Pregnancy experience of adolescent girlsPregnancy intention

There were differences in pregnancy acceptance among adolescent girls, depending on their marital status and region of residence. In the South West and South East regions where, early marriage is less common, fewer adolescent mothers reported being married, and for most of them who were either married or cohabiting with their partners, the pregnancy was their point of entry into marriage or at least cohabitation. For adolescent mothers in the North West region where early marriage was the norm, marriage generally preceded pregnancy.

Unmarried young women reported being unprepared for their pregnancies, with one describing at a mistake. Her mother’s decision for her to leave home and go and live with the father of her child is a common response to an adolescent pregnancy, as it is felt that girls who get pregnant at young ages are trying to prove that they are now adults, and as such, should be forced into the adult world of caring for their own home.

We were both in school; he was my senior, he used to come and visit me, but we never planned that I would get pregnant. (AK 02, 16, single, SW, Yoruba, urban, Christian, incomplete secondary).

No, this was a mistake…...we were dating before the mistake happened, and my mother said I should leave her house and go to the person responsible for my pregnancy, and I went to live with him. (AP06, 19, cohabiting, SW, Yoruba, rural, Christian, basic)

Married adolescent mothers, however described their pregnancies as wanted, since the expectation for them was that the next logical step after marriage would be pregnancy.

Yes, it (the pregnancy) was (planned) as I am in my husband’s house…we decided it was time to have a child. (AS05, 17, married, SE, Igbo, rural, Christian, secondary)

Whoever gets married must expect pregnancy, so I expected it. (MJ03, 18, married, NW, Hausa, rural, Muslim, no education)

However, there were adolescent mothers who had contrary opinions about their pregnancies. Here we see an unmarried adolescent mother in the South West who got pregnant on purpose to prevent an unwanted marriage.

I planned to get pregnant for my boyfriend because my parents were trying to force me to marry someone else…so I thought if I get pregnant, they would not be able to force me to marry the man of their choice. (AP02, 22, single, SW, Igbo, rural, Christian, secondary)

This young mother, despite being married and living in a community where early marriage was common, said that she would have preferred to wait a little longer after marriage before getting pregnant. This shows that even where early and childbearing are common, individual choice may differ from the norm.

I never expected to be pregnant when I got married and it was just sudden. (KT06, 19, married, NW, Hausa, urban, Muslim, incomplete secondary)

Experiences of stigma

Some adolescent mothers reported experiencing stigma especially via verbal abuse to varying degrees. Most of the mothers who reported stigma were unmarried mothers who were not living with their partners, although some married and cohabiting mothers reported being verbally abused. There was the general feeling that pregnancy was not acceptable among young girls, as they should be in school.

Somebody came to tell me that some people said I have nothing to eat…that I was impregnated and the person responsible didn’t take care of me. That I was sent to school but became pregnant. I have fought with someone in this area when she asked me why I was pregnant when I should be in school, so I fought with her over why she would say such a thing to me. (AK04, 19, single, SW, Yoruba, urban, Christian, incomplete secondary)

This adolescent mother’s experience reinforces the cultural impression that it is a shameful thing for a young girl to get pregnant while still living with her parents, and one of the major reasons why pregnant girls are asked to go and live with their baby’s father.

Yes, I experienced it…some of them were talking about the fact that I was pregnant in my father’s house…some came to say it to my face. (AS08, 20, single, SE, Igbo, rural, Christian, incomplete secondary)

For this adolescent mother, she looked much younger than she is, and due to her extremely young look, she attracted verbal abuse from a total stranger who even advised her to get an abortion as they felt she was too young to be carrying a pregnancy.

Someone met me on the road and told me to go and abort my pregnancy, that I was too young to be pregnant…he didn’t know I’m married. (AS12, 19, married, SE, Igbo, rural, Christian, basic)

Stigma was found to be tied to the perception of adolescent pregnancy by older community members. The different responses given by older women indicate that adolescent pregnancy was frowned upon among unmarried girls, and only seen as acceptable where the young girl was married.

This community leader’s response suggests that she viewed adolescent pregnancy through the lens of deviant behaviour, as girls who got pregnant did so after ignoring warnings about their lifestyle.

No, the people in this area do not see it as a normal thing. You know with some people; it is the life their child wants…. There are some children who do not pay heed even after several warnings, and there’s nothing anybody can do but to leave them alone. But it’s not something the community accepts or is happy about. (AK Community Leader, SW, urban)

This community leader in the rural North West region specifically states that premarital adolescent pregnancy was something that brought shame to the girl and to her family. In this case, while there was a preference for early marriage and childbearing, unmarried girls were not expected to engage in sexual activity.

It is a very shameful thing here for one’s daughter to get pregnant without marriage…. although it is very rare in our community and God forbid, we don’t wish it. (MJ Community Leader, NW, rural)

This older mother expressed the opinion that adolescent pregnancy was desirable, as it enabled girls to have children early. She then stated a caveat, that it was only accepted when the girl was married.

