Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

Background Many low-and-middle-income countries, including South Africa, have high rates of teenage pregnancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staff who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results Informants from both sectors expressed discomfort at pregnant learners remaining in school late in pregnancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefits of extended breastfeeding for infants and mothers, they recognised the potential conflict between the need for the mother to return to school and the recommendation for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions Our findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother.

Growth and Development of Children In Adolescent Mother In Gunungkidul

Adolescent mothers with poor knowledge and skills in parenting will adversely affect the development of children. In 2018, children under five in Gunung Kidul experienced developmental delays (1.05%). This study was descriptive observation with 30 respondents of adolescent mothers under 21 years of age. Questionnaires were used to complete the data. Other tools used were infantometer, weight scales, Denver II Form, Z Score table. The results show that predominant respondents have low education (66.7%) and the majority are housewives. The weight of the children is in accordance to their age, the majority of the height is normal, but 56.7% of children experience developmental delays

Parental Psychological Control: Maternal, Adolescent, and Contextual Predictors

Parental psychological control (PC) hinders the development of autonomy, identity formation, and the attainment of self-determination and individuation of adolescents. The aim of this study was to deepen the understanding of which conditions increase the risk of the use of maternal PC by simultaneously considering the contribution of adolescent temperament, maternal separation anxiety, and adolescents’ perception of interparental conflict. A correlational study involving a sample of 106 Chilean adolescent-mother dyads was done. Adolescents were, on average, 15.42 years old (SD = 1.09) and 77% male. Mothers were, on average, 45.46 years old (SD = 6.39). We administered self-report questionnaires to the adolescent measuring effortful control and frustration as temperamental dimensions, along with the perception of interparental conflict. Mothers reported on their separation anxiety. Both the adolescents and their mothers reported on the use of maternal PC. Adolescents reported higher levels of maternal PC than their mothers did. All predictors were associated with PC reports. Higher levels of maternal anxiety about adolescent distancing, inter-parental conflict, and adolescent frustration were associated with higher reported levels of PC. In contrast, higher levels of adolescent effortful control were associated with lower levels of maternal PC. Finally, when maternal separation anxiety and inter-parental conflict were high there was a higher use of maternal PC. The present findings inform on how adolescent’s self-regulatory skills could reduce the risk of being exposed to maternal PC. And highlight the importance of using a systemic and interactional conceptualization when trying to understand their use.

Undernutrition among Pregnant Adolescent, A scoping Review

Background In pregnant adolescents, it is hypothesized that there is ‘nutrient partitioning’, a competition for nutrients between the still growing adolescent mother and her rapidly developing fetus resulting in a compromised nutrition status of both. This scoping review examined the prevalence of undernutrition, associated factors and outcomes of adolescent pregnancy. Methods We used a five stages framework suggested by Arksey & O`Male (2005) to carry out this scoping review. Published articles, reviews and reports were identified through a complete search. We included articles published in English language from 2000 to 2020. We summarized prevalence, associated factors and health outcomes of pregnancy during adolescence. Results 25 studies met the inclusion criteria. 32% of the studies are on dietary intake, 20% of them reported nutritional status and associated factors and 48% studies discussed effect of poor nutrition on outcome of Pregnancy during adolescence. Only 4 of the studies are community based and 21 are facility based. Magnitude of undernutrition among pregnant adolescent girls ranged from 23.5–34%; Social determinants of health such as poor access to antenatal care visits, low educational status of partners, poor dietary intake, early marriage, rural residency, young age and having multiple pregnancies are associated with poor nutritional status. Pregnant adolescents have also more risks of poor pregnancy outcomes compared with pregnant adults’ women. These include fetal complications like prematurity, low or very low birth weight, and perinatal mortality, major congenital defects; hypertensive pregnancy disorders, abortion, urinary infections, and premature rupture of the fetal membranes,. Conclusion A higher magnitude of undernutrition, less dietary intake and more risks of poor pregnancy outcomes were observed from reviewed studies. This review demonstrated absence of comprehensive literature which might be explored through a population-based prospective study.

Studi Kasus pada Remaja dengan Pernikahan Dini dalam Pencapaian Pemberian ASI Eksklusif Menggunakan Analisis Fenomenologi

