Abstract
Background:
Adolescents worldwide engage in sexual activity, with the proportion rising gradually from the middle to late stages of adolescence. The incidence of early sexual initiation among female youth in sub-Saharan Africa is reported to be 46%. The increasing number of teenage pregnancies in Rwanda indicates that adolescents do not correctly use sexual and reproductive health services. In 2019, the Eastern Province of Rwanda documented 36% of all teenage pregnancies. Despite the availability of these services to youth through adolescent sexual and reproductive health (ASRH) focal persons, nurses, or midwives leading youth corners at the Health Center level, why they are not used remains unknown.
Objectives:
To explore teenage mothers’ perspectives, knowledge, and attitudes toward pregnancy and the utilization of sexual and reproductive health services in the Eastern Province of Rwanda.
Design:
Qualitative descriptive study.
Methods:
A qualitative descriptive design combined with the theory of reasoned action was used to capture teenagers’ unique perspectives on knowledge about teenage pregnancy and attitudes toward ASRH service utilization. An in-depth interview was used to collect data from 25 informants across 3 districts in the Eastern Province of Rwanda, followed by traditional content analysis.
Results:
Three major themes emerged, including lack of knowledge about teenage pregnancy, unfavorable attitudes toward ASRH service utilization, and the perceived negative impact of teenage pregnancy, including disrupting education, limiting career opportunities, and posing health risks to both mothers and infants.
Conclusion:
While all young mothers were under pressure from the multitude of impacts of teenage pregnancy, parenthood, and social responsibilities, they had limited knowledge and selective utilization of ASRH services, mimicking potential gaps in education and mobilization of youth on available ASRH services with special emphasis on preventive components. Exploring the perceived enablers and challenges facing ASRH service utilization among the study population is necessary.
Keywords
Introduction
Adolescents worldwide are sexually active, and the proportion of those who are sexually active increases progressively from mid to late adolescence. The incidence of early sexual initiation among female youths in sub-Saharan Africa is reported to be 46%. 1 Almost 1/10th of all births occur in adolescents under the age of 20 years, with over 90% occurring in developing countries. 2 According to the World Health Organization, in 2019, adolescents aged 15–19 years in low- and middle-income countries (LMICs) in 2019 had approximately 21 million pregnancies per year, with approximately half of these being unintended; these led to approximately 12 million births, of which 55% ended in unsafe abortions.3,4 Almost 95% of adolescent pregnancies occur in LMICs, with 36.4 million females becoming mothers before the age of 18. 2
In Africa, the incidence of teenage pregnancy has reached 30%. 3 The implications of teenage pregnancy are many, as they can disrupt education, limit career opportunities, and pose health risks to both mothers and infants. Financial strain is common as teenage parents navigate parenthood without a stable career. Social stigma affects the mental health of young parents. 5 The recent rise in teenage pregnancy rates in Rwanda is cause for concern. According to data from the National Institute of Statistics Rwanda, teenage pregnancies increased from 5.7% to 7.2% from 2007/2008 to 2014/2015 among young teenage women and from 14% to almost 21% among young girls aged 19-year-olds. 6 Additionally, Rwandan national data from 2019 reported that 13.2% of pregnancies occurred in adolescents between 14 and 19 years of age. 7 The same survey revealed that 20.1% of females and 23.5% of males in this age group reported having had sexual experiences. In 2019, the Eastern Province documented 36% of all teenage pregnancies in Rwanda. 8
Ensuring a reduction in adolescent pregnancies and addressing the associated risks of mortality and morbidity are essential for fostering positive health outcomes throughout life. 9 This is crucial in pursuing sustainable development goals related to maternal and neonatal health. However, evidence shows that, despite government policies (Rwanda Adolescents Strategic Plan 2018–2024) to sustain adolescents’ good health and well-being, there is insufficient understanding of sexual and reproductive health (SRH), which exposes teenagers to risky sexual behaviors and an increasing rate of new human immunodeficiency virus (HIV) infections, particularly among female adolescents in urban settings.10,11 Although youth-friendly centers exist across the country that aim to promote adolescent SRH (ASRH) service provision by ensuring that adolescents have access to adequate, easily accessible, and high-quality healthcare services, 12 little is known about how these services are utilized to empower teenagers to lead healthy lives and flourish in their communities.
