Exploring the Factors Contributing to Maternal Mortality Amongst Adolescents in Africa. A Qualitative Study

Background

In Africa, most recorded maternal fatalities are evident among adolescents. Despite attempts to control this public health issue, African adolescent maternal mortality rates remain unacceptably high. African adolescent maternal mortality is a public health crisis that has proven a menace over the years. Teenage pregnancy—pregnancy between 13 and 19—is a global health issue. It can cause serious health, social, and economic problems for individuals, families, and communities. 21 million 15-19-year-old girls got pregnant in developing countries. Over 50% of unexpected pregnancies end in abortion. (Eyeberu, 2022). Pregnancy and delivery complications kill roughly one-third of African adolescent girls. These findings show the urgent need for study into African adolescent maternal mortality factors.

Kassa et al. (2018) analyzed 52 studies with 254,350 individuals from 24 African nations and sub-regions. Their research found an 18.8% pooled prevalence of adolescent pregnancy in Africa (95%CI: 16.7, 20.9), with 19.3% in Sub-Saharan Africa (95%CI: 16.9, 21.6). East Africa had the highest prevalence (21.5%) and Northern Africa had the lowest (9.2%). Living in rural areas (OR: 2.04), being married (OR: 20.67), not attending school (OR: 2.49), having no maternal or father education (OR: 1.88 and 1.65, respectively), and lacking parent-adolescent communication on sexual and reproductive health (SRH) issues were all associated with adolescent pregnancy.

African adolescent pregnancy and maternal mortality rates are high due to socioeconomic and cultural reasons. Poor females are more likely to become pregnant because they lack education, healthcare, and other resources. Early marriage and female genital mutilation increase the risk of maternal morbidity and mortality in adolescent girls (November & Sandall, 2018). Adolescent girls have significant maternal death rates due to a lack of family planning, sexual education, and healthcare.

In another study conducted by Ahinkorah et al., (2021), Congo had 44.3% of first adolescent pregnancies, whereas Rwanda had 7.2%. However, 36.5% in Rwanda and 75.6% in Chad were sexually active teens. The study also found that first adolescent pregnancy rose with age, employment, marriage/cohabitation, elementary education only, early sexual initiation, awareness of contraceptives, no unmet contraception need, and being in the poorest wealth quintile. Rural and West African teens were less likely to have their first pregnancy.

Poverty, a measure of a country’s economic standing, has been connected to adolescents’ coerced sexual interactions with older males to meet their financial demands. Poverty and compelled sexuality are linked in Ghana, South Africa, and Tanzania. These countries’ adolescent girls may purposefully become pregnant to collect government rewards for teenage moms without contemplating the consequences. Nigeria, Africa’s largest economy, with 106 adolescent births per 1,000 people in 2021, is a rising trend (Maharaj, 2022).

This qualitative study will be responsible for investigating African adolescent maternal mortality. The phenomenological study will focus on examining African adolescent moms’ delivery experiences. It will also illuminate this population’s maternal mortality factors. Therefore, reducing African adolescent maternal mortality justifies this process and thus the primary aim of this study. To minimize maternal morbidity and death, effective interventions need to understand this population’s maternal mortality issues (Kaiser et al., 2019).

This research will also help address the psychosocial needs of vulnerable adolescent moms by shedding light on their delivery experiences. This study seeks to explore African adolescent maternal mortality variables. By looking into adolescent mothers who survived childbirth, which will be studied using phenomenology. This study will help create strategies to reduce maternal morbidity and death among African adolescent girls.

Literature Review

This literature review identifies and critically evaluates factors affecting African adolescent maternal mortality. The review searched PubMed, Scopus, and Google Scholar using the search terms “Maternal mortality,” “Adolescents Pregnancy,” “Preterm Birth,” “Factors,” “Africa,” “Perinatal Mortality,” and “Adverse Pregnancy Outcomes.” Articles published between 2015 and 2023, in English, and on maternal mortality among adolescents in Africa were included.

Early marriage, lack of maternal health services, poor education, and poverty are major issues contributing to adolescent maternal mortality in Africa (Kaiser et al., 2019). According to multiple research studies, adolescent mothers in Africa face social and cultural barriers to maternal healthcare access and quality.

Early marriage is the leading cause of adolescent pregnancy and maternal mortality in most African countries. Early marriage affects adolescent moms’ educational and economic options, limiting their healthcare access.

