Unmet and Overlooked Needs of Pregnant Adolescents and Young Mothers in Zimbabwe: The Mixed-Methods "Kids With Kids" Study.

PURPOSE: Adolescent pregnancy is common across Africa. Although programs emphasize contraception, support for those who do become pregnant is limited. We conducted a mixed-methods study in Zimbabwe to understand the service gaps and the needs of pregnant adolescents.

METHODS

Pregnant adolescents (<18 years) identified by community child workers underwent clinical and mental health assessment, and birth outcomes were recorded. Longitudinal in-depth interviews were conducted with 18 pregnant and postpartum adolescents in three waves; in addition, nonrepeat interviews were conducted with 10 next-of-kin and 16 health and community workers. These interviews were thematically analyzed.

RESULTS

The median age of 119 participants was 16 years (range 12-17). Nearly all were neither in education nor employed, and >90% (108/119) were not in a relationship with the father of their pregnancy. HIV prevalence was 10.1% (12/119) and 38.7% (46/119) had at least one curable sexually transmitted infection. Over one-third (42/119) had moderate-to-severe depression. Pregnancy loss, stillbirth, or neonatal death occurred in 7% (8/115), and 25.9% (28/108) of live births were preterm. Participants highlighted that intergenerational poverty increased pregnancy risk and antenatal and postnatal adversity. Households struggled financially, forcing girls into inappropriate economic and social responsibilities, causing substantial anxiety. Mental health support was limited and poorly tailored, while sociocultural and policy-related barriers restricted access to education, health, and psychosocial services.

DISCUSSION: There is an urgent need for approaches and policies that promote the socioeconomic empowerment, physical, and mental well-being of pregnant adolescents. Health-care providers must be equipped to offer comprehensive, nonjudgmental care, with age-appropriate and longer-term psychosocial support.