Profile of the participants
Relevant details of the participating healthcare providers are provided in Table 1. The majority (93.9%) of the participants was female and their mean age was 31.4 years. The sample included three medical doctors, a clinical psychologist, a social worker, a dietician, a physiotherapist, a physiotherapy technician, two HIV counsellors, and 23 nurses.
Nine themes emerged: decoding adolescent pregnancy, decoding community perceptions of adolescent pregnancy, personal experiences with pregnant and parenting adolescents, perceived challenges experienced by pregnant and parenting adolescents, the essential needs of pregnant and parenting adolescents, the availability of services for pregnant adolescents, issues regarding the poor uptake of healthcare services by pregnant and parenting adolescents, suggestions for improving healthcare services for pregnant and parenting adolescents, and personal and institutional efforts to support pregnant and parenting adolescents. The discussion of these themes and their related subthemes is supported by verbatim quotes.
Theme 1. Decoding adolescent pregnancy
Decoding for the purpose of this study is defined as interpreting and making sense of a situation. The participating healthcare providers provided their own interpretations of adolescent pregnancy but they all decoded adolescent pregnancy as a problematic issue and that repeat adolescent pregnancy was common in the district. Moreover, adolescent pregnancy was perceived as a risk factor for acquiring HIV/AIDS and STIs, as well as a means of acquiring financial support. Some participants also linked the marginalisation of sexual and reproductive health in education programmes with adolescent pregnancy.
Adolescent pregnancy is a problematic issue
Sarah, a clinical psychologist, stated:
“Well, I think adolescent pregnancy is an important subject. It is quite a big problem we are dealing with currently. There are too many girls affected and they are far too young. They are having babies that they cannot afford to look after. They are also not emotionally able to look after these babies. I have seen adolescent mothers who are having their second or third child. They have dropped out of school. The pregnancies are creating a ripple effect in their lives. It is a huge problem that needs to be dealt with in the public sector.”
Brenda, a Medical Doctor, stated:
“Adolescent pregnancy is a huge problem. It has been an ongoing challenge. I have worked in the maternity component for more than five years. It is one of the areas that we have not really made an impact on because looking at the data in our institution, our adolescent pregnancy rates, especially the repeat pregnancies, have been increasing. For me as a healthcare provider, a mother and community member, I know exactly how difficult it becomes for them to raise a child and attend to all their responsibilities.”
Heidi, a Professional Nurse in Paediatrics, said:
“Adolescent pregnancy is most definitely a huge problem. I have seen the pregnant and parenting adolescent mothers in our institution. They face so many problems and are afraid to speak to healthcare providers. Most of the pregnant adolescents are involved with older men for financial reasons. These adolescent girls are fighting for their survival and to meet their basic needs. Pregnancy only fuels their existing problems”
The prevalence of repeat adolescent pregnancies
Ally, a Physiotherapist, commented:
“Adolescent repeat pregnancy is common. I have seen many adolescent mothers coming to this institution with a repeat pregnancy. I think that adolescent mothers have not learnt from their first experience. Some adolescents are not keen to use contraception postpartum”
Matilda, an Enrolled Nurse, said:
“I saw a 17-year-old adolescent delivering her second baby and an 18-year-old delivering the third baby last month. This is not a shock to me because if you look at the monthly statistics of the labour ward then you’ll see that there is always an adolescent repeat pregnancy. The adolescent mothers need money for support so they have more than one child. I don’t know if they care about how they will manage to look after their children.”
Nonnie, a Dietician, stated:
“Yes, adolescent repeat pregnancy is common. I interact with adolescent mothers when they come to me if their infants or children are malnourished. In my clinical experience, I have seen some adolescent mothers with more than one child. It is worrying because the first pregnancy and raising one child is such a struggle. The second and third pregnancies during adolescence are a reality for some of these girls.”
Other participants commented as follows:
“Adolescent repeat pregnancy is a common thing. The parents get worried if their adolescent girls don’t have children. They will compare why their adolescent daughters don’t have children and why other adolescent girls have. The child grant is also enticing parents to ask their adolescent daughters to have children because the grant feeds the family” (Tina, Professional Nurse, PHC).
“Adolescent repeat pregnancy is very common. When you see an adolescent mother, you have to ask if it is their first or a repeat pregnancy” (Celine, Medical Doctor).
