Twenty-seven teenagers in the age bracket of 14 to 19 years participated in the study. The majority (24/27) claimed to be married while 3/27 were single. In regard to religion: 9/27 were Catholics, 8 were protestant, 2 Born Again Christians and 8/27 were Moslems. Their levels of education ranged between four years of education to eleven years (Primary four to Senior 4 in Ugandan System) with the majority (20/27) having not gone beyond their primary levels of education. The majority were unemployed (14/27), whereas over a third were farmers (11/27), one was a shop keeper and another, a housewife. The majority were carrying their first pregnancies (21/27), three carrying their second pregnancies and three having their first child. These teenagers were receiving antenatal care or had delivered from any of the sampled health facilities at the time of the interviews. True identities of the participants were coded using initials of the health facilities they sought services from and the numbers indicated their age. Original experiences gathered from the girls were directly quoted to enhance the description of experiences and findings of the study. Results were organized into themes and sub-themes.
Themes and sub-themes
The predetermined and emergent or sub-themes of the study are presented in Table 1. The themes emerged from the findings and a number of sub-themes were developed. The predetermined themes were three: personal, interpersonal and health facility related experiences. Each of these had emergent or sub-themes.
Table 1 Predetermined and emergent themes
Predetermined theme
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Emergent themes and sub-themes
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Personal experiences
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· Timing and decision to go for ANC
· Importance of ANC
· Motivation to come for ANC
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Interpersonal experiences
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· Support from spouses, friends and family; Facilitation in form of buying the necessities, money for transport and feeding, accompanying them and offering some education.
· Decision making power
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Health facility related experiences
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· Comfort at the facility
· Treatment given
· Health worker attitude
· Education offered
· Availability and accessibility of utilities
· Challenges faced (accessibility; distance and affordability, working hours, fear and stigma)
· Health facility compared to services by a traditional birth attendant (TBA)
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Personal experiences
Timing and decision to go for ANC
Some of the girls had attended ANC for at least three times, while others were just reporting for the first time. However, many of the girls initiated their ANC visits later than expected. Many of them came when their pregnancies were more than five months. Some were five, others six as well as seven months. Only a few of the girls reported before the five months.
“I have never come here before. The first time I came, I was sent away. I came in September last year and was sent away because I didn’t come with my husband so I just moved back home” (KU, 16 years).
“I always come for ANC. I first came when the pregnancy was 6 months because I had fear. For the second, it is 8 months and I started coming at 6 months also. My husband is at times not around. He is the one who delays me. We are told to always come with our husbands when coming for tests” (KD, 19 years).
Some of the girls had been dumped by their husbands either at home or with their relatives and showed no signs of returning.
“This is my first time to come for ANC and it is 7 months. What delayed me is that I was waiting for my husband hoping that he would come back but he did not. He is in Kampala where he works as a porter” (KR, 19 years).
“I have just returned today. I was asked to return on 9thJanuary. I first came when it was 7 months. They used to say that you come with a husband when you are pregnant. The man had left me at the brother’s home and there was no kind of support he was offering so I decided to go back home. For me, I am home now but I don’t know where he is and what is happening to him. So when I returned to my parents’ home is when I started coming here” (KD, 18 years).
Lack of money to procure the necessities required for ANC was also one of the reasons noted for delay to come to the facility.
“This is my first time to come for ANC and its 4 months (smiling). My husband delayed me from coming. He tells that there is no money to buy the polythene bag that we use whenever we go for ANC or in preparation for delivery and other things” (KR, 18 years),
“I have just started ANC today and the pregnancy is 5 months. I delayed to come because the facilitation I have is also little. I didn’t have the money to buy a polythene and yet they want it. So for today I got some money to buy it then I came. My husband himself is in Entebbe (over 100 Km from home) and that is where he works and that is their home. He doesn’t send any assistance even when I call they don’t pick me up, I don’t know what the problem is” (KR, 19 years).
One of the participants just decided that she wanted the baby to first develop before she could come to the facility.
“Yes, I have come for ANC before. This is the third time. I first came when the pregnancy was 5 Months old and is now 7. Nothing prevented me from coming. I decided personally that let this pregnancy first grow then I will go” (BS, 17 years).
Importance of ANC
Many of the mothers were aware of the importance of ANC to their health and that of their babies. They said that when they come for ANC, they are checked to find out the condition of the baby in the womb, they are also given medicines that help the baby. This was brought out by a number of girls.
“Yes, it is good to come for ANC. You can be able to tell how the baby is, may be you can get enough care, and be able to tell whether the baby is ok in the womb or not” (TR, 17 years).
This was also retorted by others respondents:
“It is good to come for ANC because they examine me and see what illness is in the womb. In case there is any, they give you treatment, they give you medicines and for me that is the good thing I see in it” (KB, 19 years).
