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Aim: This study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers. Background: Forty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children. Methods: We interviewed 1046 adolescent mothers and completed developmental assessments with their children (n = 1139) in South Africa's Eastern Cape between 2017 and 2019. Questionnaires measured childcare use, maternal and child outcomes and socio‐demographic background variables. Using cross‐sectional data, associations between formal childcare use and outcomes were estimated in multivariate multi‐level analyses that accounted for individual‐level and family‐level clustering. Results: Childcare use was associated with higher odds of being in education or employment (AOR: 4.01, 95% CIs: 2.59–6.21, p <.001), grade promotion (AOR: 2.08, 95% CIs: 1.42–3.05, p <.001) and positive future ideation (AOR: 1.58, 95% CIs: 1.01–2.49, p =.047) but no differences in mental health. Childcare use was also associated with better parenting on all measures: positive parenting (AOR: 1.66, 95% CIs: 1.16–2.38, p =.006), better parental limit‐setting (AOR: 2.00, 95% CIs: 1.37–2.93, p <.001) and better positive discipline (AOR: 1.77, 95% CIs: 1.21–2.59, p =.003). For the children, there were no differences in temperament or illness, but a significant interaction showed stronger associations between childcare use and better cognitive, language and motor scores with increasing child age (AOR: 5.04, 95% CIs: 1.59–15.96, p =.006). Conclusions: Adolescent mothers might benefit substantially from formal childcare, but causal links need to be explored further. Childcare use was also associated with improved parenting and better child development over time, suggesting positive pathways for children. At an average of $9 per month, childcare provisions for adolescent mothers may offer low‐cost opportunities to achieve high returns on health and human capital outcomes in Sub‐Saharan African contexts. [ABSTRACT FROM AUTHOR]

Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12–24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017–2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers. [ABSTRACT FROM AUTHOR]

Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high. This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare. [ABSTRACT FROM AUTHOR]

Background: Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa. Aim: To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC). Setting: The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa. Methods: A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022. Results: The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment. Conclusion: Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour. Contribution: This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents. [ABSTRACT FROM AUTHOR]

In South Africa, high rates of adolescent pregnancy and HIV pose prominent public health challenges with potential implications for mental wellbeing. It is important to understand risk factors for mental health difficulties among adolescent mothers affected by HIV. This study aims to identify the prevalence of likely common mental disorder among adolescent mothers (both living with and not living with HIV) and explores hypothesised risk factors for likely common mental disorder. Cross-sectional data from adolescent mothers (10–19 years; n=1002) utilised within these analyses are drawn from a cohort of young mothers residing in the Eastern Cape Province, South Africa. All mothers completed a detailed questionnaire consisting of standardised measures of sociodemographic characteristics, mental health, and hypothesised risk factors. Logistic regression models were utilised to explore associations between hypothesised risk factors and likely common mental disorder. Risk factors were clustered within a hypothesised socioecological framework and entered into models using a stepwise sequential approach. Interaction effects with maternal HIV status were additionally explored. The prevalence of likely common mental disorder among adolescent mothers was 12.6%. Adolescent mothers living with HIV were more likely to report likely common mental disorder compared to adolescent mothers not living with HIV (16.2% vs 11.2%, X2=4.41, p=0.04). Factors associated with likely common mental disorder were any abuse exposure (OR=2.54 [95%CI:1.20–5.40], p=0.01), a lack of perceived social support (OR=4.09 [95%CI:2.48–6.74], p=<0.0001), and community violence exposure (OR=2.09 [95%CI:1.33–3.27], p=0.001). There was limited evidence of interaction effects between risk factors, and maternal HIV status. Violence exposure and a lack of perceived support are major risk factors for poor mental health among adolescent mothers in South Africa. Violence prevention interventions and social support may help to reduce risk. Identified risk factors spanning individual, interpersonal, and community levels have the potential to impact adolescent maternal mental health. [ABSTRACT FROM AUTHOR]

