Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
Int J Equity Health. 2020 Nov 2;19(1):191. doi: 10.1186/s12939-020-01267-4.
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.
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.
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.
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.
乌干达约有 34.8%的人口是青少年。全国青少年怀孕率为 25%，在基布库区，17.6%的 12-19 岁青少年已经开始生育。青少年母亲面临许多产妇健康挑战，包括：耻辱、不友好的服务和早婚。社区记分卡（CSC）是一种社会问责工具，可用于指出社区在服务提供和利用方面面临的挑战，并最终解决这些挑战。在本文中，我们旨在记录青少年在怀孕、分娩和产后期间面临的挑战，以及社区记分卡在多大程度上可以解决这些挑战。
本定性研究于 2018 年 8 月，采用深入访谈的方法，在基布库区六个实施社区记分卡干预的分区，选取了 15 名 2 年前分娩且参加过社区记分卡会议的青少年妇女。研究助理将录音访谈逐字转录，使用框架分析方法进行手动数据分析。
本研究发现青少年在怀孕期间面临的五大产妇健康挑战，包括：心理社会挑战、身体虐待、基本人权被剥夺、不友好的青少年服务、缺乏法律和文化保护以及缺乏生育准备。社区记分卡解决了整个社区的一般产妇和新生儿健康问题，而不是具体的与青少年健康相关的产妇健康挑战。
基布库的青少年面临的产妇健康挑战具有文化、法律、社会和卫生服务层面。因此，需要采取多方面的方法来全面解决这些问题。针对整个社区的社区记分卡不太可能解决弱势群体（如青少年）的特定需求。为了解决青少年的产妇健康挑战，需要与青少年举行单独的会议，有针对性地动员青少年参加会议，并将他们的产妇健康挑战纳入社区记分卡。
