Adolescent Mothers' Parental Responsibility Study at Port Moresby General Hospital

Knowledge of parental responsibility of adolescent mothers at Port Moresby General Hospital: A qualitative study DR HEAGIVERE H LOVAI MASTER OF MEDICINE CHILD HEALTH

Introduction Adolescent pregnancies are a huge social behavioral problem with a significant health impact Defined : by WHO as % of pregnant women < 19 yrs. http://who.int/news-rion/fact-sheet Globally: 21 million adolescents are pregnant per year 14% of adolescent give birth by age 18 PNG: 13% of all deliveries are adolescents 22 % of adolescent have 1 child by 19 yrs. UNFPA:https//png.unfpa.org/en; https://data.unicef.org Laws of PNG Lukautim Pikinini Act 2015 Parental responsibility defined The child has the right to (a) adequate nutrition;(b) immunization; (c) clothing; (d) shelter; (e)education & guidance (j) medical attention Lukautim pikinini Act 2015 3/19/2025

Literature review Increased risk of mortality and morbidity among babies of adolescent mother JD et.al Int.J.Environ.Res.Public Health 2023; 20,4113; pg5-8 In some situations both the parent and child are classified as children RG et.al; BMC, pregnancy & childbirth, 2020 Oct 14;20(1):620. Vulnerable population: socially & psychological immature, limited education and economically susceptible. Prone to extreme poverty & face violence & suppression Govender et al. BMC ;Pregnancy & childbirth(2020) 20:620 birth Int J MCH Aids 2022:11 (2) e564 3/19/2025

Aim and objective Aim. Assessing the parental responsibilities of adolescent mothers at Port Moresby General Hospital Objective. To assess the knowledge of adolescent mothers on specific care giving responsibilities on adequate nutrition, immunization, clothing, shelter and medical attention 3/19/2025

Methodology Study design. Qualitative descriptive study Study site. Port Moresby General Hospital, Postnatal Ward & Special Care Nursery Study Period: March 1st 2022 to April 15th 2022 (6 weeks) Sample size. 87 adolescent mothers Recruitment Adolescent mothers age 14 year - 19 years Purpose of study was explained Verbal consent was obtained

Interview. Divided 2 parts 1: Questionnaire contained detailed demographics 2: Voice recording using mobile phone. 5 open ended questions Transcribing: Data were transcribed daily using Excel Spreadsheet From Pidgin to English or Motu to English Data was analyzed using thematic analysis Ethical clearance. Obtained from University of Papua New Guinea 3/19/2025

Thematic analysis Each row was assigned 1 participant. Each column assigned a question. Response was typed under the appropriate question in respective columns Each column had a question Feeding preference: breast feeding or bottle feeding Question All response that were similar were grouped given color code All negative response grouped together for bottle All positive response grouped together for bottle Codes identified Thematic analysis was done by column Theme identified and filtered Similar response were assigned specific color code Bottle-feeding preferred going back to school Parents advised Child was given up for adoption Themes were identified from the color coded responses Similar response color This were filtered out of the main spreadsheet and analyzed separately Filter as per the colors given and analyzed coded 3/19/2025

Results: Demographic distribution Parameter Age 13-15 n (%) 16-19 n (%) Adolescent mothers under each age group 5 (5.7%), 82 (94%) Education level Grade 2 grade 8 grade 2 grade 12 2nd Pregnancy 0 9 (10.3%) VDRL + /HIV + none 9 (10.3%) Partner >30 yr. 3 24 (27%) Imposed pregnancy Parental Support 2 3 19 (21.8 %) 26 (29.8%) Assault 5 (5.9%) Intimate Partner Violence 1 25 (28.9%) 3/19/2025

Results 1846 Total deliveries during study period Total adolescent deliveries over study period 105 were not interviewed: unwell, discharged 192 87 Adolescent mothers included in study 3/19/2025

Parental Responsibility themes Health Seeking behavior Nutrition Family planning Vaccination Breastfeeding Natural & good Advised by older women Healthy Implant Vaccinate aware protective Space Painful experience Take to hospital Practice Home remedies Refused Mixed feeding Go back to school Baby adopted Refused lacked understanding Lack of understanding Partner or parent decide Social Support Unsure Bottle feeding Adopted Aware lack understanding functions Hesitant Understand Partner decide 3/19/2025 School &work Unsure

Family planning Methods Family Planning Method Themes Reasons Verbatim response Implant 36( 42%) Avoid pregnancy & space painful experience go back to school F/17 I don t want to have another pregnancy, I would like an implant. To allow this child to grow and develop F/18 Yes , I want to use the injection , I was advised to use the injection Depo 4(5%) Refused FP 24(28%) Fear destroy body Unmarried Go back to school Lack of knowledge F/16 I heard about FP from the ANC nurses . I did not really understand how FP works .I will ask my dad for permission. I don t want another baby Unsure FP method 21(25%) Seek permission partner decides lack of knowledge F/18 yes, its to stop pregnancy, I will ask my husband ,if he say no, than I am not sure. It benefits the family I really want to use FP BTL 1 Severely mentally handicapped 3/19/2025

Nutrition Themes Reasons Verbatim response Good and healthy, Parental Advise F/17 "I will breastfeed my baby , it is free. I don t want to use the bottle and milk it is costly. F/18 " I will breast feed my baby as my mum told me that breast milk is good Breast feed 54(62%) F/18 "My baby will be exclusively breast feed; I was advised by my mum and older women to only breastfeed because it is good" Mixed feeding 18 (20%) Go Back to school Income F/17 Baby will breastfeed than given bottle feeds, because I want to go back to school F/15 "My baby will breast feed for about a month. When he turns a month old, I will return to school. Breast feeding is the best and mum will care for baby" Bottle 11(13%) Go back to school Adopted out Work F/17 Bottle feed the baby, my small daddy said that I am very young, and that I need to go back to school. His wife will take the baby F/19 I prefer to bottle feed my baby as i market to earn a living 3/19/2025