Interrupted education of adolescent mothers remains a major concern, but limited evidence-based programming exists to support postpartum schooling of this group. This study aimed to better understand the factors that render some adolescent mothers vulnerable to school non-enrollment, and how to reduce these risks. Data from 1,046 adolescent and young mothers (10–24 years) from rural and urban communities in South Africa's Eastern Cape was obtained through a questionnaire containing validated and study-specific measures relating to sociodemographic characteristics, schooling, relationships, violence exposure, and health. Using latent class analysis, we explored emerging latent groups and their relationship to mothers' enrollment in school, college, or tertiary education. The analyses revealed three distinct groups of mothers: The 'most disadvantaged' subgroup (39%) experienced multiple risks, including food insecurity, living in informal housing, lacking positive relationships with their caregiver, and the highest distance to school; The 'disadvantaged' subgroup (44%) did not experience food insecurity whilst reporting better caregiver relationships and lower distance to school. However, this group still showed high probabilities of residing in informal housing and in communities that expose them to violence; A 'least disadvantaged' subgroup (17%) was largely unaffected by economic and community risks and experienced good caregiver relationships. Compared to the most disadvantaged mothers, the least disadvantaged mothers showed the highest probability of being enrolled in education (65% versus 45%). Adolescent motherhood can impede continued enrollment in education and individual-centered interventions alone might not be sufficient to mitigate the risks for non-enrollment. Services and provisions that address severe poverty and improve family relationships might provide an opportunity to positively influence schooling among adolescent mothers. [ABSTRACT FROM AUTHOR]

Progress 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. [ABSTRACT FROM AUTHOR]

Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges. [ABSTRACT FROM AUTHOR]

South African secondary schools do not deliver school-based healthcare services despite high rates of human immunodeficiency virus (HIV) infection, sexually transmitted infections, and unplanned pregnancies among adolescents, ongoing sub-optimal uptake of healthcare services from public healthcare facilities by adolescents, and national policy support for such services. A pilot school health nursing programme (SHNP) was offered to 44 secondary schools in a single health sub-district within the Western Cape, South Africa. The programme included fortnightly nurse visits that offered a standard package of healthcare services, including sexual and reproductive health services tailored according to school preference.Of the 44 schools, 42 gave permission for the SHNP to operate, with the majority of schools selecting the full comprehensive package of services. Programme implementation was truncated such that delivery only occurred over two school terms (20 weeks); however, 344 students attended the service. The majority of service users were female with a median age of 16 years, and over a half attended the service for sexual and reproductive health services. Contribution: A key challenge to school-based health service delivery arose from inadequate stakeholder support and differential views of adolescent healthcare needs among government officials, parents, guardians, school staff and governing bodies. These findings motivate for ongoing multi-level stakeholder engagement around the reality of adolescent healthcare needs and further opportunities to deliver school health services for longer time periods such that their feasibility, acceptability, and potential to impact healthcare outcomes can be assessed in this setting. [ABSTRACT FROM AUTHOR]

