As such, Glaser's grounded theory approach was used to investigate maternity services from the perspective of different stakeholder groups. Health care planners and practitioners can use these constructs to strengthen and improve the provision and use of services for pregnant women and adolescent parents, and form the basis on which a theory of adolescent-friendly maternal care can be based.
INTRODUCTION
Much work has been done to understand the antecedents of adolescent pregnancies and to prevent such pregnancies (Corcoran, 1999; Kellogg, 1999; Arnold, 2000; Coard, 2000). Despite such efforts, pregnancy rates among adolescents in both developed and underdeveloped countries still remain high (Corcoran, 1999). This suggests that part of the focus of future research should be not only on preventing adolescent pregnancies, but also on beginning to address the issue of caring for pregnant adolescents in a realistic way.
BACKGROUND TO THE STUDY
There are currently no maternity services specifically for teenage clients in KwaZulu-Natal. At the time of the study there was no documented information from adolescent clients about maternity services in KwaZulu-Natal.
RESEARCH QUESTIONS
STUDY OBJECTIVES
SIGNIFICANCE OF THE STUDY
At the time of the study, no information was formally collected to describe the perceptions, experiences and needs of young people using current maternity services. The emerging model of working towards a grounded theory of adolescent-friendly maternity services in this study provided a foundation for future research on adolescent health and adolescent maternity services in South Africa and the rest of Africa in general.
DEFINITIONS OF CONCEPTS
Adolescent women in labor: for the purposes of this study, this referred to all women in labor between the ages of 12 and 19 who accessed maternity services at the designated study sites. Health Care Planners: For the purposes of this study, the term 'health care planners' referred to three categories of participants.
INTRODUCTION
VULNERABLE POPULATION
This is not surprising in light of the current HIV/AIDS pandemic in South Africa, the most affected province being KwaZulu-Natal (Heunis et al, 2000). Before the 1990s, young people in South Africa were seen as part of the general population and looked after in the same light.
ADOLESCENT HEALTH SERVICES
When youth health services exist, they have been shown to be very beneficial to young people. In the same study, a total of eighty-four percent of male respondents felt they had gained from the exposure they received at the youth health center.
NEGATIVE IMAGE OF ADOLESCENT HEALTH FACILITIES
Respondents in Kunene's (1995) study found that the service was too far from where they lived. The youth health center in the Kunene (1995) study was open at the same time the adolescents were in school.
ADOLESCENT-FRIENDLY SERVICES
The health care providers working in the facility must be sensitive when dealing with adolescent clients. As can be seen from the information presented, it would appear that general principles regarding what constitutes an adolescent-friendly health service have been developed.
FACTORS CONTRIBUTING TO ADOLESCENT PREGNANCY IN SOUTH AFRICA
Another factor contributing to the problem of adolescent pregnancies is the poor health care available to this vulnerable group (Abdool Karim et al, 1992; Kaufman et al, 2001). According to Kaufman et al (2001), this lack of services can be attributed to the state of governance surrounding family planning services.
KNOWN PROBLEMS ASSOCIATED WITH ADOLESCENT PREGNANCY
The cycle of the lower socio-economic environment is therefore continued and another generation is at risk of adolescent pregnancy. The educational level of the adolescent woman is seen to have a direct impact on the possibility of recurrence.
PSYCHO-SOCIAL DEVELOPMENT DURING ADOLESCENCE Adolescence is defined as the transitional stage when an individual moves from
During this period, the adolescent begins to develop a group identity and conform to peer norms (Ladewig et al, 2002). According to Piaget (1972), the adolescent who was previously a concrete thinker begins to develop formal operational thinking.
IDENTITY DEVELOPMENT AND ADOLESCENT PREGNANCY
Parents and significant others of the pregnant young person must be made aware of such needs and learn how to help the young person on the path to identity. All of these can prove to be very expensive and lead to the young person becoming even more dependent on her parents during and after her pregnancy.
ADOLESCENT PARENTING
Adolescents themselves appear to be aware of the negative consequences for babies of adolescent parents. Tantrums for the adult parent may prove difficult, but for the adolescent parent this will be even more difficult (Hanna, 2001).
NEED FOR SPECIAI.IZED CARE
Because of these issues, the need for more precise follow-up care of the adolescent mother is all the more important. A teenage mother should find a support network of people in health professionals to help her understand what it is.
CONCLUSION
This would ensure that her life is not 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 less likely to continue having more children when her situation does not allow this (Makiwane, 1998; Coard, 2002; Kaufman et al, 2001).
INTRODUCTION
DESIGN
Although grounded theory methodology was used, the purpose of this study was not to develop theory. For the purposes of this study, the researcher followed Glaser's (1992) grounded theory approach.
POPULATION
Health Care Planners (Hep)
The third target population from which this study obtained information was the persons responsible for maternity health care planning. They were joined by individuals responsible for planning spousal, child and women's health services for the Durban functional region. This category was included because, without the input of health care planners, there was no action model for adolescent-friendly maternity care.
