Experiences of Food Insecurity Among Pregnant Adolescents and Adolescent Mothers in Ghana: A Photovoice Method

Abstract

Objectives: Food insecurity (FI) remains a major public health problem globally. However, there is limited information about adolescents' experiences. The current study explored FI experiences of pregnant adolescents and adolescent mothers in Cape Coast, Ghana using a Photovoice method. Methods: This study recruited 34 pregnant adolescents and adolescent mothers from communities in Cape Coast, Ghana. Each participated in a training session then was provided prompts to take photos that portrayed food access barriers, facilitators and coping strategies. In a debrief session, each participant selected two pictures they took and explained the image, followed by a group discussion of the selected photos. Debrief sessions were audio recorded and transcribed verbatim to develop themes using a theory-driven approach. Results: Most participants reported several or many experiences with FI (64.7%) in the previous month. Participants discussed money, unwanted pregnancy, and unstable work as barriers to obtaining food and working, selling goods, and family support as facilitators to obtaining food. Coping strategies mentioned include providing services to others, borrowing food and goods, meal stretching, pawning personal items and trading. Conclusion: The FI experience of this population is complex; interventions, including trade training or school retention, should be multifaceted.

Keywords: Ghana; Photovoice; adolescent girls; adolescent motherhood; food insecurity; nutrition; pregnancy.

FIGURE 1

Study flow chart (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023).

FIGURE 2

Pictures and captions depicting barriers to food access (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023): (A) “This 10 cedis note I have taken a picture of, represents the difficulty in finding money to buy food” (Pregnant adolescent, Community 1); (B) “Some teachers even made fun of my pregnancy when I was in school, and this really made me feel uncomfortable.” (Adolescent mother 5, Community 7); (C) “Absence of the product renders me unable to afford food.” (Adolescent mother, Community 4); (D) “If people don’t come to get their hair done, I won’t get money to buy food.” (Adolescent mother 1, Community 6); (E) “There is no place in the community where someone can decide to mount a shop to sell food.” (Pregnant adolescent 4, Community 3); (F) “Stagnant water with rubbish will prevent us from planting our crops and even interfere with their growth.” (Adolescent mother 1, Community 6) (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023).

FIGURE 3

Pictures and captions depicting facilitators to food access (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023): (A) “If the general tap is closed, you can sell the stored water for money.” (Adolescent Mother 4, Community 2); (B) “I am a shop attendant and I get money to feed myself through this avenue.” (Adolescent mother, Community 7); (C) “I go to this place where I am given some footwear. This is what I sell for a living.” (Adolescent mother, Community 7); (D) “In times of difficulty, I help out my aunt who sells bread and eggs to make her sales when she is not around. This helps me both get food to eat and money for my upkeep.” (Adolescent mother, Community 7); (E) “If I stay with my grandmother, my dad gives me money for food and I also get food from her.” (Adolescent mother, Community 4); (F) When there is no food and there is money, it helps in purchasing food to curb hunger” (Pregnant adolescent 4, Community 1) (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023).

FIGURE 4

Pictures and captions depicting coping strategies (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023): (A) “Acquiring a handiwork of being a seamstress to be self-dependent” (Adolescent mother, Community 2; (B) “When I am hungry and have no food, I go and borrow gari from a woman who sells some. When I get enough money, I pay her back and the process continues.” (Adolescent mother, Community 6); (C) “This is how I get food to eat. When I want two of something and I can only get or afford one, I have to manage the one that I have like that. That is what this stone symbolizes (symbolizes having one of something).” (Pregnant adolescent, Community 3); (D) “We can sell the items and use the income for anything we need including feeding” (Pregnant adolescent 4, Community 3); (E) “If I have a store, I can pick stuff from the store to eat when I am hungry” (Adolescent mother, Community 6) (Healthy Adolescents Nutrition in Ghana study, Cape Coast, Ghana, 2023).