A mixed reception: perceptions of pregnant adolescents\u2019 experiences with health care workers in Cape Town, South Africa

Ronel Sewpaul,Natisha Dukhi,Derrick Sekgala,Rik Crutzen,Priscilla Reddy

doi:10.1186/s12978-021-01211-x

Abstract

BackgroundMaternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care.MethodsPregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data.ResultsExperiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil.ConclusionsThere is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

Highlights

Adolescent pregnancy is a serious public health concern in low- and middle-income countries, as it is associated with elevated risk of obstetric complications, gestational diabetes, anaemia, hypertensive disorders of pregnancy, and co-morbidities in comparison to adult women [1, 2]
The way in which pregnant teenagers are treated by health care workers at antenatal clinics influences their clinic attendance
This study reports on the experiences of pregnant teenagers with health care workers, when accessing antenatal care in Cape Town, South Africa

Summary

Introduction

Adolescent pregnancy is a serious public health concern in low- and middle-income countries, as it is associated with elevated risk of obstetric complications, gestational diabetes, anaemia, hypertensive disorders of pregnancy, and co-morbidities in comparison to adult women [1, 2]. The mortality rate of infants born to 15–19 year old mothers is 50% higher than that of infants born to women aged 20–29 years [4]. In South Africa the adolescent fertility rate has declined from 72 births per 1000 girls aged 15–19 years old in 2012 to 68 births per 1000 girls in 2019 [5] Despite the decline, this fertility rate is still over four times higher than the adolescent fertility rate in high-income countries [5]. Maternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care.

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Conclusion