Understanding the socio-demographic and programmatic factors associated with adolescent motherhood and its association with child undernutrition in Bangladesh.

BACKGROUND: Worldwide, a significant number of girls become mothers during adolescence. In Bangladesh, adolescent childbirth is highly prevalent and has adverse effects on children's health and undernutrition. We aimed to identify the relationship between the undernutrition of children and adolescent motherhood, the factors associated with adolescent mothers' age at first birth, and to examine the programmatic factors and gaps influencing children's undernutrition in Bangladesh. METHODS: We analysed the 'Bangladesh Demographic and Health Survey' BDHS-17-18 data and desk review. To examine the factors associated with adolescent motherhood and its impact on child undernutrition, data from 7,643 mother-child pairs were selected. Child stunting, wasting, and underweight were measured according to the World Health Organisation (WHO) median growth guidelines based on z-scores - 2. Univariate, bivariate, simple, and multiple logistic regressions were used for analyse. We followed the systematic procedures for the literature review. RESULTS: Approximately, 89% of adolescents aged ≤ 19 years were married and 71% of them gave their first childbirth. Children of adolescent mothers (≤ 19 years) were significantly 1.68 times more wasted (aOR: 1.68; 95% CI: 1.08 to 2.64), 1.37 times more underweight (aOR: 1.37; 95% CI: 1.01 to 1.86) and either form 1.32 times more stunting, wasting or underweight (aOR:1.32; 95% Cl: 1.05 to 1.66) compared to the children of adult mothers (> 19 years) after adjusting potential confounders. The factors associated with mothers' first childbirth during adolescence were the age gap between husband and wife 5-10 years (aOR: 1.81; 95% Cl: 1.57-2.10) and age gap > 10 years (aOR: 2.41; 95% Cl: 1.96-2.97) compared with the age group < 5 years, and husbands' education (aOR: 1.29; 95% Cl: 1.04-1.61) compared with the uneducated husbands. In the literature review, we found potential gaps in focusing on the Adolescent Sexual and Reproductive Health (ASRH) program in Bangladesh, from thirty-two programmes only half of them focused on adolescents aged 10-19 years, and eleven programmes focused only on girls. CONCLUSION: Children of adolescent mothers are at risk of wasting, underweight, and any form of undernutrition. For effective policies and interventions in Bangladesh, it is important to emphasise delaying adolescent pregnancy and prioritising child undernutrition.

Exploring the cognitive development of children born to adolescent mothers in South Africa.

This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross-sectional analyses present data from 954 adolescents (10-19 years) and their first-born children (0-68 months). All adolescents completed questionnaires relating to themselves and their children, and standardized child cognitive assessments (Mullen Scales of Early Learning) were undertaken. Cognitive development scores of the sample were lower than USA reference population scores and relative performance compared to the reference population was found to decline with increasing child age. When compared to children born to adult mothers in the sub-Saharan African region, children born to adolescent mothers (human immunodeficiency virus [HIV] unexposed; n = 724) were found to have lower cognitive development scores. Findings identify critical periods of development where intervention may be required to bolster outcomes for children born to adolescent mothers. Highlights: An exploration of the cognitive development of children born to adolescent mothers within South Africa utilizing the Mullen Scales of Early Learning.Cognitive development scores of children born to adolescent mothers within South Africa were lower compared to USA norm reference data and declined with child age.Previous studies utilizing the Mullen Scales of Early Learning within sub-Saharan Africa were summarized, and comparisons were made with the current sample.Findings highlight a potential risk of developmental delay among children born to adolescent mothers compared to children of adult mothers in the sub-Saharan African region.

Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder.

The mental health of adolescents (10-19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher's exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5-12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.

"I have to provide for another life emotionally, physically and financially": understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa.