It is common knowledge that adolescents are likely to avoid maternal health services due to social stigma. The reason is, premarital sex and parenting customs and beliefs shame adolescent pregnancy. Therefore, adolescent moms may feel immoral or irresponsible, preventing them from accessing maternal health services (November & Sandall, 2018). Thus, many African adolescent mothers give birth at home without a birth attendant.

African maternal mortality is also linked to adolescent moms’ poor education. Adolescent moms typically lack the information and skills essential to maintain good maternal health and care for their infants. Therefore, factors such as poor education, early marriage, and poverty contribute to this issue too.

Poverty is also another major factor contributing to African adolescent maternal mortality. Poor maternal health services impede prenatal, birth, and postnatal care. Therefore, poor maternal health care increases maternal morbidity and mortality. With most adolescents facing poverty, there is reduced access to food, water, and sanitation, thus increasing maternal morbidity and mortality (Fantaye et al., 2019).

So, the research suggests addressing cultural and social issues that cause maternal mortality in African teenagers. The evidence also suggests that enhancing maternity healthcare availability and quality is crucial in reducing maternal mortality among adolescents in Africa. However, most research is qualitative and limited to certain localities. Therefore, it is necessary to undertake more research to understand the individual experiences and views of teenagers towards maternal health services.

The literature study asserts that early marriage, lack of maternal health services, poor education, and poverty lead to maternal mortality among African adolescents. The evaluation stresses the need of addressing cultural and societal variables that cause maternal mortality and increase maternal healthcare access and quality (Sumankuuro et al., 2017). However, adolescent experiences and attitudes toward maternal health services need further study.

Goals and Objectives

Africa’s maternal mortality rate is high, especially for adolescent moms. Sub-Saharan Africa has high adolescent pregnancy rates for several reasons. Sociocultural and economic, individual, and health service-related aspects are major contributors as discussed by Yakubu and Salisu (2018). Community sensitization, sex education, and girls’ education can minimize adolescent pregnancies. Schools and healthcare organizations must also offer adolescent-friendly health services and empower teens.

This study examines African adolescent maternal mortality variables. The research question will be: What causes maternal mortality in African adolescents?

This research seeks to reduce African adolescent maternal mortality by identifying its causes. A qualitative technique will be used to interview and focus group adolescent mothers, healthcare providers, and other healthcare system stakeholders. This study will also discuss African teenage maternal health policies.

The following are the research goals:

1. To identify the risk factors associated with maternal mortality among adolescents in Africa.

African adolescent mothers confront many risk factors that increase maternal mortality. Poor maternal health services, limited education, poverty, and cultural practices that constrain decision-making are risk factors (Muriithi et al., 2022). This objective seeks to identify these risk factors and their interrelationships to explain African adolescent maternal mortality.

1. To explore the experiences and perceptions of adolescents towards maternal health services in Africa.

Adolescents use maternal health care based on their experiences. Positive experiences and impressions increase uptake, while negative ones decrease it. This objective examines African adolescent moms’ views on maternal health services, including quality, accessibility, and provider attitudes.

• To understand the barriers to accessing maternal health services among adolescents in Africa.

African adolescent mothers confront various hurdles to maternal health services. Lack of transport, great distances to health facilities, cost, and cultural norms limit their mobility (Fantaye et al., 2019). This purpose is to explore adolescent mothers’ experiences and strategies for overcoming barriers to maternal health services in Africa.

1. To develop recommendations for improving maternal health services for adolescents in Africa.

This research aims to improve African teenage maternal health services. The research will provide suggestions to address risk factors and barriers to maternal health services. The proposals will help governments, healthcare professionals, and other stakeholders solve Africa’s adolescent maternal death crisis.

The high death rate of children under five underscores the long-term implications of inadequate educational and livelihood prospects for adolescent moms, according to Noori et al. (2021). Young moms may endure societal stigma, which can contribute to mental health and poverty cycles in their families. Unintended adolescent pregnancies must be reduced in countries with high rates to meet the Sustainable Development Goals (SDG) of reducing neonatal and under-5 mortality. Adolescent girls and young women should also have access to sexual and reproductive health services to make informed fertility choices and regulate pregnancies. Wado et al. (2019) recommend a multi-sectoral approach to adolescent pregnancy. Wider development programs can improve females’ educational and career options, which can influence their birthing decisions. To overcome barriers to adolescent sexual and reproductive health services, policies and activities that promote access and usage are essential.

