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Understanding Conceptualizations and Structural Environment For University of South Carolina Scholar Commons Theses and Dissertations 6-30-2016 Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe Chiwoneso Beverley Tinago University of South Carolina Follow this and additional works at: https://scholarcommons.sc.edu/etd Part of the Health and Medical Administration Commons Recommended Citation Tinago, C. B.(2016). Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/3515 This Open Access Dissertation is brought to you by Scholar Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. UNDERSTANDING CONCEPTUALIZATIONS AND STRUCTURAL ENVIRONMENT FOR IMPROVING PRE-PREGNANCY PLANNING FOR ADOLESCENT GIRLS AND YOUNG WOMEN IN HARARE, ZIMBABWE by Chiwoneso Beverley Tinago Bachelor of Science William Carey University, 2009 Master of Public Health University of Southern Mississippi, 2010 Submitted in Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy in Health Promotion, Education, and Behavior The Norman J. Arnold School of Public Health University of South Carolina 2016 Accepted by: Lucy Annang Ingram, Major Professor Edward A. Frongillo, Committee Member Christine E. Blake, Committee Member David Simmons, Committee Member Barbara Engelsmann, Committee Member Lacy Ford, Senior Vice Provost and Dean of Graduate Studies © Copyright by Chiwoneso Beverley Tinago, 2016 All Rights Reserved. ii DEDICATION I dedicate this research to my family. To my dearest mother, Gloria Chiedza Tinago for being my rock throughout this process. I appreciate all the sacrifices you make for me and my sisters and for believing in us and our capacity to break through barriers as women and girls. You are my greatest advocate and I share this accomplishment with you. To my dearest father, Brian Alphabet Tinago, I thank you for believing in educating the girl child and for sacrificing to send all your girls to the best schools so that we could realize our dreams through a sound education. To my older sister Chidochashe, I’ve always thought you could do anything you put your mind to and I am truly appreciative for your encouragement and support throughout this process. To my loving twin sister and womb-mate Chatinoda, you are the constant in my life. A constant source of support, guidance, encouragement, and laughter. You always say, “We are built for teamwork”, and I agree. Thank you for always standing by me because together we are stronger. To my youngest sister Chamapuwa, I thank you for being a light in my life and for reminding me to see the good in all things. It’s your turn now. To my maternal grandparents Leonard Chipindu and Loice Mukwenga, and paternal grandparents David and Enesta Tinago, your granddaughter is getting a PhD! I hope you’re celebrating in heaven. My final dedication is to the research participants. Thank you for trusting me to share your stories and for reminding me to continue in sincerity and fortitude because there is still work to be done. iii ACKNOWLEDGEMENTS First and foremost, to God be the glory. Your love and grace has sustained me throughout this doctoral program. To my fearless and dedicated committee chair and advisor Dr. Lucy Annang Ingram, you inspire me and are always there to challenge and support me in my educational and professional endeavors. I cannot thank you enough for always being there for me and for believing in me. Dr. Edward Frongillo, thank you does not seem sufficient to express the immense gratitude I feel towards you. You’ve been a reliable source of guidance and inspiration, and I am honored to have you as a mentor. Dr. Christine Blake, you were the first to ignite my passion for qualitative research and you always challenge me to dig deeper and unpack my thoughts. I am truly grateful for your mentorship and support. Dr. David Simmons, you inspired my choice to enroll in the doctoral program at USC and I am so grateful for your mentorship throughout my tenure at USC. Dr. Barbara Engelsmann, you inspired the conception of this dissertation research and you provided much needed guidance and support throughout the process and for that and so much more, I am deeply thankful. I would also like to thank my other mentors; Dr. Daniel Schabot, Jennifer Talbert, Dr. Andrew Reid, Dr. Carolyn Parks-Bani, Dr. James McGuire, Mr. Grant Guthrie, Professor Rose Kambarami, Dr. Heather Brandt, and Dr. Casey Goldston-Giraudy. Thank you also to my dearest friends in the Circle and the Sistrens, Chineme, Helen, Chati, Oddessy, Odelia, Monalisa, Rumbi, Tanyaradzwa, Tanya, and Dosithe for being an amazing support system. Thank you to my extended family, amazing cohort and friends Stephanie, Tiara, Deeonna, Gabby, Caroline, Jessica, iv Ann, Andrea, Sarah, Shaun, Rudo, Maggie, and the staff and residents of Preston Residential College. Finally, a huge thank you to the Sackler Institute for Nutrition Science for funding this dissertation research. v ABSTRACT 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 pre- pregnancy interventions to promote young women’s health has been emphasized, yet many young women in developing countries like Zimbabwe do not have access to pre- pregnancy 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 vi 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 post- pregnancy 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 Zimbabwe. vii TABLE OF CONTENTS DEDICATION ....................................................................................................................... iii ACKNOWLEDGEMENTS ........................................................................................................ iv ABSTRACT .......................................................................................................................... vi LIST OF TABLES .................................................................................................................. xi LIST OF FIGURES ................................................................................................................ xii LIST OF ABBREVIATIONS ................................................................................................... xiii CHAPTER 1: INTRODUCTION ..................................................................................................1 1.1 OVERVIEW OF STUDY ............................................................................................3 CHAPTER 2: BACKGROUND AND SIGNIFICANCE ....................................................................7 2.1 SETTING ................................................................................................................7 2.2 MATERNAL HEALTH, MORBIDITY, AND MORTALITY IN ZIMBABWE ......................8 2.3 FACTORS THAT CONTRIBUTE TO MATERNAL HEALTH IN ZIMBABWE ..................15 2.4 NATIONAL STRATEGY AND INTERVENTIONS TO PROMOTE MATERNAL HEALTH
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