Maternal Healthcare Utilization and Health-Related Quality of Life among Young Pregnant Mothers Aged 10-24 Years in Eastern Uganda: A Cross-sectional Study

Pregnancy among adolescents and young women remains a major public health concern globally, especially in sub-Saharan Africa where early childbearing is associated with elevated maternal morbidity, social vulnerability, interrupted education, and poverty ¹⁹. Uganda continues to report high adolescent fertility and persistent inequalities in access to maternal healthcare services, particularly in rural and underserved regions ¹⁵.

While maternal health programs traditionally focus on mortality and morbidity reduction, increasing attention has been directed toward health-related quality of life (HRQoL) as a broader measure of maternal well-being. HRQoL encompasses physical health, psychological status, social relationships, and environmental functioning (WHOQOL Group, 1995). During pregnancy and childbirth, young mothers may experience anxiety, stigma, economic dependence, poor social support, and pregnancy-related complications that diminish their quality of life ¹.

Maternal healthcare service utilization including antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) is expected to improve both clinical outcomes and well-being through prevention, treatment, counseling, and continuity of care ^{17, 19}. However, limited empirical evidence exists on how these services influence HRQoL among young pregnant mothers in Uganda. This study therefore examined the determinants of HRQoL among young pregnant mothers aged 10-24 years in Eastern Uganda, with emphasis on maternal healthcare service utilization.

A total of 967 young mothers aged 10–24 years were recruited during pregnancy and participated in the study. The majority of respondents were aged 18-24 years (91.3%), while a smaller proportion 8.7% were aged 10-17 years. Most respondents were married (75.8%), followed by single mothers (15.4%) and those cohabiting (7.8%). Regarding education, 61.3% had attained primary education, 26.2% had secondary or higher education, and 12.5% had no formal education. Majority of the respondents were Catholics 33.9%, followed by Anglicans 31.9% while the least were from Baptist 0.10%, Isamasia 0.52% and traditionalist 0.62% respectively. A higher proportion of respondents had experienced a previous pregnancy (90.4%), while 9.6% were experiencing their first pregnancy. Respondents were drawn from Kamuli (34.7%), Ngora (34.4%), and Pallisa (30.8%) districts as shown in Table 1.

Young pregnant mothers who utilized maternal healthcare services reported significantly higher mean HRQoL scores than non-users.

ANC uptake: Mothers who attended antenatal care had higher mean HRQoL scores than those who did not (2.98 ± 1.12 vs 2.66 ± 0.96; p=0.001). There was a statistically significant association between antenatal care (ANC) uptake and health-related quality of life with higher proportions of mothers reporting good HRQoL among those who attended ANC. These findings suggested that utilization of ANC services plays a crucial role in enhancing the health-related quality of life of young pregnant mothers.

Skilled Birth Attendance: Similarly, mothers who delivered with skilled birth attendance reported better HRQoL compared with those who did not (3.00 ± 1.11 vs 2.65 ± 0.97). This difference was significant and evidenced that SBA & HRQoL were associated (F = 16.32, df = 1, 965, p<0.001). These results highlight the critical role of skilled birth attendance in enhancing maternal well-being and overall quality of life.

Access to postnatal care: Access to postnatal care was also significantly associated with improved HRQoL (2.97 ± 1.12 vs 2.71 ± 1.10; p=0.003). ANOVA (F = 8.61, p = 0.0034) indicated that these differences are statistically significant, suggesting a positive association between access to PNC services and HRQoL.

Expectant mother factors: Among expectant mother factors, immediate health-seeking behavior was positively associated with HRQoL (p=0.006), while perceived quality of care showed a strong graded relationship with HRQoL, with respondents rating services as excellent reporting the highest quality of life scores (p<0.001). Age group, religion, maternal health knowledge, and previous pregnancy complications were not significantly associated with HRQoL as shown in Table 2.

The ordered logistic regression model was employed to examined the relationship between maternal healthcare service utilization, and perceived health-related Quality of Life (QoL) among 967 participants. The individual models were statistically significant indicating that each maternal health service variable reliably distinguishes between different levels of quality of life . However, the Pseudo R² values ranged from 0.003 to 0.006, suggesting a modest level of explanatory power, which is expected given the multifactorial nature of quality of life.

ANC uptake uptake was found to be a positive and statistically significant predictor of quality of life (OR = 1.686, SE = 0.251, z = 3.510, p < .001). This result indicates that young pregnant mothers who accessed ANC services had approximately 1.69 times higher odds of being in a better category of health-related quality of life compared to those who did not. This finding suggests that ANC utilization contributes to improved maternal well-being, possibly through early detection of complications, provision of health education, and psychosocial support during pregnancy.

