Isolation: The experience of adolescent motherhood in Laos.

Background: Teenage pregnancy is a persistent public health problem with pervasive socio-economic consequences, particularly in in low- and middle-income countries, often related to low social participation and low economic security. The experiences of adolescent pregnancy and motherhood have seldom been described from a personal point of view. This study aimed to gain insights into how adolescent mothers in Laos experience their motherhood, how they perceive their situation and try to cope with it. Methods: This qualitative study was undertaken with 20 pregnant adolescents and young mothers living in peri-urban areas in two of the 18 provinces in Laos. Data were collected during 20 semi-structured interviews and two focus group discussions (n = 10). Digital recordings were transcribed verbatim, summarised and thematically analysed using an inductive analysis and exploratory approach. Results: The most common theme was that the young mothers experienced exclusion individually, socially and in relation to official systems. In only two cases was the pregnancy intended. All were determined to be good mothers, but were overwhelmed and unsure how to overcome structural barriers to educational, social and economic participation. Conclusion: Participants revealed that their adolescent pregnancy was tied to losses of past and future aspirations, and believed that working to prevent unintended adolescent pregnancy is worthwhile, but also advised that community support structures would help young women in their position.

Validation of the Questionnaire on Sexual and Reproductive Health Literacy for Adolescents Age 15 to 19 Years in Lao People's Democratic Republic.

BACKGROUND: Beyond sexual and reproductive health (SRH) knowledge, it is sexual and reproductive health literacy (SRHL) that reflects the capacity to deal with sexuality. Many interventions have been conducted to increase SRH knowledge in adolescents, but SRHL has rarely been measured, and a well-validated tool is needed to measure it. OBJECTIVE: This study aimed to validate a tool to measure adolescent SRHL. METHODS: Reliability, validity, and cultural equivalence were investigated using data from expert consultations, cognitive interviews, and two-pilot studies. Then adaptation was made to the SRHL questionnaire for correct use among Southeast Asian adolescents in Lao and in wider groups. KEY RESULTS: The SRHL tool was comprised of 39 question items focusing on teenage pregnancy, contraception, and abortion. Conceptual, item, and semantic equivalence were all met. Interviewer-administrated mode was found to be optimal. Each question offers the answer choices very difficult, difficult, easy, and very easy, with a good to excellent Cronbach's alpha (0.8-0.9); there were no missing items and no floor/ceiling effects. Construct validity was high as 6 of 7 hypotheses were confirmed. CONCLUSION: Validation was completed with good cross-cultural validity. The tool was shown to be effective in determining the level of SRHL in adolescents in Laos and potentially in other countries with similar cultures. [HLRP: Health Literacy Research and Practice. 2022;6(1):e37-e50.] Plain Language Summary: To find out how much adolescents know about sexual and reproductive health, an appropriate instrument of measurement is needed. Using different methods, we investigated the performance of a new tool, namely the SRHL questionnaire, which has 39 questions and should be used with an interviewer to assist in recording responses. This new tool could be used effectively to determine the level of literacy on sexual and reproductive health among adolescents.

Quality of family planning services for women of reproductive age in Lao PDR.

BACKGROUND: In Lao PDR, 15% of the married women want to postpone or prevent having a child, yet most are not using contraceptives to achieve this. Literature shows that usage of contraceptives is strongly dependent on the quality of family planning services. However, little is known about the quality of family planning services in Lao PDR. OBJECTIVE: To assess the quality of family planning services provided in public health facilities in Lao PDR. METHODS: Using a cross-sectional study design, public health facilities in three provinces in Lao PDR were assessed on structure, process and outcome measures of quality. Following the Quick Investigation of Quality approach, client exit interviews (n = 393), structured observations (n = 218) and facility audits (n = 17) were conducted. RESULTS: Facility audits, observations and client exit interviews painted different pictures of the overall quality of family planning services. Taking all together, the quality was rated as moderate to high. Only marginal differences in quality were found between family planning services located in different geographical areas. Notably, only married women with children were using these services. Although contraceptives were provided, little attention was given to the information provided during consultations and to the interpersonal relationship between client and provider. CONCLUSION: The results suggest that although improvements are needed to enhance quality of individual consultations, the greatest gain in reducing unwanted pregnancies would be made by ensuring access for all women of reproductive age.

