Timing and quality of antenatal care for adolescent mothers attending maternal and child health clinics at two high volume health facilities in Nakawa Division Kampala District,Uganda

Abstract

Background: Maternal health services including antenatal care have been shown to improve reproductive health outcomes of pregnant adolescents. However, full utilisation of antenatal care (ANC) services among pregnant adolescents is still low in most countries including Uganda. Objectives: To determine the timing of the first antenatal visit and the associated factors that influence the timing of the first ANC visit among pregnant adolescents. The study also highlights the content of care and experiences of seeking antenatal care amongst these pregnant teenagers. Methods: This was a parallel convergent mixed methods study conducted over a period of six months within the antenatal care clinics of two health facilities in Nakawa Division, Kampala. Participants were sampled using systematic random sampling after meeting the eligibility criteria. Focus group discussions were also conducted with selected adolescent mothers within the antenatal clinics. Results: A total of 202 adolescent mothers were recruited into the study. Only about a third (35%) had the first visit to the ANC clinic in the recommended first three months of gestation. The major barriers to timely initiation of ANC were long distances to health facilities, lack of information about the importance of ANC and stigma around teenage pregnancies, while family support was identified as the major facilitator. Adolescents who were unemployed were more likely to initiate ANC earlier. Adolescents who revealed their pregnancy at a lower gestational age as well those staying with the husband/partner started ANC early. Conclusions and Recommendations: Timely initiation of ANC in the recommended first three months of gestation was low among pregnant adolescent mothers in this study. The major barriers were distance to the health facilities, lack of information about the importance of ANC and stigma around teenage pregnancies. Family support and good health worker attitudes were reported as the main facilitators of early ANC initiation. To improve early ANC attendance, adolescent care providers should encourage family members of pregnant adolescents to give the needed emotional and psychological support. Community sensitisation about importance of early ANC should also be integrated within adolescent friendly antenatal care services.