Adverse perinatal outcomes and models of maternity care for Thai adolescent pregnant women : a mixed methods study

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Background In maternity care, pregnant adolescent women are a concern worldwide, especially in low- and middle-income countries (LMICs), as they often have a higher incidence of adverse perinatal outcomes than older women. In high income countries, studies have been conducted on models of maternity care that improve perinatal outcomes amongst adolescent women, including group antenatal care to increase support. In LMICs including Thailand, it is necessary to understand models of maternity care for this group and the needs of the adolescent women more generally. Aims of the study To describe perinatal outcomes amongst Thai pregnant adolescent women who received care from the Teenage pregnancy clinics and explore the provision of these clinics from both experiences and perspectives of healthcare professionals and pregnant adolescent women. Method and design A concurrent mixed method study carried out in three public hospitals in Bangkok, Thailand. In the first phase, a quantitative descriptive study was conducted accessing retrospective data outlining perinatal outcomes from hospital databases. In the second phase, a qualitative descriptive study using semi-structured interviews with 21 healthcare professionals was undertaken. Finally, another qualitative descriptive study was conducted with nine group interviews (22 adolescent women) who had recently given birth in the hospital. The qualitative data were analysed using thematic analysis/SPSS was used for the quantitative aspect of the study. Results In the first phase, the perinatal outcomes of 759 adolescent women and 761 babies were obtained. The most common pregnancy complications were anaemia (179/759; 23.6%) and preterm labour (59/759; 7.8%). The most common adverse neonatal outcomes were low birth weight (94/759; 12.4%) and preterm birth (59/759; 7.8%). There were two neonatal deaths (perinatal mortality rate of 2.64/1000 births). Overall, the adverse perinatal outcomes were less negative than expected although anaemia remains a significant concern. In the second phase, healthcare professionals’ experiences in caring for pregnant adolescent women were identified as ‘recognising the challenges of providing care for young Thai pregnant women’. Three themes included: 1) having an awareness of the political and cultural contexts and environment of care; 2) being aware of attitudes and the need to develop psychosocial skills in caring for adolescent women; and 3) having different approaches to caring for pregnant adolescents. In the final phase, adolescent women’s experiences in receiving care were identified as ‘having needs as a young mother’. Four themes included: 1) having access to care, 2) feelings about, and perceptions of, the care, 3) being a pregnant woman and a mother at school age, and 4) having an awareness of the challenges of the transition to motherhood. Conclusions This study provides a unique overview of perinatal outcomes and experiences of adolescent women and their healthcare professionals’ experiences in caring for them in Thailand. The results of this study may inform health care providers, local health care systems and policy makers with information that may assist to improve care for pregnant adolescent women in Thailand and potentially, in similar countries in the region.
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