Understanding+the+Impact+of+Young+Mother’s+Empowerment+Center+ on+Adolescent+Mothers+in+El+Alto,+Bolivia

GLOBAL+HEALTH

Julia&SeleznevaMS1& Jessica&EvertMD2,&Cecilia&UribeMD3

1UC&Berkeley=UCSF&Joint&Medical&Program,&Berkeley,&CA.& 2&Department&of&Family&Medicine,&University&of&California,&San&Francisco 3Centro&de&Empoderamiento

Introduction In Bolivia, 18=23% of adolescents are mothers or pregnant1,2. There exist numerous laws aimed at reducing teenage pregnancies, but little support for young mothers2=3,8. The Young Mother's Empowerment Center, created in 2013 in El Alto, Bolivia, is a daycare for children of teenage mothers to assist their pursuit of education or work. The purpose of the study was to use Photovoice to understand the lives of adolescent mothers, assess impact of center, and how to improve the lives of teenage mothers in El Alto.

Results

Conclusion

Six&women&aged&21=25,&with&their&first&child&at&age&15=21,&were&interviewed.& Categories&explored&were:&‘Life&of&an&Adolescent&Mother’,&‘Impact&of&Center’,&and&‘Improving&the&Lives&of&Young&Mothers’.& Life+of+an+Adolescent+Mother Impact+of+Center+ Improving+the+Lives+of+Young+Mothers Under this category, the main themes identified were economic hardship, difficult family lives, lack of information, and aspirations. It was found many experienced economic hardship and difficult familial relationships due to a troubled childhood or blame for pregnancy. Many commented on lack of information and access to contraceptives apart from a lecture in high school. Lastly, nearly every participant had aspirations to achieve something greater in their education – whether it was studying biochemistry, nursing, working, or desiring to help others like themselves.

Methods February=March 2016 informational sessions were held recruiting women from the center. Disposable cameras where given out to each participant followed by training. Since only 3 women took photographs and none participated in a focus group, a mixed approach of individual semi=structured interviews and discussion of photography was used instead. Interviewers and field notes were content analyzed using ATLAS to identify common themes.

de&Madres&Jóvenes

Image&1:&The&single&room&that&the&family& sleeps&in.&

“¿Cuántos cuartos tienen en su casa? 2 cuartos, pero ahora solo vivimos en un cuarto porque el otro cuarto se está rajando y parece que se va caer. Todas dormimos ahí, mi mama duerme más abajo se alquiló un cuartito de mi tía y allí duerme, porque el cuarto de mi mama es el que se está cayendo.” "How many rooms are in your house? 2 bedrooms, but right now we live in one room because the other one is cracked, and looks like its going to fall. All of us sleep in there, my mother sleeps up higher, she rents a small room with my aunt, and sleeps there because its my moms room that’s falling."

“[Estudio] bioquímica en las mañanas, y enfermería en las noches.…Yo vendo ropita de bebes, y el dinero no me alcanza…La anterior semana fui a buscar trabajo y en ningún lado quieren contratar si es que no tienen experiencia, y si quieren contratarte quieren pagar muy poco por muchas horas de trabajo. Y nadie te da la oportunidad de ganar experiencia, por eso decidí ingrese a estudiar otra cosa en la noche para tener en mi currículo más conocimientos y así conseguir más fácil un buen trabajo.” “I study biochemistry in the mornings and nursing at night…I sell clothes for babies, but the money is not enough…This past week I went looking for work, but no one wants to hire if you don’t have experience and if they do want to hire, they pay very little for lots of hours of work. And no one gives you any opportunity to gain experience, and for that reason, I decided to invest in studying something else during the evenings so that I learn more and so its easier to find a good job.”

Image+2+and+ 3: Several& participants&describe& how,&in& addition&to&being& young& mothers,&working,& and& studying,&they&do&most&of&the& chores&at&home& for&their& family.&

Under this category, the main themes identified were child development, pursuit of aspirations, and role model. The advantage of the center was child development – nutrition, space to play, and improving their social, or language skills. Many commented on how the daycare allowed them to continue their education, work without taking their children along, and in tough times, look for jobs. Many discussed the positive effect of the local pediatrician on their lives – enrolling them in the daycare, providing free healthcare, or helping find a job.

Image 4: “Le saque en mi casa a mi hijita…Ahí no hacemos casi nada y mi hija no juega tampoco hay espacio para ella, entonces le traje aquí para que aprenda, porque tampoco tengo muchos recursos para comprarle libritos para que juegue.” “I took this [picture] of my daughter at my house...There’s almost nothing for us to do and my daughter doesn't play, there’s no space for her, so I take her here [daycare] so she can learn, because we don’t have many resources to buy her books so that she can play.”

"Como es ser una madre joven? Muy duro y muy complicado, la gente no te gusta cuando eres mamá joven, pero pasando el tiempo te das de cuenta que nos hemos equivocado, pero estamos haciendo las cosas bien, no abandonar a nuestros hijos mantenerlos a lado de nosotros.”"What is it like being a young mother? It is very hard and very complicated, the people don't like you when you are a young mom, but as time passes by, you realize that you were wronged, that we are doing good things, we didn't abandon our children, that we are taking care of them.”

