Maternal healthcare service utilization and health-related quality of life among young mothers aged 10–24 years: a case of selected districts of eastern Uganda.

Abstract

Maternal healthcare service utilization (MHCSU) remains a major public health challenge in low- and middle-income countries, particularly among adolescents and young mothers who face increased biological, social and structural vulnerabilities during pregnancy. Uganda's maternal mortality ratio remains high at 189 maternal deaths per 100,000 live births. In the selected districts of Eastern Uganda, utilization of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) remains below the Uganda Ministry of Health targets of 90% for ANC and skilled birth attendance and 80% for postnatal care. While previous studies have focused primarily on service coverage and survival, limited evidence exists on how MHCSU influences health-related quality of life (HRQoL). This study examined the influence of MHCSU on HRQoL and evaluated the moderating effect of young mother factors among young mothers aged 10–24 years in Eastern Uganda. An explanatory sequential mixed-methods design was employed. The quantitative phase used a cluster randomized controlled trial involving 30 public health facilities randomly assigned to intervention and control groups (1:1). A total of 967 young mothers were enrolled using systematic random sampling. The intervention group received community-based peer support and mentorship alongside routine maternal health education, while the control group received routine care only. Endline data were collected six months after the intervention. Quantitative data were analyzed using descriptive statistics to describe participants’ characteristics; Difference-in-Differences (DiD) analysis to estimate the intervention effect; chi-square tests and ANOVA to assess bivariate associations; ordered logistic regression to examine the association between MHCSU and HRQoL; and structural equation modelling to evaluate the moderating effect of young mother factors. Qualitative data were analyzed thematically. Maternal healthcare service utilization significantly improved HRQoL among young mothers. ANC utilization (OR = 1.686, 95% CI: 1.259–2.257; p < 0.001), SBA utilization (OR = 1.761, 95% CI: 1.345–2.306; p < 0.001) and PNC utilization (OR = 1.552, 95% CI: 1.169–2.061; p = 0.002) were all independently associated with better HRQoL. Perceived quality of care significantly moderated the relationship between ANC utilization and HRQoL (β = −0.698, p < 0.001), indicating that poor perceived quality reduced the positive effect of service utilization. These findings informed the development of the Sustainable Young Motherhood Awareness, Initiatives, Support and Safety (SYMAISS) Model. Maternal healthcare service utilization across the continuum of care significantly improves HRQoL among young mothers. The study recommends adoption of the SYMAISS model to strengthen integrated, youth-responsive maternal healthcare through improved quality of care, maternal health literacy, psychosocial support and community-based peer mentorship, thereby enhancing maternal well-being.