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Introduction: despite universal efforts, child marriages still occur worldwide. However, not all child marriage unions last, and little is known about how such marriages end. Most critically, there is little information on what happens to young mothers when child marriage unions dissolve. This paper explores the experiences of adolescent mothers who were in child marriages in the cultural context of central Malawi. Methodology: using qualitative methods, data was collected in two districts in central Malawi. One focus group discussion (FGD) was conducted with key community members (n=14) and three FGD, guided by an unstandardized interview guide, were conducted with adolescent mothers aged 15-22 years (n=15). The FGD with adolescent mothers were conducted in three groups, ranging from three to nine participants per group. In addition to this, a key informant interview was conducted with a community leader who is traditionally recognized as paramount chief (n=1). The data was analysed using a content analysis. The study applied the concept of ‘doing gender’ by West and Zimmerman (1987) in the analysis. Results: what emerged from the data is that adolescent mothers embodied fragmented identities that are changing over time given the influence of life events. Amid different combinations of roles, several identities were observed: mother, wife, young, adolescent, girl, married, unmarried, victim of child marriage, survivor of child marriage, unemployed, employed, re-enrolled student, and school dropout. While these identities changed, gender did not, thus the changing identifications provided displays for ‘doing gender’ under a diverse set of subjectivities. Expressions of power at the micro-level were demonstrated by adolescent mothers through ‘resilience vs. perseverance’. Conclusions: the study highlights that cultural sensitivity and responsiveness by traditional leaders, such as the chief, play a role in the empowering revisions of one’s identity by championing liberating life events through the termination of child marriage or access to girls’ education regardless of resistance.

Highlights • Community health-workers across Africa use mobile phones ‘informally’ in their work. • Informal mhealth is an emergent phenomenon, used to bridge gaps in formal provision. • Informal mhealth is happening at scale, far outstripping its formal equivalent. • Informal mhealth is inherently responsive to local needs and contingencies. • But it carries hidden costs (financial and other) which are inequitably distributed., The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with ‘mobile health’ (mhealth) being a key component of this. However, while ‘formal’ (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers’ (CHWs’) ‘informal mhealth’ practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of ‘formal’ compared with ‘informal’ mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this ‘informal health’ usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.