Family influences on health and nutrition practices of pregnant adolescents in Bangladesh

Abstract

Adolescent pregnancy can result in serious risks to the mother and her baby; yet, adolescents are among the least likely to access healthcare. Specific nutrition or antenatal care (ANC) guidelines for supporting pregnant adolescents are not available. To understand experiences and decision‐making of pregnant adolescents in Bangladesh related to ANC and nutrition practices, peer interviewers were trained to conduct qualitative interviews in Dhaka and Rangpur with pregnant adolescents ( n = 48), adolescent mothers ( n = 48), adolescents' family members ( n = 64) and health service providers ( n = 32). Key themes explored included perception and support of adolescent pregnancy, experiences in seeking ANC, dietary practices, sources of information and roles of male and female family members. Spheres of influence on adolescent pregnancy were identified through analytical framework informed by the socio‐ecological model. Respondents felt that adolescent pregnancy is risky and that adolescents require support and guidance through this experience. Families were highly influential on the care seeking, health and nutrition of pregnant adolescents, and mothers/mothers‐in‐law primarily took on the decision‐making roles, with husbands actively participating. Adolescents valued family support but felt a loss of autonomy and agency upon becoming pregnant. Financial constraints were the greatest perceived barrier to appropriate nutrition and healthcare; yet, both were valued. There is sometimes discord of health and nutrition beliefs between families and health service providers; more research is needed to understand this further. It is essential to engage family members and adolescents in initiatives to increase access to quality ANC for pregnant adolescents, improve dietary practices and support the ability to delay pregnancy.

Experiences of Food Insecurity Among Pregnant Adolescents and Adolescent Mothers in Ghana: A Photovoice Method

“…In a cross-sectional study with pregnant women in Iran, perceived social support, such as informational, emotional, and companionship, was associated with an 81% decrease in odds of household food insecurity [ 31 ]. Our findings corroborate previous studies that reported that family support especially from mothers and mother-in-law was key in enabling adolescent pregnant adolescents and mothers acquire food to meet their nutritional need [ 17 , 27 , 32 ].…”

“…Money is a theme seen often throughout literature as a force behind food insecurity. In similar studies, teenage mothers described the financial constraints that came with motherhood as the greatest barrier to meeting their and their child’s nutritional needs [ 14 – 17 ]. Similar findings have been reported in other studies in Eritrea [ 18 ] and the United States [ 19 , 20 ].…”

“Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia

“…However, families often gave financial reasons for not accessing care, despite services being provided for free or there being financial incentives available [ 44 , 49 , 56 , 85 , 90 ], as reported by this author reflecting on a girl whose father-in-law refused treatment despite offers of free transport:…”

“…Women of all ages had their decision-making ability restricted by household hierarchies; however, restrictions were stricter for younger women and girls and those who were married early. Families considered younger girls less mature and those married early less knowledgeable [ 46 , 49 , 51 , 52 , 59 , 77 , 112 , 113 ], justifying their increased control over decision-making, as expressed by this 26-year-old aunt:…”

Beyond the mother-child dyad: Is co-residence with a grandmother associated with adolescent girls’ family planning knowledge?

“…Therefore, the adolescents identified their pregnancy as a period of increased reliance on family members for advice, guidance, and support. The study concludes that older women are “gatekeepers for health-seeking behavior” and are empowered with the culturally relevant information and knowledge to enable positive behavior change [ 24 ]. Echoing this finding, in a study of the diffusion of adolescent reproductive health knowledge in Bangladesh, the majority of girls reported that the main source of information about their periods and childbirth came from their grandmothers, older sisters, sisters-in-laws, or friends [ 26 ].…”