SAMPLE AND SAMPLING PROCEDURE
Data analysis and coding lead the researcher to the Department of Health, where data was collected from health care planners (nursing) responsible for maternity care in the Durban functional region. Data collection therefore continued at a polyclinic maternity ward, where data were collected from health care planners (nursing), health care providers (nursing) and adolescent. This is an example of how the researcher made decisions about when aspects of the data were found to be saturated.
DATA COLLECTION
Data Collection Procedure
Collecting data in two rounds also gave the researcher time to analyze the data so that he could guide further data collection. This was done to assist the researcher in taking notes and memos and to ensure that no data was lost during the session. During the semi-structured interviews, information was repeatedly returned to the participants by the researcher to verify that it was understood and interpreted correctly.
ETIDCAL CONSIDERATIONS
Again, with the permission of the city authorities, a private room was allocated for data collection among health care providers. For healthcare providers working outside healthcare facilities, data were collected at their place of business or at their homes, depending on their requirements. These categories of participants were first informed about the research by the management of the medical institution.
DATA ANALYSIS
Once this was done, the researcher turned attention to trying to determine any relationships that might exist between the core categories and subcategories. To ensure that the researcher was clear about the information participants provided, this information was fed back to participants during the focus group interviews and semi-structured interviews to verify accuracy and allow for constant comparison. The researcher then followed this line of thought to determine how other members of this focus group interview felt about the age of the health care worker.
PROOF OF PRODUCT
Second, the data were conceptualized into categories and their related attributes, which are presented in Chapter Four. The relevance of the study was highlighted by the literature review presented in Chapter Two, which clearly indicated that adolescent pregnancy was a problem worldwide. This relevance was further highlighted by the findings presented in Chapter Four, which showed that all stakeholder groups agreed that adolescent maternity clients cannot be simple.
LIMITATIONS OF THE STUDY
The constructs for a model for action presented in this report were therefore extracted from the points that participants considered key when providing maternity services to adolescent maternity clients. Consequently, the constructs and the resulting model for action were open to modification from literature, moving them beyond the findings. However, it is believed that the constructs of adolescent-friendly maternity care emerging from this study are still applicable to adolescents receiving such services either in private or public health care facilities.
RESEARCHER'S ROLE
Therefore, some aspects of maternity care presented here may be more applicable in central hospital settings than in rural settings. In doing so, I, the researcher, tried to remember the words of Glaser (1998, p. 49) who warns that "in studying the life cycle area of interest. Instead, I tried to discover what needs to be done in the area of adolescent motherhood services in relation to necessary inputs, processes and outputs by talking to as many stakeholders as possible and paying attention to emerging patterns.
CONCLUSION
INTRODUCTION
ADOLESCENT MATERNITY CLIENTS
Adolescent Client's Perceptions of the Maternity Services
- Perceived Friendly Care
- Perceived Unfriendly Care
- Friendly Maternity Services
- Role of Clients
Gentleness on the part of the health care provider conveyed concern for the adolescent client. By doing so, the healthcare provider was perceived as 'good' by the adolescent respondent. This led the teenage client to conclude that health care providers did not care about her.
This perception of health care providers being rushed can be a barrier to adolescent clients seeking health education. Adolescent respondents felt that health care providers should be understanding and try to help them with their problems.
HEALTB CARE PLANNERS
As previously mentioned, young clients were predisposed to obstetric complications, placing them in the 'at risk' category. This anger in turn affected the relationship between the adolescent and her baby in the postnatal period. 34;It is very difficult for the teenage mother. Another respondent had observed that young clients at her institution received support from their boyfriends during childbirth.
RCP Perceptions of Strengths within the Present Maternity Services Data from HCPs was analyzed and their perceptions of strengths within the present
- Perceived Friendly Care
- b Services
- c Resources
- Resources
- HCps
According to the respondent above, this approach could also lead to stagnation of healthcare providers and no sense of personal reward. One respondent believed that the lack of experienced health workers resulted in maternity wards being staffed with inexperienced young nurses. The respondent believed that this oversight was due to a lack of adequate training and skills among healthcare providers.
According to the respondent in the above statement, there was a generation gap between the client and the health care provider. Adolescent clients should be able to relate to health care providers and feel free to approach them with their problems or needs.
HEALTB CARE PROVIDERS
HCps' Perceptions of Weaknesses within the Present Maternity Service Perceptions of weaknesses within the present maternity service with regards to
- Perceived Unfriendly Care
- a Service Variables HCp-client Ratio
Respondents felt that they could not devote enough time to each client and this led to suboptimal care delivery. 34;The problem now is that we don't have enough time for our patients. You just go in to give birth, push the baby out and then you move. 34;It's very difficult, honestly, to actually give your patients individual care, it's very difficult. postnatal department RCp). This was attributed to their not understanding the potential risks of adolescent pregnancies. 34;They don't really realize the dangers of teenage pregnancy.