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Background: Little is known about longitudinal patterns of adolescent health risk behavior initial engagement and persistence in low- and middle-income countries.Methods: Birth to Twenty Plus is a longitudinal birth cohort in Soweto-Johannesburg, South Africa. We used reports from Black African participants on cigarette smoking, alcohol, cannabis, illicit drug, and sexual activity initial engagement and adolescent pregnancy collected over 7 study visits between ages 11 and 18 y. We fit Kaplan-Meier curves to estimate behavior engagement or adolescent pregnancy, examined current behavior at age 18 y by age of first engagement, and performed a clustering analysis to identify patterns of initial engagement and their sociodemographic predictors.Results: By age 13 y, cumulative incidence of smoking and alcohol engagement were each > 21%, while the cumulative incidence of other behaviors and adolescent pregnancy were < 5%. By age 18 y (15 y for cannabis), smoking, alcohol, and sexual activity engagement estimates were each > 65%, cannabis and illicit drug engagement were each > 16%; adolescent pregnancy was 31%. Rates of engagement were higher among males. Current risk behavior activity at age 18 y was generally unrelated to age of initial engagement. We identified three clusters reflecting low, moderate, and high-risk patterns of initial risk behavior engagement. One-third of males and 17% of females were assigned to the high-risk cluster. Sociodemographic factors were not associated with cluster membership.Conclusions: Among urban dwelling Black South Africans, risk behavior engagement across adolescence was common and clustered into distinct patterns of initial engagement which were unrelated to the sociodemographic factors assessed. Patterns of initial risk behavior engagement may inform the timing of primary and secondary public health interventions and support integrated prevention efforts that consider multiple behaviors simultaneously. [ABSTRACT FROM AUTHOR]

Background: Adverse maternal and child health outcomes due to adolescent pregnancy are central to public health research and practice. In addition, public health has emphasised that the care rendered by healthcare providers plays a pivotal role in the health and well-being of pregnant and parenting adolescents. Healthcare providers may differ in the ways they interpret adolescent pregnancy and parenting and consequently, this may have profound implications for healthcare decision making. The aim of this study was to explore the multiple perspectives of a diverse group of healthcare providers' delivering services and engaging with pregnant adolescents and adolescent mothers at a district hospital in Ugu, KwaZulu Natal, South Africa. Methods: This descriptive qualitative study used semi-structured interviews (n=33). Healthcare providers rendering care to pregnant and parenting adolescents were recruited from the maternity, antenatal, paediatrics, psychology, dietetics, physiotherapy and social work departments, as well as from the HIV/AIDS, STIs and TB (HAST) programme. The data were analysed using thematic analysis. Results: The healthcare providers acknowledged that adolescent pregnancy is a problematic issue in Ugu district. Furthermore, they felt that the postpartum sexual-related and reproductive health of adolescent mothers was not given priority. In the healthcare providers' view, the problems experienced by pregnant and parenting adolescents were school dropout, financial constraints, breakdown of relationships, abandonment, stigmatisation, parenting and child rearing difficulties, and both physical and mental health problems. Conclusion: This study highlights that the issue of sexual- and reproductive-related outcomes of adolescent pregnancy and parenting is not given priority. In addition, the findings also highlighted the need for a multidisciplinary approach to the care of pregnant and parenting adolescents. Multidisciplinary communities of practices as interventions can be used to generate and share knowledge, capacitate healthcare providers and improve clinical practice. The training of healthcare providers, provision of non-judgemental counselling and tailored services for pregnant adolescents and adolescent mothers are essential. When appropriately disseminated, the findings will assist relevant healthcare providers, administrators in healthcare institutions, policymakers, and officials of the Department of Health and the Department of Education in South Africa to address the lack of appropriate care for pregnant and parenting adolescents. [ABSTRACT FROM AUTHOR]

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socio-economic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges. Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13–16 years) at the district hospital under study was collected over 3 years (2011–2013) (n= 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation. Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74;p< 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits. Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge. [ABSTRACT FROM PUBLISHER]

