What factors deny access to pregnancy support mechanisms? Experiences of slum-dwelling pregnant teenagers in Colombo city

Abstract

Teenage pregnancy (TP) is a key public health issue among urban slum-dwellers in Colombo. The adverse outcomes of TP often result from poor social support backgrounds. Understanding the factors which deny access to social support mechanisms would be useful both in preventing and managing the adversities associated with TP. This paper examines the experiences of pregnant teenagers (PTs) regarding the factors which deny access to pregnancy support mechanisms both from the perspectives of support recipients and providers. Having obtained ethical approval, this descriptive-cross sectional study was conducted among 139 respondents including 109 PTs and 30 support providers (SPs) from Colombo Municipal Council (CMC) area during 2008 July to 2010 July. Both qualitative and quantitative data were collected through an interviewer-administered questionnaire, case studies and focus group discussions; data were analyzed using framework analysis method and SPSS software. Poor awareness of PTs on available support services, lack of autonomy as females of teen-age and limited mobility, were identified barriers. Being pregnant out of marriage constrained them seeking support from divers support networks. Since underage sex is considered a statutory rape, social fear, created by unmarried status and bearing pregnancy underage contrary to law have prevented PTs from seeking care. Non-availability of sufficient number of SPs constrained PTs seeking pregnancy care from PHM. Poor coordination between statuary law and reproductive health policy, inadequate attention given for specific reproductive and sexual health needs of teenagers in the National Maternal and Child Health policy in Sri Lanka were recognized as barriers for utilization and provision of social support for PTs. There is a need to review the existing marriage law so as to prevent it from being an instrument of social exclusion. Considering the unmarried and under-aged women, a special pregnancy care component should be included in MCH policy in Sri Lanka.