“I think that ANC is to get help and I think it is good to come because if there is a problem they can help you” (KB, 19 years).
“Hmm. It is good to come for ANC. Why it is good is that at times it may have an illness and the second reason, they have to see how the child is developing in the womb and the third thing they have to see whether the child is alive in the womb or it has some deformity. That is what brings us for ANC” (KD, 18 years).
“It is good to come for ANC. It is good so that you can know whether what is in the womb is ok; it is alive or dead, it is in the right position or not so that the HW knows and you also know” (KN, 17 years).
Motivation to come for ANC
Many of the girls were motivated to come for ANC because they felt that was the best opportunity for them to know the condition in which their babies were. A few were motivated after they had got what the HWs required them to always come along with to the health facility.
“What motivated me to come today is because my husband bought some requirements though he has not bought all but I am hoping that he will buy the rest” (KO, 18 years).
“For the first pregnancy the money was there, we got it fast and we bought the requirements. For this one, I have come now because I got the requirements” (BS, 19 years).
Some of them came because they were feeling unwell and wanted the health workers to help them.
“I came today because I was feeling some pain so I decided to come” (KR, 19 years).
“I myself saw my lifestyle and another thing at the beginning first of all, when the pregnancy was still young, about 4 months, I experienced some pain as if I wanted to get an abortion but that was before I came so I decided on my own that I should come to the Health Facility” (KT, 17 years).
One of them was also not staying at their home but when she got back home, she started attending ANC.
“What encouraged me to come is the fact that I came back home then I started coming for ANC” (KD, 18 years).
However, one of the participants had a personal drive that pushed her to come:
“What encouraged me to come? I just wanted to come” (KD, 18 years).
Interpersonal experiences
Support from spouses, family and friends
Many of the girls felt supported by their families including their husbands, parents, grandparents and even friends. They reported being supported in various ways like being given money for transport, feeding; others would accompany the girls to the facility, some offered guidance in relation to ANC and visiting the Health facility.
“The people I stay with encourage me to come and see that I do not get other diseases like tetanus. They also give me some transport. They educate me as well” (TR, 18 years).
“I stay with mummy, daddy and my husband himself. They give me transport, at times, they accompany me; they come and wait for me and thereafter receiving care, we go back. My husband accompanied me and the mother also accompanied me. They also teach me that going to the health facility is good so that we know what is in the womb” ( KN 17 years).
“I stay with my granny and my husband. They bought for me some requirements. My husband bought them. They also tell me the goodness of ANC. They tell me that it is good and you go to the health facility and the HWs see the condition in which you are because there might be things or medicines that are required that you can keep using” (BS, 18 years).
“I stay with my in-laws at home. These people just educate me. They encourage me to come to the Health Facility because you never know I can get a problem and fail to deliver well. Hmm. That is why you see they encourage me that my dear you take care of yourself and go” (KD, 18 years).
“I stay with my husband and his parents. They all decide for me to come for ANC. They educate me, they give me transport and even accompanying me. Hmm…(Thinking) Most importantly is that they educate me on hygiene and my husband is the one who in most cases accompanies me for ANC” (KB, 19 years).
Some of the girls also offered some piece of advice to their fellow friends. This was obtained in an interaction with one of the girls:
“My friends say me to go for ANC and get to know how the child is growing and every pregnant mother goes for ANC. It helps to know how the child is growing and they ask me how I am feeling (TR, 18 years).
Despite the majority of the participants being supported by the people they stay with, some did not really get that kind of support. Whatever they therefore did was as a result of their personal drive, including the decision making. This was noted in an interaction with one of the participants:
“I stay with my mother-in-law and brothers-in-law. I told them that I was coming to hospital. I just came with my husband so those that I stay with have not in any way helped me as far as ANC is concerned” (KR, 19 years).
Decision making power
For the majority of the girls, they did not have the decision making power. Most of the decisions to come for ANC were either made by their husbands because they claimed it is their husbands who control them and for some, because they are the heads of the families.
“My husband decides for me on whether to come for ANC because he is the head of the family” (KM, 18 years).
“My husband is the one who decides for me to come for ANC because at times I can forget the date then he reminds me. I have to ask from him” (KD, 18 years).
For others, the decisions were made by the people they stayed with like their parents and grandparents.
“Now the fact that I am staying at home, I first have to request daddy that I am going to the health facility then he allows me. Indeed, he could not refuse because it is mandatory that I have to come” (KR, 19 years).
“Mummy decides for me because she’s the one controlling me or taking care of me” (TR, 18 years).
“Mummy decided for me to come for ANC today because I had fear to come because if I come without a husband, am not attended to. You are sent back home” (KZ, 18 years).
Only a few made personal decisions to come for ANC as seen in some interactions.
“I decide for myself to come for ANC. No one at home tells me to come for ANC. I am always encouraged to come to be checked. I don’t feel well when I don’t come for ANC” (TR, 14 years).