Background: Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Objective: Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Results: Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29). Conclusion: Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent girls (10-19 years) in Eastern and Southern Africa face a high risk of pregnancy and HIV infection. However, few studies have examined whether the profound developmental, social, and economic changes that accompany adolescent motherhood contribute to HIV risk. This study examines the intersection between adolescent motherhood and HIV infection across 10 Eastern and Southern African countries, where over half of all HIV infections occur among adolescent girls., Methods: To evaluate whether adolescent motherhood is associated with HIV infection, we used Demographic and Health Survey data on girls (15-19 years) with HIV test results (N = 19,932) from Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. We examined unweighted bivariate and multivariable associations between adolescent motherhood and HIV using mixed effects logistic regression models that included a country-level random intercept. We examined heterogeneity in the association by testing country-level random slopes using a likelihood ratio test and used intraclass correlation to measure the proportion of total variance explained at the country level., Results: Nearly one fifth of adolescent girls were mothers (range: 9.80%-38.90%), and the HIV prevalence among all adolescent girls was 3.3% (range: 1.03%-10.07%). Relative to nonmothers, adolescent mothers were, on average, older, poorer, and more likely to be married, rural dwellers, and household heads. Adolescent motherhood was positively associated with HIV infection in bivariate and multivariable analyses (odds ratio: 1.87; 95% confidence interval: 1.57-2.23; adjusted odds ratio: 1.53; 95% CI: 1.24-1.89)., Discussion: Among adolescents with HIV test results, we observed a robust association between adolescent motherhood and HIV infection across 10 high-burden countries., (Copyright © 2021. Published by Elsevier Inc.)

This study explores and describes the experiences and challenges of pregnant adolescents (N = 9, mean age = 16.33 years, SD = 1.58 years) by focusing on their thoughts and feelings about their pregnancies and future prospects. The expectant mothers were in their in their second and third trimester of pregnancy. All participants were poor working-class Black South Africans from different ethnic groups. Two were Tsonga, three Zulu and four Tswana speakers. Data were collected using semistructured interviews and analysed using thematic content analysis. Findings suggest that family relationships after disclosure of the pregnancy were strained, particularly the father–daughter relationship. The teens expressed unpreparedness for the challenges of motherhood, uncertainty about the future and feelings of anger, regret and anxiety. [ABSTRACT FROM AUTHOR]

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.

Objectives: This study explores the barriers to accessing antenatal care (ANC) services amongst pregnant adolescents within a particular community of South Africa., Methods: An exploratory qualitative design was applied to examine the views of pregnant adolescents. In-depth interviews were conducted with pregnant adolescents at the Mitchells Plain Midwifery Obstetric Unit, as well as nursing staff working at the facility. Thematic analysis was then used and analysis was framed using the social-ecological model for health-seeking behaviour., Results: This study found that barriers to adolescents seeking ANC often centered on a discourse of adolescent pregnancy being deviant, irresponsible, and shameful. Pregnant adolescents often absorbed these beliefs and were fearful of other's reaction within their family, the community, at school, and within the ANC facilities., Conclusions: Stigma regarding adolescent pregnancy participates in the perpetuation of a culture of non-disclosure and shame, which stands in the way of young pregnant people seeking the care they require. Such beliefs and attitudes need to be challenged at a community and national level.

Background: Adolescent pregnancy has been a persistent area of interest and concern in the field of public health. The debate about adolescents' sexual risk behaviour has also gained prominence due to findings that have demonstrated that adolescent girls between 15 and 19 years of age give birth to 16 million infants and account for 62% of new HIV infections in the Caribbean and African regions. Health compromising behaviours often develop in adolescence, yet the sexual and reproductive health of adolescent mothers is often marginalised in the healthcare field. The aim of this study was to explore adolescent mothers' understanding of sexual risk behaviour., Methods: The study employed a descriptive qualitative design. To collect the data, four focus group discussions were conducted with adolescent mothers aged 16-19 years. The eighteen adolescent mothers were recruited using purposive sampling technique from a hospital in the Ugu district in KwaZulu-Natal, South Africa. Data were analysed using thematic analysis., Results: The study revealed that decisions to engage in risky sexual behaviour is influenced by peer pressure, drugs and alcohol, sexual experimentation, myths about contraception, the media, poor parental supervision and power gender dynamics, poverty leading to transactional sex, the vulnerability of young girls, and the fear of partner rejection., Conclusion: The findings of this study will contribute to a better understanding of adolescent mothers' perspectives of sexual risk behaviour. In the subject matter of sexual and reproductive health, adolescents' autonomy with respect to cultural and social recommendations should not be sidelined. Due to their vulnerability, adolescent women are exposed to transactional sex, and it is particularly due to poverty that adolescent women are driven into sexual relations with older men as a means of survival. Moreover, interventions to curb postpartum sexual risk behaviour are important to protect adolescent women and mothers against HIV/AIDS. The sexual and reproductive education of adolescent women should focus on resilience, negotiating skills, and protective decision making. Collaborative efforts to curb sexual risk taking by young women should be encouraged and should involve relevant agents from the educational, social and clinical fields.