There is nothing wrong about it, even our parents some of them they married early and they gained so many things from there, you will see them and see their children you will not even see the difference, they will be young and their children will grow up together, when you see them in future, they will be able to gain so many things before they age… For unmarried girls it is not good, the person should finish school before marriage…but if she is her husband’s house, then better, it is good, there is nothing wrong in that one. (OW Mother 01, SE, urban)

Support during pregnancy

Adolescent mothers in this study were largely dependent on their families for economic and emotional support to enable them cope during their pregnancies. The study showed that unmarried adolescent mothers relied mainly on their mothers or older female relatives for such assistance. The responses show in general the importance of parental, familial and spousal support for adolescent mothers, as they tend to be disadvantaged financially, emotionally and socially due to their young age.

This adolescent mother, while living with her family, was able to get quite a lot of moral and financial support from her brothers, and her older female relatives as both her parents were dead. In addition, she also got such support from her baby’s father.

I got money from my older brothers as well as my baby’s father…. My family treated me well, they did not maltreat me because of the pregnancy…...My aunties were there for me, they gave me advice and moral support as well as money. (AS02, 19, single, SE, Igbo, rural, Christian, incomplete basic)

While this adolescent mother was able to get support from her parents, she got nothing from her ex-husband and his family. This shows the importance of parental support especially in the case of marital breakdown or where the child’s father refuses to take responsibility for the mother and child.

My parents helped me during and after pregnancy. My husband and his people did not care at all. (KT05, 19, divorced, NW, Hausa, urban, Muslim, incomplete secondary).

These two adolescents have similar stories of abandonment by their babies’ fathers. While the first participant said that they had no plans to marry each other, the second participant said that her partner refused to support her because her parents refused to allow him marry her. These responses give insight into how relationship dynamics among adolescent mothers and their partners may influence the availability of partner support for young unmarried mothers.

My baby’s father does not give me money. It’s my mother that takes care of me because we did not plan to marry each other. (AK04, 19, single, SW, Yoruba, urban, Christian, incomplete secondary)

He has abandoned me, saying that it was my parents that didn’t agree to accept him, and since then he has not been calling or taking care of me or the baby. (AP04, 21, single, SW, Yoruba, rural, Christian, secondary)

This adolescent mother reported that she was abandoned by both her partner and her mother, so she was forced to fend for herself throughout her pregnancy. As earlier stated, some parents abandon their daughters when they get pregnant in a bid to force them into premature adulthood, as they believe that the girl’s getting pregnant is a statement that she is now an adult, and so should be treated as such.

My mother did not treat me well during my pregnancy…she kept me at arms’ length. (AK06, 19, cohabiting, SW, Yoruba, urban, Christian, basic)

On the other hand, married and cohabiting mothers relied more on their partners and partners’ families for all types of support.

It was my husband that was taking care of me…He abandons his work to take care of me sometimes. (KT08, 18, married, NW, Hausa, urban, Muslim, incomplete secondary)

During my pregnancy my husband took care of me, provided my needs very well together with his parents. (MJ05, 15, married, NW, Hausa, rural, Muslim, none)

My husband and my mother-in-law are the ones who give me money for my needs, including hospital. (OW01, 18, married, SE, Igbo, urban, Christian, secondary).

These adolescent mothers reported that they received adequate support from their partners during their pregnancy, as their husbands catered to their every need. Two adolescent mothers reported that they received support not only from their partners but from their in-laws also.

Experiences with health workers

There were some accounts of ill-treatment by health workers, ranging from being duped by the health worker to verbal abuse and carelessly causing the death of a respondent’s newborn baby.

This adolescent mother reports that she got scammed by a health worker in the government clinic, who collected money from her and promised to attend to her maternal health needs, However, she failed to do so and simply disappeared with the money paid, forcing the young mother to find an alternative healthcare service provider. While we cannot infer that this was a regular practice in the government health centre, it is doubtful that the said health worker would have pulled it off with a more matured and experienced client.

The first clinic I went to…the lady took my money and disappeared…she never treated me. That was the government clinic…every time I went there, she was not around and whenever I tried to phone her, I wouldn’t get through. I eventually gave birth to my baby in a private clinic. (AS03, 17, formerly cohabiting, SE, Igbo, rural, Christian, incomplete secondary)

This respondent complained about verbal abuse from the nurses at her antenatal clinic.

They are quite expressive and sharp-tongued. They insult us a lot. If we don’t do our exercises on time they ask if they are the ones responsible for our pregnancy. They insult us like that. (AK07, 20, cohabiting, SW, Yoruba, urban, Christian, secondary)

This respondent’s complaint was a serious one, as she claimed that the health worker at the government clinic was responsible for the loss of her first baby shortly after delivery.

I don’t like the way they behave in that government clinic; they are careless people. I lost my first baby there because the nurse was careless. (AS12, 19, cohabiting, SE, Igbo, rural, Christian, basic)

A common thread through these narratives is the lack of respect for these mothers by the health workers. However, despite these reported cases of negative health worker attitudes, the adolescent mothers who made the complaints still reported that they made use of health facilities for their maternal healthcare needs. This finding shows that as much as positive health worker attitudes make accessing healthcare less stressful for adolescent mothers who make use of health facilities, negative attitudes do not influence their decision to use health facilities. Rather, these decisions are influenced by other factors.

