The objectives of this study are to describe maternal health-seeking practices of adolescent and adult mothers during pregnancy and childbirth and to determine the effects of maternal health-seeking practices on their pregnancy outcomes. This study used the secondary data from a cross sectional survey named Survey of Pregnancy, Birth and Early Life (SPBEL) which was conducted in Kanchanburi province, 2003. A total of 117 nulliparous adolescent mothers aged 15-19 and 193 nulliparous adult mothers aged 20-29 who have delivered singleton live births within two years were included in this study. Binary logistic regression was used to determine the effects of maternal health-seeking practices on pregnancy outcomes.
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Our study found that the adolescent pregnancy rate (15-19 years) in Kanchanaburi province was 13%. Regarding their background characteristics, adolescent mothers tended to complete similar education level like adult mothers. A higher proportion of adolescent mothers were unemployed in comparison with adult mothers in this study. Concerning with health-seeking practices, a high level utilization of antenatal care was found in both adolescent and adult mothers and most of them received four or more antenatal visits. However, delayed and less frequent antenatal visits among adolescent mothers were found compared with adult mothers. Delivery rate at health facilities was very high and the rate did not differ between adolescent and adult mothers. With respect to pregnancy outcomes, adolescent mothers were found to have a higher incidence of preterm and LBW deliveries. Overall, pregnancy outcomes of adolescent mothers were more adverse than adults.
Bivariate analysis showed maternal health-seeking practices had no significant effects on pregnancy outcomes of adolescent and adult mothers. Further adjustment of socio-demographic factors did not change the observed associations. On the other hand, we observed that age was a significant risk factor for adverse pregnancy outcomes. Nulliparous adolescent mothers had two times higher risk of adverse pregnancy outcomes than adults. In our study, we found the associations between pregnancy outcomes and their residence. The risk of adverse pregnancy outcomes for mothers from urban stratum was higher than that of mothers from rice fields, cash crops and upland strata after controlling age, health-seeking factors, level of education and employment status.
On the basis of our findings, some recommendations for policy implications and future studies are formulated in this section.
Recommendations for policy implication
High adolescent pregnancy rate calls for policy makers to give greater emphasis on sex education and promotion of contraceptive use among adolescents in schools as well as in the community. These interventions will help in delaying the initiation of sexual intercourse and improving use of birth control among adolescent women. Effective interventions to reduce either intended or unintended pregnancies among adolescents could improve adolescentsâ€™ maternal and child health.
Despite the overall high use of maternal health care, adolescent mothers were less likely to use maternal health services compared with adult mothers. It was suggested that physical and social barriers accessing maternal health care for adolescent mothers need to be addressed by the government to improve maternal health care utilization among adolescent mothers. It is also recommended to initiate teenage specific antenatal clinic with youth friendly manner which could provide multidisciplinary care by detecting and managing biological and social risk factors for pregnant adolescents.
Adolescent mothers were more likely to deliver preterm and LBW babies who are at higher risk of neonatal death. Moreover, neonatal morbidity among babies born to adolescent mothers was relatively higher than babies born to adult mothers. Provision of better antenatal and delivery care for pregnant adolescents could minimize the risk of adverse pregnancy outcomes. It is crucial to provide training for health providers to understand more about the higher risks of adolescent pregnancy to achieve better pregnancy outcomes. In addition, health providers should be encouraged to pay special attention to postnatal contraception for adolescent mothers to postpone next pregnancy until they are biologically, psychologically and financially able to care for another baby.
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5.2.2 Recommendations for future research
Further research is needed to elucidate the relationship between adolescent pregnancy outcomes and health-seeking practices. We suggest a prospective cohort study with a large sample size that includes information about potential risk factors of adverse pregnancy outcomes such as genital tract infection, pregnancy complications such as pregnancy induced hypertension and premature rupture of membrane, maternal malnutrition, anemia, and social problems faced by adolescent mothers to confidently conclude the effects of health-seeking practices on outcomes of adolescent pregnancy.
Access to quality antenatal and delivery care will also be needed to consider as one important factor to determine the effects of maternal health care on pregnancy outcomes. Hence, it is recommended to include quality of maternal health care as one confounding factor of pregnancy outcomes.
Our results provide a starting point to explore the reasons for relatively poor health-seeking practices of adolescent mothers. Qualitative study focusing on health-seeking behavior of adolescent mothers and social problems they encountered during pregnancy and delivery should be conducted for more in-depth understanding of adolescent pregnancy outcomes.
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