BACKGROUND: Adolescent pregnancy and motherhood has been a controversial and much disputed subject within the field of public health. Early childbearing is not only characterized as a physical body experience but also embodies the experiences and perceptions of the social norms, discourses, conflict and moral judgement. There is an increasing concern that the psychosocial challenges facing adolescent mothers remains in the background since research in this field has mainly focused on the medical and physical complications of early childbearing. The aim of this qualitative study was to explore adolescent pregnancy and motherhood in order to understand this phenomenon from the perspective of adolescent mothers and to gain insight into their future aspirations. METHODS: This descriptive qualitative study was based on data from four focus group discussions with adolescent mothers utilising healthcare services at a district hospital in Ugu district, KwaZulu Natal, South Africa. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. RESULTS: Some adolescent mothers' partners were in denial and rejected them and the child while others' partners were happy and supported them during their pregnancy. Families' reactions to the pregnancies ranged between anger and disappointment to abandonment, the silent treatment, and acceptance and forgiveness. The psychological issues experienced by some of the adolescent mothers included suicidal ideation, guilt, loneliness, anxiety, and stress. They also experienced financial constraints, difficulty in returning to school, and stigmatisation in society. The participants envisioned completing their education, focusing on their dream careers, and contributing positively to society. CONCLUSION: Experiences of adolescent pregnancy and parenting are multifaceted and the healthcare needs of pregnant and parenting adolescents extend beyond information and knowledge. A multidisciplinary approach is required in the care of adolescent mothers. A key policy priority should encompass the collaboration of different professionals from various healthcare sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes as steps to securing a better future for them.

[The impact of adolecent motherhood on child development in preschool children- identification of maternal risk factors]. / Auswirkungen adoleszenter Mutterschaft auf die kindliche Entwicklung im Vorschulalter ­ Identifikation mütterlicher Risikofaktoren.

The impact of adolecent motherhood on child development in preschool children- identification of maternal risk factors Abstract. Objective: This longitudinal study aims to identify relevant risk factors in adolescent mothers which might impact their child's cognitive and speech development as well as behavior problems at preschool age. Based on earlier findings, maternal sensitivity (EA), socioeconomic status (SES) and psychological stress were identified as potentially influencing factors. Method: N = 31 adolescent and N = 47 adult mothers with their children aged 3;0 to 5;9 (M = 3;55) participated in this study. Child variables included cognitive development (WPPSI-III), language development (SSV), and behavioral problems (SDQ). Maternal factors were EA, SES, and mental health problems (BSI-18). Results: Children of adolescent mothers performed worse on cognitive and speech development and are described by their mothers as exhibiting more behavioral problems compared to children of adult mothers. Mediation analyses revealed that the effect of maternal age on children's cognitive development is occurs through reduced maternal sensitivity of adolescent mothers. Further, higher psychological stress of adolescent mothers mediated the effect of maternal age on children's behavior problems. Conclusion: Preschool children of adolescent mothers showed poorer developmental outcomes compared to children of adult mothers. This is partly explained by lower maternal sensitivity and higher rates of psychological stress among adolescent mothers.

[Maternal and child healthcare and adolescent maternity in under 100 000 inhabitants communities]. / Atención en salud materno-infantil y maternidad adolescente en localidades menores de 100 000 habitantes.

OBJECTIVE: To compare the coverage of continuous ma- ternal healthcare and early childhood care in women with and without adolescent motherhood (AM) who live in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of Ensanut 100k 2018 of 767 women aged 12 to 49 years living in under-100 000-in- habitants communities who had their last birth two years before the survey. RESULTS: Women with AM have lower continuous coverage of maternal care than those without AM (8.1 and 19.6%, respectively). Infant care coverage with adequate content was lower than 30%, and there were no differences between the groups. CONCLUSIONS: It is necessary to strengthen actions focused on this group of women in order to reduce the gaps in coverage and improve maternal and child health.

OBJETIVO: Comparar la cobertura de atención continua de salud materna y de atención en la primera infancia en mujeres con y sin maternidad en la adolescencia (MA), que habitan en localidades menores de 100 000 habitantes. MATERIAL Y MÉTODOS: Análisis transversal de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k) 2018 en 767 mujeres de 12 a 49 años residentes en localidades con menos de 100 000 habitantes que tuvieron su último hijo dos años anteriores a la encuesta. Se calcularon coberturas de atención a partir de modelos de regresión logística. RESULTADOS: Las mujeres con MA tienen menor cobertura continua en salud materna que las que no tuvieron MA (8.1 y 19.6%, respectivamente). La cobertura de atención del infante con contenido adecuado fue menor a 30% y no hubo diferencias entre los grupos. CONCLUSIONES: Es necesario fortalecer acciones focalizadas en este grupo de mujeres para reducir brechas en las coberturas y mejorar la salud materno-infantil.

