Maternal health care-seeking behaviour of married adolescent girls: A prospective qualitative study in Banke District, Nepal

Abstract

Background Nepal has one of the highest rates of maternal mortality in the South Asia region, partly due to the underutilization of maternal health services and the high number of adolescent pregnancies. This study explores married Nepali adolescent girls’ healthcare-seeking behaviour throughout their pregnancies, during their delivery and postpartum. Methods We conducted a prospective qualitative study in Banke district, Nepal. In-depth interviews were conducted with 27 married adolescent girls before and after delivery. In addition, a focus group discussion was conducted with community health works and key-informant interviews were conducted with family members of adolescent girls, representatives from the government and health care providers. We applied the Social-Ecological Model (SEM) as a framework to guide thematic content analysis and presentation of our qualitative data. Results Several factors in the SEM influenced maternal health care-seeking behaviour of adolescents. At the individual level, girls’ perceptions, their lack of knowledge about maternal and reproductive health, certain traditional practices, their sole dependency on their husbands and mothers-in-laws and their low decision-making autonomy towards their own health care negatively influenced their utilization of skilled maternal health services. Mothers-in-law and other family members played a critical role in either encouraging or discouraging the use of skilled maternal health services. At the health systems level, lack of adolescent-friendly maternal health services, difficulties in accessing quality maternal health services, and the fixed operating hours of public health facilities restricted their ability to obtain services. The existence of the Safe Motherhood Programme, knowledge sharing platforms such as “women’s groups” and the active role of Female Community Health Volunteers (FCHVs) positively influenced utilization of skilled maternal health services among these girls. Conclusion Influences on married adolescent girls’ use of skilled maternal health services in Banke District, Nepal were multi-factoral. Ensuring easy access and availability of adolescent-friendly maternal health services are important to encourage adolescent girls to use skilled maternal health services. Moreover, interventions are needed to improve adolescent girls’ knowledge of maternal health, keep them in school, involve family members (mainly mothers-in-law) in health interventions, as well as overcome negative traditional beliefs within the community that discourage care-seeking for skilled maternal health services.

Maternal Health Care Seeking Behavior of Nepalese Woman: A Perspective of Socio Ecological Model

“…At the policy level, researcher found the government's initiative program and quality of care in uenced maternal health-seeking behavior. This nding is similar to (Shahabuddin et al, 2019), quality of health services in health post, positive attitudes of health care providers, and initiative of government program directly in uenced maternal health-seeking behavior of adolescent girls. In our research, some mother sought that Safe Motherhood Program (SMF) provides cash and clothes initiatives for the use of maternal health care services including ANC and PNC check-up, and an institutional delivery.…”

“…Since this research follows phenomenological study, data were thematically analyzed using content analysis through the application of Socio-Ecological Model (SEM) approach (Shahabuddin et al, 2019). The SEM approach was applied as an analytical framework to develop an initial coding guide during data analysis.…”

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

“…We found most mothers enrolled in this study upheld traditional gender roles and were responsible for most of the instrumental and emotional child rearing tasks as well as most of the housework. This was not unexpected, given what we know about the cultural expectations for women in Nepal [12,13,15]. We found that mothers detected activity levels were in uenced by their child's age and the amount of childcare and household support they receive from family and friends.…”

“…Nepal has the second highest rate of adolescent pregnancy in South Asia [9], with approximately 40 percent of women becoming mothers before the age of 20 [10]. Childbirth is an important life event for Nepali women, ful lling a seminal social role and providing upward social mobility [11][12][13]. Generally, Nepali culture follows a patrilocal tradition where, upon marriage, women leave their maternal household (maiti) and become a permanent member of her husband's parents household [14].…”

A Mobile Phone-based Multimedia Application Could Improve Maternal Health in Rural Southwestern Uganda: Mixed Methods Study

“…Watching friendly faces in the videos was preferred to the often unfriendly physical faces that pregnant women encounter from the overworked health care providers. Lack of friendly maternal health services have previously been cited as a major barrier to adoption of maternal healthcare seeking behavior in low resource settings [31]. Providing tailored information could potentially increase women's knowledge, understanding, and engagement while at the same time creating a sense of empowerment to cope with pregnancy, which can prevent adverse maternal and child health outcomes [32].…”