Postnatal experiences of teenage mothers in selected communities in Central Region, Ghana: a phenomenological study | BMC Public Health

Postnatal experiences of teenage mothers in selected communities in Central Region, Ghana: a phenomenological study | BMC Public Health

Teenage mother’s health and development remain an issue of public health concern globally. The need to prevent early pregnancy and childbirth among teenage girls has been given prominence in recent years [1, 2]. Teenage childbirth has significant implications at individual, societal, national, and global levels [3]. Globally, about 16 million teenage girls (aged 13–19) give birth every year [4], with almost 95% of these births occurring in low- and middle-income countries (LMICs) [2, 5]. According to UNFPA, sub-Saharan Africa (SSA) has the highest prevalence of teenage pregnancy, compared to other regions of the world [6]. The average birth rate of teenage mothers aged 15 to 19 in sub-Saharan Africa is 143, higher than the world’s average of 65. This affirms that teenage pregnancy and childbearing, along with maternal and child mortality, are major challenges facing young females in African countries [2]. Without a concerted effort to deal with these challenges, the achievement of Sustainable Development Goal 3.2 which seeks to end preventable death of newborns and children under -five years of age by the year 2030, would be difficult [1, 4].

Childbirth among teenagers is associated with adverse outcomes such as preterm delivery, pre-eclampsia, puerperal endometritis, postpartum haemorrhage, neonatal deaths, anaemia, and gestational hypertension [6, 7]. Also, teenage girls who give birth before age 15 are five times more likely to experience complications or die during delivery, compared with women in their twenties, due to physical immaturity [7]. Teenage mothers have been identified to have an increased risk of infant and child mortality, with associated negative demographic and social consequences [8,9,10,11]. Other studies have observed that teenage pregnancy and childbirth have a strong association with low levels of educational achievement for young women, which, in turn, may have a negative impact on their position and potential contribution to the family, society, and the nation at large [10, 12]. Teenage motherhood requires support, attention from the family, and community involvement, irrespective of the mother’s cultural and psychological background and socio-economic position [13, 14]. Teenage mothers and their babies are at a social and health disadvantage because of unpreparedness and the maturity required for motherhood or parenthood [10]. Teenage childbirth brings negative consequences, including school dropout, helplessness, low self-esteem, depression, and suicidal attempts than married adults [10, 12]. Negative behaviours such as not accessing health services (ante and postnatal care) may cause higher rates of postpartum haemorrhage, dysfunctional labour, premature rupture of membrane, preterm babies, or low birth weight babies. Previous studies have also examined socio-cultural factors and the economic outcomes for teenage mothers—poverty, unemployment, and others—which may result in poor childbirth and child-rearing [2, 15, 16].

At the end of 2011, 12 per cent of teenage girls aged 13 to 19 years were either pregnant or had already given birth in Ghana [17]. The teenage birth rate in Ghana has been increasing over time [18, 19]. Evidence shows that adolescents were responsible for 30 percent of all births registered and 14 percent of teenagers aged 15 to 19 had begun childbearing [8, 19]. In terms of regional prevalence, the Central Region has consistently increased teenage pregnancy and childbirth and the number of teenage mothers with one child in the region was estimated at 7% which is higher than the other regions [2, 20]. However, the Western, Brong Ahafo, and Volta regions also account for the high teenage pregnancy rate in the country [20, 21]. Despite the effectiveness of efforts aimed at promoting family planning and improving access to adolescent sexual reproductive health and comprehensive sexuality education in Ghana [9, 22].

A recent growing body of literature has examined attitude, sexual health knowledge, behaviour, health services use, and risk factors for pregnancy among teenagers [2, 21], as well as correlates of unintended teenage pregnancy [23]. Other studies have delved into teenage pregnancy and motherhood [8, 12], unsafe abortion and contraceptive use, and adolescent sexual and reproductive health [9]. In addition, previous studies conducted in the Komenda-Edina-Eguafo-Abrem municipality showed that with the existence of negative socio-cultural norms, teenage girls are exposed to the risk of pregnancy and childbirth [2, 16, 24]. Whereas these studies have contributed immensely to the field of interest, particularly with older mothers (> 20 years), there is a paucity of empirical literature on teenage mothers’ experiences with childbirth. Our study contributes to the discourse by exploring teenage mothers’ postnatal experiences with childbirth in the five selected communities (Komenda, Elmina, Eguafo, Abrem, and Ankaful) in the Central Region of Ghana. Our findings could be useful for policy and implementation decision-making regarding maternal and child health in Ghana, SSA, and beyond. The study interrogates the following research questions: What are postpartum experiences of teenage mothers? How do teenage mothers adjust to motherhood and what support available to them?

