From the information presented earlier it is clear that adolescent health issues need to be addressed. There is a paucity of information on maternity services for adolescents in South Africa, indicating the possible lack of such services. Lack of maternity services for adolescent clients is not a concern in South Africa alone. A 1993 survey done by the Victorian Advocacy Network in Australia, reported pregnancy tobe the second most important health issue for youth at a staggering 88%. lbis in turn
brought about the need for the youth health care centre toaim at providing "continuity of care specifically antenatal and postnatal care" (McNair&Brown, 1996, p.348).
As documented earlier, where adolescents were expected to use the same services as the rest of the patient or client population, they chose not to seek health care
(Akinbami et al, 2003). Taking into consideration the perspectivebyDickson-Tetteh
et al (2001), making maternity services adolescent specific may not be financially viable for the South African Department of Health. A better solution would be to take the current services and make them adolescent-friendly (Dickson-Tetteh et al200l), thereby providing "an approachable environment" for adolescent clients where they can receive support (Mngadi et al, 2002,pAl).
Whilst damage to the reputation of health care professionals may already have been done in earlier encounters, the situation is by no means irreversible. Williams, Gouws, Colvin, Sitas, Ramjee and AbdoolKarim(2000) show an increase from 10% in 1995 to 16% in 1999 of adolescents between the ages of 15 - 19 attending antenatal clinics in SouthAfricaIbis is a considerable increase within a mere four years, indicating the importance of considering the specific needs of the adolescent client within the context of maternity health care provision. Once adolescentsbeginattending antenatal services, it is essential that the midwives who render care in these services make a concerted effort tobenon-judgmental and supportive. They should strive to make the service adolescent-friendly (Dickson-Tetteh et al, 2001; Mngadi et al, 2002) and build partnerships with the adolescent that promote health and prevent disease (WHO, Annex I, 2001). The result should be a well-monitored pregnancy, optimal labour and delivery, appropriate and effective adjustments in the postnatalperiodand a healthy infant and adolescent mother.
Physical care afforded by midwives to adolescent clients is in effect no different from that given to their adult counterparts (Treffers et al, 2001). However, closer
supervision maybenecessary in light of the earlier statement by Ehlers et al (2000) regarding mortality and morbidity. Studies have shown increased incidence ofpre-
eclampsia, anaemia, malnutrition, cephalo-pelvic disproportion and sexually
transmitted infections in pregnant adolescents (Trad, 1999; Ehlers et al, 2000; Rivera et al, 2001; Treffers et al, 2001; Mngadi et al, 2002). Closer supervision will also provide opportunity for adequate health education to ensure good health promotion and possible disease prevention.
The postnatal period is also crucial. Literature reviewhas shown that adolescents are pre-disposed to many problems during this period. As mentioned earlier, they still face problem with conditions such as anaemia and pre-eclampsia during the postpartum period. They require close monitoring to detect ,problems early so that intervention is possible. To prevent future pregnancies or another pregnancy too close to the present delivery, health care providers need to ensure that the adolescent has a good knowledge and understanding of the need to delay future pregnancy and the methods that canbeemployed to do this. Regular postnatal follow-up will ensure supervision and monitoring of child spacing. Povertyhasalso been linked to the likelihood of adolescent pregnancy and implies that resources are scarce. Hence, it is important to have some system to encourage breastfeeding among adolescent
mothers, to prevent babies receiving inadequate nutrition (Treffers et al, 2001). These issues make the need for closer follow-up care of the adolescent mother all the more essential.
The area where more emphasis and specialized care needs to be given has been identified tobethat of social support. Tanga and Uys (1996) found social support to pregnant adolescents by health care professionals tobelacking. Asmentioned
previously, pregnant adolescents face many negative consequences. Their families are
usually upset and angry with them for becoming pregnant (Makiwane, 1998). They have had to leave school or may still have to 'cross that bridge' . Hence, they may face rebuke from teachers and peers (Elhers et al, 2000). Female adolescents may have had to deal with boyfriends denying paternity, and the feelings of betrayal that go with this declaration (Makiwane, 1998; Kaufman et al, 2001). Hence, rebuke from the boyfriend's family may also be forthcoming. Suffice to say that by this stage the last thing that the adolescent needs is a health care professional who adds more rebuke and feelings of guilt and shame to an already psychologically painful situation. The job of the midwife here would be to give support andtryto aid the adolescent, her partner, both the families involved and the resultant infant towards a positive outcome for all concerned.
The first year of the newborn's life is one of great dependence. For the adult mother this means sacrifice and having to put her baby before herself. A certain level of maturity is expected in order to parent and make the necessary adjustments to this demanding role. For the immature adolescent female, this may prove to be very stressful (Trad, 1999).Itmakes sense then that supportive care from significant others and health care professionals is vital during this first year post-delivery (Tanga and Uys, 1996). Psycho-social support shouldbeginwhen the adolescent commences attendance at the antenatal clinic and should be formalized into supportive follow-up care for at least one year post-delivery. The aim of this care is preparation for
childbirth and subsequent motherhoo<L with the idea that adequate preparation of the adolescent for situations that may arise, will result in being better able to cope and overcome problems (Amold, 2000). The adolescent mother should find in health care professionals a supportive network of people who help her understand what she is
facing and find appropriate strategies for coping and dealing with problems. This would ensure that her life does not become irrevocably derailed by the pregnancy and birth of her baby. If the adolescent learns to cope, she will be more likely to resume her education and be less likely to continue having more children while her situation does not permit (Makiwane, 1998; Coard, 2002; Kaufman et al, 2001).