Exploring how the Perinatal Services of Primary Health Care Settings in Rwanda Support Adolescent Mothers to Inform the Delivery of Trauma- and Violence-Informed Care: An Interpretive Description
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.