Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria

Lola Kola,Ian M Bennett,Amritha Bhat,Bibilola D Oladeji,Dolapo Abiona,Neda Faregh,Jibril Abdumalik,Pamela Y Collins,Olatunde O Ayinde,Oye Gureje

doi:10.1186/s12884-020-02970-4

Abstract

BackgroundDepression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.MethodsFocus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.ResultsA total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.ConclusionsParticipants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.

Highlights

Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited
95% of all births to girls under age 18 occur in low- and middle -income countries (LMICs), where supporting infrastructure for healthcare is limited (UNFPA, 2013)
The care providers were comprised of 3 men whose views did not differ from those of the women and neither was there any obvious gender tension during the Focus Group Discussion (FGD)

Summary

Introduction

Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. Maternal health care for adolescents is complex and involves a range of psychosocial issues while requiring attention to both the developmental needs of the childparents and medical problems related to the pregnancy [28]. 95% of all births to girls under age 18 occur in low- and middle -income countries (LMICs), where supporting infrastructure for healthcare is limited (UNFPA, 2013). Nigeria, like other low resource nations of the region, lacks adequate numbers of trained care providers as well as appropriate infrastructure to support high quality primary maternity care for adolescents [31]

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Results

Conclusion