Pemberian ASI eksklusif selama 6 bulan hingga bayi berusia 2 tahun merupakan hak setiap bayi. Hal ini berkontribusi dalam memberikan asupan yang sehat, dan menyediakan gizi dan energi yang cukup bagi bayi, sehingga dapat mencegah kelaparan dan malnutrisi. Perempuan yang menikah pada usia terlalu dini, juga rentan mengalami masalah anemia atau kekurangan zat besi. Dampak terburuknya adalah melahirkan bayi dengan berat badan rendah atau bayi lahir pendek, dan meninggal saat bersalin. Data menyebut 10 % anak dilahirkan dengan kurang berat badan, artinya gizi saat hamil kurang baik. Melakukan studi kasus permasalahan yang dialami pada ibu remaja dengan pernikahan dini dalam pencapaian pemberian ASI Eksklusif menggunakan analisis fenomenologi dengan melibatkan anggota keluarga. Penelitian kualitatif ini dianalisa dengan fenomonologi bertujuan mengetahui pengalaman menyusui eksklusif pada seoarang ibu remaja dengan pernikahan dini. Teknik sampling menggunakan aciidental sampling yang sesuai dengan kriteria inklusi. Teknik pengumpulan data dengan wawancara mendalam. Penelitian ini menunjukkan permasalahan pada ibu remaja dalam pencapaian pemberian ASI eksklusif diantaranya pemahaman ibu rendah, persiapan diri untuk kesuksesan pemberian ASI eksklusif masih kurang, cara pemberian ASI eksklusif, dukungan suami selama pemberian ASI eksklusif, dan dukungan keluarga selama pemberian ASI eksklusif. Kata Kunci: ibu usia remaja; pernikahan dini; ASI eksklusif CASE STUDY ON ADOLESCENT WOMEN WITH EARLY MARRIAGE IN THE ACHIEVMENT OF EXCLUSIVE BREAST MILK USING PHENOMENOLOGICAL ANALYSIS ABSTRACT Exclusive breastfeeding for 6 months until the baby is 2 years old is the right of every baby. This contributes to a healthy diet, and provides the baby with adequate nutrition and energy, thereby preventing hunger and malnutrition. Women who marry at an early age are also prone to anemia or iron deficiency problems. The worst impact is giving birth to babies with low birth weight or babies born short, and dying during childbirth. Data mentions that 10% of children are born underweight, meaning that nutrition during pregnancy is not good. Conducing a case study of the problems experienced by adolescent mothers with early marriage in achieving exclusive breastfeeding using phenomenological analysis involved family members. This qualitative study was analyzed using phenomenology, with the aim of knowing the exclusive breastfeeding experience of a young mother with early marriage. The sampling technique used accidental sampling in accordance with the inclusion criteria. Data collection techniques with in-depth interviews. This study shows problems in young mothers in achieving exclusive breastfeeding including low maternal understanding, lack of self-preparation for successful exclusive breastfeeding, exclusive breastfeeding methods, husband's support during exclusive breastfeeding, and family support during exclusive breastfeeding. Keywords: adolescent mother; early-age marriage; exclusive breastfeeding

A qualitative investigation of adolescent participation in Care Groups for improved maternal and child nutrition: experiences from rural Zimbabwe

The Amalima program in Matabeleland North and Matabeleland South Provinces of Zimbabwe, an intervention funded by the United States Agency for International Development (USAID) Office of Food for Peace, promoted Care Groups from 2014-2020. Care Groups are community peer- to- peer support groups that provide a platform for promoting optimal nutrition and health for pregnant and lactating women, as well as children 6-23 months of age through training sessions run by community group leaders to promote recommended maternal, infant and young child nutrition practices. A qualitative study was conducted to describe adolescent mother inclusion and participation in Care Groups, highlighting key enablers and barriers for participation. A total of 28 in-depth interviews were conducted with adolescents in Care Groups, as well as adolescents not participating in Care Groups. Focus group discussions were also held with family members of adolescents. The key enablers for Care Group participation by adolescent mothers were found to include the motivation to learn how to take care of their children, the social and interactive benefits, family support, and positive facilitator attitudes. Key barriers to participation were workload and chores at home, lack of family support, and lack of adolescent-friendly approaches amongst facilitators. Key recommendations include training facilitators on adolescent-friendly approaches and group dynamics so they can better understand and relate to adolescents.

Investigation of some factors associated with utilization of maternal health care services by adolescent mothers in Tanzania

This study examined some factors associated with the utilization of maternal health care servicesby adolescent mothers (15-19 years) in Tanzania in order to provide advice accordingly. The studyused cross-sectional study of adolescent mothers aged 15-19 years using Demographic HealthSurvey and Malaria indicator Survey 2015/16 data. The dependent variables were number ofantenatal care visits, the place where an adolescent mother delivered and post-natal checkup(adolescent mother’s health checking after being discharged or after a home delivery). Theindependent variables were birth order, education level of a mother, marital status of a mother,media exposure, wealth index, distance to health facility. Multiple binary logistic regression wasused to examine an association between each dependent variable and their respective independentvariables. Data was analyzed using IBM SPSS statistics and STATA. This study used 550adolescent mothers in the analysis. Majority of the adolescent mothers had less than four AntenatalCare (ANC) visits (53.5%), while 68.5% of adolescent mothers delivered at a health facility.Adolescent mothers with two or more children had less odds of having at least four ANCscompared to those with one child, whereas adolescent mothers with at least secondary educationhad greater odds of delivering at a health facility compared to those who had no education.Adolescent mothers who had at least four antenatal care visits and those who are married hadgreater odds of checking their health after being discharged compared to adolescent mothers whohad less than 4 ANCs and single adolescent mothers. It was advised that provision of maternaleducation to young girls on the importance of safe delivery and health checking after delivery isvery important to reduce adolescent maternal morbidity and mortality in the country. Keywords: Adolescent; Maternal Health; Logistic regression; Chi-square