The ASRH package was developed as a comprehensive solution to adolescent needs; it has been implemented since 2008 in youth-friendly centers that function under the Ministry of Youth with financial and technical support from various local and international partners of the Government of Rwanda. 10 Youth-friendly centers offer activities and services during non-school hours to children and teens (ages 6–17), including recreation, health and fitness, citizenship and leadership development, job training, teen pregnancy prevention programs, and counseling for problems such as drug and alcohol abuse. Despite their establishment, 13 their existence and functionality are concomitantly being reinvigorated along with a very decentralized package of ASRH services provided at each center through youth corners and at schools.14 –16 ASRH services cover both preventive and curative aspects, though emphasis is placed on preventive aspects to ensure that users have adequate knowledge about their reproductive health, contraceptive methods, and prevention and management of sexually transmitted infections, including HIV as well as unintended pregnancy; they provide services such as counseling and male circumcision.10,15,16 Various studies have recommended that quantitative and qualitative information are important for communicating SRH services to adolescents in Rwanda.6,12 Understanding adolescents’ perspectives on, knowledge of, and utilization of ASRH services is an important step toward improving the provision and access of these services. This study aimed to explore teenage mothers’ perspectives, knowledge, and attitudes about pregnancy and the utilization of ASRH services in the Eastern Province of Rwanda.
Methods
This study used a qualitative descriptive design, aiming to capture the unique perspectives of teenagers aged 16–19 years old who have experienced pregnancy, focusing on their knowledge of, attitudes surrounding, and utilization of ASRH services. The theory of reasoned action (TRA) 17 was used to define, understand, and explore the knowledge, attitudes, and utilization of SRH services among female adolescents who had delivered. The TRA was chosen because it explains why people act in certain ways and clarifies that their attitudes and subjective norms influence an individual’s behavior based on their beliefs and perceptions of others. This is crucial to understanding and influencing human behavior while providing a structured approach to analyzing how attitudes and social influences shape human actions.18,19 The TRA, which posits that behavioral intention is the primary predictor of behavior, is structured around two key constructs: first, attitudes encompass beliefs and feelings regarding specific behaviors, and these, along with values (positive or negative), are associated with the outcomes of these behaviors; second, subjective norms involve knowledge, encompassing beliefs about whether influential individuals are aware of their behavior and their motivation to adhere to these standards. The TRA helped understand behaviors by coding and categorizing them to arrive at the final themes. The interviews were conducted in September 2022, and each interviewee participated in a one-to-one session. The COREQ guidelines were followed. 20
Settings
This study was conducted in the Eastern Province of Rwanda, chosen because of the higher number of teenage pregnancies reported in this area in 2019. 17 The study was conducted in three districts of the Eastern Province: two rural and one semi-urban. These three districts were randomly selected from the seven districts of this province in alphabetical order: Gatsibo, Kirehe and Nyagatare. By coincidence, each of the 3 selected districts had a youth-friendly center and youth corners at each health center, with 20, 19, and 19 health centers in Nyagatare, Gatsibo, and Kirehe, respectively.
Sample size
The sample size adhered to the principle of data saturation, wherein no new information was provided by the study participants. For the descriptive qualitative analysis, researchers suggested 6 to 12 informants, 21 which were considered before data collection. We targeted 12 individuals per site and recruited 36 participants. However, the principle of data saturation provided 8, 7, and 10 informants in Nyagatare, Gatsibo, and Kirehe, respectively, yielding a total of 25 informants.