High risk for contracting HIV and STIs
The participants’ views corroborated arguments about the risk factors associated with adolescent pregnancy:
“Adolescents girls are involved with older men. These older men are not only impregnating them but also infecting them with HIV and STIs” (Norma, Professional Nurse, General Stream).
“Adolescent pregnancy is a scary issue. Well, it is a consequence of unprotected sex. This means the risk of acquiring HIV and STIs is high” (Pippa, Professional Nurse, Midwifery).
“These adolescent mothers are at high risk of acquiring HIV and STIs. I have noticed that some pregnant adolescents are in denial about their HIV status. They are afraid of the stigma. They don’t take their prescribed medication. They become so ill that they struggle to take care of themselves and their babies” (Shelly, Professional Nurse, Midwifery).
“Adolescent pregnancy is a risky issue because from the clinical point of view, there is HIV infection and cervical cancer” (Tina, Professional Nurse, PHC Stream).
Adolescent pregnancy as a means of obtaining financial support
The fact that young girls fall pregnant to obtain financial support from the government was a common concern.
“This is my personal view. Adolescent pregnancy is complex. The government is providing an income through child support grants. Most adolescent mothers obtain the grant but they are not looking after their babies. The babies are left with the grandmothers. The adolescent mothers use the grant money to do their hair at the salons, buy cellphones and airtime” (Valerie, Professional Nurse, General Stream).
“I am sure that the child support grant is also promoting adolescent pregnancy. I have seen the adolescent mothers in my community using the grant money to do their hair and nails at the salon. The grannies are looking after the babies using their pension money” (Zuzi, Professional Nurse, Midwifery).
“The child support grant is an incentive to the adolescent mothers. The taxpayers have to support them in order for the government to give them the child support grant. This is a burden on the economy” (Mpho, Professional Nurse, Midwifery).
The marginalisation of sexual and reproductive health issues
“I don’t think there is much done for adolescent pregnancy. The issues of adolescent pregnancy are not managed comprehensively. Sexual and reproductive health is not emphasized. We focus on adolescent girls but we are not addressing the issue of the men who impregnate these girls. When the adolescent mother leaves the hospital after delivery, she is forgotten. Her postpartum sexual and reproductive health is sidelined once again. I do not think we do justice to sexual and reproductive health education because there are time constraints and shortages of staff as well. That is the reason we will attend to many adolescent repeat pregnancies” (Beauty, Professional Nurse, General Stream)
“The issues of sexual and reproductive health are shunned. That’s the reason we are plagued by adolescent pregnancy. There are school governing bodies that will not allow for comprehensive sexual and reproductive health to be taught at schools and the topic of adolescent pregnancy is not confronted. Sometimes parents do not want to accept that their children are sexually active at a young age and therefore they will not acknowledge that adolescent pregnancy is a reality. We also have a shortage of nursing staff and struggle to impart the much needed sexual and reproductive health education” (Talmay, Professional Nurse, General Stream).
“I would like to point out that due to customs and traditions sex is not discussed in families and communities. We know that unprotected sex can result in HIV infection, STIs and pregnancy. But families and communities are not realizing the importance of talking about sexual and reproductive health. People often think that educating young people on sexual and reproductive health is promoting them to be sexually active and increasing adolescent pregnancies. However, this not the reason why we educate young people on sexual and reproductive health but to ensure that young people make informed decisions” (Frank, Professional Nurse, Psychiatry).
Theme 2. Decoding community perceptions of adolescent pregnancy
Some participating healthcare providers argued that the community regarded adolescent pregnancy as a norm, while others felt that adolescent pregnancy was deemed unacceptable. Some believed that community members were divided in their views about adolescent pregnancy.
“I truly believe that adolescent pregnancy has become a norm in our communities. Even in the religious sectors or the very traditional sectors, we seem to have adopted the style that adolescent pregnancy is okay. In schools, it has become normal to venture into sexual activities and have babies” (Brenda, Medical Doctor).
“Adolescent pregnancy is a norm within communities. I think families have accepted the occurrence of adolescent pregnancy. This could be the reason for the high adolescent pregnancy rates” (Sumeera, Professional Nurse, General Stream).
“Adolescent pregnancy is not an isolated issue. It is an ‘in thing’ so everybody accepts it. There is nothing abnormal about adolescent pregnancies in the community” (Maggie, Professional Nurse, Midwifery).
