FACTORS INFLUENCING THE LOW TURNOUT OF TEENAGE MOTHERS AT ANTENATAL CLINIC (Research done in June 2007 by Oumie Jatta)

DECLARATION

This dissertation has been submitted in partial fulfillment of the requirement for the award of Higher National Diploma in Public and Environmental Health. This research was done at Bakau Health Center in The Gambia. The examiners, however, can neither be held responsible for the views expressed here, nor the factual accuracy of the contents of this thesis.

EXECUTIVE SUMMARY

Found in Kombo Saint Mary of the Western Region, Bakau is a town with a total land of about 1600 sq.km. It has a demography of 461117 and a growth rate of 130/person/sq.km. It has various tribes within, but Mandingos form the majority. In terms of Religion, there are both Muslims and Christians with the Muslims forming the larger percentage.

The study was aimed at determining the factors influencing the low turnout of teenage mothers at antenatal clinic, and to make recommendations that will help strengthen the antenatal services, as well as promote it in Bakau after the research.

Cross-sectional study was used to conduct this study. The following methods were used to interview the respondents:

  • Interview
  • Records review

With regards to the results, 80% of the teenage respondents waited for more than an hour during antenatal clinics. 45% fall under the work type of others in which seventeen were found out to be students and only one was an unemployed teenager. 98% was influenced by bad socio-cultural beliefs. 58% of the respondents were affected by lack of privacy during interviews. The study concluded that Occupation, Poor Administration and Bad socio-cultural beliefs were the main influencing factors on the low turnout of teenage mothers.

ACRONYMS

AIDS           Acquired Immunodeficiency Syndrome

BP                Blood Pressure

BSc.             Bachelor of Science

CAN            Community Nurse Attendant

DoSH          Department of State for Health

FP                Family Planning

HB               Hemoglobin

HEU             Health Education Unit

HIV              Human Immunodeficiency Virus

KMC            Kanifing Municipal Council

MCH            Maternal and Child Health

NACP           National AIDS Control Program

PHC              Primary Health Care

RCH              Reproductive and Child Health

SEN              State Enrolled Nurse

SEN/M          State Enrolled Nurse Midwife

SRN               State Registered Nurse

SRN/M          State Registered Nurse Midwife

TT                  Tetanus Toxoid

UN                 United Nations

WHO             World Health Organization

 

BACKGROUND INFORMATION

History

The Gambia was colonized by Britain in 1615 and gained her independence on 18th February 1965. She became a Republic in 1970. The country experienced a major political upheaval in 1981 foiled coup attempt. However, in July 1994, there was a military coup in which Yahya Jammeh became the President. It is known as “the Smiling Coast of West Africa”. (A. Jatta 2001)

Location

The Gambia is in West Africa, enclosed on the north, east and south by Senegal and in the west by the Atlantic Ocean. It is situated on latitude 13 degrees north, longitude 16 degrees west.

Climate

The Gambia has a Sahelian climate typified by a long dry season (November- May) and a rainy season (June-October). The rainfall tends to be irregular with recurrent drought, but in 1999-2000, the country experienced substantial rainfall that caused havoc in some parts of the country. The average rainfall is about 1020 mm. Temperature ranges from 16 degrees Celsius in the Harmattan season to 45 degrees Celsius in the hot wet season.

Demography & Vital Statistics

The Gambia is demarcated into five regions and two administrative areas: KMC and Banjul, headed by respective headquarters; the Kombo St. Mary (Kanifing), Western Region (Brikama), Lower River Region (Mansakonko), North Bank Region (Kerewan), Central River Region (Janjanbureh) and Upper River Region (Basse). “The country has a land area of 11, 295 sq.kin. Different ethnic groups live side-by-side with each other, preserving individual languages and traditions. These include the Mandinka (45%), the Fula (18%), the Wolof (16%), the Jola (10%) and others. The provincial population and housing census indicated that the population of The Gambia is 1.5 million (UN, 2004)”. Women constitute 51% of the total population.