Background: Knowledge and practices of sexual and reproductive healthcare is pivotal to the Safe Motherhood Initiative; however, only a few studies have investigated adolescent mothers' knowledge of sexual and reproductive health in light of the above initiative. Research should thus focus on the knowledge and attitudes of adolescent girls as well as peer influences related to pregnancy and sexual and reproductive health among adolescents, as the findings may highlight vital health interventions that should be introduced. The aim of this study was thus to determine the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents who attended maternal health services in a district hospital in Ugu, KwaZulu-Natal, South Africa., Methods: A cross sectional study was conducted. Data were collected from 326 adolescents who accessed maternal health services in a peri-urban district hospital during June 2017 and November 2017. The questionnaire surveyed the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health. The questionnaire was administered by fieldworkers using mobile devices powered by the Mobenzi Researcher® technology. The completed surveys were uploaded to the Mobenzi server where it was stored and aggregated. The data was analysed using R software., Results: Of the 326 participants, 65 (19.9%) experienced repeat pregnancies in adolescence. Overall, only 143 (43.9%) of the participants answered 50% or more of the knowledge questions on pregnancy and HIV/AIDS and STIs correctly, while 183 (56.1%) answered less than 50% of the knowledge questions correctly. There was no relationship between knowledge of pregnancy and HIV/STIs and repeat adolescent pregnancies., Conclusion: Adolescents' knowledge of pregnancy and sexual and reproductive health was deficient as, even with repeat pregnancies, these adolescents were evidently no better informed about pregnancy and sexual and reproductive health. This suggests that social determinants, modes and platforms regarding the delivery of adolescent sexual and reproductive health education are important. An innovative mode to the delivery of sexual and reproductive health education includes the emerging digital platform. The digital platform encompasses social media, multimedia and mobile phones which is growing popular among young people.

Background: Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes., Aim: The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children., Setting: The study was conducted in a local district hospital in Ugu, KwaZulu-Natal., Methods: An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis., Results: Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers., Conclusion: In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Purpose: The impact of pregnancy on the health and livelihood of adolescents aged 15-19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings., Methods: The Well-Being of Adolescents in Vulnerable Environments study used respondent-driven sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), New Delhi (500), and Shanghai (438). RDS-II and poststratification age weights were used to explore the odds associated with "ever had sex" and "ever pregnant"; adjusted odds of pregnancy and 95% confidence interval were developed by site and gender., Results: Among the sexually experienced, pregnancy was most common in Baltimore (females, 53% and males, 25%) and Johannesburg (females, 29% and males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, New Delhi, and Shanghai. Current schooling and condom use at the first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were early sexual debut (Johannesburg participants and Baltimore females) being raised by someone other than the two parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males and Johannesburg participants)., Conclusions: The reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, and differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside with particular attention to neighborhood-level factors., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Adolescents having unprotected heterosexual intercourse are at risk of HIV infection and unwanted pregnancy. However, there is little evidence to indicate whether pregnancy in early adolescence increases the risk of subsequent HIV infection. In this paper, we tested the hypothesis that adolescent pregnancy (aged 15 or younger) increases the risk of incident HIV infection in young South African women., Methods: We assessed 1099 HIV-negative women, aged 15-26 years, who were volunteer participants in a cluster-randomized, controlled HIV prevention trial in the predominantly rural Eastern Cape province of South Africa. All of these young women had at least one additional HIV test over two years of follow-up. Outcomes were HIV incidence rates per 100 person years and HIV incidence rate ratios (IRRs) estimated by Poisson multivariate models. Three pregnancy categories were created for the Poisson model: early adolescent pregnancy (a first pregnancy at age 15 years or younger); later adolescent pregnancy (a first pregnancy at age 16 to 19 years); and women who did not report an adolescent pregnancy. Models were adjusted for study design, age, education, time since first sexual experience, socio-economic status, childhood trauma and herpes simplex virus type 2 infection., Results: HIV incidence rates were 6.0 per 100 person years over two years of follow-up. The adjusted IRR was 3.02 (95% CI 1.50-6.09) for a pregnancy occurring at age 15 or younger. Women with pregnancies occurring between 16 and 19 years of age did not have a higher incidence of HIV (IRR 1.08; 95% CI 0.64-1.84). Early adolescent pregnancies were associated with higher partner numbers and a greater age difference with partners., Conclusions: Early adolescent pregnancies increase the incidence of HIV among South African women. The higher risk is associated with sexual risk behaviours such as higher partner numbers and a greater age difference with partners rather than a biological explanation of hormonal changes during pregnancy.