“Communities have accepted adolescent pregnancy. It is the norm. Everyone in the labour ward gets shocked if they see a 30-year-old coming to deliver. They think they are old and should not have conceived. Communities do not have an issue with adolescents having babies but the issue is with older women getting pregnant” (Frank, Professional Nurse, Psychiatry).
“Adolescent pregnancy is considered as a burden by many communities and totally unacceptable. The community perceives that adolescent pregnancy is a serious matter. Parents are totally embarrassed and they have to face financial problems. The girls drop out of school and poverty increases in communities” (Ian, Physiotherapy Technician).
“…adolescent pregnancy is such a challenge in the communities. Most community members are worried about this issue and do not condone adolescent pregnancy. No one is happy to see a child pregnant at the age of 14 years” (Sophia, Social Worker).
“I think the community ostracises pregnant and parenting adolescent girls. They do not condone adolescent pregnancy because it is an embarrassment to families. In fact, other children are advised not to befriend pregnant and parenting adolescents. I have seen this in my own community where my grandmother did not want my siblings and I to associate with adolescent girls who were pregnant or parents” (Zoe, Professional Nurse, Midwifery).
Perceptions about adolescent pregnancy are ambivalent
“I think it’s two fold. The community’s perception is that it is okay because it seems to be happening so much. But I also hear that a lot of the parents of these adolescent girls get incredibly angry because the girls engaged in premarital sex and lost their virginity. So there is initial anger and then it’s accepted. Everyone calms down and moves on” (Sarah, Clinical Psychologist).
“The community is generally divided in their perceptions of adolescent pregnancy. Some treat adolescent childbearing as a norm and then the very traditional and strict members do not accept adolescent pregnancy” (Kate, HIV Counsellor).
“The community’s perception of adolescent pregnancy is a complex issue and there are different perspectives. Premarital sex angers the elders. They do not accept adolescent pregnancy. In fact, the parents and the older generation are against family planning. They believe contraception causes sterility. They also perceive that family planning is encouraging adolescents to have sex. However, there are members of the community who accept adolescent pregnancy and associate childbearing with both womanhood and motherhood” (Shaz, Professional Nurse, Midwifery).
Theme 3. Personal experiences with pregnant and parenting adolescent women
Some participants described their experiences with pregnant and parenting adolescents as difficult while others felt overwhelming empathy.
Pregnant and parenting adolescents are difficult
“The adolescent mothers in the paediatric ward are very troublesome as they do not accept our health education. They feel that we are forcing our advice on them. Some adolescent mothers are not honest with healthcare providers, especially when they gave herbal medication to their children” (Heidi, Professional Nurse, Paediatrics).
“In the labour ward, I find that the pregnant adolescents are difficult patients. When I try to speak to them, I find that they are not listening to me” (Merri, Professional Nurse, Midwifery).
“The adolescent mothers can be very difficult as they do not want to be counselled about family planning. They are very reluctant and their attitudes are not good” (Neri, Medical Doctor).
“Pregnant adolescents do not listen to healthcare providers. They are difficult and they not follow healthcare advice” (Hillary, HIV Counsellor).
“In the labour ward, we experience difficulties with pregnant adolescents. Even though they attend antenatal care and they receive education from the midwives, they are still not co-operative and are difficult. The midwives have difficulties delivering the babies of adolescents. Sometimes they do not understand the instructions or they do not want to follow instructions. We understand the pain is overwhelming but we need these adolescents to co-operate with us” (Sandra, Professional Nurse, General Stream).
Expressions of overwhelming empathy
“I found pregnant adolescents to be co-operative when I was educating them about their pregnancy. I understand that they are young and they do not have the same knowledge as adult mothers. They have difficulties taking care of themselves. They are also vulnerable. I have empathy for these mothers” (Tazz, Enrolled Nurse).
“My experiences have been overwhelming and such an eye opener to the difficulties experienced by these mothers. I have seen adolescent mothers that have no support. They do not even have clothes for their newborns. We just see incidences of adolescent pregnancy but not the person or human being who is going through emotional turmoil” (Sophia, Social Worker).
“I felt that I could relate to the pain that adolescent mothers were experiencing during counselling sessions. When I spoke to them, I found that they just needed someone to talk to and not someone who would judge them” (Tina, Professional Nurse, PHC).
“My experiences have been positive. I can empathise with adolescent mothers because they are humans and they do show remorse. They do listen to me when I advise them about postpartum contraception” (Constance, Professional Nurse, General Stream).