Economy

About 82% of the working population of The Gambia is engaged in agriculture. Rice and millet, as well as cattle, sheep, goat and poultry are raised for local consumption. Peanuts are grown primarily for export. The coastal villagers are mostly engaged in fishing. Other sections of the community include tourism; re-export trade and small-scale industries.

Literacy Rate

The literacy level rate in The Gambia is 40%. It is higher among males (55%) than females (25%). Females who are 10-years-old and above have literacy rate of 35%, while males have 71%. The current basic cycle education enrollment rate is 70%, of which young school girls represent 44.2%.

Education

The Gambia’s formal education sectors consist of six years Lower Basic education, three years Upper Basic education and three years Senior Secondary education. The country’s higher institutions of learning include the University of The Gambia, the Gambia College, Gambia Technical Training Institute, Management Development Institute, Gambia Technical Multimedia Institute and other training schools. The informal education system includes the ‘Daras’ and Madarasas. It also includes informal literacy classes in communities where mostly women are trained on different economic activities, like tie and die, batik, soap-making, etc.

Health & Government Services Profile

The Secretary of State for Health and Social Welfare is at the top of the political hierarchy of the medical and health department and the Permanent Secretary is the administrative head. The Permanent Secretary is assisted by the Director of Health Services, who serves as the government’s technical adviser on matters relating to health. The health department has several specialized units, of which NACP is one among the whole caboodle. The Gambia has a demographic system of government, headed by a Head of State who is democratically-elected by the electorate. There are Secretaries of State and Members of the National Assembly who have the executive and legislative powers under their jurisdiction. There are five administrative divisions, all headed by a Governor, except Banjul City Council and KMC, which are headed by Mayors. In each division, there are districts that comprise towns and villages. Chiefs and Alkalolu head the districts and villages, respectively.

Profile of Study Area

Location

Bakau is a town located on the Western Region of The Gambia in the Kombo Saint Mary’s Region. It has a total land area of about 1600 sq.km.

Demography

According to the provisional, the town has a population of 461117 and a population density of 130 person/sq.km.

Ethnicity and Religion

Mandingos form the majority, but there are other tribes within, and Wolof is being spoken more frequently. The Muslims have the greater percentage, but however, Bakau also has Christians living within.

Health Services

Health services delivery in Bakau is overseen by the Western Region, Divisional Health Team (DHT — Western). The team comprises of a Divisional Health Officer (DHO), a Divisional Public Health Nurse (DPHN) and a Divisional Pharmacist. The team is responsible for the coordination of health activities in the Region, including training the supervision of health personnel (DHT Western, 2003).

Catchment’s Area

Bakau has various catchments’ areas amongst which are Bakau New Town, Fajara, Cape Point, South Atlantic, Sanchaba, Mamakoto, Farokono, Mile Seven, Katchically, Pipeline, Kanifmg and Old Jeshwang. Kotu and Latrikunda German are being shared with Serekunda Health Centre. Bakau proper is divided into various “Kabilos” as well, and they all fall under Bakau Health Center.

PROBLEM STATEMENT

For teenage mothers to turn up for antenatal services they should be well informed about its benefits and how it will positively impact on their children’s health. After awareness has been achieved, effective use of the services can then be attained.

When administering medications during antenatal services, thorough explanation of the side-effects of the drugs should be given to the patients. For certainty, some drugs cause itching, dizziness, vomiting or spontaneous abortions. If this is not explained prior to taking the drugs, it can cause the uninformed teenage mother to lose faith in the services, thereby leading to low turnout of patients at clinics.

If the health facility is far from the teenage mother’s residence, she finds it difficult to get to the antenatal services. If the place is somehow hidden, it makes it hard for teenage mothers to have a great turnout as expected. Also, poor roads make accessibility virtually impossible, especially during the rainy season. When a teenage mother is having physical, emotional or psychological disability, it is up to the immediate family to help bring her to get all the required attention she needs from the services.

Occupation has an influence on the turnout of teenage mothers at antenatal services. If a teenage mother has a paid-up job with long working hours, she sometimes gives more priority to the job than attending antenatal services. Poor administration leads to low turnout at antenatal services as well. If teenage mothers are not given proper counseling, or if they lack the confidence in staff members, they do not relate very well with them, thus, leading to low turn out. If the health facility is understaffed, it slows down the work, which eventually leads to long waiting hours. This in turn discourages teenage mothers from attending antenatal services.

