Psychosocial health in adolescent unmarried motherhood in rural Uganda: Implications for community-based collaborative mental health education, and empowerment strategies in the prevention of depression and suicide

Abstract

Teenage pregnancy rates in Uganda are among the highest in sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and is recognised by Uganda's government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress, social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon among this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers’ feelings of depression, whereas mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated a willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage and, in a context of poor mental health service access, there is a substantial role for community mobilisation and the promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach.

Contingent universality: The epistemic politics of global mental health

“…Unmarried girls, they show, experience extreme stress, social exclusion and rejection by their families when becoming pregnant, and they suffer bereavement from school expulsion, the loss of career aspiration and from efforts to marry them off to avoid social stigma. Girls who became independent rather than being married off fared better psychologically, which led the researchers to pursue a values-based approach in collaboration with community stakeholders to promote independence strategies over marriage (Webb et al, 2023).…”

“…Co-produced and participatory mental health research thus often explores mechanisms of change beyond the medical model. In this issue, Lucy Webb and colleagues (2023), examine the psychosocial impact of unmarried motherhood on girls in Uganda using co-produced open space and ethnographic methods. Unmarried girls, they show, experience extreme stress, social exclusion and rejection by their families when becoming pregnant, and they suffer bereavement from school expulsion, the loss of career aspiration and from efforts to marry them off to avoid social stigma.…”

Effects of the Momentum project on postpartum family planning norms and behaviors among married and unmarried adolescent and young first-time mothers in Kinshasa: A quasi-experimental study

“…Teenage mothers and unmarried mothers are vulnerable groups whose reproductive health issues often stir up controversy. Unmarried mothers, particularly adolescents, may face social exclusion and rejection by their families, school expulsion, the loss of their career aspirations, and unique challenges accessing health care and support during and after pregnancy [ 19 , 20 ]. Unmarried mothers often experience difficult socioeconomic circumstances compared to married mothers [ 21 ] and may have a high risk for rapid repeat pregnancies due to insufficient knowledge of FP methods, perceived barriers to contraceptive use and an inability to negotiate sex, compounded by parental reluctance to take daughters who were unmarried mothers to FP clinics [ 22 ].…”

“…This study evaluated the effectiveness of Momentum, a Bill & Melinda Gates Foundationfunded project designed to increase postpartum family planning (PPFP) uptake, improve care seeking and maternal and newborn health (MNH) practices, and foster more gender-equitable behaviors and attitudes among first-time mothers (FTMs) and their male partners in Kinshasa, the capital city of DRC. We sought to determine whether the project's interventions had significant effects on PPFP-related norms and behaviors among ever married and never married FTMs age 15-24. We also examined whether the project's effects on PPFP-related outcomes were significant among both adolescent girls (age [15][16][17][18][19] and young adult women (age [20][21][22][23][24]. Previous analyses of the same data set demonstrated the effect of Momentum on increased PPFP-related knowledge, perceived norms, personal agency, partner discussion, and modern contraceptive use [18].…”