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Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies



Fertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published.


To synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.


An extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument.


After screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents’ relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services.


Adolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Peer Review reports


Despite falling adolescent fertility rates globally, births to adolescents still account for 11% of total annual births worldwide [1]. The greatest incidence is in LMICs, with the adolescent birth rate in the world’s poorest countries four times higher than in high-income regions [2,3,4]. Pregnancy in adolescence is more common in Latin America and the Caribbean, South Asia and sub-Saharan Africa than anywhere else in the world [5, 6], with 29 of the 34 countries reporting adolescent fertility at more than 80 per 1000 between 2015–2020 to older adolescent girls, in Africa [7].

Globally, adolescents who are poor, rural living and less educated are most likely to become pregnant, as they have less power, opportunities and choices than their peers [8,9,10]. In LMICs approximately half of pregnancies are unintended [11], with peer pressure, substance misuse and the media identified as factors influencing adolescents sexual risk-taking behaviour and experiences of becoming pregnant [12, 13]. Whilst sexual risk-taking is not isolated to adolescents in these regions, gender power imbalances with an associated need to placate partners, sexual coercion and transactional sex increase adolescent’s vulnerability to unintended pregnancy [12,13,14,15].

The high pregnancy incidence in the identified regions is associated with a significant unmet need for contraception; evidenced by countries in sub-Saharan Africa with the highest adolescent birth rates also reporting the lowest use of modern contraceptives [6, 11]. Adolescent’s engagement with sexual and reproductive health services is influenced by a lack of pregnancy and prevention of pregnancy knowledge, myths about the harms of contraception, poor health worker attitudes and legislation restricting contraception to married women [8, 15, 16]. Fear among adolescents of social stigma associated with pre-marital sex and concern they will be perceived as promiscuous or being unfaithful to their partners, are additional deterrents for adolescents accessing sexual and reproductive health services or using contraception [8, 11, 17].

The low incidence of pre-marital sex and unintended pregnancy across Asia [18] suggests pregnancies are more likely to be planned and occur within marriage. Pregnancies occurring within marriages may be intended, but are often not freely chosen by adolescents, with social pressures to conceive, coercion from family members and a lack of control over contraceptive choice and use, enabling pregnancy in adolescence [3, 19,20,21]. Adolescents living in contexts with socio-cultural norms, such as beliefs the only role for girls is to bear children, that pregnancy marks the transition to womanhood and is proof of maturity, and that pregnancy is a means of gaining respect within society, also face a predisposition to pregnancy in adolescence [6, 7, 22, 23].

The consequences of pregnancy in adolescence are well documented, with adolescents’ life trajectories altered when they become pregnant, propelling them prematurely into adulthood, with opportunities for education, employment and associated freedoms, opportunities and choices all reduced [18]. Psychosocial and economic consequences are particularly challenging amongst unmarried adolescents who can experience stigma, social isolation and being ostracised from their families with ongoing adverse psycho-social implications [24, 25].

Pregnancy complications and unsafe abortions are the leading cause of death amongst older adolescents [26] and a higher incidence of childbirth related morbidities, such as obstetric fistula, are seen in young adolescents compared to older adolescents and adults [4, 27]. Adolescents and their babies face an increased risk of pregnancy and childbirth related mortality and morbidity compared to adult women [28,29,30,31,32]. Although these outcomes are undeniably associated with physiological age, other factors including reduced care-seeking and insufficient antenatal care among adolescents are also associated with an increased risk of complications [33,34,35].

Despite efforts to reduce the incidence of pregnancy in adolescence, including preventing child marriage, keeping girls in education and improving access to contraception [36], adolescents continue to become pregnant and few LMICs adequately prioritise their care [4, 37]. Gaining insight into adolescents’ experiences of pregnancy will help identify if context specific services meet their needs, if they require additional support, and how to optimise their pregnancy experience. Several researchers have conducted studies exploring adolescent pregnancy experiences in LMICs [38,39,40,41], but a meta-synthesis will produce an integrative interpretation, more substantial than can be afforded by individual studies [42, 43].

Despite the increasing interest in the value of synthesising qualitative studies, to inform future research, policy and practice [42, 43], a meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published. Meta-syntheses have focused on pregnancy in adolescence [44,45,46], but most of the included studies were undertaken in high-income contexts. The significant contextual differences mean findings are unlikely to be transferrable to LMICs which, considering the increased incidence in these regions, highlights an important area of research warranting further exploration.

