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Table 3 Example extracts from the literature and stakeholder events used to develop CMO 2

From: Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances

CMO 2 – Choice between motherhood and other goals, triggers notions of motivations (conscious or unconscious) could lead the adolescent to manage their expectations of motherhood and take control of sexual encounters.
Raneri & Wiemann [33] “Nevertheless, medical and social service providers should help young mothers to think about how potential age, financial or relationship imbalances may affect decisions regarding childbearing and other life plans.”
Herrman [39] “when asked about decision making before unprotected sexual activity, the mothers claimed that either they did not weigh the consequences or that the consequences were not powerful enough to alter behaviours.”
Raneri & Wiemann [33] “…Some teenage mothers may be ambivalent about using contraceptives to prevent additional pregnancies. Others feel they have limited educational and occupational options, and that early motherhood is not tragic or even problematic choice.”
Barnet et al [32] “Motivational interviewing is a counselling style that emphasizes an individual’s personal goals and self-efficacy in relation to complex health behaviours…Motivational interviewing aims to highlight discrepancies between current behaviors and personal goals, thereby promoting an intention and optimism for change.”
Carvajal et al [45] “Positive provider communication is associated with pregnancy prevention self-esteem.”
Clarke [30] “…commitment to their maternal identities, provided a buffer against the potential threats to self-esteem.”
Stakeholders involved in the research stated “Teenagers may be getting pregnant as there are no jobs, no prospects. Girls sometimes “drift”, thus they just continue the pregnancies because they do not know there are other options.”
Stakeholders involved in the research stated “…there is a need for increased self-esteem, life skills and empowerment of teenage girls.”
Stakeholders involved in the research stated “Need to empower the girls to make choices, this message needs to be given by all services consistently.”