Bad socio-cultural beliefs also contribute to the low turnout of antenatal mothers. Some teenage mothers get shy to show up at public clinics during their first pregnancies. Some taboos, like “a mother should not let anyone know about her status during the first few weeks or even months”, also have a negative impact on teenagers’ turnout. If a girl gets pregnant out of wedlock, she feels embarrassed to attend public clinics.

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JUSTIFICATION

Antenatal services are very important to both the mother and growing fetus. Since teenage mothers are more likely to disregard these services, it is crucial that they are fully involved in the program to make sure that they do not miss out on it. Low turnout of teenagers at antenatal services is beginning to be a plaguing problem at Bakau health center and in the community.

Though diligent health talks are frequently given during base clinics, more information must be put across to teenage mothers to arrest to the problem of low turnout at antenatal services. This makes it necessary for a research to be carried out on this issue to investigate in detail the factors influencing the low turnout and how to effectively solve the problem.

Since lack of awareness about the services is the key influencing factor, positive impact is sure to be achieved if teenage mothers get an improved sensitization about the importance of it and the benefits that they can get from it. In setting awareness, important information could also be given on HIV/AIDS which is of great importance to the teenage mother. Family planning (FP) measures could also be put across to the young teenager whilst making her aware of the services.

During antenatal clinics, teenage mothers have the opportunity of being sensitized about how to interpret the various signs of complications and “at risk” conditions like anemia. They are guided on the types of food they should eat, (that is, green leafy vegetables, meat and fish), so that they will have enough iron to prevent anemia.

Though the information provided is needed by mothers of all ages, the findings will go a long way in focusing more on teenage mothers and making them have sensitizations about the services and how much their growing fetus needs it. They can be advised thereafter not to skip any stage of the antenatal services.

LIMITATIONS OF THE STUDY

Due to lack of resources as a limitation of the study, the author (Oumie Jatta) acknowledges the use of small sample size. The author also realized language barrier during the personal interviews and translators were employed. Therefore, any person who wants to generalize the findings obtained herein is cautioned by the author to interpret the results with care.

LITERATURE REVIEW

Introduction

For there to be effective use of antenatal services, consumer advocates and service providers need to be very committed to delivering quality care to reduce maternal and perinatal morbidity and mortality. The soon to-be teenage mothers need to be encouraged to seek and demand quality health care services. They should be told the harmful effects of defaulting from the services. Not only would their fetus be put at risk if they fail to acquire the services, but they will also face some difficulties. It is a joint responsibility, therefore, of the service providers and teenage mothers to keep a track record of the care they receive.

History of Antenatal Services

The first antenatal clinic was opened in 1915 by Doctor Ferguson in Edinburgh and was later supervised by Ballantyne who also opened the first antenatal bed for inpatients. Until then, most women had no routine antenatal care from midwives or doctors during pregnancy and were rarely seen by one of these professionals until they were into labor (Mayes’ Midwifery, 2002). By that time, there were often complications, which could have responded to early diagnoses and treatment if it had been available and so improved the outcome for both mother and baby (Mayes’ Midwifery, 2002). Now, most women are seeking regular antenatal care and accept that it is important for their own health and that of their baby. Unfortunately, those who are least likely to attend an antenatal clinic tend to be those who are at risk of developing complications, for example, women from the lower socio-economic classes, young teenagers and women of high party (Fatty, 2005).

Aims of Antenatal Care

  • To inform women about all aspects of care and to make them realize how important it is to be in control of their own health and that of their baby.
  • To promote psychological, emotional and social well-being in pregnancy by providing appropriate support.
  • To promote the maintenance, and where necessary, the improvement of health in pregnancy by giving health talks and education.
  • Regular monitoring of maternal and fetal conditions in pregnancy to ensure detection of any abnormality and providing appropriate management in time.
  • Preparation for labor and a safe, normal, delivery that is a pleasurable and fulfilling experience for both the mother and her partner.
  • The provision of education on parenthood.
  • Preparation on successful breastfeeding and its importance.

