Achieng Anne, Ajayi Anthony Idowu, Kabiru Caroline W
SRMNCAH, African Population and Health Research Center, Nairobi, Kenya
SRMNCAH, African Population and Health Research Center, Nairobi, Kenya.
BMJ Open. 2025 Jun 5;15(6):e093696. doi: 10.1136/bmjopen-2024-093696.
Adolescent girls living in low-income urban informal settlements face unique challenges that elevate their susceptibility to early childbearing. However, there has been limited research attention, especially qualitative studies, on their use or non-use of antenatal care (ANC) services. Informed by the socioecological theory, we examined the obstacles to and facilitators of ANC services use among pregnant adolescent girls in a low-income urban informal settlement in Kenya.
The study adopted a qualitative explanatory design. We purposively selected 22 adolescent girls aged 13-19 who were either pregnant or had given birth, 10 parents and three health providers to participate in individual interviews. We employed inductive and deductive thematic analyses informed by socioecological theory to explain the barriers to enablers of antenatal services use among pregnant adolescent girls in low-income informal settlements.
Most adolescent girls interviewed faced barriers at multiple socioecological levels, resulting in delayed ANC initiation and fragmented engagement with services. At the intrapersonal level, girls grappled with internalised stigma and late pregnancy recognition and acceptance, often dismissing early signs due to fear or denial. Their young age and limited knowledge of maternal health left them terrified in fear, caught between societal judgement and the daunting prospect of confronting their condition. At the interpersonal level, societal stigma and discrimination pushed many into secrecy, hindering their access to antenatal services. However, parents, other family members, and health providers played a key role in enabling access to care by offering various forms of support to pregnant girls, including offering counselling and accompanying girls to clinics. At the organisational level, user fees and condescending health providers' attitudes hindered ANC use. Yet, good patient-provider communication, privacy and confidentiality played a key role in enabling ANC attendance.
Pregnant adolescent girls face unique challenges that prevent them from accessing ANC early and completing the recommended number of visits. These challenges range from intrapersonal factors to interpersonal and organisational factors. Programmes to improve early initiation of ANC for pregnant adolescents should include interventions that address the social stigma associated with early and unintended pregnancy, promote family support and make health facilities responsive to the needs of pregnant girls.
生活在城市低收入非正规住区的青春期女孩面临着独特的挑战，这增加了她们早孕的易感性。然而，对于她们使用或不使用产前保健（ANC）服务的情况，研究关注有限，尤其是定性研究。基于社会生态理论，我们研究了肯尼亚一个城市低收入非正规住区中怀孕青春期女孩使用ANC服务的障碍和促进因素。
本研究采用定性解释性设计。我们有目的地选择了22名年龄在13 - 19岁之间、已怀孕或已生育的青春期女孩、10名家长和3名医疗服务提供者参与个人访谈。我们采用基于社会生态理论的归纳和演绎主题分析，以解释低收入非正规住区中怀孕青春期女孩使用产前服务的促成因素的障碍。
大多数接受访谈的青春期女孩在多个社会生态层面都面临障碍，导致ANC开始时间延迟且与服务的接触不连贯。在个人层面，女孩们与内化的耻辱感以及怀孕的晚期认知和接受作斗争，常常因恐惧或否认而忽视早期迹象。她们年龄小且对孕产妇健康知识有限，在恐惧中感到害怕，处于社会评判和面对自身状况的令人生畏的前景之间。在人际层面，社会耻辱感和歧视使许多人选择保密，阻碍了她们获得产前服务。然而，家长、其他家庭成员和医疗服务提供者通过为怀孕女孩提供各种形式的支持，包括提供咨询和陪女孩去诊所，在促成获得护理方面发挥了关键作用。在组织层面上，用户费用和医疗服务提供者居高临下的态度阻碍了ANC的使用。然而，良好的医患沟通、隐私和保密性在促使女孩参加ANC方面发挥了关键作用。
怀孕的青春期女孩面临着独特的挑战，使她们无法尽早获得ANC并完成推荐的就诊次数。这些挑战从个人因素到人际和组织因素不等。旨在改善怀孕青少年早期开始接受ANC的项目应包括解决与早孕和意外怀孕相关的社会耻辱感、促进家庭支持以及使医疗机构响应怀孕女孩需求的干预措施。