Sub-Saharan Africa has one of the highest rates of teenage pregnancy, which puts both moms and children in danger. This causes medical, social, and economic issues for them, their families, and society. Although some sub-Saharan nations have taken steps to address adolescent pregnancy, it remains a major public health issue (Gunawardena et al., 2019). Few studies have examined Sub-Saharan African teen pregnancy predictors. Therefore, this study seeks to reduce African adolescent maternal mortality by examining these teen pregnancy predictors. The research objectives are to identify risk factors for maternal mortality, explore the experiences and perceptions of adolescent mothers towards maternal health services, understand barriers to accessing these services, and develop recommendations for improving maternal health services for adolescents in Africa (Muriithi et al., 2022). This research will inform evidence-based policies and initiatives to improve maternal health outcomes for African adolescents.

Methods

The primary focus of this phenomenological study is examining the causes of maternal mortality in African adolescents. The proposal’s research design will look into adolescent females’ views of maternal health services. Worku et al. (2021) found that Demographic and Health Survey (DHS) datasets are useful for research in 12 East African nations. A multilevel binary logistic regression analysis was used to determine characteristics related to adolescent pregnancy in 17,234 sexually active girls. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was used to identify factors associated with adolescent pregnancy. This research is best suited to phenomenology since it focuses on subjective experiences and how people interpret them.

The research will follow the PICO (Population, Intervention, Comparison, Outcome) framework. This study will include 15-19-year-old African female teenagers to conduct the research. For data variety, these adolescents will be chosen from across Africa. The intervention will investigate and get female teenage views on maternal health services. Adolescents without maternal mortality will be also compared. The project will then determine the African adolescent maternal mortality variables.

The research team will use purposive sampling based on inclusion criteria to represent the study population. Female adolescents aged 15-19 who have had at least one pregnancy, maternal mortality, or neither will be included. Social media, local health facilities, and youth organizations will invite eligible participants to the study.

A screening questionnaire will be responsible for determining eligibility. The questionnaire will cover age, pregnancy history, and the mother’s health. The responses that are gathered will then determine study eligibility. To make this project a success, it would recruit all adolescent girls who use maternal health care in health institutions and communities.

The study team will describe the context and data collection process to ensure transferability. Triangulation—gathering data from numerous sources and analyzing it by multiple researchers—who will boost the study’s credibility. Peer debriefing and member verification will verify that the research team’s findings appropriately reflect participants’ experiences and perceptions of maternal health services.

This study must address ethics and moral values. The study will follow the Helsinki Declaration, which demands informed permission, anonymity, and participant rights (World Medical Association, 2013). Ethical review boards will look into and approve the study before starting. Before conducting the study, participants must complete written informed consent forms. The participants need to confirm they are willing to participate in this process and are aware of the project’s aim. By providing unique identifying numbers and securely storing data, the study will protect participants’ privacy and confidentiality.

In-depth interviews and focus groups will be used to gather data. In-depth interviews provide rich, detailed data about participants’ experiences and perceptions, while focus group discussions allow participants to interact and share their thoughts. The study will combine semi-structured interview guidelines with open-ended questions about maternal health service experiences and perceptions. Face-to-face interviews and focus groups will be held privately. Participants will discuss their experiences with maternal health services in the focus groups.

The data will be transcribed verbatim and analyzed thematically. The thematic analysis finds, analyses, and reports data patterns. It is normally applied in cases whereby, there is categorizing of data themes and patterns. The inductive analysis will also be used as it reveals themes and patterns too. With these, it is easy to familiarize yourself with the data, generate initial codes, search for themes, review and refine themes, define and name themes, and write the report. Then two separate research experts will analyze the data to further verify reliability and validity.

In terms of rigour, the study will aim to demonstrate dependability, confirmability, and transferability. Dependability refers to the stability and consistency of the data over time. Therefore, the study will utilize a clear methodology and standardised data collection to ensure reliability. Confirmability refers to the objectivity and neutrality of the findings. The reflexive approach will critically reflect on the researcher’s preconceptions and views and how they may affect the research process and findings to ensure confirmability. Finally, transferability is how well the findings can be applied elsewhere. In this case, purposive sampling and unambiguous and transparent findings will ensure transferability.

Reliability/Validity and Trustworthiness

Qualitative research examines people’s subjective feelings and perspectives. Thus, rigorous research procedures that yield valid and dependable data are essential. We’ll explore the study’s reliability, validity, and trustworthiness in this part. Credibility, dependability, transferability, and confirmability will guide our qualitative study to ensure rigour.