Skilled Birth Attendance also exhibited a positive and statistically significant association with quality of life (OR = 1.761, SE = 0.242, z = 4.120, p < .001). Mothers who delivered with the assistance of skilled health personnel had about 1.76 times higher odds of reporting better quality of life outcomes compared to those who did not. The magnitude and strong statistical significance of this effect highlight skilled delivery care as a critical determinant of maternal well-being, likely due to improved management of labor, reduced obstetric risks, and enhanced post-delivery support.

Access to Postnatal Care was similarly associated with improved quality of life and was statistically significant (OR = 1.552, SE = 0.224, z = 3.040, p = 0.002). Mothers who received postnatal care services had approximately 1.55 times higher odds of experiencing better health-related quality of life than those who did not. This positive relationship underscores the importance of postnatal care in facilitating recovery, detecting postpartum complications, and providing essential guidance on maternal and newborn care as shown in Table 3.

Age: Age group was not a significant predictor of health-related QoL. Young pregnant mothers aged 18–24 had slightly lower odds of reporting higher QoL compared to those aged 10–17 (OR = 0.771, p = 0.228), but this difference was not statistically significant. This suggests that perceived quality of life is relatively independent of age within this sample, and that experiential or healthcare-related factors may play a more influential role than age alone.

Religion: Religion was also not significantly associated with health-related QoL. Christian young pregnant mothers had slightly lower odds of reporting higher QoL compared to non-Christians (OR = 0.837, p = 0.328), although this effect was not statistically significant. This indicates that religious affiliation alone does not independently predict perceived well-being, and that structural and service-related factors may be more important determinants of QoL.

Maternal healthcare service knowledge was not significantly associated with QoL (OR = 1.023, p = 0.934). This finding suggests that awareness of available maternal health services, while important for service utilization, does not directly translate into improved perceived well-being. Knowledge without positive healthcare experiences may be insufficient to influence quality of life.

Health-seeking behavior: Health-seeking behavior was a significant predictor of QoL. Young pregnant mothers who sought care immediately after recognizing a health concern had higher odds of reporting better health related QoL (OR = 1.411, p = 0.006). This highlights the importance of proactive health behavior, suggesting that early engagement with healthcare services may reduce complications, enhance reassurance, and improve overall well-being.

Perceived quality of care: Perceived quality of care was strongly and significantly associated with QoL. Compared to participants who reported excellent care (reference category), those who rated care as “good” had lower odds of higher QoL (OR = 0.394, p < .001). Those who rated care as fair (OR = 0.083, p < .001) or poor (OR = 0.077, p < .001) had substantially lower odds of reporting better QoL. These findings indicate that poorer perceptions of care quality are strongly linked to worse perceived well-being, emphasizing the critical role of healthcare experience in shaping maternal quality of life.

Previous pregnancy experience: Experience of complications in the last pregnancy was not significantly associated with health-related quality of life (OR = 0.890, p = 0.376). Young pregnant mothers who had experienced complications in a previous pregnancy did not differ significantly in their quality of life compared to those without such experiences. This suggests that prior pregnancy complications do not independently influence current perceived well-being when other factors are taken into account.

In summary, proactive health-seeking behavior and perceived quality of care were the most important predictors of health-related QoL. While age, religion, maternal health knowledge, and past complications were not significant, the results emphasize that positive experiences with healthcare services and timely health-seeking behavior contribute substantially to higher perceived quality of care.

Overall, the analyses indicate that perceived health-related quality of life among young pregnant mothers is influenced more by experiential and behavioral factors than by socio-demographic characteristics or prior knowledge. Timely health-seeking behavior emerged as a significant positive predictor, showing that mothers who seek care promptly report higher well-being. Perceived quality of care was the strongest predictor, with mothers reporting good or excellent care experiencing substantially higher HRQoL than those perceiving care as fair or poor, highlighting the importance of positive healthcare experiences. In contrast, age, religion, maternal healthcare knowledge, and previous pregnancy complications did not independently predict HRQoL, suggesting that awareness or past experiences alone may not improve perceived well-being without supportive, high-quality healthcare interactions. These findings emphasize the importance of promoting timely care-seeking and ensuring high-quality, patient-centered maternal healthcare to enhance the quality of life of young pregnant mothers Table 4.

This study examined the determinants of health-related quality of life (HRQoL) among young pregnant mothers aged 10-24 years in Eastern Uganda, with particular focus on maternal healthcare service utilization. The findings revealed that uptake of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) were significantly associated with better HRQoL. In addition, immediate health-seeking behavior and perceived quality of care were important predictors of maternal well-being. These findings suggest that both utilization of maternal healthcare services and positive care experiences are critical for enhancing quality of life among young mothers.