Maternal healthcare utilisation by adolescent girls

Adolescent mothers reported different factors that influenced their use and non-use of maternal healthcare services for prenatal and delivery care.

Affordability and misinformation about cost of care

Some of the adolescent mothers reported that they were unable to make use of modern healthcare services because they could not afford the cost of healthcare, because they had no financial support, or they were misinformed about the true cost of healthcare for pregnant women.

You know, those that use hospitals are those that can afford them, to know their condition…I was told that the hospital was expensive then, so I chose to use the ‘mission’…I couldn’t afford the cost of the hospital that was why I decided to go to the ‘mission’. (AK 02, 16, single, SW, Yoruba, urban, Christian, incomplete secondary).

The “mission house” mentioned by this respondent refers to unlicensed maternity centres which are run by some churches. These centres are often staffed by women who have little or no formal training in pregnancy and delivery care who often learn their craft via experience. These alternative healthcare practitioners are a common feature in the urban South West zone. Some young mothers erroneously assumed that the “mission houses” were cheaper than modern health facilities but this was not always the case, as evidenced by one of the mothers whose daughter made use of the health centre for her maternal healthcare needs.

The money they collect is not much. When my child gave birth, they collected #2,000 (about US$4) from me because the things we were to bring were not complete. Their fee normally is #1,000 (about US$2) but we didn’t take sanitary pads along, that’s why we paid #2,000. So, their money is not that expensive. (AP Mother 01, SW, rural)

The responses below show the situation of some adolescent girls, particularly the unmarried ones, who were unable to make use of any form of healthcare during their pregnancies because they lacked a means of financial support.

I didn’t go for any health care because my mother is not financially buoyant so I did not register in any hospital, mission or do any scan. (AK04, 19, single, SW, Yoruba, urban, Christian, incomplete secondary)

I didn’t have money for clinic because my mother kicked me out… I am grateful that I have my baby here. I thank God…. No, I didn’t attend the clinic at all throughout my pregnancy. (AK05, 19, single, SW, Yoruba, urban, Christian, incomplete basic)

I didn’t attend the clinic because there was no money for me to pay (AS10, 18, single, SE, Igbo, rural, Christian, basic)

I am not going (sic) anywhere, because that time no help, nobody is helping me (sic). (AS09, 19, widowed, SE, Igbo, rural, Christian, incomplete secondary)

Healthcare preferences

Individual healthcare preferences were found to influence maternal healthcare usage, and were observed to be shaped by religious beliefs, community and family preferences. Some adolescent mothers preferred using traditional healers and “mission houses”, others preferred using modern health facilities, and yet others used a mixture of the two.

There was a day I visited a friend who just gave birth and the midwife who took her delivery saw a vision about my friend and I, that we should do a special bath for spiritual cleansing. So, when I was in labour I told my people to take me to the woman at the mission. So, it was the woman who was helped me on that day when I delivered my baby. (AK04, 19, single, SW, Yoruba, urban, Christian, incomplete secondary)

The above response shows the importance of religious influences on the type of healthcare patronised by pregnant adolescent girls. This young mother reported that she delivered her baby at a “mission house” rather than a health facility due to a prior “prophecy” given to her during her pregnancy.

Some other adolescent girls reported that they made use of both traditional and modern healthcare service providers during their pregnancies. A key to their choice to make use of both types of healthcare is found in the participants who said that they had either heard of the efficacy of herbal methods, or were advised to make use of certain healthcare providers by persons they had relationship with in the community.

I used both modern and traditional healthcare…because I like the two…I was going to the health centre and using herbs also…they made me and the baby to be strong. (AS02, 19, single, SE, Igbo, rural, Christian, incomplete basic)

Yes, when I was pregnant, I took herbs…they said it aids easy delivery and widening of the (cervix) during labour. (KT03, 18, married, NW, Fulani, urban, Muslim, no education).

I gave birth at home. A woman in the community assisted me during the child birth. After I gave birth, she advised that we go to the hospital for proper check up to ascertain my health and that of the baby. We were all ok and drugs were given for me and the baby. (MJ05, 15, married, NW, Hausa, rural, Muslim, none)

These responses also show that their choices of maternal healthcare provider were influenced by what was perceived to be the norm in their environment.

It is evident from the narratives is that mothers are an important influence over their daughters’ choice of healthcare provider, as the daughters tended to use the same type of provider as their own mothers did, and possibly suggested to them to use. The daughters of the two women interviewed below made use of the same type of healthcare providers that their mothers used in their own childbearing period.

When I was still giving birth; I didn’t go to the hospital. I went to the church till I gave birth to my four children. What took me to the hospital is the immunisation that I took them to the hospital for. (AK Mother 01, SW, urban)

That time was better than now… Although many of my children I delivered them in private hospital …Yes, my daughter also delivered in a private hospital. (AS Mother 01, SE, rural)