Abstract:
Poor healthcare practices are a major cause of maternal morbidity and mortality among Unmarried Young Adolescents (UYA), especially in sub-Saharan Africa. Previous studies on maternal healthcare among adolescents largely focused on the biomedical aspects and high prevalence of ever-pregnant adolescents in Southern Nigeria. However, little attention has beengiven to the socio-demographic and cultural factors influencing maternal healthcare practices among adolescents aged 16 years and below who are at greater risk of pregnancy related complications. This study, therefore, examined maternal healthcare practices among UYA in Akwa Ibom State, Nigeria.
The Subcultural and Rational Choice theories were adopted as framework. An analytical cross-sectionalsurvey design was employed. Purposive sampling was used to select Southern Iman of Akwa Ibom State because of its high prevalence of ever-pregnant UYA (18.0%). Systematic sampling was used to select 20 out of the 30 communities from which households with an ever-pregnant UYA were purposively selected.Cochran’s (1977) formula was used to determine the sample size, and a random sampling technique was employed to administer structured questionnaire on 621 respondents. Data were elicited on socio-demographic characteristics, determinants of pregnancy among UYA, antenatal care, delivery care, and postnatal care practices. Thirty-five in-depth interviews were conducted among UYA (10), skilled (5) and unskilled healthcare providers (10) and caregivers (10). Twelve focus group discussions were conducted among UYA (4), community leaders (4) and community members (4), while four life histories were conducted among UYA. Quantitative data were analysed using descriptiveand multivariate logistic regression at p≤0.05;qualitative data were content-analysed.
Respondents’ age was 13.9±1.8 years; 77.9% had secondary education and 9.5% were currently pregnant. Pregnancy among UYA was mainly influenced by the desire for sexual experimentation (48.1%), peer pressure (34.1%), financial inadequacy (9.6%) and parental/guardian negligence (5.2%). Antenatal care utilisation from Skilled Healthcare Providers (SHP) was associated with secondary school education (Odds Ratio (OR) = 7.35), wealthiest households (OR = 6.74) and age at childbirth 14-16 (OR = 0.17). Delivery care from SHP was significantly associated with wealthiest households (OR = 6.60), non-catholic church membership (OR = 0.15) and distance to healthcare facilities (OR = 0.53). Postnatal care from SHP was significantly associated with wealthiest households (OR = 2.62) and those whose parents were alive (OR = 2.13). Inadequate sex education exposed adolescents to early sexual experimentation and pregnancy. Drinking large quantities of palm wine during pregnancyto induce lactation was reported by SHP to increase the risk of miscarriage and stillbirths. Low patronage of modern healthcare facilities and forbidden intake of certain foods such as beans, pap and tea during pregnancy influenced maternal morbidity and mortality. The application of harmful substances, such as fluid from a dead spider on the umbilical cord stump exposed new-born of UYA to deadly infections.
Socio-demographic and cultural factors influenced maternal healthcare practices among unmarried young adolescentsin Akwa Ibom State. Stakeholders should therefore increase awareness about sex education among young adolescents in order to reduce appreciably the rate of early exposure to sexual intercourse, pregnancy and related health risks.