The significant association between ANC uptake and improved HRQoL indicates that antenatal services remain a vital entry point for promoting maternal well-being. Young pregnant mothers who utilized ANC reported better quality of life than those who did not. This finding is consistent with the work of ², who observed that ANC improves maternal outcomes through screening, prevention, and continuity of care. Similarly, a study ⁶ found that regular ANC attendance contributes to improved psychological confidence and preparedness for childbirth. The WHO also emphasizes that quality ANC supports positive pregnancy experiences through nutritional counseling, mental health support, and early management of complications ¹⁷. Therefore, the better HRQoL observed among ANC users in this study may be attributed to both medical and psychosocial benefits gained during pregnancy.

Skilled birth attendance was also strongly associated with better HRQoL, suggesting that delivery under trained health professionals improves both maternal safety and overall well-being. Young mothers who delivered with skilled attendants reported higher HRQoL scores than those who did not. The findings agree with results from a study in United Kingdom that also found out that identified skilled birth attendance as one of the most effective interventions for reducing maternal mortality and morbidity ⁵. Likewise, skilled and respectful intrapartum care have been found to enhance childbirth experiences, emotional reassurance, and maternal dignity ⁴. Furthermore, WHO recommends universal access to skilled birth attendance as a key strategy for improving maternal and newborn outcomes ¹⁸. In the context of Eastern Uganda, these findings imply that expanding access to safe facility delivery may substantially improve both survival outcomes and maternal quality of life.

Postnatal care utilization was similarly associated with improved HRQoL. Young mothers who accessed PNC reported better well-being than those who did not. This result aligns with a study conducted in Uganda and Zambia thatfound out that postnatal care improves women’s physical recovery, psychosocial support, and satisfaction after childbirth ¹². The WHO notes that the postnatal period is crucial for detecting postpartum complications, supporting breastfeeding, and providing family planning counseling ¹⁹. For adolescents and young mothers, who may face anxiety, stigma, and limited support after delivery, access to PNC may be especially beneficial. Therefore, the positive HRQoL outcomes among PNC users in this study reinforce the importance of strengthening postpartum follow-up services.

Immediate health-seeking behavior was another significant predictor of better HRQoL. Young mothers who sought care promptly when symptoms arose were more likely to report improved well-being. This study finding supports the “three delays model” proposed by ¹³, which explains how delays in deciding to seek care, reaching care, or receiving care contribute to poor maternal outcomes. Similarly, proactive health-seeking behavior increases timely utilization of maternal services and reduces preventable complications ⁷. The current findings therefore suggest that empowering young mothers with danger-sign recognition, decision-making confidence, and prompt care-seeking behaviors can improve both health outcomes and perceived quality of life.

Perceived quality of care emerged as one of the strongest determinants of HRQoL. Mothers who rated care as fair or poor were significantly less likely to report better quality of life compared to those who perceived care as excellent. This finding strongly agrees with a global systematic review, which documented that disrespect, abuse, poor communication, and lack of privacy during maternal care negatively affect women’s emotional well-being and future care-seeking intentions ³. Likewise, ¹⁴ argued that quality maternal healthcare should include both provision of care and experience of care. Thus, even where services are available, poor provider attitudes or unfriendly environments may diminish maternal well-being. In contrast, respectful, compassionate, and youth-friendly care may enhance confidence, trust, and satisfaction, leading to improved HRQoL.

Interestingly, age group, religion, maternal healthcare knowledge, and previous pregnancy complications were not independently associated with HRQoL after multivariable adjustment. This suggests that socio-demographic factors alone may be less influential than experiential and behavioral factors. Similar findings were reported that women’s perceptions of treatment quality and responsiveness often outweigh background characteristics in determining maternal satisfaction and well-being ¹. While knowledge of services is important for increasing utilization, the present findings indicate that awareness alone does not guarantee better quality of life unless accompanied by accessible and high-quality services.

The findings of this study have important implications for policy and practice in Uganda and similar settings. First, increasing uptake of ANC, SBA, and PNC should remain a priority, particularly among adolescents and young mothers. Second, health systems should invest in respectful maternity care, provider communication skills, privacy, and youth-responsive service delivery. Third, community outreach interventions that promote early care-seeking and birth preparedness are needed to address delays in service utilization. These recommendations are consistent with Uganda’s RMNCAH Sharpened Plan, which prioritizes adolescent-responsive maternal health services and continuity of care ¹⁰.