“I decided to come by myself for ANC today. I said that let me go to the chairman and go to the health facility. When I went to him, he wrote for me a letter and I came before they accepted to attend to me” (KX, 19 years).
Health facility related experiences
Comfort of using a health facility
Many of the girls said that they felt comfortable when they came to the health facility. This is because they felt they had come to the right place and would therefore receive what they have always anticipated; treatment and go back home better.
“I feel comfortable at the health facility because I come and they palpate me and give me some tablets to go and take” (TR, 19 years).
“I feel good when I come to the health facility for ANC because the HWs will have attended to me well and I go back home” (TR, 18 years).
“I have felt some comfort coming here today because I have been tested, given some medicines, palpated and I feel life is not like it has always been” (KV, 18 years).
“I feel comfortable when I come here for ANC. Hmm... I feel comfortable as well when I come to deliver from here. I find my friends and we come” (BS, 19 years).
Some however, since this was their first time were anticipating comfort only after they have interacted with the HWs and received some medication.
“I have not yet felt some comfort. I will feel after I have got some medication” (KR, 19 years).
“I didn’t feel comfortable the first time I came because, I was feeling some pain but today I am fine” (KH, 16 years).
Treatment given
Many of the girls who came were given some kind of medication. Some included vaccination and medicines. Some of them had some slight idea of the importance of the medication they were given. Many of them therefore promised to continue coming to the facilities for the ANC services.
“I was given some iron tablets and some which are two, when you first come; whether they are two or three fansidar tablets? I will be coming back for ANC here” (TR, 17 years).
“I got some medicines when I came here. Some that are for blood when you have delivered, when you over bleed and for some, I was told that I had some flu. I will continue coming for ANC and will even deliver from the health facility because I am still here and still producing” (KB, 18 years).
“I am immunized and given some tablets when I come for ANC and palpation. I hope to come back for the remaining time (laughing), the remaining two times because the months are still there and I think it is good (laughing) because I am not yet relieved” (TR, 18 years).
However, some of them did not really understand why they had to swallow some of the tablets. Despite the limited knowledge on the importance of the treatment they were receiving, they also promised to continue coming to the facility.
“I was injected and they gave me some medicines. They didn’t tell me the importance of the injection. I hope to deliver from the health facility because at times you never know you can get a problem and fail to deliver from the village. I will continue coming here because pregnancy things are difficult” (KD, 18 years).
Unfortunately, some of the girls also said that they had never received any kind of medication from the health facility. This is because whenever they came, they were told that there were no medicines so they got a prescription and were asked to go and get them from physicians.
“They have given me some medicines when I came here. I don’t really know how they are called because when I came they just wrote for me on a piece of paper. They just write for me and I go and buy. I hope to continue coming because of the help I am rendered” (KB, 19 years).
“For me for the times I have come, they have not given me any medication but they gave me a mosquito net. I sleep under it and will continue coming for ANC but I don’t know why” (KS, 17 years).
Health worker attitude
For all the girls, on interaction with them, they said that the HWs treated them well. They did not therefore have any problem with the way they were treated by the HWs. They said that the HWs were always calm in the way they talked to them. Even in instances when they failed to do what was expected of them, the HWs were a little hard with them but later attended to them. The HWs were also noted to be patient and kind to the girls.
“There is nothing bad the health Workers can do to us but only give us advice” (TR, 17 years).
The HWs treat the girls well. They do not bark at people, they ask them well (KR, 19 years).
“The HWs treat well. If the ones who come to deliver their polythene bags are far, they assist them with theirs. They give them and they speak with us well” (BS, 17 years).
“The HWs treat us well. They first educate us when we have come with our husbands that you go and tell your husbands to buy for you clothes. They are not rude” (KB, 19 years).
Education offered
Some girls acknowledged receiving some education when they came for ANC. This they said was important for them as young girls.
“They educate us to come to the health facility with our husbands. But for me I didn’t come with mine because I didn’t know. They tell us that both of you have to be tested. They also tell us what is required when coming for delivery like the polythene and clothes and on diet, we were told that you need to eat some pineapples” (BS, 17 years).
“Like us who are pregnant, they tell us to come with plastic bags, gloves and during delivery you come with everything that is required. That’s all I have heard being taught. Even on hygienic, feeding habits” (TR, 14 years).
However, while some claimed the education was adequate, others felt there was some more that they needed to know.
“They educate us like preparing for ANC; clothes, polythene and panties (Hmm.). They also educate us on what to eat like taking millet porridge. We still need to learn more like going for Family planning” (BS, 19 years).
“They teach us that we need to eat well like eating some beans, silver fish, greens. You need to stay in a clean environment. They need to add on what we are taught” (TR, 18 years).
