The predictors of and experiences in the use of maternal healthcare services by unmarried youth in Uganda

Agaba, Peninah

Abstract

Introduction
Uganda has a high maternal mortality rate combined with poor use of maternal health services among unmarried youth. Improved use of maternal health services by unmarried youth would help reduce maternal deaths in the country. A better understanding of the reasons for the poor use of maternal health services, and the needs and priorities of young women is necessary for designing appropriate policies to address the problem of maternal mortality in Uganda.
The Andersen’s behavioural model of access to medical care provided a framework for this study. This thesis explores: predisposing and enabling factors associated with the use of maternal health services among unmarried (compared to married) youth aged 15- 24 years between 1995 and 2011; and the experiences of unmarried youth aged 15-19 years during the maternity period in Uganda. More specifically, it examines: i). predisposing and enabling factors associated with the timing and the number of antenatal care visits among unmarried (compared to married) youth aged 15-24 years; ii) the variation in enabling and predisposing factors associated with the use of health facilities at childbirth among unmarried (compared to married) youth, aged 15-24 years; iii). the experiences and support for unmarried youth aged 15-19 years at home and in the community during the maternity period; and iv). the health providers’ perspectives in the use of maternal health care services for unmarried youth aged 15-19 years in Uganda.
Methodology
Using a sequential explanatory mixed methods design, two-level binary logistic and linear regression models with district as a second level of analysis were conducted on pooled data of the 1995, 2000/01, 2006 and 2011 Uganda Demographic and Health Surveys. This analysis was among 581 unmarried, compared to 5,437 married youth, aged 15-24 years. Qualitative data collection that followed was conducted among purposively sampled unmarried youth who were pregnant or had had a birth within three years before fieldwork aged between 15-19 years (14 in-depth interviews & 8 focus group discussions). Seven in-depth interviews with youth parents and seven key informant interviews with health providers in Bushenyi and Kibale districts of western Uganda were also carried out. Lived experiences and support to unmarried youth at their homes, in the community, and health facilities were explored using interpretative phenomenological analysis.
Results
The levels of using antenatal care in the first trimester were generally low among youth, and unmarried youth were less likely to start antenatal care early compared to married youth. Education was the only factor that was significantly associated with the use of antenatal care in the first trimester among unmarried youth. Education predicted use of antenatal care in the first trimester among both unmarried and married youth, but the association was in the opposite direction. Whereas high education was associated with higher chances of the use of antenatal care in the first trimester among married youth (OR=1.30, 95%CI=1.08-1.57), it was associated with late start among unmarried youth (OR=0.56, 95%CI=0.31-0.98). In addition, higher parity, protestant membership and residence in eastern region were associated with late start of antenatal care, while access to radio and television, and at least primary education level of the partner were associated with higher odds of the use of antenatal care in the first trimester among married youth.
It was observed that overall, married youth were more likely to have more frequent antenatal care visits than unmarried youth during the study period. Among unmarried and married youth, higher educational attainment and greater access to radio were associated with frequent antenatal care use. Although high wealth index was associated with more antenatal care visits among unmarried youth (Estimate=0.889, SE=0.424), married youth in highest wealth quintile were associated with infrequent antenatal care (Estimate= -0.334, SE=0.131). Residing in western region was associated with fewer antenatal care visits among both married and unmarried youth. Additionally, married youth living in esstern Uganda had fewer antenatal care visits. Also, access to newspaper was associated with more antenatal care visits among married youth though not among unmarried youth.
Overall, unmarried youth had higher chances of having a childbirth within the health facilities than married youth. Most individual level factors were consistent with patterns observed in the literature among youth, for instance higher educational attainment and access to mass media were asoociated with higher odds of the use of health facilities at childbirth while higher parity and rural residence were associated with a lower likelihood of the use of health facilities at childbirth. However, some unique patterns emerged. For instance, both unmarried and married youth engaged in agriculture activities had a lower likelihood of using health facilities at child birth compared to non- working youth (OR=0.47, 95%CI=0.25-0.89 for unmarried vs OR=0.70, 95%CI=0.57- 0.87 for unmarried). Among married youth, use of health facilities was lower among those residing in western region compared to those residing in central region (OR=0.55, 95%CI=0.34-0.88), yet not among unmarried youth. Membership of other religions, middle and highest wealth quintiles, more access to radio, high partner education, and residing in a district with a middle education level district were associated with increased chances of the use of health facilities at childbirth among married youth but not among unmarried youth.
The qualitative results reveal that unmarried youth in Bushenyi and Kibale districts of western Uganda had mixed experiences through the maternity period. Most youth experienced psychological distress because of negative attitudes from family, partners and community, and health providers. They were abused by parents, partners denied responsibility for the pregnancies, and most had limited support for their needs during this difficult time. Some got support with information, hospital requirement, and basic needs from parents especially mothers. Few youths got support from their fathers, partners, and community members. Mothers were supportive of the youth mostly to discourage them from engaging in risky abortion.
At the health facilities, sharing of information was not tailored to unmarried youth who were pregnant for the first time. Most young women were mistreated by health providers. They waited for long hours to receive the services in a non-private general waiting area, and some were denied services because they did not go with their partners as the implementation of a policy aimed at increasing male involvement in reproductive health gave priority to couples. A few were satisfied with the competence of the health providers, reported better treatment from the male providers, good maternal and child care information, and appreciated supplies like mama kits provided at the health facilities. All these experiences influenced the unmarried youth’ use of maternal health services. The qualitative data were also used to explain some of the observed trends and associations in the quantitative analysis.
Conclusion
Although predisposing and enabling factors are important predictors of the use of maternal health care services, the findings on environment, need, and health provider factors like provider attitudes and implementation of a policy on increasing male involvement in reproductive health services as well as the change in parents’ attitudes provide crucial areas for policy intervention. The study provides important findings where policies should be focused to overcome barriers to the use of maternal health care services and reduce maternal deaths among unmarried youth in Uganda.

Citation

Agaba, P. (2019). The predictors of and experiences in the use of maternal healthcare services by unmarried youth in Uganda. (Thesis). University of Hull. Retrieved from https://hull-repository.worktribe.com/output/4222986

• Thesis Type: Thesis
• Deposit Date: Mar 26, 2021
• Publicly Available Date: Feb 23, 2023
• Keywords: Social policy
• Public URL: https://hull-repository.worktribe.com/output/4222986
• Additional Information: Department of Sociology, The University of Hull
• Award Date: Dec 1, 2019