Abstract
BackgroundAdolescent girls (10–19 years) are at increased risk of morbidity and mortality from pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths. Few adolescent girls in Tanzania access antenatal care at health facilities, the reasons for which are poorly understood.MethodsWe conducted a qualitative thematic analysis study of the experiences of pregnant adolescents with accessing antenatal care in Misungwi district, Tanzania. We recruited 22 pregnant or parenting adolescent girls using purposive sampling, and conducted in-depth interviews (IDIs) about antenatal care experiences. IDI data were triangulated with data from eight focus group discussions (FGDs) involving young fathers and elder men/women, and nine key informant interviews (KIIs) conducted with local health care providers. FGDs, KIIs and IDIs were transcribed verbatim in Swahili. Transcripts were then translated to English and analysed using emergent thematic analysis.ResultsFour main themes emerged: 1) Lack of maternal personal autonomy, 2) Stigma and judgment, 3) Vulnerability to violence and abuse, and 4) Knowledge about antenatal care, and highlighted the complex power imbalance that underlies barriers and facilitators to care access at the individual, family/interpersonal, community, and health-systems levels, faced by pregnant adolescents in rural Tanzania.ConclusionAdolescent antenatal care-seeking is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may act as barriers, thereby, potentially reducing maternal morbidity and mortality in Tanzania.
Highlights
Pregnancy and childbirth complications are the leading cause of death among adolescent girls (10–19 years of age) [1]
Antenatal care for adolescent girls in rural Tanzania
Adolescent antenatal care-seeking is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse
Summary
Pregnancy and childbirth complications are the leading cause of death among adolescent girls (10–19 years of age) [1]. Low and middle income countries (LMIC) including Tanzania, have the world’s highest maternal mortality rates for pregnant adolescents at 36 per 100 000 births [4]. Adolescent girls in developing countries are twice as likely to die during childbirth as older mothers, and their infants are at 50% increased risk of neonatal mortality [5]. ANC visits are especially important for reinforcing healthy pregnancy practices, discussing delivery/postnatal care and family planning needs, and to allow for screening and treatment of infection, pregnancy-related, and pre-existing conditions, to reduce risks of maternal and infant morbidity and mortality [1]. Adolescent girls (10–19 years) are at increased risk of morbidity and mortality from pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths. Few adolescent girls in Tanzania access antenatal care at health facilities, the reasons for which are poorly understood
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