Use of maternity services by adolescents in the Bandundu Urban-Rural Health Zone in the context of free care: Lived experiences, challenges, and perspectives of pregnant adolescents and adolescent mothers

Introduction In many developing countries, maternity care for adolescent girls is often inadequate, adversely affecting their health. In the Democratic Republic of the Congo (DRC), although access to maternity care has been studied, the specific experiences of adolescent girls with free maternity services remain underexplored. This study assesses adolescent girls’ satisfaction with maternity services in the Bandundu Urban-Rural Health Zone. Maternal mortality in the DRC remains high, at 846 deaths per 100,000 live births, with poor care during pregnancy and childbirth being major contributors. Data on adolescent health needs and services remain limited. Purpose The primary objective of this research is to evaluate the satisfaction levels of adolescent girls aged 16 to 19 with free maternity services in Bandundu, DRC. The study explores their lived experiences, challenges, and perspectives regarding these services, with particular attention to the quality of care received. Methods A qualitative, descriptive, and exploratory approach was adopted. Semi-structured interviews were conducted with 18 adolescent girls aged 16 to 19 who had accessed maternity services in the Bandundu Health Zone. Thematic content analysis was performed using QDA Miner software. Donabedian's conceptual framework for assessing the quality of care guided the analysis, focusing on structural, process, and outcome aspects. Results The findings revealed that the majority of participants expressed satisfaction with the maternity services received, particularly appreciating the quality of care, the environment, and the fact that services were free of charge. However, several issues were identified, including poor infrastructure (e.g., unsanitary toilets, inadequate equipment) and challenges in the care process (e.g., negligence, informal fees, verbal abuse, and long waiting times), which negatively impacted their overall experience. Despite these difficulties, most adolescents reported a generally positive experience and indicated a willingness to return and recommend the services to others. Conclusion While the free maternity care policy in the Bandundu Health Zone is generally appreciated by adolescent mothers, several areas require improvement to enhance service delivery. These include infrastructural upgrades and better management of care processes to minimise negligence and eliminate informal fees. This study highlights the importance of refining the policy to retain its strengths while addressing identified weaknesses, thereby ensuring a more positive maternity care experience for adolescent girls.