Conceptual framework

Our study is underpinned by the Ecological Systems Theory (EST) developed by Urie Bronfenbrenner [25]. The ecological systems theory is a study of the progressive, mutual accommodation between the developing person and the changing properties of the immediate and broader perspective in which the person lives [25]. The original model of EST (in Fig. 1) has been applied in studying teenage mothers’ experiences [14, 15]. This theory concentrates on the layers of the environment as identified by Bronfenbrenner as micro, meso, exo, macro, and chrono systems and focuses on the interaction between the individual, for instance, the teenage mother, and her environment based on the events and processes that occur in each of these systems [5, 25]. In our study, a microsystem would be the connection between the microsystem such as the relationship between members of the teenage mother’s own family and between her parent’s family and the family of the baby’s father, or the connection between the teenage mother and her parent’s home or her school (see Fig. 2, adapted EST model).

Fig. 1
figure 1

Conceptual framework original Ecological System Theory (EST). Source: Bronfenbrenner (1979)

Fig. 2
figure 2

Conceptual framework adapted Ecological System Theory (EST). Source: Bronfenbrenner (1979)

The exosystem contains the external environment settings and other social systems that indirectly affect the development of the individual. In this study, the exosystem of teenage mothers is the community, media, organisations, religious affiliation, health, and other social services. The macrosystem, which is seen as the broader layer, includes the culture, sub-culture in the form of societal beliefs or norms, and lifestyle of the people that directly or indirectly influence the teenage mother. In this study, it is somewhat understood that the culture and beliefs of the people in the communities influence teenage mothers’ behaviour and experiences. Chronosystem was later added by Bronfenbrenner outside the systems, which is made up of all the other levels. It accounts for the temporal changes in the individual or teenage mother’s environment or life and social–historical events that occur or happen over time. This also has some level of influence on the interactions between developing individuals (teenage mothers) and the micro, exo, and macrosystems in which they are embedded [14].

These factors or systems have been adapted to understand the scope and the impact of the health and social context on ‘childbirth’ experiences among teenage mothers. The perceived weakness of this conceptual framework is its inability to critique factors/systems that would have directly or indirectly influenced the teenage mother in the mesosystem in the third layer of the original framework. Again, the theoretical perspective did not provide the possible success of difficult situations or circumstances which means that ecological theory is lacking in the dimension of resilience. The basic contention of the ecological systems theory has often remained that the individual (teenage mother) develops within a context. However, the model focused on factors such as the technological, environmental, attitudes, and ideologies of culture that depend on each other and influence everyday life. These factors or systems have been modified to help to understand the scope and the impact of the health and social context on ‘childbirth’ experiences and where challenges, constraints, support or as well as coping mechanisms and a combination of both positive and negative experiences exist to make this framework (Figs. 1 and 2) suitable for this study.

In addition, teenage mother’s ability and capability to adapt to difficult situations, recover from physical and emotional challenges, risk-taking, despite their exposure to stressful experiences (childbirth complications) is referred to as resilience [26, 27]. Resilience is the capacity to overcome challenges, frustration, and unfortunate circumstances [28]. The literature suggests several characteristics that explain resilience. Positive self-esteem, hardiness, effective coping mechanisms, and a perception of a major threat to development’s ability to adapt are some of these variables [26, 29]. According to Perry [27], resilience is the ability to deal with challenges without experiencing a major decline in one’s ability to function. Protective psychological risk variables that promote the development of favourable outcomes and good personality characteristics are commonly used to describe resilience [28, 29].

A young first-time mother and her newborn/infant face numerous complications, challenges and difficulties while still in their adolescent years. Their extended families and the communities in which they reside are also affected. The difficulties come in juggling the demands of motherhood, such as meeting the infant’s or kid’s material, emotional, and medical needs while completing the typical teenage developmental chores, with the need to look after yourself and your child (child care). Some teen mothers exhibit tenacity in the face of these obstacles to meet their children’s developmental needs. Some of these teen mothers manage to sustain themselves financially and get support to finish their education while others do not complete it. Consequently, teenage mothers might experience the challenges and constraints of being a first-time mother/parent and demonstrate indications of developmental distress, such as anxiety, despair, and low self-esteem [29].

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