Qualitative studies require researchers to build trust with participants to allow them to share their thoughts and feelings. We will triangulate the findings utilizing interviews, observations, and document analysis. This will allow us to verify participant data and guarantee the findings are correct. To analyze data reliably, we’ll use a coding framework. A second coder will check the coding framework. This will keep the findings consistent over time and context.

We will describe the study context, methodologies, and data collecting to improve transferability. This lets others assess our findings’ applicability. To represent a variety of experiences and opinions, we will purposively sample individuals. An audit trail will ensure data gathering and analysis confirmability. Keep field notes, interview transcripts, and other pertinent data. The audit trail will allow us to link study conclusions to data and verify them.

To improve confirmability, we will also evaluate the researcher’s prejudices and views. To do this, we will reflect on our assumptions, prejudices, and beliefs that may affect the study findings. This will help us uncover biases and lessen their effects on study findings. Qualitative research must use rigorous methodologies matched to its context and goals to be reliable, valid, and trustworthy. Credibility, dependability, transferability, and confirmability ensure that our study findings accurately reflect our participants’ experiences and perceptions and can be trusted to provide insights that are relevant and useful to other contexts and populations.

Strengths and Limitations

Any research effort must assess its strengths and weaknesses. This research seeks to investigate African adolescent maternal mortality-causing factors. This study’s qualitative technique will help the research team understand adolescents’, healthcare professionals, and other stakeholders’ views on maternal healthcare. Qualitative research allows individuals to communicate their views and experiences in their own words, enabling a more nuanced understanding of complicated and sensitive topics like maternal mortality.

The study’s focus on African adolescent maternal mortality is another merit. Adolescents—10–19-year-olds—have distinct healthcare needs, including sexual and reproductive health (Ramulumo, 2019). Maternal healthcare research typically excludes this age range. Thus, this proposed research will address a vacuum in the literature by examining the causes of maternal mortality in African adolescents.

This study’s findings will also help guide African adolescent maternal mortality reduction programs. It will help build more effective and culturally relevant maternal healthcare interventions by revealing healthcare providers’, adolescents’, and other stakeholders’ experiences, views, and beliefs.

This study’s setting and population will be limited. The study will examine African adolescents, thus the results may not apply to other populations. Thus, the study’s findings should not be used to draw global implications concerning adolescent maternal mortality.

The sample size may also limit generalizability. The study team will recruit different adolescents, healthcare practitioners, and other maternal healthcare stakeholders. Time and resource restrictions may limit the sample size. This may affect the study’s generalizability and require further research to validate the results.

Social desirability bias may limit the study. Participants may lie about their experiences, views, and beliefs. This may underestimate or overestimate African teenage maternal mortality factors. Therefore, the study team will ensure participants’ anonymity and confidentiality, create relationships with them to foster open communication and use open-ended questions to encourage honest responses.

It is crucial to take note that qualitative research limits quantification. Qualitative data is descriptive but difficult to analyze and generalize to bigger populations. The research team will employ thematic analysis to carefully and objectively analyze the findings. Thus, the suggested research project’s qualitative technique and population emphasis are its assets. Its shortcomings include limited generalizability and social desirability bias. This study’s strengths and weaknesses should be considered before interpreting its conclusions, and more research may be needed to confirm them.

Timetable

The following table outlines the key milestones of the research project:

Teen pregnancy is common in Sub-Saharan Africa. Social programs like comprehensive sex and relationship education and family planning can be improved by identifying the causes of teenage pregnancies. These interventions can improve the health of adolescents, families, and communities in sub-Saharan Africa (Ahinkorah et al., 2021). Therefore, a timeframe for this project is necessary to promote efficiency and effectiveness. Success requires a detailed research project timeline. This study’s timeline is as follows;

Ethical approval comes first. This step ensures ethical and legal research. An ethical committee analyzes the research proposal for ethical compliance. Ethical approval for this study project takes one month. The research team will submit the proposal to the ethics committee, address any concerns, and gain ethical approval before starting the research.

The interview guide is step two. This milestone requires preparing an interview guide to collect participant data. Research questions and objectives will inform the interview guide. A month is enough time to build a complete and relevant interview guide.

Piloting is the third step. A small-scale study to evaluate the interview guide, find flaws, and make modifications is this milestone. The pilot study will last one month to test the interview guide and make any required changes before data collection.

