University of Global Health Equity, Kigali, Rwanda,!y.
University of Zimbabwe, Harare, Zimbabwe.
Reprod Fertil. 2024 Nov 7;5(4). doi: 10.1530/RAF-24-0008. Print 2024 Oct 1.
Unplanned pregnancies increased among adolescents in Zimbabwe, resulting in unsafe abortions, sexual and gender-based violence, and forced marriages. Access to Sexual and Reproductive Health and Rights (SRHR) has been scanty among pregnant adolescents and adolescent mothers owing to negative social norms, stigma and discrimination. This project specifically targeted pregnant adolescents and adolescent mothers through a differentiated and targeted care approach to improve uptake and sexual and reproductive health outcomes.
Target-specific peer support groups for pregnant adolescents and adolescent mothers were established in Epworth district of Zimbabwe. The Champions of Change, a peer-based approach, was used to facilitate comprehensive sexuality education. Mentors were adolescent mothers trained on how to use a tailor-made manual to facilitate sessions. Two health centers, namely Epworth Clinic and Overspill Clinic, were purposively selected to participate in this study. A total of 60 participants were recruited into this study, 30 from each clinic. Knowledge and attitude were measured using a semi-structured questionnaire administered before and after the intervention. A scorecard was used to assess friendliness and quality of service provision. A Chi-square test of association was used to determine the significance of the change in outcomes.
A significant improvement in knowledge of SRHR, attitudes, and healthcare-seeking behaviors was noted. There was a significant improvement in attitudes and friendliness in service provision. Access to services significantly increased with improvements in relationships and trust.
A targeted and differentiated care approach increases the uptake of services and health outcomes among adolescent women by addressing their unique needs and circumstances.
Adolescent pregnancy and motherhood have significantly risen in Zimbabwe with the advent of the COVID-19 pandemic. The condition of these adolescent women has been worsened by poor access to and utilization of sexual and reproductive health services by this unique group, resulting in poor sexual health outcomes. Pregnant adolescents and adolescent mothers are less likely to access sexual and reproductive health services due to heightened stigma and discrimination by peers, communities and service providers themselves. We adopted a peer-based approach to increase the agency of adolescent women and empower them through comprehensive sexuality education, engaging healthcare service providers, and improving parent-child communication. With our intervention, we noted a significant improvement in the proportion of pregnant adolescents and adolescent mothers accessing services and reporting improvement in relationships with parents and healthcare providers. We encourage health providers to consider providing targeted services to this group to improve uptake and health outcomes.
津巴布韦青少年的意外怀孕率上升，导致不安全堕胎、性暴力和性别暴力以及强迫婚姻。由于负面的社会规范、耻辱和歧视，怀孕青少年和未成年母亲获得性健康和生殖健康及权利（SRHR）的机会很少。该项目专门针对怀孕青少年和未成年母亲，通过差异化和针对性的护理方法，提高她们的接受度和性健康及生殖健康结果。
在津巴布韦的埃普沃思区为怀孕青少年和未成年母亲设立了特定目标的同伴支持小组。利用变革拥护者这一基于同伴的方法促进全面性教育。导师是接受过培训的未成年母亲，她们学会了如何使用定制手册来促进课程。选择埃普沃思诊所和溢出诊所这两个保健中心参与这项研究。这项研究共招募了 60 名参与者，每个诊所 30 名。在干预前后使用半结构式问卷测量知识和态度。使用评分卡评估友善度和服务提供质量。使用卡方检验评估结果变化的显著性。
注意到 SRHR 知识、态度和寻求保健行为显著改善。服务提供方面的态度和友善度有显著提高。随着关系和信任的改善，服务获取显著增加。
针对特定群体和差异化护理方法通过满足这一独特群体的独特需求和情况，提高了青少年妇女对服务的接受度和健康结果。
津巴布韦的青少年怀孕和母亲身份在 COVID-19 大流行期间显著上升。由于这一独特群体获取和利用性健康和生殖健康服务的机会较差，这些青少年妇女的状况进一步恶化，导致性健康结果不佳。由于同龄人、社区和服务提供者自身的高度耻辱感和歧视，怀孕青少年和未成年母亲不太可能获得性健康和生殖健康服务。我们采用了基于同伴的方法，通过全面性教育、让医疗服务提供者参与进来并改善亲子沟通，增强青少年妇女的权能。通过我们的干预，我们注意到怀孕青少年和未成年母亲获得服务的比例以及她们报告的与父母和医疗服务提供者关系改善的比例都有显著提高。我们鼓励卫生保健提供者考虑为这一群体提供有针对性的服务，以提高接受度和健康结果。
