Osok Judith, Kigamwa Pius, Huang Keng-Yen, Grote Nancy, Kumar Manasi
Department of Psychiatry, School of Medicine College of Health Sciences, University of Nairobi, P. O. Box 20386-00100, Nairobi, Kenya.
Department of Psychiatry, School of Medicine College of Health Sciences, University of Nairobi, P. O. Box19676-00202, Nairobi, Kenya.
BMC Womens Health. 2018 Jun 15;18(1):96. doi: 10.1186/s12905-018-0581-5.
Adolescent pregnancies present a great public health burden in Kenya and Sub-Saharan Africa (UNFPA, Motherhood in Childhood: Facing the challenge of Adolescent Pregnancy, 2013). The disenfranchisement from public institutions and services is further compounded by cultural stigma and gender inequality creating emotional, psychosocial, health, and educational problems in the lives of vulnerable pregnant adolescents (Int J Adolesc Med Health 15(4):321-9, 2003; BMC Public Health 8:83, 2008). In this paper we have applied an engagement interview framework to examine interpersonal, practical, and cultural challenges faced by pregnant adolescents.
Using a qualitative study design, 12 pregnant adolescents (ages 15-19) visiting a health facility's antenatal services in Nairobi were interviewed. All recruited adolescents were pregnant for the first time and screened positive on the nine-item Patient Health Questionnaire (PHQ-9) with 16% of 176 participants interviewed in a descriptive survey in the same Kangemi primary health facility found to be severely depressed (Osok et al., Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi, BMC Psychiatry, 2018 18:136 https://doi.org/10.1186/s12888-018-1706-y). An engagement interview approach (Social Work 52(4):295-308, 2007) was applied to elicit various practical, psychological, interpersonal, and cultural barriers to life adjustment, service access, obtaining resources, and psychosocial support related to pregnancy. Grounded theory method was applied for qualitative data sifting and analysis (Strauss and Corbin, Basics of qualitative research, 1990).
Findings revealed that pregnant adolescents face four major areas of challenges, including depression, anxiety and stress around the pregnancy, denial of the pregnancy, lack of basic needs provisions and care, and restricted educational or livelihood opportunities for personal development post pregnancy. These challenges were related both to existing social and cultural values/norms on gender and traditional family structure, as well as to service structural barriers (including prenatal care, mental health care, newborn care, parenting support services). More importantly, dealing with these challenges has led to negative mental health consequences in adolescent pregnant girls, including feeling insecure about the future, feeling very defeated and sad to be pregnant, and feeling unsupported and disempowered in providing care for the baby.
Findings have implications for service planning, including developing more integrated mental health services for pregnant adolescents. Additionally, we felt a need for developing reproductive education and information dissemination strategies to improve community members' knowledge of pregnant adolescent mental health issues.
青少年怀孕给肯尼亚和撒哈拉以南非洲带来了巨大的公共卫生负担（联合国人口基金，《童年期为人母：应对青少年怀孕的挑战》，2013年）。公共机构和服务的剥夺权利状况因文化耻辱感和性别不平等而进一步加剧，给脆弱的怀孕青少年的生活带来了情感、心理、健康和教育问题（《国际青少年医学与健康杂志》15(4):321 - 9，2003年；《BMC公共卫生》8:83，2008年）。在本文中，我们应用了参与式访谈框架来研究怀孕青少年面临的人际、实际和文化挑战。
采用定性研究设计，对内罗毕一家医疗机构产前服务部门的12名怀孕青少年（年龄在15 - 19岁之间）进行了访谈。所有招募的青少年均为首次怀孕，在九项患者健康问卷（PHQ - 9）上筛查呈阳性，在同一家坎格米初级卫生机构进行的描述性调查中，176名参与者中有16%被发现患有严重抑郁症（奥索克等人，《肯尼亚怀孕青少年的抑郁症及其心理社会风险因素：内罗毕社区卫生中心的横断面研究》，《BMC精神病学》，2018年18:136 https://doi.org/10.1186/s12888 - 018 - 1706 - y）。采用参与式访谈方法（《社会工作》52(4):295 - 308，2007年）来引出与怀孕相关的生活调整、服务获取、资源获取和心理社会支持方面的各种实际、心理、人际和文化障碍。采用扎根理论方法进行定性数据筛选和分析（施特劳斯和科尔宾，《定性研究基础》，1990年）。
研究结果表明，怀孕青少年面临四个主要挑战领域，包括围绕怀孕的抑郁、焦虑和压力，对怀孕的否认，基本需求供应和护理的缺乏，以及怀孕后个人发展的教育或生计机会受限。这些挑战既与现有的关于性别和传统家庭结构的社会和文化价值观/规范有关，也与服务结构障碍（包括产前护理、心理健康护理、新生儿护理、育儿支持服务）有关。更重要的是，应对这些挑战给怀孕少女带来了负面心理健康后果，包括对未来感到不安全，对怀孕感到非常挫败和悲伤，以及在照顾婴儿方面感到无助和无力。
研究结果对服务规划具有启示意义，包括为怀孕青少年制定更综合的心理健康服务。此外，我们认为有必要制定生殖教育和信息传播策略，以提高社区成员对怀孕青少年心理健康问题的认识。