Participant recruitment comes forth. Choosing research subjects is this milestone. Advertising, social media, and referrals will help recruit candidates. Two months is enough time to find and choose participants.

Data collecting is fifth. Interviewing people utilizing the guide is this milestone. Four months is enough time to acquire enough pertinent data.

Data analysis comes sixth. The data is analyzed using theme analysis in this milestone. Three months is enough time to analyze data and draw conclusions.

Results writing and distribution are the final steps. This milestone entails writing up and sharing study findings with stakeholders. Two months is enough time to create a full report, make presentations, and disseminate findings.

Any research endeavour needs a clear, well-structured timetable. This research project has a clear timeline for ethical approval, preparing the interview guide, running a pilot study, recruiting participants, data collection, data analysis, and dissemination of the results. Each milestone has a timetable that allows for thorough and efficient completion. The research team can efficiently complete the study, meet its goals, and create valuable findings that will advance the area by following the timetable.

Conclusion

Teenage pregnancies are most common in sub-Saharan Africa, although rigorous reviews are lacking (Sama et al., 2017). Accurate epidemiological data on adolescent pregnancy rates, predictors, and negative effects on mothers and newborns may help achieve the Sustainable Development Goals. Therefore, this project investigates African adolescent maternal mortality variables. The proposed qualitative study investigates adolescents, healthcare practitioners, and other stakeholders in maternal healthcare’s experiences, perceptions, and beliefs. This study could inform African adolescent maternal mortality policies.

We will undertake a qualitative study using in-depth interviews and focus group discussions with a purposive sample of adolescents, healthcare practitioners, and other stakeholders in maternal healthcare to meet the goals of this research proposal. The responses will then be analyzed thematically. Nursing practice and policy will be considered to address primary healthcare nurses helping adolescent children with responsible sexual behaviour when their parents lack the abilities (Mashia et al., 2019). Nurses should implement mobile healthcare programs at their typical hangouts to improve their ties with adolescents. Management should also fund nurses’ multimedia engagement with adolescents. This research aims to increase knowledge of the causes of maternal death among African adolescents and guide policies and strategies to reduce maternal mortality in this vulnerable demographic.

The study could improve the lives of African adolescent girls and young women. Maternal mortality is a substantial public health concern, and adolescent girls are particularly vulnerable to unfavourable maternal health outcomes due to several biological, social, and economic variables (Kaiser et al., 2019). By understanding the experiences, perceptions, and beliefs of adolescents, healthcare providers, and other stakeholders in maternal healthcare, we can identify gaps in current policies and interventions and develop evidence-based recommendations to improve maternal health outcomes for this population. For instance, health-seeking can minimize the risk of adolescent pregnancy, which lowers child survival rates, according to Noori et al. (2021). Biological and sociocultural factors may explain this. Understanding the risk to babies born to extremely young moms requires accurate maternal age reporting. More biological and social data can illuminate this relationship. Preventing unplanned pregnancies in younger adolescents improves child survival.

21 million adolescent females are pregnant each year in LMICs (low- and middle-income countries). These pregnancies in females aged 10–19 are linked to maternal mortality, severe newborn problems, and low birth weight (Maharaj, 2022). Adolescent pregnancies significantly impact emotional, physical, and social health and are the top cause of death for adolescent girls worldwide. This study could inform African teenage maternal health policies and programs. The results could be used to build targeted interventions to improve access to quality maternal healthcare, increase teenage awareness of maternal health, and address cultural and societal norms that may hinder care. The study could also inform policies and programs that target poverty, education, and gender inequality as social determinants of maternal health.

Adolescent pregnancy is a global concern, especially in poor socio-economic circumstances where it contributes to a complex social inequality network. In South Africa, adults have devised and taught school prevention programs without considering the views of the adolescents who benefit (Wood & Hendricks, 2017). This project engaged school-aged teens in research and preventative efforts that met their needs. Therefore, this research proposal aims to contribute to our understanding of the factors that contribute to maternal mortality among adolescents in Africa. We aim to improve maternal health outcomes in vulnerable adolescents by conducting a qualitative study on adolescents, healthcare providers, and other stakeholders in maternal healthcare (Geleto et al., 2018). The findings of this study have the potential to inform policies and interventions aimed at lowering maternal mortality among adolescents in Africa and to contribute to the formulation of larger public health policies aimed at improving maternal health outcomes more broadly.

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