title: Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review.
abstract: Adolescent mothers aged 15-19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20-24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes.
  
  
  
  We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation.
  
  
  
  Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered.
  
  
  
  Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Opportunities that have adolescents engaging with health providers also need to be seized. These will be critical in improving adolescent MHS utilisation. However, policy and programmatic choices need to be based on recent, relevant and robust datasets. Innovative approaches that leverage new media to generate context-specific dis-aggregated data may provide a way forward.
authors.affiliation: Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Oluwasola Eniola
authors.initials: OE
authors.lastname: Banke-Thomas
authors.affiliation: Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK. aduragbemi.Banke-Thomas@lstmed.ac.uk.|McCain Institute for International Leadership, Arizona State University, Tempe, AZ, USA. aduragbemi.Banke-Thomas@lstmed.ac.uk.
authors.forename: Aduragbemi Oluwabusayo
authors.initials: AO
authors.lastname: Banke-Thomas
authors.affiliation: Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Charles Anawo
authors.initials: CA
authors.lastname: Ameh
mesh_terms: D000293:Adolescent; D036861:Delivery, Obstetric; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery; D010342:Patient Acceptance of Health Care; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adolescents; Ante-natal care; Delivery; Intra-partum care; Maternal health; Maternal health services; Post-natal care; Utilisation of health services