Overall, this study contributes to growing evidence that maternal healthcare services influence not only survival outcomes but also broader dimensions of health-related quality of life. As countries strive toward the Sustainable Development Goals, HRQoL should be considered a key maternal health outcome, particularly for young mothers who experience heightened vulnerability due to biological, social, and economic factors.

Utilization of ANC, SBA, and PNC was significantly associated with better HRQoL among young pregnant mothers in Eastern Uganda. Immediate health-seeking behavior and positive perceptions of care further enhance maternal well-being. Strengthening equitable access to quality, respectful, and youth-responsive maternal healthcare services is therefore essential for improving maternal outcomes and quality of life among young mothers.

NJ conceptualized and designed the study. MM, MN, FPK and OM participated in data analysis and methodology alignment. All authors contributed to the drafting, critical review, editing, and final approval of the manuscript.

All participants provided informed consent for participation and publication. Consent was documented within the informed consent form, which included explicit agreement that anonymized data and results could be published and disseminated among relevant stakeholders.

1. 1.P A Afulani, Phillips B, R A Aborigo, C A Moyer. (2019) Person-centred maternity care and maternal outcomes.BMC. , Pregnancy and Childbirth 19, 18.
   Google Scholar

1. 2.Benova L, Tunçalp Ӧ, A C Moran, Campbell O M R. (2018) Not just a number: examining coverage and content of antenatal care in low-income settings.BMJ Global Health. 3(2), 000779.
   Google Scholar

1. 3.M A Bohren, J P Vogel, E C Hunter. (2015) The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review.PLoS. , Medicine 12(6), 1001847.
   Google Scholar

1. 4.M A Bohren, Tunçalp Ӧ, Miller S. (2019) Transforming intrapartum care: respectful maternity care.The Lancet. 394, 2307-2310.
   Google Scholar

1. 5.Campbell O M R, W J Graham. (2006) Strategies for reducing maternal mortality: getting on with what works.The. , Lancet 368, 1284-1299.
   Google Scholar

1. 6.A F Fagbamigbe, E S Idemudia. (2015) Barriers to antenatal care use in. , Nigeria.BMC Pregnancy and Childbirth 15, 95.
   Google Scholar

1. 7.Gabrysch S, Campbell O M R. (2009) Still too far to walk: literature review of determinants of delivery service use.BMC Pregnancy and Childbirth. 9, 34.
   Google Scholar

1. 8.S K Lwanga, Lemeshow S. (1094) B.C.E.).Sample size determination in. , InHealth and Quality of Life Outcomes(Vol 10, 10-1186.
   Google Scholar

1. 9.Larsson H, Tegern M, Monnier A, Skoglund J, Helander C et al. (2015) et al.Content Validity Index and Intra- and Inter-Rater Reliability of a New Muscle Strength/Endurance Test Battery for Swedish Soldiers. , PLoS ONE 10, 0132185.
   Google Scholar

1. 10. (2021) Ministry of Health Uganda.RMNCAH Sharpened Plan 2021–2025. , Kampala: MoH
   Google Scholar

1. 11.Moon K, Blackman D. (2014) A Guide to Understanding Social Science Research for Natural Scientists. , Conservation Biology 28, 1167-1177.
   Google Scholar

1. 12.Sacks E, T B Masvawure, L M Atuyambe. (2017) Postnatal care experiences among women in sub-Saharan Africa.Health Policy and Planning. 32(8), 1090-1099.
   Google Scholar

1. 13.Thaddeus S, Maine D. (1994) Too far to walk: maternal mortality in context.Social. , Science & Medicine 38(8), 1091-1110.
   Google Scholar

1. 14.Tuncalp Ӧ. (2015) Quality of care for pregnant women and newborns. , BJOG 122, 1045-1049.
   Google Scholar

1. 15.Child Health Factsheet. (2012) Uganda Bureau of Statistics and ICF International.Uganda Demographic and Healt Survey 2011:Key Indicators Report. UBOS, and Rock ville. UBOS and ICF. Uganda Bureau of Statistics. (2017).The National Populations and Housing Census 2014Area Specific Profile Series , Maryland, USA: .
   Google Scholar

1. 16. (2015) United Nations.Transforming our world: the 2030 agenda for sustainable development. , New York: UN
   Google Scholar

1. 17. (2016) World Health Organization.WHO recommendations on antenatal care for a positive pregnancy experience. , Geneva:
   Google Scholar

1. 18. (2021) World Health Organization.WHO recommendations on maternal and newborn care. , Geneva:
   Google Scholar

1. 19. (2022) World Health Organization.WHO recommendations on postnatal care of the mother and newborn. , Geneva:
   Google Scholar