Maternal healthcare coverage for first pregnancies in adolescent girls: a systematic comparison with adult mothers in household surveys across 105 countries, 2000–2019

Abstract

BackgroundEffective maternal service delivery for adolescent mothers is essential in achieving the targets for maternal mortality under the Sustainable Development Goals. Yet little is known about levels of maternal service coverage in adolescents compared with adult mothers.MethodWe used data from 283 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 105 countries between 2000 and 2019 to estimate the levels and trends of inequality in coverage of five maternal health services between adolescent girls (aged 15–19) and adult mothers (aged 20–34), including receiving four or more antenatal care visits, delivering with skilled birth attendants and receiving a postnatal check-up within 24 hours of delivery.ResultsWe analysed data from 0.9 million adolescent girls and 2.4 million adult mothers. Using the most recent data, we found adolescent girls had poorer coverage across all indicators, with receipt of four or more antenatal care visits 6.5 (95% CI 6.3 to 6.7) percentage points lower than adult mothers, delivery with skilled birth attendants 3.6 (95% CI 3.4 to 3.8) lower and having a postnatal check-up within 24 hours of delivery 3.2 (95% CI 2.8 to 3.6) lower. The coverage was 54.2% (95% CI 53.9 to 54.5) among adolescents for four or more antenatal care visits, 69.7% (95% CI 69.4 to 70.0) for delivery with skilled birth attendants and only 30.0% (95% CI 29.3 to 30.7) for receiving a postnatal check-up within 24 hours of delivery. Country-specific coverage of the maternal services increased over time in most countries, but age-related differences persisted and even worsened in some, particularly in the Western Pacific (eg, Vietnam, Lao, Cambodia and Philippines).ConclusionEven though their pregnancies are of higher risk, adolescent girls continue to lag behind adult mothers in maternal service coverage, suggesting a need for age-appropriate strategies to engage adolescents in maternal care.

Mães adolescentes, autocuidado e cuidado infantil: validação de conteúdo de um calendário histórico de eventos

“…Tais aspectos voltam-se para a importância do contexto de mães adolescentes, para a compreensão de circunstâncias e do enfrentamento de barreiras e para a construção do autocuidado seguro e dos cuidados protetores com a saúde da criança (1,6) . Nesse âmbito, o fenômeno da maternidade na adolescência requer um cuidado de enfermagem singular para mães adolescentes, alicerçado na prática solidária, sem julgamentos, com compreensão de seu contexto de vida e de suas necessidades (10) e de construção da autonomia (6)(7)(8)(9)(10)(11) . Na atenção à saúde de adolescentes, de modo geral, a abordagem do EHC tem potencial para apoiar a comunicação entre enfermeiras/os e adolescentes (1,15) .…”

“…Em termos da atenção efetiva à saúde das mães adolescentes, são apontados como essenciais o alcance de metas de mortalidade materna e a melhoria na cobertura dos serviços de saúde, atentando para desigualdades e vulnerabilidades entre mães adolescentes (15 a 19 anos) e adultas (20 e 34 anos) no pré-natal, nascimento e puerpério (8) . Os conhecimentos e a proximidade com o cenário de vida de mães adolescentes permitem que os profissionais de saúde ofereçam mais suporte na prestação de cuidados (6,(9)(10)(11)(12) .…”

Adolescent mothers, self-care and childcare: content validation of an Event History Calendar

“…Such aspects focus on the importance of the context of adolescent mothers, for the understanding of circumstances and facing barriers, and for the construction of safe self-care and protective care with the child's health (1,6) . In this context, the phenomenon of maternity in adolescence requires a unique nursing care for adolescent mothers, grounded in supportive practice, without judgments, with understanding of their life context and needs (10) and the construction of autonomy (6)(7)(8)(9)(10)(11) .…”

“…In terms of effective care to health of adolescent mothers, the achievement of maternal mortality goals and the improvement in the coverage of health services are pointed out as essential, paying attention to inequalities and vulnerabilities between adolescent (15-19 years old) and adult (20-34 years old) mothers in prenatal care, birth, and puerperium (8) . The knowledge and proximity to the life settings of adolescent mothers allow health professionals to offer more support in the provision of care (6,(9)(10)(11)(12) .…”

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

“…Globally, adolescents have significantly lower coverage of PNC as compared with their older counterparts. 10 While research has explored trends related to adolescent pregnancy, 11 12 its drivers, 9 12 complications, 13–15 prevention, 16 use of antenatal care (ANC), 17 and responses to complications in the postnatal period, 18 evidence is limited on the factors related to accessibility and use of postnatal care (PNC) services following pregnancies among adolescents. Additionally, while structural determinants are explored in designing policies and programmes to reduce the number of unintended pregnancies, 17 less is known around addressing barriers in the access to and use of PNC by adolescent girls, particularly regarding the design and implementation of appropriate, acceptable and adolescent-centred care.…”