What Is Antenatal Care

This is the health care given to both the expecting mother and the baby from the time of conception till the time of delivery. Systematic and comprehensive care, given throughout the course of the pregnancy, keeping in mind the well-being of both the mother and the growing fetus.

Importance of Antenatal Care to Pregnant Teenagers

Pregnancy imposes additional demands for iron and other nutrients. Iron and Folic acid are for the prevention and treatment of anemia during pregnancy. The expecting mother requires approximately 500 mg of iron spread over 40 weeks of pregnancy while the fetus requires 300 mg and the placenta 25 mg. If extra iron is not given, the maternal iron stores will be depleted, and anemia may result. Anemia commonly accompanies frequent, closely spaced pregnancies because the iron stores have no time to recover. Diseases like malaria and hookworms also use up iron stores and so contribute to anemia.

If the pregnant teenager is frequent at antenatal services, she will have the advantage of being guided on the type of foods to eat to have sufficient iron at all times. Iron is found in green leafy vegetables, meat and fish. A good diet can therefore help prevent anemia. In the case that anemia is already established in a pregnant teenager, antenatal care services will help make early recognition possible, and malaria and hookworm could be treated if present in the teenage mother’s system.

If an expecting teenage mother is put under good nutrition, she will have the advantage of being physically fit and prepared and low birth weight babies would be fewer. A well-fed pregnant mother with a good balance diet throughout her pregnancy will expect to gain about 14 kg weight whilst an underfed pregnant mother would gain a much lower weight of only 6 kg.

Vitamins are important during pregnancy. Severe vitamin deficiency can cause night blindness. If the intake of riboflavin is less than the recommended requirement, this can cause cracking of the lip and sore mouth. During antenatal clinics, pregnant teenagers are advised not to fast, and they are also told the main dangers of doing so.

There are two main dangers:

  • Lack of food, giving rise to a low blood sugar level.
  • Lack of water, causing dehydration.

Low blood sugar levels are potentially harmful to the unborn baby because its main food is sugar, which the baby extracts from the mother’s blood. Lack of water leading to dehydration is another potential threat, but surprisingly, few ill effects were detected. The mothers seemed to have a number of adaptations to water depletion during the day which protected them from some of the potentially harmful effects.

At antenatal care services, vaccination of the mother is done to prevent maternal and neonatal tetanus on the child. If the mother is given three doses of TT at monthly intervals during the second half of pregnancy, antibodies will be produced which will pass through the placenta and into the blood of the unborn child. As a consequence of this, the child will be protected from neonatal tetanus. Tetanus toxoid is available at R.C.H clinics and vaccination coverage of pregnant women with at least one dose of vaccine is presently very high, although smaller numbers received all three vaccines. Drug prophylaxis for malaria could be administered through the PHC and MCH systems. Prophylaxis for all pregnant women should be provided, though it is expensive. Iron and Folate prophylaxis should be provided to prevent anemia during pregnancy. Antenatal services provide health education for all pregnant teenagers which play a vital role in protecting them from conditions which arise because of pregnancy. Screening is done at antenatal clinics and it is another form of secondary prevention for “at risk” mothers.

Maternal Health Issues

Both the pregnant mother and her unborn child need care throughout pregnancy so as to have a safe and normal delivery. In so doing, diseases, defects, or potential hazards can easily be detected during tests on the woman and fetus. The woman can also be advised on issues like diet, immunization, exercise, and so on.

Many women do not have access to good health services during pregnancy and childbirth. For good quality services to be provided to pregnant women, health care providers need to be well trained and sensitized about their needs and make sure that facilities have all the necessary equipment. Most women of reproductive age in developing countries die because of complications in pregnancy and childbirth. Almost 8000,000 stillbirths and early neonatal deaths occur each year. Women’s poor health during pregnancy, inadequate care during delivery and lack of newborn care mostly cause these deaths. At least 40% of women experience complications during pregnancy, childbirth and the period after delivery. An estimated 15% of these women develop potentially life-threatening problems. Long-term complications can include chronic pain, impaired mobility, damage to the reproductive system & infertility (http://www.safemotherhood.org/facts).

