Mahidol Model: Integrative, Area-based, Prevention and Alleviation of Teenage Pregnancy - มหิดลโมเดล: รูปแบบการป้องกันและแก้ไขปัญหาการตั้งครรภ์ของวัยรุ่นในพื้นที่อย่างบูรณาการ

Mahidol Model is an integrative model developed by Mahidol University. It was implemented in Municipality of Salaya, Nakhon Prathom province. The model aimed to prevent and alleviate teenage pregnancy problem in the same area consisted of the following setting-based: (1) Family-based in­terventions: from the research “Thai family matter”, a randomized-controlled family study from 168 households with children under 18 years old were recruited randomly. The intervention included the provision of 5 education guided-books given to the study group. During the given time, parents would follow and record the exercise activities with their teenagers. It was found that the study group had better relationship and communication than the control (p=0.004). Although their awareness in their teenagers’ risk behavior and supervision were better, however these were not statistical significant. (2) Communi­ty-based interventions: 79 community volunteers including teenagers were recruited to set up “commu­nity teen center”. They were trained to be facilitators to perform community mapping and surveillance, empower teenagers to participate in positive activities, and provided health information. Their activities were granted by the local municipality for sustainabilities. (3) School-based activities: teen clinic in school was set up and integrated into the existing system of school, i.e. student screening, supervision and referral system. We facilitated the teachers to use the computer-based youth risk behavior survey. The whole school activity-based comprehensive sexuality education (CSE) both students and teachers were empowered. Networking with local health personnels was set up to manage teen problems at school instead of visiting the hospital. (4) Hospital-based activities: teenage pregnancy clinics were set up in local community health center and hospital. Existing local health volunteers were empowered regarding CSE, birth control method and detection of teenage pregnancy to urge early antenatal care (ANC). The teenage pregnancy clinic provided comprehensive ANC including psychosocial evaluation and education regarding breast feeding and long-acting reversible contraception (LARC) to prevent repeated pregnancy. Postpartum home care both mothers and children were actively provided and supported by conditioned welfare. Prepaid limited essential item vouchers were given to teenage mothers who had early ANC, breast-fed, LARC, and complied to well baby clinic (WBC) schedule. The result showed that, with the Mahidol-Model, teenage mothers had more early ANC, lower prematurity birth rate, 100% LARC and 100% WBC visits. Thus, Mahidol Model is a promising model to empower existing local personnel from various sectors to work together with the same plan and same goal. However, some obstacles are suggested for further improvement.