Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Smye, Victoria

Affiliation

Arthur Labatt Family School of Nursing, Western University

Abstract

According to the recent Rwanda demographic health survey, 5% of adolescents aged 15-19 in Rwanda are pregnant or mothers, with anecdotal data indicating an increase in adolescent pregnancies translating into an increasing need for community support for young mothers in Rwanda. However, adolescent pregnancy is considered deviant and shameful in Rwandan culture and indeed criminalized; thus, young pregnant women and girls are often abandoned by the men who impregnated them and face rejection from families and friends, stigma from the community, and increased rates of domestic violence. In addition, over half of these pregnancies are the result of rape. All of these factors increase the risk for mental health problems among these young women and girls, including high rates of depression and posttraumatic stress. These trauma experiences may pose additional challenges to young mothers using healthcare services, for example, when perinatal services fail to employ trauma- and violence-informed care (TVIC).

The aim of this study was to explore how perinatal services in primary health care settings in Rwanda support adolescent mothers using interpretive description (ID) methodology. From December 2021 to March 2022, individual interviews were conducted with 15 adolescent mothers, 12 nurses and midwives, 12 maternal community health workers (MCHWs), and seven key informants (heads of health centers and community health officers [CHOs]). Two relevant documents (antenatal care [ANC] and prevent mother to child transmission [PMTCT] guidelines) that guide professional practice in this area were also reviewed.

The findings indicated that adolescent mothers had mixed experiences (tailored care and the re-creation of trauma) when navigating perinatal services. Cross-cutting themes from our interviews with adolescent mothers, nurses, midwives, and MCHWs were relational engagement, personal and structural barriers, and vicarious trauma.

Findings from this study illuminate that there is a need to build perinatal services that are safe, inclusive, welcoming and trauma- and violence- informed for adolescent mothers. Based on the recommendations from this study, a framework to inform the integration of TVIC into perinatal services was created.

Summary for Lay Audience

Globally, adolescent pregnancies continue to increase, many in developing countries. In Rwanda, in 2020, 5% of adolescents aged 15-19 were pregnant or mothers. According to anecdotal reports, the number has risen in the past three years. It has been found that the majority of these pregnancies (75%) resulted from sexual violence. Due to cultural factors, the Rwandan community does not perceive adolescent pregnancy well, resulting in abandoning adolescent mothers from families and communities. All these factors increase mental health problems among adolescent mothers, including depression and trauma. These trauma experiences may pose additional challenges to young mothers using healthcare services, for example, when perinatal services fail to recognize that these adolescent mothers have trauma histories or are experiencing ongoing violence.

This study aimed to explore how perinatal services support adolescent mothers to resist re-traumatization. Interviews were conducted with 15 adolescent mothers, 12 perinatal nurses and midwives, 12 community health workers in charge of maternal child health, and seven heads of health centers and community health officers. I also reviewed two perinatal guidelines to explore how they influence perinatal practices.

This study found that adolescent mothers have mixed perceptions (positive and negative experiences). The positive experience includes receiving tailored care, while the negative experience has been the re-creation of trauma. Maternal community health workers, perinatal nurses and midwives reported that caring for adolescent mothers is challenging and requires additional skills.

The findings from this study suggest the need to build perinatal safe, welcoming, and inclusive services to support the needs of adolescent mothers to ensure services are trauma- and violence-informed. The framework to achieve this was created based on the findings from this study.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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