Health Equity and Teenage pregnancy

Target population: Pregnant teenagers between the age range of 13 - 19 years in Ife East LGA

Problem: poor utilization of antenatal clinic and maternal healthcare services, Lack of information about Antenatal Clinic, poor access to right healthcare,inequalities, maternal mortality and poverty at Ife east local council area.

Impact: Maternal diseases, high maternal mortality, unable to cater for their health, not employed and health inequality.

Causes: Lack of access to the right healthcare, lack of education, poor information, pressures from peers, societal inequalities, poor attitude of health workers and poverty.

Change needed: Reduce incidence of maternal mortality, increase awareness, gainful employment,right healthcare, Health equality, advocacy & social impact, trained healthcare workers, adolescent friendly clinic.

Teenage mothers are presumed by WHO (2015), to be at a higher risk for infant and maternal mortality. This is because teenage pregnancy is associated with poor economic and educational consequences, increased risk for stillbirths and neonatal deaths, with an estimated 50 percent higher risk among babies born to women under the age of 20 years compared to older women. Also, teenage mothers account for about 65 percent of women living with obstetric fistula which has a negative impact on their physical and social lives. From Unicef's latest Situational analysis of women and children in Nigeria, women of child bearing age suffer a dis proportionally high levels of health issues related to childbirth where Nigeria is noted to represent 2.4 % of the world's population and a contributory 10% of global pregnant mothers' deaths. In a related study of Stress and resilience among pregnant teenagers in Ile-Ife, Olajubu et al (2021) gave the prevalence of teenage pregnancy in Nigeria ranging between 1.62% and 51%. Maternal and infant mortality rates are social indicators used in measuring the development of any country. According to available data by Olonade et al (2019) in Maternal Mortality and Maternal Healthcare in Nigeria: Implications for Socio-Economic Development, maternal mortality accounts for 59,000 deaths of women annually in Nigeria and 166 maternal death per 100,000 live births in southwest Nigeria. 

However, World Health Organization (2020) in Reducing maternal mortality in Nigeria: addressing maternal health services' perception and experience reported Nigerian maternal mortality rate as 814 per 100,000 live births as well as the probability of a Nigerian woman dying during pregnancy, childbirth, postpartum or post -abortion as 1:22. The Nigeria Demographic Health survey (2018) recorded that 1 in every 5 teenage mothers are either pregnant with their first child or already mothers.

Available statistics by Olowookere and Adeleke (2011) on Pattern of Maternal Mortality in A General Hospital, South Western Nigeria reported Osun State to have had a maternal mortality ratio of 214 per 100,000 live births.

Orji V.O  (2018) in an unpublished PhD thesis titled "Socio-cultural factors affecting the utilization of Antenatal clinic at Ife East Local Government Area, Osun State revealed that Utilization of Antenatal care and maternal health care services are influenced by bad attitude of health workers, poor knowledge and poverty. It is imperative to increase the awareness on it through modest campaigns and outreaches. There is need to provide adolescent friendly maternity clinics in a conducive atmosphere, train heath workers on improving their attitude & skills in handling pregnant teenagers, provision of advanced screening equipment at the health facility so as to attract more women to the health facility.

In Nigeria, the utilization of maternal health care services among teenage mothers has been found to be influenced by factors ranging from lack of money, marital status to husband's level of income and mother's occupation. Other health services barrier to accessing healthcare include ways of handling pregnant teenagers, inappropriate healthcare infrastructure and poor funding. Hence this project will accelerate equitable access to maternal health services at Ife East local government area of Osun state.

 The solution is adolescent friendly clinic with delivery pack. It is innovative as this will contribute to reduction in health inequality. 

Adolescent friendly clinic is ran by trained healthcare workers who interact with the teenagers with their skills. It is done in a conducive atmosphere,  without harassing the pregnant teenagers. Counselling and prescriptions are also included, and may be ran alongside with antenatal clinics. This clinic provides privacy for the pregnant teenagers. While the delivery pack consists of the necessary and essential materials that are necessary for the delivery. This eradicates excuses by pregnant teenagers who cannot afford these for delivery and in the process, avoid the hospital care. The solution uses phone  and health information technology in retrieving data of clients.

Target group:Pregnant Teenagers between ages 13 - 19 years in Ife East L.G.A, Osun State.

Teenage pregnancy is associated with poor economic and educational consequences, increased risk for stillbirths and neonatal deaths, with an estimated 50 percent higher risk among babies born to women under the age of 20 years compared to older women. 

Orji V.O  (2018) in an unpublished PhD thesis titled "Socio-cultural factors affecting the utilization of Antenatal clinic at Ife East Local Government Area, Osun State" revealed that Utilization of Antenatal clinic and maternal health care services are influenced by bad attitude of health workers, poor knowledge and poverty.

