Research Brief: Highlights from Formative Research with First-Time Young Parents in Kogi State, North Central Nigeria

By the age of 19, 18% of girls in Kogi State will have begun childbearing. Adolescent girls are at a disadvantage due to limited social support and knowledge about reproductive, maternal, newborn, and child health (RMNCH). In addition, these girls often have poor nutrition, limited resources, and few financial opportunities. Adolescent girls are less likely to use essential health care than are older women, with 46% of mothers under 20 years receiving no antenatal care and only 26% delivering with a skilled provider. The United States Agency for International Development's flagship Maternal and Child Survival Program (MCSP) conducted qualitative research in Kogi and Ebonyi States in 2016 and in Bauchi, Cross River, Ondo, and Sokoto States in 2017. The aim of the research was to understand the RMNCH needs of first-time young parents (FTYPs), factors influencing care use, and current care gaps. In each of the six states, two health facility catchment areas were purposively selected, one each from urban and rural areas. Study participants, including pregnant and parenting adolescent girls aged 15-19, were recruited through youth groups, community health workers, and facility-based health providers. Across all states, FTYPs felt that health care was important, although they did not often use it. The most important barriers to care were the financial burden of care, influence of individuals with power over first-time adolescent mothers' (FTAMs') decision-making, and health care that does not respond to the needs of adolescents. In Kogi State, adolescents' experiences with pregnancy and parenthood ranged from being shocked, unprepared, and regretful about the difficulties of early parenthood to being happy and excited. Marriage moderated the responses, as in other states, with couples who were married expressing happiness and perhaps a little nervous, while unmarried couples reacted mainly negatively. Individuals who most influence FTAMs' use of health care include their families, whose preferences are informed by their own knowledge, customs, and experience with health care. Older female relatives, particularly mothers and mothers-in-law, act as barriers in some cases, but in other cases, they facilitate use of health care. Male partners who were present and involved were influential and played a major role in facilitating use of health care. Factors that facilitate use of health care include perception of need for health care, understanding of the benefits of formal health care, and belief that health facilities offer the best RMNCH care. Adolescents and their influencers desire to space pregnancies, with both first-time mothers and fathers and older women valuing spacing of children for health and family well-being. In Kogi, couples report that they make decisions together about family planning. Findings from Kogi differed sharply from the other five states in that no negative comments were made about contraceptive methods and their side effects, a common theme from the other states. Barriers to use of health care include adolescent girls' lack of power and social capital, with inequitable gender norms being pervasive and women needing to defer to the wishes of their husbands.