Visits to the Antenatal Clinic

During the first visit to the clinic, the woman is screened to detect any abnormalities in her or the baby. If everything is normal with both, the woman visits the clinic monthly until the 28th week and then every two weeks until the 36th week. From the 37th week to the 40th week (that is the delivery week for most women, which is from the mother’s first day of menstrual period to the last), the woman goes on a weekly clinic visit.

Weighing of Pregnant Women

The weight gain of pregnant women is associated with fetal growth and can help predict possible delivery complications and birth weight. Birth weight is a predictor of child survival and is useful for classifying newborns into risk categories. Those falling under the specific cut-off point (that is, 2.0 kg-2.5 kg), can receive special care or be referred to higher level health services.

The birth weight of an infant is the single most important determinant of newborn survival and low birth weight contributes to the estimated 9.1 million infant deaths which occur each year. Low birth weight is defined by WHO for international comparisons as “less than 2.5 kg, that is, up to and including 2.5 kg”. Low birth weight is more common in developing than developed countries and significantly contributes to both neonatal and post neonatal mortality in those settings. In 1990, the estimated number of live births and low birth weight infants were 40,000 respectively.

GENERAL OBJECTIVES

To determine the factors influencing the low turnout of teenage mothers and to make recommendations that will help strengthen the antenatal services, as well as promote it in Bakau after the research.

SPECIFIC OBJECTIVES

  • To determine the health seeking behavior of teenage mothers in Bakau.
  • To measure the level of awareness of expecting teenage mothers.
  • To determine the access to the health facility by the pregnant teenagers.
  • To determine the occupational schedules on pregnant teenagers’ turnout at the services.
  • To identify the poor administration methods used by the healthcare staffs.
  • To identify the bad socio-cultural beliefs of teenage mothers.
  • To make recommendations that will help strengthen the antenatal services, as well as promote it in Bakau after the Research.

 

METHODOLOGY

STUDY DESIGN

Cross-sectional study design was used to conduct this study. The reason being that it is less expensive, quick and suitable; furthermore, all measurements are made on a single occasion.

VARIABLES

The factors (those phrased in the negative form) influencing the low turnout of pregnant teenagers have been rephrased to the positive form representing the variables for the study. Each objective has been provided with a set of variables and each variable with a set of operational defamation of indicators from which the questions for the study were drawn and the scale of measurement for each indicator was given.

DEPENDENT VARIABLES

Turn out of teenage mothers at antenatal clinic.

INDEPENDENT VARIABLES

  • OCCUPATION
  • AWARENESS
  • ACCESSIBILITY
  • GOOD SOCIO-CULTURAL BELIEFS
  • GOOD ADMINISTRATION
  • POSITIVE/GOOD EFFECTS OF DRUGS
  • AFFLUENCE

 

DATA COLLECTION TECHNIQUE

In this research, the Data Collection Technique used was observation of antenatal staff personnel, and review of records. Teenage mothers were also interviewed during antenatal clinics. Questionnaires were administered to both antenatal teenage mothers and health personnel at Bakau Health Centre. In order to have clear and correct data collected, the questions were translated in the language understood by all interviewed teenage mothers. Records are mostly kept for reference, but some health personnel made careless records for generation of information. Contrastingly at Bakau Health Centre, I came across authentic records which helped me a lot in the research.

SAMPLING

Simple Random Sampling was used in this study to select the respondents (teenage mothers). After going through the antenatal records and picking out sixty names, forty teenage names were indiscriminately selected by a kid from a box with their names rolled up in small sheets of paper. The individuals were then used in conducting the research.

INTERVIEW

The pregnant teenagers were interviewed using structured and unstructured questionnaires. I (being the researcher) carried out the interview and in so doing, the teenage mothers’ knowledge about the antenatal services was found out. This helped a lot in knowing why the turnout of teenage mothers was low at antenatal services in Bakau Health Center.