Inclusion and exclusion
Adolescents who had given birth between 16 and 19 years of age and consented to participate in the study were included; otherwise, participants were excluded. The guideline for post-abortion care and family planning in 2023 does not require an adolescent to bring a parent to make decisions related to sexual and reproductive issues on their behalf 22 ; because of this, we did not require parental consent.
Adolescents who had abortions in any way/method were not included, though they are an important category for exploration of SRH knowledge and use of services; several reasons were behind the choice to exclude them, such as them not being part of the gatekeeper-followed group. Additionally, interviewing someone who voluntarily interrupted a pregnancy or who just lost her pregnancy can be a sensitive and potentially controversial topic due to emotional sensitivity, privacy and stigma, potential bias, misrepresentation, political and ethical considerations, and legal implications.
Sampling strategy, recruitment, and data collection
Before data collection, the research team secured permission from administrative entities to approach participants. They defined a gatekeeper at each site to call and meet informants at one of the administrative entities, preferring buildings of selected sector offices. The gatekeepers were mostly community health workers (CHWs) in charge of maternal health. During the follow-up of all pregnancies in the catchment areas, the women were well-informed about those targeted in this study and were told who to call according to the sample size. Gatekeepers were assigned to call 12 informants from the sector registers. After receiving a call, participants set a day and time (with a 2-h interval) to meet at the sector office, learn more about the study, and participate if willing. After calling, the CHWs informed the research interviewer about the agreed day and time.
The research team met individual adolescents at the selected location, where they introduced the study, explained the content of the consent forms, gave participants time to ask questions before consenting, and preserved their rights to not participate or withdraw from the interview at any time. As each participant attended the previously agreed-upon appointment and was free to bring her child, no refusal was observed. Adolescents willingly consented and signed an individual consent form before starting the one-to-one interview. The interviews were conducted using the local language (Kinyarwanda). Interviewers from various sites held daily debriefing sessions to ensure that data saturation was respected. Gatekeepers progressively communicated to maintain a set appointment or cancel it accordingly.
Interviews and guide
In-depth interviews (one-on-one) were conducted to collect data from study participants. Participants consented to be recorded during the interviews. An interview guide comprised questions related to ASRH accessibility, availability, and use, as well as the knowledge and attitudes of participants on getting pregnant, the source of such knowledge, and potential risks after teenage pregnancy. The research team conducted the interviews, comprising two researchers (SM and CN) who were knowledgeable about maternal health, the interview guide, and the scope of the study; they were familiar with interviewing participants and had experience in conducting qualitative studies.
Data analysis
The information recorded from the interviews was transcribed verbatim. Field notes were used to retrieve important information shared and observed by the informants that was not recorded, mainly concerning the signs and gestures displayed while sharing the information as part of emphasizing the experience. Mimique, the art of facial expressions to convey emotions, thoughts, and ideas, was observed. Data were analyzed using traditional content analysis. 21 As the interviews were conducted in Kinyarwanda, the research team translated the interviews verbatim into English using an independent translator; subsequently, the research team verified whether the meaning had changed. The codebook was created by translating coding definitions and decision rules into operational terms, involving multiple revisions of the coding manual. 23 The coder additionally examined quotations within three distinct nodes: knowledge of ASRH, attitude toward ASRH service utilization, and the perceived impact of teenage pregnancy. A single coder (SM) accomplished these tasks with input from the primary investigator (CN) and project mentor (MM).
Results
Demographics
Participants ranged from 16 to 19 years old; they were all single, most (15) were farmers, others dropped out of school (10), and a large number (10) attended semi-secondary school. The majority (20) had 1 child, while 3 were pregnant for the first time (Table 1).
Demographic characteristics of those who became teenage mothers by 2022.
Themes from the interviews
This study noted the following themes; the results of the interviews are presented under each theme with a specific quote:
Lack of knowledge about teen pregnancy and ASRH
This study revealed that pregnancies are prevalent among female adolescents; however, the participants knew little about this, and menstrual cycles were unclear. Some quotes from the interviews were:
“My cycle is not stable, and I cannot know when to get pregnant.” “It was my fault; I shouldn’t have gone to visit him! He is not my brother; I should not trust him, and I was not aware of my body changes and that I am in the reproduction phase.” “I am truly not sure about how I can calculate my days and know my interval of getting pregnant. I learned about this at school, but it was not enough for me to be able to recall what to do.”