Customary practices, domestic violence, and psychosomatic pain among adolescent mothers in Turkey.

BACKGROUND: Adolescent motherhood is present in many societies worldwide, including Turkey. AIMS: We aimed to determine the demographical and cultural characteristics of adolescent mothers, lifetime domestic violence and history of miscarriage, and whether they suffer from any kind of medically unexplained (psychosomatic) pain in a study in south-eastern Turkey. METHODS: We included 501 mothers in this case-control study. The study group comprised 228 mothers who gave their first deliveries at or before 19 years of age, and the control group consisted of 273 mothers who first delivered after 19 years of age. The case-control study was conducted between February and April 2013 in Diyarbakir, Turkey. RESULTS: Adolescent mothers marry more frequently with their relatives. They have a higher prevalence of culture-bound customary applications such as bride price. They are less likely to be asked for their consent to marry and tend to have more children. They are more frequently victims of domestic violence and more often report medically unexplained psychosomatic pain. CONCLUSIONS: Adolescent motherhood is still a public health problem that seems to be related to certain culture-bound customary practices, continuing domestic violence across generations, increased number of children, and more prevalent psychosomatic pain.

Intervention with Adolescent Mother-Child Dyads and Cognitive Development in Early Childhood: a Meta-Analysis.

The cognitive development of children of adolescent mothers has often been considered to be at risk. The purpose of this meta-analysis is to examine whether early intervention could help foster more positive cognitive development in the 0- to 4-year-old children of adolescent mothers. Twenty-two studies were reviewed, involving 29 different intervention strategies and 3577 participants. An overall effect size (corrected for publication bias) of d = .24 was found (95% CI .11, .36). Intervention strategies that focused specifically on the quality of parent-child interaction (d = .89; 95% CI .36, 1.43) or that included parent-child interaction as an important target of intervention (d = .53; 95% CI .34, .73) yielded greater effect sizes than those that emphasized maternal support and education (d = .23; 95% CI .12, .34). Intervention that was delivered in groups (d = .56; 95% CI .36, .74) yielded greater effectiveness than dyadic intervention (d = .27; 95% CI .14, .39). Intervention delivered by trained professionals (d = .39; 95% CI .22, .56) was more effective than that delivered by paraprofessionals (d = .20; 95% CI -.02, .61). Older studies (slope = -.015) and those that involved smaller numbers of participants (slope = -.0008) also yielded greater effect sizes. There was also a marginal tendency for shorter intervention strategies (slope = -.002), and those that involved younger children (slope = -.005) and mothers (slope = -.074) to show greater effects. Discussion focuses on the developmental and practical implications of these results.

The experience of adolescent motherhood: An exploratory mixed methods study.

AIM: To identify and better understand opportunities for and challenges in attaining the maternal role among women who began childbearing in adolescence in rural Mexico. BACKGROUND: Adolescent mothers often face challenges rising from their socioeconomic status and developmental stage that can strain the process of developing confidence and competence in the maternal role. In Mexico, 19% of births are to women under age 20. Little is known about these mothers' experiences with parenting. DESIGN: Mixed methods. METHODS: Quantitative data collected in 2008 from a cluster-random sample of mothers (n = 1,381) in rural, impoverished areas of three southern states provided objective measures of mothers' socioeconomic position, well-being, and parenting practices. Semi-structured interviews conducted in 2013 with mothers (n = 30) provided insight into perceptions of motherhood and opportunities for and challenges in attaining the maternal role. FINDINGS: Ever-adolescent mothers scored lower than never-adolescent mothers on the total HOME and the parental responsivity and learning materials subscales. They also occupied the most economically disadvantaged positions, showing the lowest levels of education and wealth and the most depressive symptoms compared with never-adolescent mothers. The qualitative analysis supported these challenges and highlighted areas of opportunity: (1) early-adolescent parents faced economic challenges; (2) adolescent childbearing was normative with some exceptions; (3) participants' mothers and mothers-in-law provided social support; and (4) mothers focused on learning to parent and helping their children "get ahead" in life. CONCLUSION: Findings have important implications for identifying how to support young women as they become mothers and continue in this role.