RECORDS REVIEW

The records were reviewed to gather information on pregnant teenagers and to find out how they make use of antenatal services at Bakau Health Center. The RCH unit was visited for this purpose and valuable information was gained on how expecting teenage mothers are attended to. There was a good record keeping system and a lot of genuine information was obtained from the records.

Amongst these records were:

  • Antenatal cards — in antenatal care, the patient’s medical history is very important. In knowing the accurate history, the health personnel will be alerted whenever the pregnant teenager develops problems that may cause complications during pregnancy or labor.
  • Tally sheets — these are used to record the statistics and registers made by the staff. If these records are well kept, the antenatal services will be carried out faster and more accurately.

ETHICAL CONSIDERATIONS

Prior to interviewing the teenage mothers, permission was first sought and after obtaining their consent, the interrogation was then carried out.

Factors Rephrased as Variables

 

Factors as Present in The Analysis Diagram

 

 

Variables

1.      Lack of awareness

·         Stigmatization

·         Lack of general knowledge about services

·         Not well informed about the benefits of antenatal services

1·         Awareness

·         Acceptance

·         General knowledge about the services

·         Well informed about the benefits of antenatal services

2.      Occupation

·         Paid jobs

·         Time constraints

·         Mothers with long working hours

2.      Occupation

·         Disengaged

·         Time availability

·         Mothers with short working hours

3.      Adverse effects of drugs after injection and use 3.      Positive/good effects of drugs
4.      Inaccessibility

·         No mapping/direction

·         Disability

·         Poor roads

·         Transportation problems

·         Distance

4.      Accessibility

·         Proper mapping/direction

·         Able-bodied

·         Good roads

·         Transportation availability

·         Distance covered

5.      Poor administration

·         Drug shortage

·         Harassment

·         Staff coming late

·         Poor counseling

·         Lack of confidentiality

·         Under-staffing

–          Long waiting hours

–          Delay in treatment

5.      Good administration

·         Drug availability

·         Satisfaction

·         Staff coming on time

·         Proper counseling

·         Confidentiality

·         Sufficient staff

–          Short waiting hours

–          Hastening in treatment

6.      Bad socio-cultural beliefs

·         Shyness in admitting being pregnant

·         Pregnant out of wedlock

·         Taboos

·         Unplanned pregnancy

6.      Good socio-cultural beliefs

·         Boldness in admitting being pregnant

·         Pregnant in marriage

·         Permitted

·         Planned pregnancy

7.      Poverty

·         Low income level

7.      Affluence

·         Significant income level

 

RESEARCH QUESTION

What factors are responsible for the low turnout of teenage mothers at antenatal services?

PRESENTATION OF FINDINGS/RESULTS

4.1 Introduction

This chapter presents the results of the study outlined in tables, showing the frequencies of different variables.

4.2 Results from teenagers’ questionnaire.

Table 1. Respondents’ distribution according to their level of awareness of services.

Awareness # of Respondents Percentage (%)
Not well-informed 15 37.5
Lack of general knowledge 1 2.5
Knew about the services 24 60
Total 40 100

Table 1 shows that majority of the respondents, 24 (60%) out of the total 40 under study knew about the antenatal services. 15 (37.5%) were not well informed about the benefits it offers during the antenatal period and only 1 (2.5%) lacked general knowledge about it.

Table 2. Respondents’ distribution according to the number of pregnancies they have had so far.

# of Pregnancies # of Respondents Percentage (%)
1 28 70
2 10 25
3 2 5
4 0 0
Total 40 100

As shown in Table 2, out of a total respondent of 40, 28(70%) had only one pregnancy, 10(25%) had two pregnancies and 2(5%) had three pregnancies. None of the respondents have had up to four pregnancies.

Table 3. Respondents’ distribution according to the type of transport the use.

Type of transport # of Respondents Percentage (%)
On foot 9 22.5
By car 31 77.5
Total 40 100

Table 3 shows that 9 (22.5%) respondents out of 40 went to the health center on foot while 31 (77.5%) went by car.

Table 4. Respondents’ distribution according to their time of booking.