Informants did not know about ASRH or knew little; most testified that they were pregnant because of rape and that they were not in the best position to have a baby at a young age.
“I know I was raped, but I never wanted to go through that (teen pregnancy).” “A good girl with culture should not sleep with men before her official marriage; that is among our cultural norms. When you are pregnant, you are a burden to your family, and you should no longer get married. You are done, idiot!” “We are considered prostitutes, and what happened to me is considered my misbehavior. They used to say that we are ashamed for what we did, ignoring that we were even raped.”
Attitude toward ASRH service utilization
Most respondents did not utilize ASRH services because they did not possess sufficient information about packaging, eligibility, and service provision. Quotes from participants were as follows:
“Reproductive health services for adolescents: I do not use them. I did not go to them.” “For sure, I do not even know what these services cover. I wish I knew them before.”
The study participants revealed that they had some biased reproductive health information from their boyfriends as well as the old men who impregnated them.
“He told me that if I sleep on him, I will not get pregnant; however, I got pregnant though I did what he told me (crying).”
The informants further revealed that power relations between males and females were the cornerstone of what happened.
“He asked me to go for a visit and told me that he would pay for my good body lotion. I did not think that he would profit from that visit by asking for sex.” “I went there, but I did not expect him to touch me. He used to be a humble man.”
Informants felt that adolescent love, life, and financial situations played vital roles in their attitudes toward teen pregnancy. They claimed their families were poor and did not meet their needs. Teens need various facilities and materials, and once they are not provided by their parents, they might get them from someone else with sex as the payment.
“I was a student in senior 2; sometimes my family missed school materials and I used to go to school without books. So, if someone gave me one, I just picked it up, and I had to thank him with sex.” “My parents were unable to provide me with hygiene materials such as pads, lotions, and soaps. One businessman in my area helped me. One day, as he used to give me that, he invited me to his house, telling me that I would take my package; however, I cannot forget that day. He raped me and no longer gave me the package. That was the end of the journey, although I got pregnant then (crying).” “I was a beautiful girl, and I had to be loved and loved My husband called me to his house and gave me a soda, which caused me to sleep. He raped me. After a while, I found out that I was pregnant (crying), and that was not what I wanted from him.”
When asked if they attended antenatal consultation, delivered at health facilities, and attended postnatal consultation, including vaccination of their babies, participants testified that they attended all these services but did not know they were part of the ASRH services.
“I only did one antenatal consultation and gave birth at a health center. I also attended my child’s vaccination program. But I was like a foreign individual because everyone looked at me and pointed fingers at me.” “I do not know what ASRH services are provided to adolescents.”
Although adolescents testified that they knew of some diseases as the impact of unprotected sex, they were not aware of ASRH services regarding this or the packages offered there. They revealed that they did not attend any health facility to test for any disease before or after pregnancy.
“What happened to me was not planned, and I did not even think about condoms. I feel like I do not want to be tested for AIDS because if I tested positive, I would not tolerate that situation, and my child would die in my absence. You understand what I mean (crying).”
They further asked for support from those who understood the situation of teen mothers in terms of finances, which could help them return to school.
“I thank you very much for my district’s support of 20000 Rwandan francs (Rwfrs). I also ask help from the Good Samaritan to go back to school.”
Perceived impact of teenage pregnancy
Our study revealed that teenage pregnancies have several impacts on the daily lives of mothers, and all participants noted that they hindered their education. All participants were primary and secondary (high) school students; because they were all single mothers, they could not leave their babies to go to school. Additionally, pregnant women cannot return to school until they give birth.
