Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France.
PLoS One. 2019 Sep 4;14(9):e0221789. doi: 10.1371/journal.pone.0221789. eCollection 2019.
Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies.
Thirty semi-structured indepth interviews were carried out among adolescents (aged 13-19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders.
The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors.
Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.
加纳阿克拉市的一个沿海贫民窟詹姆斯敦，是该国青少年怀孕率最高的地区之一。我们试图了解青少年怀孕的决定因素和相关经历。
对至少怀孕过一次的 30 名青少年（年龄在 13-19 岁之间）进行了半结构化深入访谈。其中一半是青少年母亲，另一半至少有过一次人工流产经历。还对青少年参与者使用和了解避孕措施的情况进行了预测试和验证的问卷调查。为了帮助社会背景化，还对 23 名有针对性选择的利益相关者进行了半结构化深入访谈。
决策的主要角色包括家庭、朋友、学校老师和伴侣，其中怀孕的青少年起着最突出的作用。青少年在决定是否堕胎或继续怀孕方面表现出高度的确定性。有趣的是，宗教因素很少被考虑在内。尽管几乎所有青少年（96.1%）都知道避孕措施，但在怀孕前都没有使用过。在有过堕胎经历的 15 名青少年中，有 13 名（87.0%）是在不安全的情况下进行的。获得安全堕胎服务的主要障碍包括对加纳堕胎法相当宽松性质的认识不足、耻辱感、高费用以及不安全堕胎服务费用的不统一、负面的堕胎经历（死亡和出血）以及对医疗保健提供者的不信任。选择继续怀孕的青少年是出于个人和社会文化因素的动机。
青少年怀孕的决策受到多种外部因素的影响，其中许多因素是可以改变的。尽管可以合法获得服务，但并没有选择安全终止妊娠或预防妊娠的主要选择，导致了大量负面的经历和结果。将安全堕胎护理纳入性健康和生殖健康服务包中，可以减少获得安全堕胎服务的障碍。鉴于詹姆斯敦的脆弱性，建议提供一套全面的性教育方案，解决主要的决策因素。旨在降低青少年怀孕率的干预措施也应该认识到，在某些情况下，在某些情况下，青少年怀孕在一些环境中是可以接受的，并且是青少年自己所期望的。