Black teenage pregnancy and sexually transmitted diseases in South Africa have reached a threatening level. Accepting that teenage pregnancy is multi-causational, this article outlines selected consequences. It concludes that teenage pregnancy as a social problem needs reexamination in terms of two hypotheses: that the pheronomal climate has an impact on prepuberal girls; and that teenage pregnancy is nature's way of ensuring the survival of the species.

Teenagers make up a quarter of all mothers in Transkei, South Africa, and well over 75% of them are unmarried. Such a high rate of teenage pregnancy is indicative of a high level of unprotected adolescent sexual activity. We examined sexual behaviour, knowledge and attitudes to sexuality among adolescent school girls in Transkei, using a self-administered questionnaire, in order to establish the incidence of sexual activity, and associated risk factors. Of the 1072 respondents, 74.6% were already sexually experienced, and 21.0% were not. The majority of sexually experienced girls (SEGs) and sexually inexperienced girls (SIGs) were living with both their parents. There were no religious differences between the two groups of girls. The age of SEGs at first coitus correlated positively with the age of menarche, and the age at the first date, suggesting that sexual maturation and onset of dating were possible risk factors for initiation of sexual activity. Contraceptive use was low, and a third of SEGs had been pregnant at least once. The knowledge of reproductive biology among both groups of girls was generally poor, although SEGs were significantly more knowledgeable than SIGs. The majority of girls in both groups did not approve of premarital sex, and adolescent pregnancy. They also did not approve of the idea of introducing sex education in schools, or the provision of contraceptives by schools. Nearly a third of the respondents in both groups did not wish to get married in future. In conclusion, there is a high level of unprotected sexual activity among school girls in Transkei. The risk factors for this include early sexual maturation, early onset of dating, and poor knowledge of reproductive biology and contraceptives.

There is concern about poor knowledge of human sexuality and a high rate of teenage pregnancies among Blacks. The primary aim of the study was to measure the knowledge that teenagers have on human sexuality and to identify the sources from which they obtain such knowledge. The secondary aim was to detect how teenagers perceive the teenage pregnancy problem and its consequences. A descriptive study was undertaken. Questionnaires were handed out and collected from 210 teenagers in two Senior Secondary Schools at a Black township near Empangeni. The study revealed that teenagers have reasonable knowledge about the anatomy and development of the reproductive organs at puberty but lacked sex counselling which resulted in their failure to understand the implications of sexual behaviour. The levels of knowledge an utilisation of the Youth Health Services was found to be low. The study also revealed a high level of awareness of the negative consequences of teenage pregnancies. The teenagers had numerous suggestions to make for the prevention of teenage pregnancies.