Trends And Predictors of Maternal Health Services Utilization Among Adolescent Mothers in Uganda; A Secondary Analysis Of 2000 – 2016 Uganda Demographic Health Surveys (Udhs

Abstract

Background: Uganda has a high teenage pregnancy rate. The risk of morbidity and mortality is high if pregnant adolescent mothers do not utilize maternal health services. This study analyzed the trends and predictors of maternal services utilization by adolescent mothers aged 15-19 years in Uganda. Methods: Secondary data were extracted from 2000/2001, 2006, 2011, and 2016 Uganda demographic and health survey datasets. The participants were selected based on a national stratified-cluster sample design. Data were analyzed using Stata/SE 14.2 software to investigate the trends and predictors of antenatal care, delivery care, and postnatal care utilization by adolescent mothers. DHS survey protocols were approved by the IRBs at Inner City Fund (ICF) and Uganda, and access to the datasets was authorized by DHS. Results: The number of pregnant adolescent women aged 15-19 in each respective survey from 2000/01 to 2016 were 376, 348, 352, and 789. Utilization of maternal health services by adolescent women increased from 2000/01 to 2016. The average percentage point (pp) increase in utlization was 23.58 with the highest in PNC (pp=32.08, p<0.0001) and the least in early ANC timing (pp=11.07, p<0.001). Not living together with a partner was negatively associated with ANC visits (aOR=0.43, 95%CI: 0.23-0.80, p=0.009); while northern region (aOR=1.87, 95% CI: 1.02-3.40; p=0.042) and those living together with their partners (aOR=2.19, 95% CI: 1.15-4.16; p=0.016) were positively associated with ANC timing. Being an urban adolescent woman positively predicted institutional delivery (aOR=3.34, 95% CI: 1.45-7.49; p=0.005). Being married (aOR=0.38, 95% CI: 0.38-0.91; p=0.019), not living together with a partner (AOR=0.46, 95% CI: 0.24-0.90; p=0.024), and primary education level (AOR=0.10, 95% CI: 0.013-0.819; p-0.032) negatively predicted PNC check before discharge. Conclusions: Maternal health services utilization by adolescent women in Uganda increased over the years, but with variations predicted by regional and rural-urban differences, education level, and living with partner. These findings show the significant roles of gender, social, cultural and economic factors in maternal health, and calls for policy and implementers to address them in order to achieve to the intended improvements in reduction of maternal and maternal and perinatal mortality among teenage mothers.