Overall Goal: To contribute to promotion of healthy lives and well-being among pregnant women in Ife East L.G.A

Specific Objective: 

1.0 Increased capacity of pregnant women to access quality health services  beyond 9 months in Ife East local government area

Output /Expected Results:

1.1: Increased knowledge of utilization of Antenatal Care services among pregnant teenagers in Ife East local government area.  

1.2: Increased access to quality Maternal & Child health services as well as basic health services for pregnant teenagers thereby contributing to reduction in maternal mortality rate.

Victoria Orji is the Executive Director as well as the team lead. She has over 3 decades of experience as a Registered Nurse and Midwife, and over two decades of experience as a Peri-operative Nurse. She has led advocacy on many health issues. She also led advocacy on Baby friendly Support group. In her array of experiences, she walked closely with pregnant teenagers and saw their plight as vulnerable group, which caught her interest as a social worker. She has invested her time and resources in assisting these group of people. But more needs to be done to promote the health of these vulnerable group positively. Victoria Orji currently holds a PhD in Social Works from the prestigeous Texila American University. She has attended Grants Readiness workshop, Grants Attraction System workshop, Strategic Building Plan and Pitch workshop.

Adeleke Yewande is our Programs Manager. She holds her First degree and Masters in Demography & Social Statistics from OAU, Ife. She is a member of the Board and she also volunteers  in seeing to the welfare of the project.

Other volunteers are some of the Board members of the non-profit organization, who are medical doctors. They are health workers and they include Dr Ernestina Orji,  Faith Orji,  Flourish Orji  and Dr Ayodeji Yusuff. The nurses who work with the Pregnant Teenagers during Antenatal Clinics include Nurses Anjolaiya, Akeju and Owolabi. They hold their basic Registered Nurse (RN) certificates and work with St. Victoria Specialist Hospital, Ife which is located under Ife East L.G.A.

The house keepers at St. Victoria Specialist Hospital, Ife are Ajayi ,Omisakin and Olarewaju who are also volunteers on the project.

I applied for the Solve to facilitate integration of the community in to innovations to increase access to maternal & child health services by pregnant teenagers, as well as increase the utilization of antenatal care services by pregnant women. 

2) Also to empower abandoned pregnant teenagers. 

3)To engage health workers through training, Supervision in the way they handle pregnant teenagers. The use of ' adolescent friendly clinic with delivery packs' models are the innovations meant to promote social support system, delivery planning and safe motherhood for teenage mothers beyond the project life hence, the project seeks financial support.

Project is targeting pregnant teenagers for antenatal care, maternal care, as well as  adolescent pregnant girls that have been abandoned for empowerment too. Project will be implemented at Ife East LGA where farming is predominantly the work of the people.

Adolescent pregnant girls have difficulties accessing right health services as a result of socio-cultural and socio-economic factors as mentioned earlier.

This project will bridge the gap in Ife East LGA. It is being expected to enable broader positive impacts from donors. The collaboration with TBA's will enable smooth implementation, sustainability. To enhance continuity, stakeholders must be trained on inclusive health service delivery. For sustainability, members of the board will also be privileged to make some commitments, while the Executive Director can get some income from consultancy services for sustainability.

The solution " adolescent friendly clinic with delivery pack " is innovative, which will cater for the abandoned or stigmatized pregnant teenagers in the community, thereby reducing maternal mortality and health inequalities.

The target is on 200 pregnant teenagers and those who are poor for empowerment. While taking into consideration, the Covid-19 guidelines.

We like to establish "support groups" within the next one year while we strengthen these groups for sustainability purposes.

In the next five years, sustainability plan is as described above. Also , plans are underway to seek for more investors in this project, while private - public partnerships are encouraged in form of health insurance to further reduce the inequalities in health for these group of people.

Data source, Survey report, Health Information's monthly record of pregnant women's antenatal clinic, delivery record, data collection, Training report, monitoring & evaluation.

Victoria Beacons Initiative wishes to implement a project on accelerating access to adolescent friendly clinic and maternal and child health services thereby increasing antenatal clinic utilization in Ife East L.G.A.

Health Information system register, Nurses's Delivery record, referral letter and booking register.

Working at the community level and with Traditional Birth Attendants for better service delivery.

Key resources: Currently, the support for maternal and child health services for this project and other health services are from St. Victoria Specialist Hospital, Ife.

Partners + Key Stakeholders: The partners for this project is St. Victoria Specialist Hospital, Ife. This is the Hospital being use for the project. The workers and the Hospital Board are key stakeholders as well as the Board members of Victoria Beacons Initiative, Ife.

Key activities are as described above.

Cost structure: It costs about #50,000 - #150,000 for routine antenatal clinic to delivery or assisted delivery in the hospital, which is being subsidized by this Hospital for the pregnant women.

By writing more grants and lobbying for the funding, advocacy services and seeking for donors and partners too.

The organization is hoping to receive some funding /grants from donors. Health insurance is another alternative towards sustaining this.