Pregnancy care: a burden or a gift? The adherence to maternal health care of adolescent girls in Kenya, before and during the COVID-19 outbreak.

Abstract

Receiving care during pregnancy is important to keep the mother and baby healthy. The World Health Organization recommends eight antenatal care visits, a skilled delivery and four postnatal care visits. However, many pregnant teenage girls in Kenya do not adhere to these numbers. What adds complexity to the adherence of care is the arrival of the COVID-19 pandemic. Since the beginning of 2020, Kenya has been in lockdown and several others measurements against the virus have been taken.

This research aims to discover the patterns and determinants relating to the utilisation of antenatal care and skilled delivery by adolescent girls in Kenya, and what changed in their care seeking behaviour during the COVID-19 outbreak. To obtain the answers to these questions several statistical analyses, a systematic literature and multiple experts interviews have been carried out.

The outcomes of the research identified several patterns and determinants that influence the adherence to care by adolescent girls in Kenya. The utilisation of antenatal care visits and skilled delivery were already relatively low but decreased even further during the COVID-19 outbreak. The most important determinants that contribute to or disrupt the utilisation of maternal health care before COVID-19 are their knowledge about maternal health care services, the support from her boyfriend, family and community, societal stigma, attitudes from health workers and religion. Patterns of utilisation of care did change during the COVID-19 pandemic, with the most influential changes found in the use of transportation to the clinic and the travel distance to the clinic, the social network and support from family and the community, and the knowledge of teenage girls about COVID-19.

Most importantly, a domino effect in the adherence to care is noticed, if the teenage girl enrols early for care, she will have more antenatal care visits what will enlarge the probability of a skilled delivery. This domino effect is visible before and also during the COVID-19 outbreak in Kenya.