Theme 4. Perceived challenges experienced pregnant and parenting adolescents
According to the participants, they perceived the following as challenges experienced by pregnant and parenting adolescent women: returning to school and completing their schooling, finances, relationships, abandonment, social interaction and stigmatisation, parenting and childrearing, and physical and mental health.
Difficulty returning to school and completing their education
“The pregnant adolescents’ girls usually drop out of school. Then they have difficulty returning to school and completing their education. They also have problems seeking employment due to their low educational levels” (Celine, Medical Doctor).
“I know of many adolescent mothers who dropped out of school. They are well spoken and intelligent individuals who are aware of the benefits of completing school and obtaining tertiary education. However, due to the responsibilities of raising a child, they drop out of school and this closes the door to a brighter future” (Heidi, Professional Nurse, Paediatrics).
“I think schooling is a challenge. Early pregnancy is affecting their education. They may drop out of school or complete school at a later stage” (Sarah, Clinical Psychologist).
“Finances are an issue for adolescent mothers. They don’t have the financial backup to look after their babies” (Pippa, Professional Nurse, Midwifery).
“Most adolescent girls who are pregnant or mothers do not have an income. The financial difficulties result in frustration” (Sophia, Social Worker).
“The adolescent mothers face financial problems. Most of them are unemployed. They are from poverty stricken families” (Constance, Professional Nurse, General Stream).
Issues involving relationships, abandonment, social interaction and stigmatisation
“Adolescent mothers have to deal with stigma. They are treated poorly at home and abandoned by their partners and family members. In fact, the relationships become so strained that the family members tell these mothers to look after themselves and their babies. The families are tired of the responsibilities of looking after young mothers and their children. The community members do not interact with them” (Mpho, Professional Nurse, Midwifery).
“There are many social problems that pregnant and parenting adolescent girls experience. They are abandoned by their partners. Their family relationships break down. Parents remain angry with these girls for falling pregnant. Some of these girls will leave home and live with other relatives. They will also find it difficult to interact with other girls of the same age in the community. Society looks down upon adolescent mothers” (Tina, Professional Nurse, Primary Healthcare).
“I think the pregnancy affects these adolescents’ relationships with family members, other men and their friends. They face issues of abandonment and also stigma” (Sarah, Clinical Psychologist).
Issues associated with parenting and childrearing
“The adolescent mothers find it difficult to raise their children. They do not have parenting skills. These young mothers are children themselves” (Beauty, Professional Nurse, General Stream).
“If you attend the paediatric ward, you often find adolescent mothers with malnourished babies. This is a problem that could have been avoided. The young mothers are also unaware of child development” (Ian, Physiotherapy Technician).
“The parenting part for adolescent mothers is difficult as most of them do not have good support structures at home. Sometimes adolescent mothers are not raising their own children but leave them with their grandmothers. This is a huge burden for grandmothers. Grandmothers have only their pension money to survive and sometimes they run out of money for baby formula and nappies” (Sandra, Professional Nurse, General Stream).
Issues associated with physical and mental health
“Adolescent mothers also experience postpartum blues and depression. These young mothers are not able to understand the emotions they are experiencing. In the African culture, mental health issues are poorly understood. Adolescent mothers who are depressed experience a reduction in breast milk production. They may also abandon their babies” (Frank, Professional Nurse, Psychiatry).
“Pregnant and parenting adolescent girls are often infected with sexually transmitted diseases. They do not take care of their health and default treatment. They become physically ill and are unable to care for their children” (Nora, Professional Nurse, Paediatrics).
“Most adolescent girls do not understand pregnancy. They do not understand the physical changes in their bodies. Their bodies are not even physically mature for a pregnancy. I have seen adolescents sustaining complications such as obstetric fistulas. It is a very distressing complication. These girls with obstetric fistulas are teased because they smell of faeces and urine. Their peers shun them” (Roslyn, Professional Nurse, Midwifery).
“Psychologically, adolescent mothers are not able to fit into society. They experience emotions such as guilt and embarrassment and do not feel good about themselves. Physically, they are not proud of their bodies because they are no longer virgins. They also have to deal with sexually transmitted diseases” (Tina, Professional Nurse, Primary Healthcare.)
Theme 5. The essential needs of pregnant and parenting adolescent women
According to the participants psychosocial, family and partner support; antenatal and postnatal support; financial support; encouragement; acceptance; and personal empowerment are essential needs for pregnant and parenting adolescent women.