“They have educated us like for a woman when you are pregnant, you need to prepare yourself, you be with a polythene, gloves, petticoats and knickers when you are going to deliver because some people when they come for delivery, they don’t even have requirements. Actually like us who are first time mothers, there is a lot that we really need to know because since this is the first time we are getting pregnant, there is a lot that we need to know that we don’t know” (KR,19 years).
On the contrary, there are some of the girls who did not receive any kind of education for the times they had visited the health facility. These were captured during interactions with them:
“No, the HWs have never educated us. Even what is required when we are preparing for delivery, they have not yet told us. They have never told us anything so it is about you to know that this is required and what is not” (KF, 17 years).
“For me they have not yet given me any kind of education but I think the education is necessary like when you are pregnant and there is something you can do” (KB, 19 years).
Availability and accessibility of utilities
Some girls noted that the utilities were enough, but others found that they were not adequate enough and therefore needed to be added. These included the beds, equipment used for checking them, medicines and the limited number of HWs as well.
“They have never given me any medicines; they told me to buy since they were out of stock in the facility. They told me to buy for swallowing but I didn’t buy so there’s nothing I am swallowing” (KC, 17 years).
“Me if I was to go by what I think, the utilities are not enough. The beds themselves that they use for delivery are few, where the patients themselves rest are few, the medicines, they can tell you to come back another day, you come back and they tell you that there are no medicines and you come back another day, then you come back again and in the end, you yourself feel tired and yet it is mandatory that you come” (TR,17 years).
Challenges faced (Accessibility; distance and affordability, working hours, Stigma and fear)
Many of the girls claimed that the health facilities were accessible and felt the HWs in most cases worked on time save for a few of them who once in a while delayed. However, one outstanding challenge that most girls kept identifying was that the clients were in most cases many and with may be only one HW attending to them.
“At times you come here early but you leave the place late. Only one HW attends to the patients and yet the people are always many. You feel some fear as well but it is now gone. I overcame by involving in conversation with people. For the medicines, they at times tell you to go and buy medicines but they give you some which are there” (BS, 17 years).
“O! at times you come here and sit before the HWs have even arrived like today we came here and found some man complaining that the HWs have delayed to come. I can never get fear to come to the health facility because I decided that I want marriage and what I want is a child” (KT, 18 years).
“…………….I don’t blame this on HWs but us as individuals as well, we have our lifestyles that are bad like you can be told to come early and you reach at your own time when the HWs are finishing to work and they have also got tired and in their tire, they are also using anger when they don’t have any more strength. Sometimes they are also caught up and they delay to reach and at times you come and are told that they won’t work and you go back home or you come and you have not come with what they want and you don’t have money to buy them. You can be attended to but they also first make you feel the pain because they told you but you did not also think of it” (TR, 17years).
The girls did not also have any stigma apart from a few who were coming for the first time but were later able to get over it.
“The second time I came; they were in for a meeting we were asked us to go back home. But whenever we come they attend to us and they release us early. Transport has never been a problem to me because from where I stay to come here is 500/= and going back is also 500/= only. I only had stigma the first time and that is when my mother-in-law accompanied me because I had fear then. The next time I came back, I came alone and had no fear any more” (KC, 17 years).
“I have got a challenge coming here at times when you lack requirements but we are attended to on time. I at times fear to come here because people will look at me pregnant but it’s about staying strong” (KR, 18 years).
Health facility compared to services by TBA
Many of the girls preferred using the health facility as compared to the TBA. This is because most of them said that at the Health facility, one easily gets immediate attention and assistance.
“I have not yet gone to a TBA and do not really hope to go there. Why? Hmm...Only a few things do they know from what is at a health facility” (BS, 18 years).
“I would prefer to come here because here I find a lot of reference points because a HW can tell you, ‘Go and swallow this medicine, go and do this and don’t do that because it is going to hurt you but when you go to a TBA, she will continue giving you medicine and you take” (TR, 19 years).
“I will continue coming here to the health facility. Why? (Laughing) There are some TBAs in the village who tell you that your pregnancy is unhealthy and you come here, to the health facility and they tell you that the illness is not there which shows that the TBAs are deceiving” (KB, 19 years).
However, few of the girls said they would go to the TBA only to take medicine, be palpated and depending on the nature of circumstances but would deliver from the health facility due to the nature of assistance offered.
“There are TBAs in the community where I stay and I hope to go there to be palpated. I hope to deliver from the health facility because I can decide to deliver from home and I fail” (KB, 19 years).
“I went to a TBA during delivery, but I had never gone there before but only to deliver. I am sure I can go back” (TR, 17years).
One of the girls felt that the HWs were better confidantes than the TBAs.
“Aaah! I have never thought of going to a TBA. We have one near our home but the ones she helps deliver, she talks about them with others so I would rather come to the health facility” (TR, 14 years).