Peers, stereotypes and health communication through the cultural lens of adolescent Appalachian mothers.

The purpose of this study was to understand how young Appalachian mothers retrospectively construct sexual and reproductive health communication events. Sixteen in-depth qualitative interviews were conducted with mothers between the ages of 18 and 22 from the South Central Appalachian region of the USA. Findings indicate that within this population, peer influence, stereotypes medical encounters and formal health education are experienced within a culture that exhibits tension between normalising and disparaging adolescent sexuality. Theoretical and applied implications acknowledge the role of Appalachian cultural values, including egalitarianism, traditional gender roles and fatalism, in understanding the social construction of young people's sexuality in this region. Practical implications for sexual education and the nature of communication in the healthcare setting can be applied to current education curricula and medical communication practices. We suggest that future programmes may be more effective if they are adapted to the specific culture within which they are taught.

Infant Feeding Practices, Prevalence of Adolescent Motherhood and Malnutrition among Infants in Mangu Local Government Area, Plateau State, Nigeria.

Background: Adolescent motherhood and malnutrition among children are significant challenges in Africa, but there is limited data on the impact of adolescent motherhood on their children's health and nutrition. This study assessed infant feeding practices, prevalence of adolescent motherhood, and malnutrition among infants in Mangu local government area (LGA). Methodology: A cross-sectional survey using multistage sampling was conducted. Validated questionnaires were used to collect socio-demographic data, and appropriate tools were used for anthropometric measurements. Data were compared with established standards. Descriptive statistical tools, chi square, Pearson correlation, and independent sample t-test were used for data analysis, with significance set at p < 0.05. Results: A total of 200 mothers completed the study. The majority of the infants (78.5%) were less than 6 months old, and 21.5% were 6-12 months old. Breastfeeding initiation within 1 hour was reported by 39% of mothers, while 38% practiced prelacteal feeding. Only 28.5% practiced exclusive breastfeeding, and all mothers breastfed their babies. The prevalence of adolescent motherhood was 37.5%. The prevalence of stunting, wasting, and underweight among infants were 29.5%, 12%, and 8.5%, respectively. Children of adolescent mothers had higher rates of severe stunting compared to children of mothers above 19 years of age. There were significant differences (p = 0.017 and p = 0.029) in stunting rates and weight-for-age indices between children of adolescent mothers and mothers above 19 years of age. Conclusion: Adolescent motherhood contributes to chronic malnutrition in children, and there is a high prevalence of malnutrition among infants in Mangu LGA, Plateau State.

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

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.

Assessing Biomedical and Psychosocial Factors in a Cross-Sectional Study of School Dropouts Among Pregnant Adolescents and Young Mothers in Quito, Ecuador.

BACKGROUND: Over nearly three decades, Ecuador experienced a significant rise in adolescent motherhood. OBJECTIVES: By focusing on social, health, and psychological aspects, the research aims to reveal the complex factors influencing the decision to discontinue education. The emphasis on providing a platform for direct expression of personal experiences not only adds qualitative depth to the study but also ensures that the voices of those involved are heard authentically. METHODS: Employing a nonexperimental, descriptive, cross-sectional approach with qualitative and quantitative methods, the research delves into the interplay of biological, psychological, and social factors. Descriptive statistics, presented through tables and graphs, were used for variable analysis, complemented by inferential statistics to validate hypotheses. Focus group sessions, processed with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) underwent a thorough review in workshops with Servicio de Atención Integral para Adolescentes (SAIA) experts. Adolescent participants were randomly recruited through the hospital's system. RESULTS: The findings unveiled a significant dropout rate among adolescents, where pregnancy was just one factor influencing their decision. Those discontinuing education often embraced a life project centered on motherhood and domestic roles, facing domestic violence and mental health disorders. In contrast, those persisting with education were driven by professional development, facing challenges but benefiting from family support. Despite unwanted pregnancies and low contraceptive use, many found personal growth and identity affirmation in motherhood. CONCLUSIONS: Our research highlights key insights into factors like pregnancy desire, contraception, reactions, and challenges. Urgent action is needed to address systemic problems and provide holistic support, acknowledging the resilience and validity of choices made by adolescent mothers in balancing motherhood with education and career goals.

