Midwives’ perspectives and care practices for pregnant adolescents: a qualitative study in Northern Malawi

Adolescent pregnancy remains a significant concern in Malawi, associated with adverse outcomes for both mothers and their infants. Despite the implementation of youth-friendly care programs, there is a paucity of evidence regarding the provision of quality, context-specific care for pregnant adolescents. Midwives, as primary healthcare providers, play a critical role in addressing these challenges. This study aimed to explore midwives’ perspectives and practices concerning adolescent pregnancy care in Malawi. The findings will contribute to the development of contextually grounded, evidence-based interventions to provide quality care for this vulnerable group. This study employed a descriptive qualitative design. Six focus group discussions were conducted with 38 midwives, who were purposefully recruited from three hospitals in Northern Malawi, during the period from January to February 2024. Thematic analysis was used to identify key themes related to the midwives’ perspectives and practices. Three themes emerged from the analysis: (1) perspectives and attitudes related to positive engagement, (2) care practice as holistic care, and (3) envisioning equitable opportunity to receive antenatal care (ANC). Midwives engaged empathetically with adolescents, building trust and providing individualized health education. They collaborated with families and other professionals to support pregnant adolescents. Midwives advocate youth-friendly care training, dedicated antenatal care sites, community engagement, and peer support networks. However, system inadequacies and sociocultural factors continue to be the main challenges to effective maternity care for adolescents. These findings suggest the necessity for a comprehensive, context-specific approach to the care of pregnant adolescents in Malawi, which transcends individual-level support. It is imperative to enhance collaborative care involving families, communities, and multidisciplinary professionals to address the complex needs of pregnant adolescents. Furthermore, it is crucial to strengthen midwifery training in youth-friendly care and to improve the health system infrastructure to facilitate its delivery. These initiatives are vital for improving the quality of care for adolescent pregnancies and for maternal and newborn health outcomes. In Malawi, the adolescent pregnancy fertility rate is estimated to be 136 births per 1,000 individuals, contributing to adverse maternal and child health outcomes. Although antenatal care is important in preventing maternal and neonatal complications and promoting health, adolescents often delay initiation and encounter challenges related to accessing care, and once engaged in care, the substandard provisioning of antenatal care components. Providing high-quality antenatal care to pregnant adolescents may increase access to antenatal care. However, there is a lack of research focusing on how to tailor care to meet the needs of this vulnerable group. Midwives are primary healthcare providers of antenatal care and play a crucial role in Malawi. This qualitative study investigated midwives’ perspectives and practices regarding adolescent pregnancy care in Northern Malawi. Six focus group discussions were conducted with midwives from three urban hospitals. The thematic analysis resulted in three themes: (1) perspectives and attitudes related to positive engagement, (2) care practice as holistic care, and (3) envisioning equitable opportunity to receive ANC. Many of the concerns and aspects advocated by participants in their care for adolescents are applicable to maternity care in general and not to the age or developmental stage of mothers. To improve adolescent pregnancy care in Malawi, we recommend investing in youth-friendly care training for all health care providers, adopting a multidisciplinary approach, and engaging with families and communities. Additionally, we suggest addressing infrastructure to meet the unique needs of adolescents and reduce accessibility barriers to antenatal care for pregnant adolescents.