Time of booking # of Respondents Percentage (%)
1st trimester 27 67.5
2nd trimester 12 30
3rd trimester 1 2.5
Total 40 100

Table 4 shows that 27 (67.5%) out of 40 teenage respondents said that they had booked in the 1st trimester and 12 (30%) in the 2nd trimester. For the teenage respondents who were booked in the 1st trimester, most of them did so because of the sicknesses they had and because most of their parents wanted to confirm their conditions. For one reason or another, there was a single 3rd trimester booking.

Table 5. Respondents’ distribution according to their waiting time.

Waiting time # of Respondents Percentage (%)
An hour or more 32 80
Less than an hour 8 20
Total 40 100

Table 5 shows that 32 (80%) teenage respondents said that they waited for more than an hour whilst 8 (20%) said it was not up to an hour.

Table 6. Respondents’ distribution according to their occupational schedules.

Work type # of Respondents Percentage (%)
Housewife 15 37.5
Business woman 7 17.5
Others 18 45
Total 40 100

According to the results, Table 6 shows that out of 40 respondents, 15 (37.5%) were housewives, 7 (17.5%) were engaged in business and 18 (45%) fall into the group of others. In that group, 17 were found out to be students whilst only 1 was unemployed and not in either the group of housewives or that of the business women.

Table 7. Respondents’ responses in relationship to the bad socio-cultural beliefs.

Bad socio-cultural beliefs # of Respondents Percentage (%)
Shyness 21 52.5
Pregnant out of wedlock 18 45
Taboos 1 2.5
Total 40 100

Table 7 shows that out of a total respondents of 40, 21 (52.5%) said that they get shy to attend clinics, 18 (45%) said that the fact that they were pregnant out of wedlock dissuaded them from going to clinics whilst 1 (2.5%) said that it was because of some taboos (that is, not to be seen in the first few months of pregnancy).

Table 8. Respondents’ distribution in relationship to whether they were interviewed and examined in private or not.

Privacy High (%) Low (%) Total (%)
Yes 11 (27.5) 6 (15) 17 (42.5)
No 7 (17.5) 16 (40) 23 (57.5)
Total 18 (45) 22 (55) 40 (100)

As shown in Table 8, out of the 40 teenage respondents under study, 23 (57.5%) were interviewed in public whilst 17 (42.5%) were seen in private. For those interviewed in private, 6 (15%) of the respondents formed the low turn outs whilst 11 (27.5%) of the respondents formed the high turn outs. As for the respondents who were not interviewed in private, out of the total 23 (57.5%) teenagers, 16 (40%) of the respondents formed the low turnout and 7 (17.5%) formed the high turnout. For examination, all the teenage respondents agreed that they were physically examined in private.

DISCUSSION

This section of chapter 4 discusses the study findings presented in the previous section (4.1) of the same chapter. It aims at discussing the meaning of the findings with regards to the research questions.

The groundings of the findings as given in Table 1, showing the distribution according to the respondents’ awareness level revealed that majority of the teenage respondents had general knowledge about antenatal services and the benefits it offers.

In the case of the number of pregnancies had by the respondents, majority of them had only one whilst quite a few had two or three. No teenage respondent under study has had up to four pregnancies.

From the results of the findings, it was also shown that most of the teenage respondents got to the clinic by car whilst only a few got there on foot.

The study also revealed that majority of the teenage respondents booked in the 1st trimester and the rest did in the 2nd and 3rd trimesters respectively.

Regarding the space of waiting time, most of the teenage respondents waited for an hour or more whilst only a few waited for less than that.

The distribution on the occupational schedules of the teenage respondents showed that quite a number of them were housewives and a few were involved in business. The rest though, were all students, except for one who was just an unemployed teenager.

The bad socio-cultural beliefs also showed from the results that most of the teenage respondents were discouraged from going to the clinic because of shyness whilst the remaining few said it was because of their unwed status. Amongst the teenage respondents, only one said that she did not start going to the clinic on time because of a taboo that says that a pregnant person should not be seen in her early months.

