Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe

Type Thesis or Dissertation - Doctor of Philosophy in Health Promotion, Education, and Behavior
Title Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe
Publication (Day/Month/Year) 2016
URL http://scholarcommons.sc.edu/cgi/viewcontent.cgi?article=4519&context=etd
Zimbabwe has a high maternal mortality with adolescent girls and young women
facing disproportionately high risk of maternal morbidity and mortality. Current
approaches to reducing maternal mortality in Zimbabwe focus on the pregnancy period
with antenatal care, obstetric care, and micronutrient supplementation during pregnancy.
Although important, these approaches are not reaching a large number of women and
may benefit from integration with pre-pregnancy approaches. The importance of prepregnancy
interventions to promote young women’s health has been emphasized, yet
many young women in developing countries like Zimbabwe do not have access to prepregnancy
care because little is understood about the concept of pre-pregnancy planning.
Furthermore, it is unknown which interventions will have the greatest impact on maternal
outcomes of women in these countries. The purpose of this research was to work
collaboratively with adolescent girls, young women, and key stakeholders in Harare,
Zimbabwe to bridge the knowledge gap around pre-pregnancy planning and to inform the
development of a pre-pregnancy planning intervention. Interview data were collected
from June-August 2015 from adolescent girls and young women (14-24 years) (n=48)
and key community stakeholders (n=24) from two low-income high-density communities
in Harare. Sixteen focus groups were also conducted in November 2015 with females
aged 14-24 years, healthcare workers, and partners of females aged 14-24 years (n=134).
Qualitative analysis with Nvivo 10 software indicated that adolescent girls and young
women conceptualized pregnancy across 8 themes: carrying a child, motherhood, the best
time for pregnancy, pregnancy decision makers, who is responsible for the pregnancy,
pregnancy burden, pregnancy dangers, and increase in social status with pregnancy.
Participants expressed mixed views concerning the possibility of planning a pregnancy
and described pregnancy planning across the pre-pregnancy, pregnancy and postpregnancy
phases. Key community stakeholders described a physical environment related
to pregnancy and planning for pregnancy that was limited in programming targeting
adolescent girls and young women and a social environment that was deeply rooted in
culture and cultural practices. Focus group participants described potential pre-pregnancy
efforts that included clinic programs, community outreach, edutainment, empowerment
of young women, parent and partner involved or targeted programs, peer education,
school programs, technology programs, and youth friendly environments. Findings
suggest that considering the socio-sociocultural influences on pregnancy will be
beneficial in developing pre-pregnancy efforts to improve maternal and child health in

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