Presented by: Dr. Myat Sandi Min (Myanmar) Social Determinants of Health among Adolescent Pregnant Mothers Living in a Peri-urban Area of Yangon, Myanmar. (Qualitative Study) Presented by: Dr. Myat Sandi Min (Myanmar)

Rationale & Justification In Myanmar, 5% of the total population were 15-19 years old. Adolescent fertility rate was 17.2% in 2013. Government aimed to reduce the rate of adolescent pregnancy. Researches on adolescent pregnancy have been encouraged. To implement effective measure to reduce the rate adolescent pregnancy, it is essential to understand what social determinants of health in the community are related to this problem. Very limited number of study has done.

Rationale & Justification In comparing adolescents in rural, peri-urban and urban areas, adolescents in peri-urban areas have poorer health literacy than those living in urban areas higher risks to encounter consequences when they get adolescent pregnancy than those living in rural areas. Good relationship with respondents was essential in dealing with those vulnerable group which took time Qualitative study was done to explore the information more detail

Operational Definitions Social Determinants of Health According to Centers of Disease Control & Prevention, these are the complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities, also being shaped by the distribution of money, power, and resources throughout local communities, nations, and the world. According to Healthy People 2020 Approach, 5 key determinants are included : (1) Economic Stability, (2) Education, (3) Social and Community Context, (4) Health and Health Care and (5) Neighborhood and Built Environment.

Operational Definitions Health Literacy Whether a person can obtain, process, and understand basic health information and services that are needed to make suitable health decisions. A complex group of reading, listening, analytical, and decision-making skills and the ability to apply these skills to health situations The ability to understand instructions on prescription drug bottles, appointment cards, medical education brochures, doctor's directions, and consent forms. The ability to navigate complex health care systems. Health literacy is not simply the ability to read.

Operational Definitions Adolescent Pregnancy According to WHO, a girl between the age of 15 to 19, getting pregnant, is called adolescent pregnancy. Adolescent Reproductive Health Knowledge The female menstrual cycle, conception and puberty change Causes and Consequences of Adolescent Pregnancy Contraceptive methods and correct use of contraception Signs and Symptoms , means of transmission and prevention of STIs

Objectives To describe the social determinants of health among adolescent pregnant mothers, living in a peri-urban area of Yangon, Myanmar. To access the health literacy on adolescent reproductive health among adolescent pregnant mothers, living in a peri-urban area of Yangon, Myanmar. This study has 2 objectives which are to describe……..

Methodology Qualitative study (Case-study, In-depth interviews) 5 adolescent pregnant mothers living in East Dagon Township, a peri-urban area of Yangon. (Convenience sampling) Semi-structured open-ended questions were asked to respondents. Part of the thematic paper submitted to Psychology Department, Yangon University. Results of the study were analyzed according to Healthy People 2020 Social Determinants of Health Framework. Why quali How analyse?

General Characteristics of Respondents Case Age (year) Gravida, Para Age at the time of Marriage (year) Age at the time of 1st pregnancy (year) A 18 G3P0 16 B 17 G1P0 C D E 19 G3P1 14 Why quali How analyse?

Findings & Discussion on Social Determinants 1 (Economic Stability) Economic instability (4 Respondents) Inadequate family income to fulfill basic needs Unstable job and unsafe working experiences Inaccessible to appropriate employment “Although I worked hard, it is very difficult to earn enough money… so I wanted to rely on someone who could give enough financial support to me and my family…”

Findings & Discussion on Social Determinants 2 (Education) Low educational status and early drop out of school (4 Respondents) Lack of school policy for health promotion and comprehensive sexual education for adolescents (5 Respondents) “If someone supported me to continue my study, I would focus to study hard to become graduated… rather than married him early…” “I have never heard about the word: reproductive health… at our school..”

Findings & Discussion on Social Determinants 3 (Social and Community Context) Poor Relationship with society (5 Respondents) Low social cohesion and civic participation Experience of discrimination and inequity in the society Negative peer pressure. (5 Respondents) “As I am poor, most people do not respect me… and.. I have a very few friends who treat me kindly…” “My friend introduce me with my future husband who is older than me and has wife…”

Findings & Discussion on Social Determinants 4 (Neighborhood and Built Environment) Poor Relationship with family (5 Respondents) Low family strength Has adverse childhood experiences verbal abuse, physical abuse, intimate-partner violence, household substance abuse “My dad hit me or my mother whenever he was drunk… I felt so stressed to live at home… I wanted to have a husband who could help me to escape from this home…”

Findings & Discussion on Social Determinants 5 (Health & Health Care) Poor accessibility (5 Respondents) reproductive health care services counselling on family planning sources of health information Induced abortions of adolescent pregnancy. (2 Respondents) “I didn’t know what is exactly like contraception … but I didn’t want to deliver this baby at that time … so I went to traditional birth attendant, suggested by my Aunt…”

Findings & Discussion on Health Literacy (Adolescent Reproductive Health) “I have got a brochure about condom … but I do not understand some words and instructions written in it…”

Don’t know how to use contraception correctly. Cannot choose appropriate contraception for themselves. Can read and write simple words , however, cannot understand more complicated words related to health. Don’t know where to ask information or get health services. Cannot decide what they have done can harm them or not (e.g; induced abortion) Poor knowledge on adolescent reproductive health

Conclusion & Recommendation Similar social determinants of health were detected in all the respondents. social and community context neighborhood and built environment health and health care poor health literacy Further researches are required to determine the association between these social determinants and adolescent pregnancy in Myanmar.

Conclusion & Recommendation Common age for early drop out of school among adolescents in peri-urban areas should be identified. Appropriate comprehensive sexual education should be given at respective levels at school Adolescent reproductive health knowledge should be put in school curriculum and proper training of teachers should be done Those high risk population will be equipped with essential knowledge to prevent adolescent pregnancy. The rate of adolescent pregnancy in that population will be reduced.

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