Psychosocial, familial and partner support
“I think parental support is necessary for pregnant and parenting adolescents followed by support from healthcare providers. The social worker and psychologist play an essential role in providing psychosocial services” (Maggie, Professional Nurse, Midwifery).
“The support of parents and partners is very important to help pregnant and parenting adolescents to look after themselves and their children. Pregnant adolescents need to be able to turn to their parents or caregivers to talk to them about their problems” (Neri, Medical Doctor).
“Families should be the first line of support for pregnant adolescents. Psychosocial support without a doubt is so important in adolescent pregnancy. We also refer pregnant adolescents to a social worker and psychologist” (Sandra, Professional Nurse, General Stream).
“Adolescent mothers need a lot of family support. I personally believe that partner support is also essential. A multidisciplinary support structure at the hospital with social workers and psychologists is also important” (Sumeera, Professional Nurse, General Stream).
Antenatal and postnatal support
“Antenatal and postnatal care is so important. Most of the pregnant adolescents cannot talk to their family members about their pregnancy. I also think they need to have access to clinics where nurses do not treat them in an angry manner because the pregnancy has happened. In order to safeguard the adolescents from pregnancy complications, they need good antenatal support” (Sarah, Clinical Psychologist).
“Antenatal care is important for pregnant adolescents. Many hide their pregnancies and do not attend antenatal clinics. Adolescent girls have high risk pregnancies so it is important for them to be monitored in antenatal care. Postnatal care is also essential because adolescent mothers don’t take care of their physical health. They need counselling on postpartum contraception” (Beauty, Professional Nurse, Midwifery).
“Apart from family, social, emotional and community support, pregnant adolescents need good antenatal care and support. At the antenatal clinic, they should be counselled on the upbringing of the baby and breastfeeding. Postpartum care must also reinforce child care and contraception” (Frank, Professional Nurse, Psychiatrist).
“The financial needs of adolescent mothers cannot be underestimated. The child support grant is inadequate” (Kate, HIV Counsellor).
“Financial support is important because I have seen adolescent mothers who do not have clothes for their babies. They do not have transport money either. We have to ask for donations for these mothers” (Matilda, Enrolled Nurse).
Encouragement, acceptance and personal empowerment
“I think pregnant and parenting adolescents need to forgive themselves. They also need acceptance in society and not to be punished. They need to pick themselves up and further their education. They need to move on in life and achieve a brighter future” (Pippa, Professional Nurse, Midwifery).
“I think it would be wonderful to empower young mothers to take charge of their lives. We need to teach them to be hands-on parents so that they will appreciate parenting and this can prevent repeat pregnancies. They need to be encouraged to set goals for themselves and these should include their education. They also need acceptance” (Merri, Professional Nurse, Midwifery).
Theme 6. The availability of healthcare services for pregnant adolescents
Some healthcare providers mentioned that healthcare services were freely available and accessible for pregnant adolescents. However, some argued that these services were generic and not channelled to serve the needs of pregnant adolescents.
“In my opinion, healthcare services are available to pregnant adolescents. The clinics are now operating 24 hours. These healthcare services are also free and serve pregnant adolescents” (Sandra, Professional Nurse, General Stream).
“The healthcare services are available for pregnant and parenting adolescents. In fact, I think they receive more support than adult mothers. I do not think that they should not receive special treatment or attention” (Valerie, Professional Nurse, General Stream).
Lack of support services for adolescent mothers
“I do not think that healthcare services are channelled towards pregnant adolescents but are channelled towards pregnant mothers in general. So there are no specific services available to pregnant adolescents. I think there should be something quite specific for adolescents because the way you explain to them, teach and handle them is very different to how you would handle adult women. Pregnant and parenting adolescents are slipping through the cracks in the system and, as a result, they are getting pregnant again” (Sarah, Clinical Psychologist).
“The services are not tailored for pregnant adolescents. They sit together with pregnant adult women. If I had my way, there would be a separate adolescent pregnancy clinic. I would make sure the nurses are trained to handle pregnant adolescents” (Tina, Professional Nurse, Primary Healthcare).
“The healthcare services or maternity services are generalised. There is no clinic that caters for pregnant and parenting adolescents. Even at family planning, you will see an elderly lady telling adolescents that they are too young to be engaging in sex. The pregnant adolescents need specific services and trained healthcare providers that can deal with the needs of adolescents” (Frank, Professional Nurse, Psychiatry).