Main text


This review aimed to synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.


The meta-ethnographic approach, which focuses on interpreting what a collection of studies can contribute as a whole [47], was used for the synthesis. This review was registered with PROSPERO, the International prospective register for systematic reviews (PROSPERO ID: CRD42021251591).

Inclusion criteria

Mixed methods or qualitative empirical studies of any methodology were included. Participants were male or female and adolescents, aged 10-19 years, in accordance with the definition provided by the World Health Organization [26], who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. The location of the study had to be a low or middle income country, as classified by The World Bank [48]. Only English language papers were included, and no date restrictions were applied.

Search strategy

A search strategy was developed, based on an initial scoping search, to identify papers relevant to the review aims. Search terms were formulated using the SPIDER search strategy tool [49], designed for use in qualitative research (Table 1). Searches of the databases Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete), Medline complete, Global Health, PubMed and African Journals Online and PsycINFO, were conducted in May 2021 and repeated in February 2022. As poor indexing of qualitative studies can mean database searches fail to yield optimal results [50, 51], papers suitable for inclusion were also citation searched. Search terms specific to each database can be seen in the supplementary information (S1).

Table 1 Initial search strategy using the SPIDER search strategy tool

Quality appraisal

A quality assessment of included studies was undertaken, as the quality of included studies has been found to impact the trustworthiness of review findings [52,53,54], using the checklist tool developed by Walsh and Downe [53] (Supplementary Information – S2) and the grading categories described by Downe, Simpson and Trafford [55] (Table 2). Consistent with the approach of other authors who utilized these tools [56,57,58], studies graded C or above were considered of sufficient quality for inclusion, with those graded D excluded from the synthesis.

Table 2 Quality assessment grading as described by Downe, Simpson and Trafford [55]

Data extraction and synthesis

The meta-ethnography approach, involves analysing the primary studies to appreciate their collective meaning, described as discovering a whole from all of the parts, to generate a final line of argument [47, 59, 60]. This was achieved by using a constant comparative method [61] to consider how the studies were related, looking first for similarities (reciprocal findings) between the papers and then by looking for conflicts with the evolving concepts (refutational analysis). The process was iterative, with emerging themes revised, until final themes were drawn together to form a line of argument.

To enhance the trustworthiness of the synthesis and reduce bias, an audit trail was maintained, multiple authors were involved in the review process and reflexivity was maintained throughout. Authors met regularly to discuss the review and acknowledge how our positionality, as midwives with varied experiences of working with adolescents in low-and middle-income countries, may have impacted assumptions and interpretations.


The search strategy generated 1,144 papers, 1,137 from database searches and seven from citation searching. The search in African Journals Online generated 954 results, however only the first 100, classified as the most relevant papers, were accessible, which is a limitation of this review. After removal of 117 duplicates, 1027 papers were screened by reading the title and abstract which lead to 835 exclusions. Full texts were sought for the remaining 192 papers, however, three were not found despite contacting the authors directly. One hundred and eighty-nine full texts were read, with 167 studies excluded, for one of six reasons detailed in Fig. 1. The remaining 22 studies were quality assessed, with 25% of the papers reviewed by the other two authors to ensure consistency and agreement on grading. Twenty-one papers were graded ‘C’ or above and were included in the review. Studies graded ‘C’ lacked detail in some of the components assessed, rather than obvious methodological flaws which may affect the trustworthiness of findings. For example, two studies used appropriate methods and analysis but lacked detail on sampling strategies [62, 63]. One paper [64] was excluded with a grade of ‘D’ because few of the components assessed were identified in the paper, with poor reporting of the methods and results. A summary of the quality assessment can be found in the supplementary information (S3). Study characteristics are summarised in Table 3 (below).

Fig. 1
figure 1

Prisma flow diagram [65] showing process of identifying studies for inclusion

Table 3 Characteristics of included studies

Description of themes

Emerging themes evolved throughout the synthesis process, with final themes and associated core concepts generated, as summarised in Table 4, which contributed to the final line of argument.