”Esta persona te daña va matando tu autoestima..por ejemplo cuando ya tienes tu hija te dicen: ´´ Quien te va querer con una hija, donde vas a ir con tu hija, que vas hacer tu sola”. “This person hurts you and kills your selfaesteem... for example, when you already have your daughter, he will say “Who will love you with your daughter? Where will you go with your daughter? What will you do alone?”

Under this category, the main themes included the need for closer and more affordable daycare centers for teenage mothers, more information about contraceptives, and increased health centers for teenagers. Many complained that the center was far away, and was the only center for teenage mothers in El Alto. They suggested increasing accessible daycares and health centers with access to contraceptives specifically for teenage mothers. “Yo no sabía cómo cuidarme nadie me hablaba no tengo mama, ni mi hermana me hablaba...gracias a la Doctora Uribe ahora, después mira… ya son tres años que estoy con implante y no tengo ni bebe.” “I didn’t know how to take care of myself, I didn’t have a mom to talk to, my sister didn’t tell me…thanks to Dr. Uribe now, look, its been three years with my implant and I don’t have another baby.”

References

Image+6:+One& of&the&participants& enrolling& in&university.

Image+7:&one&of&the&participants& in&front&of&the&daycare.&

"Una sugerencia que yo tengo de como la guardería puede ayudar a las madres jóvenes, implementando más jardines en diferentes zonas…el problema es la distancia.” “One suggestion that I have of how the daycare can help young mothers, is to create more daycares in different areas…the problem is the distance.” "Ser madre joven es más difícil que una madre madura que ya tenga un instrumento para apoyarse como estudios..pero en madres jóvenes o adolescentes algunas no terminaron ni el colegio…no son maduras emocionalmente están constantemente en ese batalla de criar a sus hijos como no son maduras emocionalmente, no pueden encontrar las formas de salir adelante. Es bien difícil saltar de la adolescencia a ser madre, donde la adolescencia debería ser una etapa donde deberías salir con tus amigos, pasear y estudiar pero cuando ya eres madre en ese etapa se corta todas esas cosas porque tienes que preocuparte por criar a tu hijo. Debería haber centros para madres jóvenes para ayudar a las madres a darse valor …También se debe implementar centros donde puedan darles cursos técnicos como: confección de ropas, costura…etc. Cosas con las que una mujer pueda salir adelante.” Image 5: “Esta foto es en clases cuando le se llevar conmigo a clases, le sé hacer sentar en la mesa y le se dar un juguito para que esté tranquila.” “This photo is in class, when I take her with me to classes, I make her sit on the table and give her juice so that she stays calm.”

This study confirmed findings from other research that teenage pregnancies are higher among poorer families, that many experience social and familial stigma, and that children of teenage mothers are at higher risk of developmental issues4=9. Surprisingly, there was a paucity of information in El Alto, despite laws targeting teenage pregnancy. Policy changes aimed at increasing accessible daycares and health centers for teenage mothers in rural and city areas and supporting community role models will improve the lives of young mothers.

“Being young mother is harder than a mature mother who already has the tools to help themselves, such as with their education..but for young mothers or teenagers, some don’t even finish college…they are not emotionally mature, and they are frequently in this battle to raise their children even though they are not emotionally mature, and they can’t encounter the different ways of getting ahead. It is difficult jumping from teenager to being a mother, where the teenage years should be a stage where you are going out with friends, walking around, and studying, but when you are a mother, this stage shortens for all of these things because you have to worry about raising your child. There should be centers for young mothers in order to help them and give them value…There should be centers, where they can give them technical skills, such as how to get clothes, the cost, etc. Things that can allow the woman to advance and continue…”

1.&World&Development&Indicators,&The&World&Bank.& 2.&LoaizaE,&Liang&M.&Adolescent&pregnancy:&a&review&of&the&evidence.&2013. 3.&UNFPA&Bolivia.&February&2016:1=7.&http://bolivia.unfpa.org 4.&Schuler&SR,&ChoqueME,&RanceS.&Misinformation,&Mistrust,&and&Mistreatment:&Family& Planning&among&Bolivian&Market&Women.&StudiesIinIFamilyIPlanning.&1994&6.&LipovsekV,& Karim&AM,&Gutiérrez&EZ,&MagnaniRJ,&Castro&Gomez&MDC.&Correlates&of&adolescent& pregnancy&in&La&Paz,&Bolivia:&findings&from&a&quantitative=qualitative&study.&Adolescence.& 2002 7.&&Castro&MD.&EmbarazoenAdolescentes:IAccesoDeIAdolescentesEmbarazadasaI ServiciosPúblicosDeISaludSexualIYISaludReproductivaenElIAlto. 8.&Pardo&CG.&Análisisdel&embarazoy&la&maternidaddurantela&adolescencia:&diferencias socioeconómicas.&2012.& 9.&Alfonso&M.&Girls&Just&Want&to&Have&Fun?&Sexuality,&Pregnancy,&and&Motherhood&among& Bolivian&Teenagers.&2008.

Correspondence Please&feel& free&to&email& [email protected] for&any& further&questions: Acknowledgements This study would not have been possible without the support of the Diana Sklar Global Health Initiative Fund, my wonderful mentors: Drs. Jessica Evert, Cecilia Uribe, Mylo Schaaf, Chris Stewart, the participants who let me into their lives, my husband Yogi, and my kitten.