Lessons learned from using linked administrative data to evaluate the Family Nurse Partnership in England and Scotland.

Introduction: "Big data" - including linked administrative data - can be exploited to evaluate interventions for maternal and child health, providing time- and cost-effective alternatives to randomised controlled trials. However, using these data to evaluate population-level interventions can be challenging. Objectives: We aimed to inform future evaluations of complex interventions by describing sources of bias, lessons learned, and suggestions for improvements, based on two observational studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP) in England and Scotland. Methods: We first considered how different sources of potential bias within the administrative data could affect results of the evaluations. We explored how each study design addressed these sources of bias using maternal confounders captured in the data. We then determined what additional information could be captured at each step of the complex intervention to enable analysts to minimise bias and maximise comparability between intervention and usual care groups, so that any observed differences can be attributed to the intervention. Results: Lessons learned include the need for i) detailed data on intervention activity (dates/geography) and usual care; ii) improved information on data linkage quality to accurately characterise control groups; iii) more efficient provision of linked data to ensure timeliness of results; iv) better measurement of confounding characteristics affecting who is eligible, approached and enrolled. Conclusions: Linked administrative data are a valuable resource for evaluations of the FNP national programme and other complex population-level interventions. However, information on local programme delivery and usual care are required to account for biases that characterise those who receive the intervention, and to inform understanding of mechanisms of effect. National, ongoing, robust evaluations of complex public health evaluations would be more achievable if programme implementation was integrated with improved national and local data collection, and robust quasi-experimental designs.

Isolation: The experience of adolescent motherhood in Laos.

Background: Teenage pregnancy is a persistent public health problem with pervasive socio-economic consequences, particularly in in low- and middle-income countries, often related to low social participation and low economic security. The experiences of adolescent pregnancy and motherhood have seldom been described from a personal point of view. This study aimed to gain insights into how adolescent mothers in Laos experience their motherhood, how they perceive their situation and try to cope with it. Methods: This qualitative study was undertaken with 20 pregnant adolescents and young mothers living in peri-urban areas in two of the 18 provinces in Laos. Data were collected during 20 semi-structured interviews and two focus group discussions (n = 10). Digital recordings were transcribed verbatim, summarised and thematically analysed using an inductive analysis and exploratory approach. Results: The most common theme was that the young mothers experienced exclusion individually, socially and in relation to official systems. In only two cases was the pregnancy intended. All were determined to be good mothers, but were overwhelmed and unsure how to overcome structural barriers to educational, social and economic participation. Conclusion: Participants revealed that their adolescent pregnancy was tied to losses of past and future aspirations, and believed that working to prevent unintended adolescent pregnancy is worthwhile, but also advised that community support structures would help young women in their position.

Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component.

ABSTRACTYoung mothers living with HIV (YMHIV) experience heightened risks to their mental health, as their transition to adulthood is marked by social stigma, health and socioeconomic challenges. Targeted psychosocial interventions may improve the mental health of YMHIV; however, no evidence-based interventions have been developed for this group. Peer support models, more common for youth living with HIV, show promise as a design to reach YMHIV in a non-stigmatising way. This manuscript describes the process of adapting and co-developing an evidence-based psychosocial component (Boost) of a larger intervention called Ask-Boost-Connect-Discuss. Peer supporters in Malawi, Tanzania, Uganda, and Zambia used ABCD to guide group sessions with YMHIV. The research team partnered with an implementing partner, Paediatric-Adolescent Treatment Africa, to undertake this work in three phases: 1) formative research, 2) content adaptation and development, and 3) consultation, refinement, and modification. YMHIV (n = 4), peer supporters (n = 21), and technical advisors (n = 4) were engaged as co-developers, shaping the resulting Boost intervention component at each phase. Peer support models may effectively reach young mothers, and consultation, co-creation, and integration with existing programming can offer rich insights to inform these models. We discuss the implications and promise of this approach.

Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis.

Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.

