A qualitative study exploring the experiences of adolescent mothers accessing perinatal services in Rwanda to inform the delivery of trauma- and violence-informed care: a double-edged sword

Adolescent mothers face several challenges when utilizing perinatal services, which can lead to (re-)traumatization due to their vulnerability, potential trauma histories, and ongoing violence, especially when those services fail to adopt trauma- and violence-informed approaches. To explore and describe adolescent mothers’ experiences accessing perinatal services in primary healthcare settings in Rwanda to inform the delivery of trauma- and violence-informed care (TVIC). This study utilized an interpretive description (ID) methodology and was carried out in eight Rwandan primary health care settings. Purposive sampling was used to recruit 15 adolescent mothers who accessed perinatal services to participate in an in-depth individual interview. Two relevant maternal-child health care guideline documents were also reviewed. Data were thematically analyzed. Two main themes were identified: (a) tailored care, and (b) re-creation of trauma. While some young mothers had positive experiences related to the provision of unconditional support/care, emotional and psychological safety and strength-based practices, the majority encountered challenges and barriers which re-activated trauma, including interpersonal violence and forms of institutional and structural violence. Adolescent mothers had mixed experiences accessing and using perinatal services, but these were primarily negative. It is important for perinatal services to accommodate the unique needs and especially the prior and ongoing traumatic experiences of adolescent mothers and to provide supportive and non-judgmental care. This can help ensure that adolescent mothers receive the care and resources needed for a positive pregnancy and childbirth experience. A TVIC approach is outlined to make perinatal services safe, supportive and inclusive.