“I was a student in high school, and all my dreams and goals were set off. I know I have to raise this baby alone, and his father is not helping.” “I was a traditional dance member, among the best performers at my school. As you can see, I have a baby, and I have to stop what I loved to do, including dancing and walking around with my friends. . . it is so sad to miss what you love.”
Teen mothers highlighted their overwhelming responsibility of becoming mothers. They testified to bearing that burden alone with nobody to help them.
“I cannot leave home and leave my child there because I have nobody to help. Wherever I must go, I must go with her. Even though I must go for simple work, I go with her; it is not easy.”
Teen mothers learned from their experience of being a parent at a younger age, although raising a child alone was a burden.
“This was a lesson I learned from my love life relationship. I understood that I could no longer trust men. It helped me grow up and feel very much responsible.” “I learned a lot from what happened to me. I ask God to protect me from any disease so that I remain with my child.”
Participants perceived that responsibility was often attributed to teen mothers instead of teen fathers by those around them.
“Because the pregnancy is in the girl’s womb, people tend to judge the girl more harshly than the guy.” “When a girl becomes pregnant at a young age, she is often viewed as promiscuous, irresponsible, and a negative influence in society.”
They expressed their feelings about financial constraints, which was a major concern in their daily lives. They testified that they had lost plans and opportunities for the future. Some participants mentioned that they had received support from local governments.
“Having a kid at this younger age compromises your wishes; you cannot get a job or pay someone to stay with your kid either. This is a dilemma in life.” “We live in poverty because we cannot afford what our kids need. No father’s help, no family help apart from a small district’s support I received, but not all of us receive that support.”
All study participants highlighted the impact of being the only parent raising a baby. They recalled what others had told them about their future after becoming teenagers. One teenage mother remembered being told, “People always said, ‘Oh look, you’re not going to be able to finish high school because you became pregnant at a young age.’”
Adolescents who came from low-income families had resoundingly more negative attitudes due to their respective family conditions, including lack of support for them and their babies, misunderstandings in the family, and, more frequently, criticism from their fathers.
“Since I knew that I was pregnant, I did not tell anyone about it because I knew that my dad would kill me and chase my mother together with me because we struggled to find something to eat. I used to be out of my home during the day to return to sleep.”
They spoke about their babies’ fathers’ behaviors, indicating that most participants were left alone.
“Men experience a diminished sense of responsibility when we become pregnant.” “Men often feel comfortable just walking away.” “Many fathers don’t stick around. You have a baby, and then they leave.”
This study identified diseases that might arise in association with teenage pregnancy.
“I do not know many of the diseases, but I know that AIDS, trichomonas, and gonorrhea are transmitted via unprotected sex.” “AIDS is a very common disease that may affect us if the partner is positive with AIDS.” “I think when you have some wounds in the vagina, you may attract some diseases such as AIDS and trichomonas.”
Discussion
Using in-depth interviews with teen mothers, the general purpose of this study was to explore their knowledge about teenage pregnancy and attitudes toward ASRH service utilization. Several themes were identified.
Lack of knowledge about teen pregnancy and ASRH
Teenage pregnancy is a complex problem with significant social, economic, and health consequences. A high number of girls aged 15–19 years live in developing countries, where there is a power imbalance, limited access to contraception, and societal pressure on girls to demonstrate their fertility. 24 ASRH services offer comprehensive SRH knowledge, as well as promote reproductive health and menstrual cycle confidence among adolescents to prevent unwanted teenage pregnancies.10,25 Adolescents need to enroll in and use ASRH services from ages 10 to 24 years, as planned in Rwanda15,16; they need comprehensive support, including access to quality healthcare, education, and counseling, provided nonjudgmentally and compassionately. ASRH programs provide a full package of medical and psychological services along with orientation to gender-based violence services for the legal care of pregnant teenagers. However, the majority of adolescents are unaware of these services and lack critical skills such as knowledge of the menstrual cycle and the ability to calculate their fertility period.
