two different health professional categories (registered nurse and enrolled nurse and midwifery) who were working in health centres and clinics, Ongha Health Centre, Odibo Health Centre, Engela Clinic and Eenhana Clinic in Ohangwena Region. A purposive sampling strategy was applied to identify 12 participants out of the 98 potential participants from four purposively selected sites. The identification of potential participants was based on their professional categories: one nurse dealing with antenatal consultations per professional category per site (enrolled Nurse and registered nurse), culminating in the selection of two nurses per site. Furthermore, these potential participants were considered information-rich, based on their inputs into the quantitative aspects of the study. Only the adolescents who were pregnant at the time of the data collection, aged 15 to 19 years old, 1–40 gestational weeks pregnant and resident of the Ohangwena Region, were considered for inclusion in the study. Excluded in the study were women below the age of 15 or older than 19, not from the Ohangwena Region, and not pregnant at the time of data collection. For the selection of the nurses, the following inclusion and exclusion criteria were applied: Inclusion criteria: any year of age, working at ANC clinics, registered nurses or enrolled nurse and those from midwifery, male or female; Exclusion criteria: staff members who were not nurses, nurses who were not working at antenatal clinics, nurses who had worked less than one month at an antenatal clinic. This study was conducted over a three-month period (December 2018 to March 2019). The lead researcher, who had some training on qualitative research, conducted semi-structured in-depth interviews with pregnant adolescents who presented for ANC visits at the four sites and with eight nurses from four different health centres and clinics. An interview guide used to generate data covered the following areas: Reasons for late to start of antenatal care, mode of transport to the clinic, the distance to the nearest clinics, waiting time and challenges affecting access to MCHI. Questions pertained to how pregnant adolescents accessed ANC clinics, including the factors that affected the utilization of services. Questions directed to the nurses pertained to the observed ANC clinics attendance patterns by the pregnant adolescents, including the challenges viewed to affect the service uptake by this age group. A maximum of four interviews per day were scheduled through telephonic appointments. Each interview lasted for about 30–40 min per participant and no follow-up interviews were conducted. The interviews were conducted in Oshiwambo, since the participants were more comfortable to talk in their own language. The interview venues were determined by the participants to ensure that they were less inconvenienced. A majority of participants preferred to be interviewed at the nearest clinics and some preferred to be interviewed at their place of residence and maternity shelters, as they were closer to their time of giving birth. The interviews for nurses were conducted either at their clinics or health centres. With the participants’ permission, note-taking and digital audio-recordings were used to record the data. Code saturation was reached at 10 interviews, as data collection and analysis were conducted iteratively. However, the meaning saturation was reached after interviewing all twelve selected pregnant adolescent girls. Two university students experienced in qualitative research were recruited to transcribe the audio materials verbatim. For quality-check purposes, the lead researcher listened to the audio materials while reading the transcriptions, in order to assure the quality of transcription prior to translating from Oshiwambo to English. Notably, the lead researcher (JS) is competent in both Oshiwambo and English. Furthermore, a Ph.D. graduate from the University of Namibia independently verified the quality of the transcriptions. Data were exported into NVivo computer software version 12 for analysis. Thematic analysis techniques were applied to analyze the data, the following process of thematic analysis being followed: Data was condensed in small units, and then the coding process was conducted. The process of categorization of the data followed and, finally, thematic analysis was conducted by classifying the data into sub-themes and main themes. The lead researcher (JS) immersed herself in data through several readings of the transcripts in order to generate concepts. To support the findings, verbatim quotes were extracted from the transcripts. Five main themes and eighteen sub-themes were identified. The main themes were: Reasons for late starting of ANC, mode of transport to the clinic, the distance to the nearest clinics, waiting time and challenges affecting access to MCHI.
