Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda

Abstract

Introduction Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12–19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. Methods This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. Findings This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. Conclusion The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.

Social accountability as a strategy to promote sexual and reproductive health entitlements for stigmatized issues and populations

“…Few studies on social accountability for SRHR assess the inclusiveness of the social accountability process or the extent to which the outcomes favor equity, though some programs have gender or age specific groupings in order to encourage participation among marginalized people [11][12][13]. One study that set out to examine explicitly the extent to which pregnant adolescents participated in a community scorecard project focused on maternal health, found that the while pregnant and recently pregnant adolescents reported stigmatizing and rude treatment by health providers, they were unlikely to participate in or benefit from the community scorecard project [14]. The meetings were inconveniently timed, the adolescents felt uncomfortable discussing their own pregnancy, and the priorities arising from community meetings did not include their particular challenges [14].…”

“…In addition to challenges in ensuring inclusion and equity in social accountability efforts generally, efforts regarding SRHR are shaped by the politicization, social mores, and stigma attached to SRHR in particular [13][14][15]. In the context of rising populism; a global, coordinated anti SRH movement; and the COVID-19 pandemic; stigmatization and hostility to SRHR is increasing in many contexts, contributing to a less enabling environment and extra challenges for civic engagement [16][17][18].…”

“…One study that set out to examine explicitly the extent to which pregnant adolescents participated in a community scorecard project focused on maternal health, found that the while pregnant and recently pregnant adolescents reported stigmatizing and rude treatment by health providers, they were unlikely to participate in or benefit from the community scorecard project [ 14 ]. The meetings were inconveniently timed, the adolescents felt uncomfortable discussing their own pregnancy, and the priorities arising from community meetings did not include their particular challenges [ 14 ]. On top of these concerns related to marginalized groups’ desire and ability to participate, there are also broader ethical concerns about expecting marginalized individuals to articulate their concerns in contexts where collective action among particular groups is unsafe and responsiveness by the state is unlikely [ 7 ].…”

Implementation of Maternal Services for Young Mothers: A Scoping Review

“…Although there are maternal health service facilities for adolescents, which are public facilities where services and commodities are supposed to be free, there is often a shortage of medicine stocks so that teenagers are expected to buy some medicines and birth supplies. For adolescent mothers, most of whom do not get the support of their husbands or parents, buying medicine and supplies for birth can be expensive and burdensome (Apolot et al, 2020). In Nepal, each pregnant woman receives 500 rupees (5 $) to give birth in a public health facility but this amount is not enough to cover the cost of an ambulance (Sarker et al, 2019).…”

“…The quality of health services for young mothers is assessed by the availability of service facilities and the skills of health workers in providing maternal services to young mothers. Limited visual and voice privacy during services, long waiting times, unreachable maternal health services, limited family planning services, and the lack of post-abortion care services make maternal health services uncomfortable, especially for unmarried adolescents and lead to exclusion health services (Apolot et al, 2020).…”