Exploring strategies to integrate trauma- and violence-informed care into perinatal services within primary healthcare settings in Rwanda to support adolescent mothers

Introduction Adolescent mothers in Rwanda often face stigma, discrimination, and various forms of violence (interpersonal and structural), leading to mental health challenges. Without trauma- and violence-informed care (TVIC), perinatal services may unintentionally re-traumatize adolescent mothers. Aim To develop strategies for integrating TVIC into perinatal services in primary healthcare settings in Rwanda to support adolescent mothers. Methods This interpretive descriptive study purposively selected 46 participants, including 15 adolescent mothers, 12 perinatal nurses and midwives, 12 maternal community health workers, and seven key informants from eight primary healthcare settings. Data collection was conducted from December 2021 to April 2022. Two practice guidelines (Antenatal Care and Maternal Community Health Workers Training Module) were reviewed. Data were sorted and organized using Dedoose software and deductively and inductively analyzed. Results Four overarching implementation strategy domains and operational sub-strategies were developed. First, the participants emphasized the need to increase awareness of trauma and violence through education, training, and sensitive care practices. Second, they highlighted the importance of building safety and trust by creating welcoming, confidential, and inclusive perinatal environment. The third implementation strategy domain focused on amplifying adolescent mothers’ voices and promoting collaboration, flexibility, and shared decision-making in care. Finally, participants stressed the value of strength-based practices that recognize and build on adolescent mothers’ resilience. Conclusions Emergent strategies provide actionable guidance that can be effectively implemented within perinatal services in resource-constrained settings with contexts like Rwanda. Governments and health authorities in comparable settings can build on these strategies to advance equitable, compassionate, and adolescent-responsive perinatal care.