Theme 7. Issues associated with the poor uptake of healthcare services by pregnant and parenting adolescent women
The healthcare providers suggested that issues such as embarrassment, fear, the need for confidentiality, the attitude of healthcare providers, difficulties with transport, distances to clinics, and a preference for the services of traditional healers impacted adolescent young women’s decision to access healthcare services.
Embarrassment, fear and the need for confidentiality
“I think that pregnant and parenting adolescents are afraid to use our services because of stigma. They are also embarrassed because a lot of the healthcare services are in their communities which means most people working there know their parents or guardians. They are scared that they will be reported if they are using our services. They are scared that they are going to be reprimanded so they rather stay away” (Roslyn, Professional Nurse, Midwifery).
“Pregnant adolescents are so scared that there will be a lack of confidentiality in clinics and the hospital. They are embarrassed and fear that their relatives or neighbours will see them accessing such services. They are also scared that people will gossip about them” (Merri, Professional Nurse, Midwifery).
“Most adolescents hide their pregnancies and do not tell their families. They are scared and embarrassed to be seen at a clinic. The community is small and it’s possible that they will meet relatives and neighbours at the hospital. Confidentiality is also an issue” (Shelly, Professional Nurse, Midwifery).
The negative attitude of healthcare providers
“Pregnant and parenting adolescents are scared of the nurses at the clinic because they shout at them” (Shola, Professional Nurse, Midwifery).
“The attitudes of healthcare providers are negative towards pregnant and parenting adolescents. This chases pregnant and parenting adolescents away” (Tina, Professional Nurse, Primary Healthcare).
“Pregnant and parenting adolescents fear being shouted at by healthcare providers. There are healthcare providers who get very angry at adolescent girls for getting pregnant. So instead of helping them, they frighten them. Healthcare providers often believe that adolescents should be punished for falling pregnant” (Sarah, Clinical Psychologist).
“It is the shameful attitudes of healthcare providers. We discriminate against pregnant and parenting adolescent mothers. We shout at them and scare them” (Kate, HIV Counsellor).
Difficulties with transport to and from clinics
“Apart from healthcare providers’ negative attitudes, another issue is transportation problems. The clinics are far and the transportation costs are high. The hours of service delivery also restrict access. Taxi fares are expensive, especially when the girls have to travel from rural areas” (Brenda, Medical Doctor).
“The distance from home to the clinic is far for most pregnant or parenting adolescents. Sometimes there is no transport available, especially in deep rural areas. In most rural areas, you take three taxis to reach this hospital which may cost approximately R120 a day” (Frank, Professional Nurse, Psychiatrist).
“There are people who live very far from the clinics and the hospital. There is a lack of transportation as well. If transport is available, the transportation fees are expensive. The girls have to walk long distances to the clinic if they cannot afford the fee” (Tazz, Enrolled Nurse).
Preference for care by traditional healers
“It appears that pregnant and parenting adolescents prefer care that is rendered by a traditional healer. I have seen pregnant adolescents using herbal medication during their pregnancy. In the paediatric wards, the children of adolescent mothers are [often] hospitalised for herbal intoxication” (Neri, Medical Doctor).
“These adolescents listen more to their parents and other family members. They are going to traditional healers as their first preference. Pregnant adolescents take medication supplied by traditional healers to induce pregnancy. They also consult traditional healers for child-related illnesses” (Shola, Professional Nurse, Midwifery).
Theme 8. Suggestions for improving healthcare services for pregnant and parenting adolescents
The participants suggested that closing the gap between the Department of Health and the Department of Education would improve the healthcare services for pregnant and parenting adolescents. Others suggested that tailoring healthcare services to accommodate pregnant and parenting adolescents would lead to improvement in the services rendered to these young women. Home visits, community outreach programmes, collaboration with traditional healers and NGOs, and support groups were additional suggestions for improving healthcare services for pregnant and parenting adolescents.
Closing the gap between the Department of Health and the Department of Basic Education
“I think schools have an important role in educating adolescents about pregnancy and sexual and reproductive health through the Life Orientation programme. The Department of Health should also collaborate with the Department of Education. Adolescents need to know about the services that are available. In fact, antenatal and postnatal care needs to be accessible through school health nurses so that these adolescents do not fall through the cracks in the system” (Sarah, Clinical Psychologist).
“We need to take healthcare services to the schools. The Department of Health must approach schools. The school healthcare nurses need to help and liaise with antenatal healthcare nurses” (Beauty, Professional Nurse, General Stream).