Perceived barriers in accessing sexual and reproductive health services for youth in Lao People's Democratic Republic.

BACKGROUND: Sexual activity during youth is common in Lao PDR. However, young people seldom utilize sexual and reproductive health services and subsequently suffer from poor sexual and reproductive health. The aim of this qualitative study was to explore the barriers perceived by youth that prevent their access to sexual and reproductive health services. METHODS: Twenty-nine semi-structured interviews were conducted with 22 participants aged 15-25 years, from urban and rural areas. A vignette was used during interviews with those who had no experience with sexual and reproductive health services. Additionally, seven semi-structured interviews were conducted with health providers from youth-friendly health clinics and from public sexual and reproductive health services. Data were analyzed using a thematic approach. RESULTS: The main barriers preventing young people from accessing sexual and reproductive health services were related to cognitive accessibility and psychosocial accessibility. The cognitive accessibility barriers were a lack of sexual knowledge and a lack of awareness of services. Perceived barriers in psychosocial accessibility were the feelings of shyness and shame caused by negative cultural attitudes to premarital sex, and the fear of parents finding out about visits to public sexual and reproductive health services, due to lack of confidentiality in the services and among health providers. In addition, the barriers of geographical accessibility, mainly insufficient availability of youth-friendly health clinics. CONCLUSION: To improve access to services, a multi-component strategy is needed: promotion of youth-friendly health clinics; sexual education in schools; a formal referral system between schools and youth-friendly health clinics; and community support interventions. Prior to implementation, more research should be done on the applicability of these methods in the Laos context. Future research should try to determine the cost-effectiveness of youth-friendly health clinics integrated in a district hospital and stand-alone clinics, to provide insight into which form should be further developed.

Sexual and reproductive health literacy of school adolescents in Lao PDR.

RATIONALE: Adolescent pregnancy in Lao PDR is the highest in Southeast Asia. It leads to negative health and social consequences in young people. It is anticipated that this problem is partly caused by limited sexual and reproductive health literacy (SRHL), leading to poor sexual and reproductive health (SRH) decisions. Based on the concept of health literacy, SRHL goes beyond knowledge and behavior and is the self-perceived ability of an individual to access the needed information, understand the information, appraise and apply the information into informed decision making for a good way to contribute to sexual and reproductive health. It is not only knowing (knowledge) and doing (behavior), but it is the process of individual's thought on an SRH problem before taking an action. The aim of this study was to measure SRHL among school-going adolescents aged 15-19 and to determine factors associated with SRHL. METHOD: We conducted a cross-sectional study in rural and urban areas of Lao PDR in 2017. Respondents completed a self-administered questionnaire with five parts: socio-demographic, personal health, SRH knowledge and behavior, SRHL, and functional literacy. We calculated the SRHL score based on the HL-EU index and used descriptive statistics to determine the score and levels. Then we used bivariate statistics and multiple linear regression to identify factors associated with SRHL in these adolescents. RESULT: Among 461 respondents, 65.5% had inadequate SRHL. Scores were positively and significantly associated with several factors, including: school location (ß: 3.218; p<0.001), knowledge on SRH and attending SR class in school (p:0.010-p<0.001), and functional literacy on condoms, which reflected how respondents understood the use of condoms (ß: 0.871; p<0.001). CONCLUSION: Because most school adolescents had inadequate SRHL, comprehensive sexual education and enabling information as well as service access for adolescents are essential to ensure that adolescents can access, understand, appraise and apply good SRH knowledge in decision-making to benefit their own health.