Continuum of care for maternal, newborn and child health: Evidence from a national survey in Mexico.

OBJECTIVE: To compare coverage of maternal, newborn and child health (MNCH) continuum of care between women who had experienced adolescent maternity (AM) and those who had not. METHODS: Using a Mexican probabilistic survey representative at the national level (ENSANUT 2018-19), we developed a cross-sectional analysis of 1,768 women aged 12 to 49 years who had a child within five years before the interview. We used modified Poisson models to estimate prevalence ratios (PRs) and independent and conditional coverage levels based on the probability estimates yielded by these models at different stages of maternal-newborn care process. RESULTS: PRs for the MNCH continuum of care were approximately 40% lower for women who had experienced AM compared to those who had not (95%CI:0.35, 1.14). The coverage for the MNCH continuum of care was only 7.4% [95%CI: 3.5, 11.2] and 11.7% [95%CI: 9.3, 14.1] in women who had/not experienced AM, respectively. CONCLUSIONS: The provision of a continuum of care for mothers and their children can be achieved through a combination of well-defined policies and strategies that improve health care practices and services throughout the life cycle. It is necessary to expand the coverage and quality of care, which will provide the opportunity to shift the focus from vertical programs to integrated continuous care. Policy makers must implement interventions that are consistent with specific problems of population and health-care providers. Our analysis highlights the deficiencies in the care process, making this study a useful reference for countries with similar characteristics.

Agency under constraint: Adolescent accounts of pregnancy and motherhood in informal settlements in South Africa.

AbstractProgress in adolescent sexual and reproductive health (SRH) remains unequal: adolescent pregnancies are more likely to occur in marginalised communities, or in very poor households. This study aimed to comprehend from adolescents' own perspectives, the circumstances of falling pregnant and coping with motherhood in informal settlements in South Africa, to better understand the SRH challenges adolescents in these settings may face. A qualitative study was carried out over a two-month period in 2019 to analyse the perceptions held by adolescents in informal settlements served by four community-level clinics in the adjacent township. We found that adolescents face overlapping barriers in seeking to avoid unintended pregnancy in informal settlements. Once they become mothers, their trajectory is limited by the resources and support available from their own parents, particularly their mothers, and to a lesser extent, their partners. We draw on the concept of agency to examine their accounts and to highlight the importance of addressing broader contextual constraints.

Partner's characteristics and adolescent motherhood among married adolescent girls in 48 low-income and middle-income countries: a population-based study.

OBJECTIVES: The objective of this study was to examine the prevalence of adolescent motherhood among married adolescent girls and its associations with their partners' characteristics in low-income and middle-income countries (LMICs). DESIGN: Population-based study. PARTICIPANTS: 54 285 ever married (or lived with a partner) adolescent girls (15-19 years old) were including in prevalence analysis. However, partner characteristics were assessed in a subsample of 24 433 adolescent girls who were married (or living with a partner) at the time of interview. SETTINGS: Data from the latest available Demographic and Health Survey round during 2010-2018 in 48 LMICs across different geographic regions. RESULTS: The overall prevalence of adolescent motherhood was 73.98% (95% CI 70.96 to 78.10) among married adolescent girls in this study. In the pooled analysis, statistically significant and positive associations were observed between adolescent motherhood and partners' desire for more children (adjusted marginal effect (AME): 2.34, 95% CI 1.21 to 3.47) and spousal age gap (AME: 1.67, 95% CI 0.30 to 3.04 for three plus age gap). However, no statistically significant association was observed between adolescent motherhood and partners' education (AME: -0.36, 95% CI -1.77 to 1.05 for primary education) and partners' agricultural occupation (AME: 1.07, 95% CI -0.17 to 2.32). Overall, there was significant variation in the associations across countries; however, the positive associations persisted between adolescent motherhood and partners' desire for more children and spousal age gap in most of the studied countries. CONCLUSIONS: Our findings may inform policymakers about the importance of incorporating partners of married adolescent girls into the existing birth control programmes to delay age at first birth among married adolescents in LMICs. More attention should be given to the married adolescent girls who have older partners, and efforts to discourage marriages with much older partners may have a secondary benefit of reducing adolescent motherhood in LMICs.