“The gap needs to be closed between the Department of Health and Department of Education. If both these government departments can work hand in hand, we would be able to strengthen adolescent pregnancy prevention and ensure the dignity and well-being of pregnant and parenting adolescents. Nurses should be allowed into schools to educate learners about pregnancy and encourage those who are already pregnant to use antenatal services” (Maggie, Professional Nurse, Midwifery).
Prioritising healthcare services that are tailor-made for pregnant and parenting adolescents
“I would suggest a tailored clinic for pregnant and parenting adolescents. The staff must be well trained in adolescent health issues and be able to communicate with adolescents at their level of understanding” (Nonnie, Dietician).
“We need specialised adolescent antenatal and postnatal clinics. Pregnant and parenting adolescents’ issues are different from those of adult mothers and they need specific services” (Shaz, Professional Nurse, Midwifery).
Home visits and community outreach programmes
“I think home visits and community outreach [programmes] can help pregnant and parenting adolescents. We have community healthcare workers who can be trained to help educate these girls. We can also use mobile clinics to do community outreach” (Constance, Professional Nurse, General Stream).
“We should be accessible to pregnant and parenting adolescents outside the formal setting. We should consider community outreach programmes. It would be ideal to conduct home visits to educate and support these adolescents” (Heidi, Professional Nurse, Paediatrics).
“For the TB programme, we have staff that go out and trace patients. I think we can extend this to the care of pregnant adolescent girls. We should be able to go into the communities and provide antenatal care. We can also trace pregnant women who default antenatal care” (Kate, HIV Counsellor).
Collaboration with traditional healers
“I think we need to communicate with traditional healers and also learn from each other. We need to educate traditional healers about the medical management of pregnancy. This is a necessary step because we know that pregnant and parenting adolescents consult traditional healers” (Neri, Medical Doctor).
Collaboration with non-government organizations (NGOs)
“I think a downfall in the healthcare system is the lack of collaboration with NGOs and youth empowerment organisations regarding adolescent pregnancy. I just think of the anxiety that a 15-year-old pregnant adolescent experiences when sitting with a group of 30-plus-year-old mothers who are in their third pregnancy. I wish there was a non-governmental organisation that could quietly and confidentially support these adolescents. The adolescent girls will be more likely to report their pregnancies instead of aborting or self-aborting. They could also be counselled on how to disclose their pregnancy to their parents. I often find that they come in and they haven’t told their parents or caregivers. It is a frightening situation for them. So if they could have that support, maybe we could promote family involvement” (Sarah, Clinical Psychologist).
“I would approach school health services and establish a support group. I would use the support group to empower pregnant and parenting adolescents” (Frank, Professional Nurse, Psychiatry).
“We need to establish support groups for pregnant and parenting adolescents” (Shelly, Professional Nurse, Midwifery).
Theme 9. Personal and institutional efforts to support pregnant and parenting adolescents
The healthcare providers mentioned that counselling and health education formed part of their personal and institutional efforts to support pregnant and parenting adolescent women.
“I conduct counselling during community outreach programmes. I counsel the adolescent mothers on returning to school and completing their secondary education” (Shaz, Professional Nurse, Midwifery).
“We provide counselling to the pregnant adolescents on all the available pregnancy options. We also counsel adolescent mothers that are experiencing a crisis. We also extend our services during community outreach programmes. Counselling is provided during pregnancy and after birth as required” (Sophia, Social Worker).
“When the pregnant adolescent mothers are referred to us, we counsel them. We discuss if they have disclosed their pregnancy to their family. Then we discuss issues regarding how they are going to care for the child. We discuss their school attendance and future goals. I also try to place emphasis on the road ahead because it is going to be a difficult road to travel. We reassure them that we are always available if they need to talk to us. We also counsel them on family planning in order to prevent repeat pregnancies” (Sarah, Clinical Psychologist).
“I provide pregnant adolescents with nutritional education with regards to a healthy pregnancy. I also have to educate adolescent mothers on how to care for their children who suffer from malnutrition” (Nonnie, Dietician).
“I conduct health education on pregnancy, sexual and reproductive health. The pregnant adolescents need health education to make informed decisions” (Zoe, Professional Nurse, Midwifery).
“I conduct health education in the antenatal clinic. I enjoy talking to pregnant adolescents. I have also done health education talks in the communities for adolescent mothers” (Tina, Professional Nurse, Primary Healthcare).