Adolescent Pregnant Women Experiences in Three Primary Health Care Centers of YOGYAKARTA: the Need of Friendly and Sensitive Support Care

Purpose: Explore the meaning of adolescent's experience and social support needs from health staff in pregnancy.Method: This research was a qualitative research with phenomenology. The study was conducted in three catchment areas of Puskesmas Jetis, Gedongtengen and Umbulharjo 1 from 6 May to 7 July 2017. The selection of participants using the technique of maximal variation and the number of participants adjusted to the varied place of study and the variation of participants and the number of participants was 6. The research data was collected by using in-depth interview technique with semi-structured interview guide. The data were analyzed with Collaizi technique analysis.Results: There are 5 themes in this study that is, the experience of adolescents at the beginning of their pregnancies, differences in the reasons adolescent maintain their pregnancies, the form of support that adolescent have gained during pregnancy, adolescent perspectives on the behavior of health staff during accompanying pregnancy and social support needs of adolescent pregnancy from health staff .Conclusion: Adolescent acceptance of pregnancy occurs as pregnancy progresses, support from optimal health staff increases teen motivation to maintain and run pregnancy well and informational support from health staff is a key requirement for teenage pregnancy.


INTRODUCTION
Adolescence is the life phase in which individuals are making transition into adult communities, so that the children do not feel under age, but the same level as older people in rights and life issues. Adolescence is a period of transition from childhood into adulthood that is beginning when a child is sexually mature and ending when he reaches legal age (1). One of the teenage problems is pregnancy. The World Health Organization (WHO) indicates that the birth of babies from teenage mothers aged around 15 to 19 years on average in the world is 49 of 1,000 teenage girls (2). Pregnancy in adolescents has a long-term effect on some aspects, including physical, mental health, education, and family. The influence of health on teenage pregnancy is significant with risk of maternal mortality, morbidity, disability, preterm labor, complications of unsafe abortion, sexually transmitted infections including HIV, and health risks and deaths in infants (3). Social support from spouse, peers and parents is very important to help teenagers in facing this pregnancy problem. Social support can help adolescents to avoid depression that is very likely experienced during pregnancy, thus increasing the confidence of pregnant teens to become mothers (5).
The results of the study by Ajoulat et al (2010) found that adolescent mothers need health support in the form of counseling services to continue pregnancy. The results of Mohammadi's study suggest that adolescent women need strong social support to deal with any problems in teenage pregnancy (6). Healthcare providers are expected to fulfill the needs of pregnant teenagers by developing professional counseling services and support systems by stakeholders to strengthen the emotions of pregnant teenagers as was recommended by the Ministry of Health.

METHODS
This research was a qualitative study with phenomenology approach. The aim of this method is to explore, analyze, and describe adolescent experiences and social support needs of health staff in pregnancy in Triangulation of resources was carried out with 1 companion of participants (mother) and 2 health staff, while triangulation method was done by observation during pregnancy examination process. Observations were conducted by researchers and also research assistants who are students of D-III midwifery, D-IV midwifery.

RESULTS
The main participants in this study were 6 teenagers who were pregnant. The age range of participants in this study varied from the youngest age  Other participants explained how to reduce difficulties by telling about the difficulties experienced and felt to the nearest person such as to mother, husband or neighbor as the following expression: "To the mother, if telling the story to mother is more comfortable than the others and if telling the story much better anyway if telling the story to The other participants said they were afraid to sin again, had sinned because of an unmarried pregnancy, did not want to sin again by aborting their pregnancy, as the following participant expressed: "Why is it? Because of the fear of sin, already make sins why have I to make sin again ". (P2, 18 years) "In the beginning there was a thought to abort it but I just said I was pregnant how the people see me, you scared yes so I follow the mother said" don't be strange to do abort stuff "say so how many years already already two week pregnant like two weeks so would be reply if aborted it will make a sin also anyway, yes already defend the "From the delivery room they continue to keep asking me, they already know that I sick still questioning me and continue to ask for a signature again and it is annoyed me, it will be more sick when more asking and make me more in pain.  This is in accordance with research by Kusumaningrum which obtained the result that the first support requested by youth KTD is instrumental and informational support (12). The interesting part is that during the process of information and instrumental support that is provided, emotional support such as attention and acceptance is also channeled by the support giver to the KTD teenager without being asked. It has implications that social networks around KTD teenagers function effectively to connect young KTD teens with greater support to help KTD teenagers solve the problem.

CONCLUSION
The results of the study found 3 main findings that describe the adolescent experience and the social support needs of health staff in pregnancy, namely: the process of acceptance of pregnancy by adolescents occurred along with the development of pregnancy, support from optimal health personnel increased teenagers motivation to maintain and run pregnancy well, and informational health workforce is a major requirement for teenage pregnancy (11). Research conducted by Monica also found the needs of young women to receive support in the form of advice, motivation, information either comes from family, friends or health personnel (7). In this study all participants lived with their immediate family or with their husbands so that the need for social support was met but not as much as the need for social support in adolescents who were isolated or did not live with their families or husbands, as in the study by Ajoulat which emphasized the role of health services and social nets.