Adolescents are prone to various health and social challenges. Our study found that the participants did not wish to become pregnant at their age despite having unprotected sex. Engaging in sexual activity without sufficient knowledge and protective skills increases the vulnerability to undesired pregnancies, unsafe abortions, and sexually transmitted infections, including HIV. 24 In this study, there were no discernible differences among adolescents from various districts, suggesting that cross-border teenagers tend to assimilate different cultures into the mainstream after exposure. Other studies conducted in Rwanda have revealed cross-generational silence about ASRH across the country, which has an impact on attitudes toward teenage pregnancy.17,26
The findings of our study revealed the impact of cultural norms on exposing adolescents to pregnancy, which further disagrees with previous quantitative literature showing that culture does not have any relationship with risky behaviors in adolescents. 27 The attribution of cultural norms from the communities where adolescents live has a strong impact on how they decide to engage in relationships; years ago, in Rwandan culture, a girl visiting a boy was considered to have promoted prostitution and brought shame to her family. Adolescents who wished to have partners or relationships were told to wait until they were officially married. This is not unique to adolescents from the aforementioned districts; other qualitative studies have highlighted that teen mothers reported being shameful to the family and community. 28 Developing and globally implementing content-related adolescent curricula has demonstrated significant improvements in educational outcomes regarding teen pregnancy rates and adolescent empowerment, 29 suggesting the importance of educating and informing teenagers about SRH and how they can access related services. The role of parents in providing sex education to teenagers is undebatable, including open communication in a safe and conducive environment that helps open dialog about sexual health, relationships, and related decisions; modeling values with an emphasis on influencing teens’ attitudes and behaviors regarding relationships and sexual activity; and support and guidance, including emotional support, to inform teen decision-making and balance the importance of health and relationships.
Attitude toward ASRH service utilization
Our study findings showed that participants had some negative attitudes linked with poor knowledge that exposed them to pregnancy. As an example, some men lie to female adolescents, telling them that they will not get pregnant if the female is above them during sex. This emphasizes the need to improve ASRH service utilization as a source of reliable information on reproductive health. Our findings show that men with money used tricks to call young girls for visits; when they entered their homes, they failed to return safely. This is consistent with other studies that revealed that adolescent pregnancy is frequently linked to poverty and lack of economic opportunities for girls. 30
A poor attitude and limited knowledge exists about ASRH service utilization among the study participants in these three districts. This is not unique to these areas; a study in Iran found that only one in four secondary school adolescents utilized ASRH services. 5 Our findings showed that teen mothers attend antenatal, postnatal, and vaccination services but are not aware that these are part of ASRH. Similar to other studies, most teen mothers participated in antenatal care. 31 The findings suggest that healthcare providers should inform adolescents attending antenatal care about ASRH services and how they can fully access them.
Perceived impact of teenage pregnancy
All participants in this study dropped out of school and struggled to raise their children. In the study setting, adolescent females perceived that judgments were passed more on to teenage girls who were pregnant than to those who impregnated them. This is possible because females must physically endure pregnancy and childbirth, and culturally, society tends to scrutinize and judge women more than men. This finding is significant as they were pointed out with fingers when they went for antenatal, delivery, vaccination, and other health appointments by their counterparts who were not teen mothers. Literature notes the importance of informing society about SRH and the need to participate in their children’s engagement. 12 In Rwanda, the United Nations Population Fund encourages and supports increased communication between parents and adolescents regarding SRH and rights. The initiative ensures that families are well-informed and can discuss these important topics with their children. 32 However, the testimony from the study participants reveals another step for parents to understand this concept in their communities, suggesting focused education about SRH for both parents and adolescents.
