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Why Don’t Adolescent Mothers Use Maternal Health Services?

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Vulnerability of adolescent mothers

Between 1995 and 2011, roughly one in five girls living in developing countries became pregnant before she turned 18 years old. Adolescent girls, particularly those living in low-resource settings, are uniquely vulnerable during pregnancy and childbirth. Girls who become pregnant between the ages of 15 and 19 are 50% more likely to die during childbirth compared to women between 20 and 24 years old. In fact, complications during pregnancy and childbirth are the second most common cause of death among girls between 15 and 19 years old. Furthermore, babies born to adolescents are at greater risk of being delivered preterm, having a low birth weight and dying as infants.

Receiving high quality care during pregnancy, delivery and postpartum is critical to reducing maternal and newborn deaths. Despite the vulnerability of young girls during this period, the literature on maternal health care utilization among adolescents is scarce.

Influential factors

A systematic review published in BMC Pregnancy and Childbirth examined the factors influencing adolescent mothers’ utilization of maternal health services in low- and middle-income countries (LMICs). Based on available studies, the authors identified the strongest factors related to the utilization of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC), summarized in the following table.

Antenatal care Skilled birth attendance Postnatal care
Wealth X X X
Rural/urban residence X X
Parity X
Girl’s education X X X
Husband’s education X X
Mass media exposure X X
Antenatal care Not applicable X
Use of a skilled birth attendant Not applicable X

An X indicates that the majority of studies that included the factor in their analysis found statistically significant relationships.

The findings from this review illustrate that girls with the following characteristics are less likely than their counterparts to utilize maternal health services in LMICs:

– Lower socioeconomic status
– Lower education level
– Husband with lower education level
– Live in rural areas
– Not exposed to mass media

Girls who were pregnant with their first child were more likely to have SBA than girls who had given birth previously. Additionally, ANC utilization was a strong predictor of having SBA, and having SBA was a strong predictor of utilizing PNC.

When interpreting these results, however, it is important to consider that the review is based on limited evidence; the studies were conducted in diverse settings and examined different factors; data on adolescent health—especially among non-married adolescent girls—is inadequate in many settings, and certain factors may be more influential in some places than others.

Moving forward

The authors note the paucity and poor quality of research in this area and call for efforts to fill this gap. For example, there have been no qualitative studies examining maternal health service utilization among adolescents. Qualitative methods would be ideal for exploring adolescents’ experiences, beliefs and perspectives related to care and learning about the challenges they face as young mothers.

Addressing the unique needs of adolescent mothers and pregnant girls is an essential component of accomplishing the goals set forth in the Global Strategy. Additional high quality quantitative and qualitative research in diverse settings is an essential first step towards increasing adolescents’ utilization of maternal health care.

Source: Banke-Thomas et al. Factors influencing utilization of maternal health services by adolescent mothers in low- and middle-income countries: A systematic review. BMC Pregnancy and Childbirth, 2017.

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