Table 2 Example extracts from the literature and stakeholder events used to develop CMO 1

CMO 1 - Individual experiences of young mothers trigger self-efficacy, perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters.

Paukku et al [29] “Adolescents’ contraceptive practice differed remarkably by pregnancy history.”

Barnet et al [32] “Similar to findings of previous studies, our findings show an increased subsequent pregnancy risk for an adolescent mother who reports a romantic relationship with the baby’s father.”

Black et al [9] “Finally in some communities, rapid second births among adolescent mothers may be valued and regarded as desirable, thereby undermining many intervention programs…”

Herrman [39] “In low-income communities there may be contextual rewards for bearing children, where the norms might not discourage adolescent childbearing.”

Bull & Hogue [37] “....in school all the girls either got babies or is expecting…it’s got to the point where it’s normal in a group of girls; if you haven’t been pregnant, then you don’t fit in”

Clarke [41] “…a purely mechanical approach to contraceptive provision is very unlikely to work for many young people…Therefore, contraceptive providers…need to widen their approach to ensure that there are opportunities for the many emotional and psychological barriers to contraceptive use…”

Stakeholders involved in the research stated “If their first pregnancy resulted in termination, still birth or the child was taken into care, they want to replace a baby…these young women do not receive any bereavement counselling.”