After having a close discussion with one of the teenage antenatal and hearing her complaints, I thought the total 40 respondents were going to say that they do not feel comfortable with the service providers. But contrastingly, majority was quite comfortable with them and only a few were not. The total 40 teenage respondents agreed to being examined in private, but for private interviews, they were mostly carried out in public. That had a negative effect on the turnout of teenage antenatal because most of the respondents preferred being seen in private.

Out of the seven staff respondents, two were SRN/M, two SRN, one SEN/M, one SEN and the last one a CNA.

For the position held by the staff respondents, the SEN/M was the Officer in charge, whilst the remaining six were all team members.

All the staff respondents under study took part in caring for the teenage antenatal mothers and they spent an average of five minutes with each of them during base clinics.

The total staff respondents of seven gave health talks to the teenage mothers and the antenatal clinics were done sixteen times monthly. Out of the seven staff respondents, only one admitted to being overworked, the rest had an average work-load. All the seven respondents had enough space for examining the antenatal mothers and the essential drugs were always available. Functional equipments were all also available at the health center.

The results revealed that though all equipments were available, they were not all routinely used for check-up during antenatal clinics. The basic antenatal drugs were provided during clinics, but the rest had to be bought from the nearby pharmacy which the teenage respondents complained were hard to get because of economic burden. This tends to make most of them less interested to visit clinics.

Though from the findings, most of the teenage respondents were comfortable with the staff, the few who were not were impolitely addressed and they were also frequently embarrassed.

CONCLUSION

With regards to the findings, the following were found out to be the main influencing factors on the low turnout of teenage mothers at antenatal clinic in Bakau; Occupation, Poor Administration and Bad Socio-cultural Beliefs.

RECOMMENDATIONS

  1. Health talks should always be given before the start of antenatal services to help with the problem of lack of general knowledge about the services and also to help inform the respondents about the benefits of the antenatal services.
  2. For the teenage respondents who feel shy because of their unplanned or unwed pregnancies, they should be sensitized about the dangers they pose not only to their growing fetus, but to themselves as well. They should also be told to disregard all those unimportant taboos that can cause problems for them if followed.
  3. At all times, the teenage respondents should lodge complaints to their service providers whenever they are affected by the drugs or other conditions.
  4. The staff should make the environment as socially conducive as possible and there should be no case of humiliation, harassment, or lack of confidentiality on any teenage respondent.
  5. Long waiting hours should be avoided so that all those respondents who have domestic chores or financial businesses to take care of can do so without any complications.
  6. The service providers should frequently be given education programs on management and quality improvement activities to help improve their skills and competence.
  7. All these will go a long way in improving the turnout of teenage antenatal mothers at Bakau Health Centre. Some of the listed variables, like inaccessibility and poverty were found not to be influencing factors on the low turnout of teenagers at the clinic.

 

REFERENCES

  1. Annual gaps in antenatal care in developing regions. (2018, May 09). Retrieved from https://www.guttmacher.org/infographic/2018/annual-gaps-antenatal-care-developing-regions
  2. Jatta, 2001 — Background information on the Gambia — Research on KAP of senior secondary students towards AIDS/HIV.
  3. Department of State for Health (1998) — Gambia Government.
  4. Divisional Health Team 2003.
  5. HEU — Giving health education during antenatal clinics.
  6. Mayes’ Midwifery, 2002 — 12th Edition.
  7. Fatty, 2005 — Research on The Factors That Affect Quality Antenatal Service Provision.
  8. NACP — Antenatal care and HIV/AIDS.
  9. (n.d.). Retrieved from http://www.accessgambia.com/information/farming-agriculture.html
  10. RCH unit (Medical and Health Department in Banjul).
  11. Ruder R.H and M. Ternmerman 1991 — The effects of HIV infection during pregnancy and perinatal period on maternal and child health.
  12. Safe Motherhood Fact Sheet: Maternal Health Services. http://www.safemotherhood.org/facts.
  13. Sexual health exchange 1998 — Published by Royal TROPICAL Institute.
  14. UN 2004 — Provincial population and housing census.
  15. WHO — Making Pregnancy Safer Initiative.

 

By Oumie Jatta

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