Adolescent motherhood in rural Nepal: passive sensing data illuminates daily experiences in maternal lives

Abstract

Background: Adolescent pregnancy, particularly in low-income settings, is associated with adverse health and social outcomes for both mother and child. Nepal has the second highest rate of adolescent pregnancy in South Asia alongside high rates of maternal depression and suicide. While the maternal morbidity risks of adolescent pregnancy are well researched, impacts on everyday lives, including behaviors and predictable patterns are less well-known. Passive sensing (geographic movement, physical activity, and proximity to infants using Bluetooth technology) is an emerging technology that can enhance the detection of behavior patterns. Given the risk of the postpartum period in LMIC settings, we sought to characterize normal behavioral patterns via passive sensing technology. Methods: We collected passive data over a two-week period with 22 mothers using phone-based GPS, accelerometry, and Bluetooth technologies. Passive data was aggregated for each mother, collapsed into hourly readings, and descriptively summarized. We triangulated this information in a constant comparative approach with a range of qualitative data including multiple in-depth interviews, a daily diary, and systematic fieldnotes. Results: Passive data illuminated a range of behaviors that varied across our participants. Women, during the average time window of 4am and 8pm, spent more than 80% of the day with their infants, were detected as ‘active’ 10-20% of the time in any given hour with peaks in the morning and mid-afternoon, and traveled fewer than 1675 meters from their homes. Household work, instrumental childcare, and household support, paired with the infant’s age, appeared to drive activity patterns. Women with higher amounts of activity and GPS movement had more household support for chores and childcare. Women with young infants had smaller amounts of activity and GPS movement. Women that had nearly no time away from their infant expressed overwhelming responsibilities and increased stress, but also role fulfillment in that time with their infant was an indicator of good mothering. Conclusion: We reveal typical behavioral patterns of rural adolescent mothers and highlight opportunities for integrating this information to improve health and well-being.