The variation in opinion emphasizes the need for focused reproductive health education among adolescents, which includes the menstrual cycle and sexuality. Moreover, it implies the need for an additional support package during pregnancy, particularly for adolescent mothers, as negative stigmatization can disrupt the well-being of both mother and child, paralyzing the future of the next generation. 33 While our study did not include young men, young female adolescents perceived that most of their partners would depart either after the birth of their child or during pregnancy. The adverse judgments directed at teenage mothers extend, to some extent, to their partners as being irresponsible and absent. Other researchers have identified similar burdens and consequences in various regions of the world.20,23 –25 Teen mothers learned from what happened to them and considered the event as a lesson for the future. This view is noted in the literature, indicating that pregnant teenage mothers are more likely to be involved in future pregnancy prevention. 24
Teenage pregnancy was noted as a predictor of low economic status, as teen mothers concentrate on raising their children through limited activities to generate income. 34 Teenage pregnancy is strongly linked to poverty, in which they require social assistance to meet the needs of their children. Our participants asked for social support and thanked the government for its support throughout their districts, although not all received it. They further testified that once they were supported and equipped with the necessary needs, they could return to school and serve the country like any other member of society.
Enhancing women’s empowerment is crucial for their welfare and contributes positively to agricultural production, food security, diet, and child nutrition. 35 Achieving gender equality and empowering women is vital for ensuring the sustainable development of a country; research underscores that sustainable development hinges on these factors. Economically empowering women significantly impacts their lives and the overall economy; this includes providing access to education, employment opportunities, and financial resources. 36 Investing in girls’ education is crucial for empowerment as part of educational attainment. For teen mothers, resuming education can help them return to their vision before becoming pregnant. Education equips them with the knowledge and skills needed to participate in the workforce and make informed life decisions. 35 Education enables women to make decisions that enhance their children’s health, well-being, and ability to acquire essential survival skills. 35 This study strongly recommends that young women’s economic empowerment and educational attainment be focused on improving their status quo and enabling them to participate in their own country’s development.
Strengths and limitations
This study used the TRA in research regarding sexual behavior and pregnancy with teen mothers, providing a roadmap of how to define, understand, and explore the knowledge, attitudes, and utilization of ASRH services among female adolescents who have ever delivered and those intending to deliver. The findings can contribute to public health efforts to enhance the sexual and reproductive health outcomes of adolescent girls in the Eastern Province of Rwanda by addressing barriers to ASRH service access and implementing comprehensive interventions that empower and provide support for teenage mothers. However, each province of Rwanda may have its own views on teen pregnancies; some families may feel comfortable with teen marriages, even though marriage law in Rwanda does not support those under the age of 21. The participants in this study may not fully represent all teen mothers, potentially affecting the generalizability of the results. Due to the factors stated in the exclusion criteria, only adolescents who gave birth and those with impending childbirth were included; those who had an abortion were excluded, though this group constitutes another important demographic that could benefit from ASRH services.
Conclusion
This study examined teenage (aged 16–19) mothers’ perspectives, knowledge, and attitudes about pregnancy and the utilization of ASRH services in the Eastern Province of Rwanda. Significant gaps were uncovered in understanding teenage pregnancy and ASRH, with many participants being unaware of their menstrual cycles and available ASRH services. Cultural norms and misinformation led to risky behaviors and unintended pregnancies. The mothers experienced social stigma, educational disruption, and economic difficulties, with limited awareness of ASRH services; although they attended some health services, they did not recognize them as part of the ASRH spectrum. These findings underscore the need for enhanced education, accessible services, and supportive interventions to address teenage pregnancy and promote adolescent health in Rwanda. Exploring the perceived enablers and challenges of ASRH service utilization among the study population is necessary and adolescents in other districts, as ASRH services are designed as a preventive strategy for youth aged 10–20 years.
The results suggest an examination of the overall community context to make communities sensitive to the particular priorities of their teenage daughters and sons. We recommend that the Rwanda Biomedical Center, Ministry of Health, and other stakeholders with mandates to protect children and adolescents plan and implement targeted health interventions for this specific group, including health education about sexuality, child development interventions to assist children born to young teenagers, and capacity-building interventions to financially assist this population.
Footnotes
Acknowledgements
We acknowledge the Pre-Publication Support Service (PREPSS), which strengthened this study and our team through scientific communication training and follow-up support, including pre-publication peer reviews.