Vaccination Would you vaccinate Reasons Illustrative narrative Vaccinate n 26(30%) F/18 Baby will get the vaccination F/19 Know about vaccinations, it is for protecting the baby from disease F/17 "I was informed about vaccination from my mum, it s Aware Vaccine Protect baby avoid disease keeps body health grow strong Live far purpose is to make the child grow strong" Refused to Vaccinate n 49(56%) Inadequate knowledge Lacked understanding Functions Purpose F/16 "I don't really understand the purpose of vaccination" F/15 I don t know what baby injections are, what are these things F/18 "I don t understand , I don t know what baby injections are" Unsure to vaccinate 12(13.8%) Aware of vaccines Lack of understanding Functions & purpose F/18 "I know the dates and when to go for vaccination , however I struggle to understand the purpose of giving baby injections" F / 19 "I know about vaccinations , when the mothers take babies but I don t understand their functions." 3/19/2025

Health-seeking behavior Themes Verbatim response Take to hospital 22(25%) F/18 "My husband is male nurse at the Gerehu hospital F/17 If baby has a fever, I will bring the child to the hospital and give the baby some Panadol" Practice home Remedies 19(21%) F/18 "Give the baby a warm bath if she has a fever, if she has diarrhea, some coconut juice. F/17 "I will for my care baby, boil water and give the baby a warm bath. If baby is still sick, bring to the hospital Not Sure 24 (27%) F/18 "I am not too sure about what to do, I am too young Social support 17 (19%) F/18 "There is another women assisting me take care of my 2 babies, she will help if they are sick. I have another baby at home. 3/19/2025

Discussion Adolescent mothers are a vulnerable population where Social & psychological immaturity is common among mothers Who have limited education, economically disadvantaged & are suppressed Adolescent pregnancy (who.int) Lack the ability to make informed choice Lack comprehension of basic fundamental health messages Parental perspectives and choices are influenced by their parents or partners Removes the role of parenting Restricts them from making informed choice Positive or negative influences in term of their choice 3/19/2025

Discussion cont. Finding from this study Positive influence of older women on breast feeding choice in adolescent mother, 62% preference for breastfeeding, 25% displayed health seeking behavior BMC pregnancy & childbirth, April 16;91 At an individual level "the perception, inadequate knowledge, low decision-making autonomy, and dependency on the husband influencing seeking services the level of influence extended to interpersonal and community to affect health seeking services behaviour. ShabUddin et.al: 2019, 3/19/2025

Limitations of study Covid 19 - causing vaccine hesitancy One researcher Data entry bias Data analysis Translation and transcribing Approach different perspective , review one aspect of the study Positive response bias 3/19/2025

Conclusion From this study it can be concluded that adolescent mothers have some knowledge of parental responsibility 62% preferred breast feed, 29% displayed health seeking behavior, and 42% had implants as a choice of FP. The implication of this is to influence the integration of adolescent parental responsibility into the adolescent health policy framework, and support adolescents to delay getting pregnant 3/19/2025

Recommendations Preventing primary pregnancy among adolescents and pregnancy- related mortality and morbidity Targeted focused Interventions : Integrate Sexual Reproductive health into Education Adolescent Resource Centers Multi-sectorial approach Education, law & Justice, Media Integrate adolescent sexual & reproductive health Education curriculum Young people's leadership and participation Encourage open discussion among churches , communities, families etc 3/19/2025

Acknowledgements God Almighty for his provisions The participants - Adolescent girls for their courage & time Professor Trevor Duke for believing in me to do this Professor John Vince for the inspiration to study pediatrics Dr Pulsan for insight into data analysis Dr Marcus & Dr Daur quality control & critique Dr Laki an awesome senior colleague anyone could have Sr Sitaing, Labour ward Nursing Staff and Dr Kona for support All the women in my life that inspired me Richard & my 4 who sacrificed for this Rhondi, Rachel and Hicks PMGH Pediatric registrars making this mountain bearable

References http://who.int/news-rion/fact-sheet UNFPA : https//png.unfpa.org/en; https://data.unicef.org Lukautim pikinini Act 2015 JD et.al; Adolescent Pregnancy outcomes; Int.J.Environ.Res.Public Health 2023; 20,4113; pg5-8 RG et .al; The burden of adolescent motherhood and health consequences in Nepal,; BMC; Pregnancy & child birth, 2020; 20:318 S.Ndritu; Factors influencing FP uptake among adolescents and Post Partum women Kenya, Walden University, Medicine & Health Sciences Campus, Scholar works; 2021 SKD, Factors Influencing Family Planning Uptake Among Adolescents and Postpartum Women in K omen in Kenya; University of Walden Scholar works Dissertation and Doctoral studies; 2021 Aaron Asibi Abuosi & Emmanuel Anongeba Anaba, Barriers on access to and use of adolescent health services in Ghana. Department of Public Health Administration and health Services management Business School, University of Ghana, Journal of Health Research Vol.33 No 3,2019 pp197-207, Emerald publishing WHO, Introduction to adolescent and adolescent health P. Manjula et. al. / A Study to Assess the Knowledge of Adolescent Girls towards Teenage Pregnancy at Selected Government Junior Colleges, Tirupathi Community and Public Health Nursing / Volume 1 Number 2 / July - December 2016 Adolescent-Health-Missing-Population-in-UHC.pdf 3/19/2025

We say thank you for listening to our story 3/19/2025 Used with permission