Learner pregnancy in South Africa’s Eastern Cape: The Factors affecting adolescent girls' school withdrawal during pregnancy

Jochim, Janina; Cluver, Lucie; Meinck, Franziska

doi:10.1016/j.ijedudev.2021.102484

Cited by 9 publications

(11 citation statements)

References 54 publications

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“…Nevertheless, the promotion of education continuity and school reenrolment following birth may be of benefit to both adolescent mother and their child. Whilst the South African Department of Education supports the continued education of pregnant girls and young mothers, at least a quarter of adolescents might discontinue school during the pregnancy [46] and a large proportion of young mothers does not manage to return to school postpartum [47][48][49][50][51]. Yet, there remains a clear lack of evidence-based programmes that successfully address adolescent mothers' hurdles to return to school, for example through financial and childcare provisions [1,52].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Adolescent parenthood and HIV-infection in South Africa—Associations with child cognitive development

Roberts

Sherr

Haag

et al. 2022

PLOS Glob Public Health

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HIV, both directly and indirectly, impacts child development outcomes. The most severe impacts are for children infected with HIV, and those exposed but uninfected are also shown to have challenges–though less severe. However, little is known regarding the development of children born to adolescent mothers affected by HIV. This study aims to examine cognitive development for children born to adolescent mothers, comparing those children living with HIV, those HIV exposed and uninfected (HEU) and those HIV unexposed (HU). Analyses utilise cross-sectional data from 920 adolescent mother (10–19 years)-first born child dyads residing in the Eastern Cape Province, South Africa. Participants completed detailed study questionnaires inclusive of validated and study specific measures relating to sociodemographic characteristics, HIV, and maternal and child health. Trained assessors administered standardised child development assessments (using the Mullen Scales of Early Learning) with all children. Chi-square tests and ANOVA tests were used to explore maternal and child characteristics according to child HIV status (HIV, HEU, HU) on cognitive development. Linear regression models were used to explore the cross-sectional associations between child HIV status and child cognitive development. 1.2% of children were living with HIV, 20.5% were classified as being HEU and, 78.3% were classified as HU. Overall, children living with HIV were found to perform lower across developmental domains compared to both HEU and HU groups (composite score of early learning: 73.0 vs 91.2 vs. 94.1, respectively: F = 6.45, p = 0.001). HEU children on average scored lower on all developmental domains compared to HU children, reaching significance on the gross motor domain (p<0.05). Exploratory analyses identified maternal education interruption as a potential risk factor for lower child cognitive development scores and, higher maternal age to be protective of child cognitive development scores. These exploratory findings address a critical evidence gap regarding the cognitive development of children born to adolescent mothers affected by HIV in South Africa. Analyses identify stepwise differences in the average scoring on child cognitive development domains according to child HIV status among children born to adolescent mothers affected by HIV; with children living with HIV performing worse overall. Young mothers and their children may benefit from adapted interventions aimed at bolstering child development outcomes. Targeted programming particularly among younger adolescent mothers and those experiencing education interruption may identify those families, particularly in need. Attention to maternal continuity of education and age of conception may be interventions to consider.

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Section: Plos Global Public Healthmentioning

confidence: 99%

Adolescent parenthood and HIV-infection in South Africa—Associations with child cognitive development

Roberts

Sherr

Haag

et al. 2022

PLOS Glob Public Health

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“…Such findings support previous literature identifying child development being impacted by maternal education [ 69 ]. In South Africa, about a quarter of school-going girls discontinue their education during pregnancy [ 70 ] and only between 30%-65% of adolescent mothers manage to return to education after their child(ren) are born [ 71 – 74 ]. Promoting the educational attainment among adolescent mothers and support their return to school following childbirth might require increased efforts to address young mothers’ unmet needs for childcare and lacking financial resources [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Roberts

Smith²,

Cluver³

et al. 2022

PLoS ONE

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Background Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. Methods Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. Results The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. Conclusions This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.

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“…Our findings highlight important missed opportunities. Although education is globally recognised as a social vaccine [ 37 ], adolescent mothers fall behind both during pregnancy and after birth [ 38 ]. It is notable that gender equality is very far from being reached: adolescent mothers are largely un-supported by partners or fathers of children.…”

Section: Discussionmentioning

confidence: 99%

Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort

et al. 2022

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The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.

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Learner pregnancy in South Africa’s Eastern Cape: The Factors affecting adolescent girls' school withdrawal during pregnancy

Cited by 9 publications

References 54 publications

Adolescent parenthood and HIV-infection in South Africa—Associations with child cognitive development

Adolescent parenthood and HIV-infection in South Africa—Associations with child cognitive development

Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort

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