Table 4 Evolving themes and core concepts

A wealth of emotions

Reacting to pregnancy

Consistent among the studies which addressed discovery of a pregnancy were the fraught emotions and psychological challenges adolescent’s experienced [41, 67, 70, 72, 79]. Feelings of fear, anger, guilt and shame were associated with the disappointment of no longer meeting religious, socio-cultural or parental expectations that unmarried adolescents should refrain from sexual relationships [41, 67, 70, 72, 79], as evidenced:

“I had intense feelings of guilt and shame. I had previously attended the reed dance and I was so proud of my virginity” [41].

The only study that actively recruited male adolescents noted a difference in the reactions of male and female participants [67]. Female participants were fearful, and in some instances, desperate to end the pregnancy. Whereas most male adolescents were open to the pregnancy, seemingly compelled by religious conviction:

“…. I didn’t want to kill my baby…I was the kind of person who did a sin and was adding more and more sin…” [67]

Profound psychological implications of this distress were evident in participant reports of suicidal ideation and attempts [41, 67, 79]:

“…I suspected that I might be pregnant, I attempted suicide, but I failed…I took a pregnancy test. The test was positive. I attempted suicide again…” [41].

Whereas married participants in the Middle East and North Africa [38, 73] expressed conflicted feelings on discovering their pregnancies, suggesting a sense of ambivalence to pregnancy, as evidenced:

“I was happy getting pregnant because it made me a mother, but at the same time I believe being unmarried is better…I liked pregnancy and did not like it at the same time…” [38].

Mixed emotions

Emotions and feelings experienced by adolescents as the pregnancy continued were more varied. Continued negative feelings associated with shame, fear and isolation were evident in two studies from sub-Saharan Africa [41, 68], for example:

“My repeat pregnancy has made life very challenging. I feel secluded. I don’t have a social life.” [41].

However, participants were identified in three studies that shared a sense of purpose, happiness and thankfulness on seeing their babies [23, 38, 73], as reflected in the quote below. This suggests becoming a mother can be a positive experience, even if pregnancy is not.

“…But when I delivered the baby and saw him all my feelings changed. I love him so much…” [38].

I am not ready

Too young to be a mother

Not being ready for pregnancy, childbirth or motherhood, was suggested in several studies [38, 68, 73, 78]. Feelings and experiences of lost childhood, early development and not being emotionally ready to transition from being mothered to mothering, were seen in the studies of married adolescents in the Middle East and North Africa [38, 73]:

“I still like to be with my mother. I need to be loved by my mom… It often keeps my mind busy that I’m not ready emotionally…” [73].

There were few accounts from participants of desiring or choosing pregnancy in this life stage [72, 78], with the majority of married participants in Nepal [78] acknowledging little decision-making power over their pregnancy choices. However, some participants did:

“No, I didn’t consult with anyone. I was willing to have a child, so I consulted with my husband and decided on having only one child…” [78].

Unprepared for birth

Adolescents were often psychologically, emotionally and practically ill prepared for labour and childbirth [38, 40, 62, 66, 74, 76]. A lack of mental preparedness led to fearful and negative birth experiences [38,39,40], as evidenced:

“I had no idea about the birth process except…How the baby came out I did not know, I did not imagine the severity of the pain…” [38].

Adolescents wanted, appreciated and benefitted from antenatal education, when it was available, but there was evidence of a lack of discussion and information about labour and childbirth [39, 40, 76]:

“They needed to tell us what we should expect during labour, we are young we know nothing…so we are afraid” [40].

Four studies in sub-Saharan Africa described adolescent’s awareness of the materials required for birth and immediate care of the baby [40, 62, 74, 76], but recognised inability to practically prepare was due to a lack of financial means [62, 74], for example:

“The midwife gave us a list of items to buy for delivery…but I do not have any of them…even getting money for buying medicines and food is a problem…” [74].

Impactful relationships

Support, acceptance and encouragement

The need for, and benefit of support, acceptance and encouragement was inferred in several studies [41, 66, 67, 70, 72, 79]. Fathers were more dismissive or took longer to accept the pregnancy than Mothers [23, 70, 72, 75]. While support from women in the family was particularly helpful, with mothers, sisters and grandmothers having a caring role [66, 70, 72], for example:

“My ma [grandmother] was disappointed [about the pregnancy] but ...she said that…she will stand by me” [70].

Participants also wanted and benefitted from having a birth partner during labour and childbirth [69, 77, 78]. Both studies in South Asia reported the desire for a female birth companion during labour was one of the reasons for choosing home delivery over hospital birth [77, 78]. Many participants desired and appreciated comfort, encouragement and support, as evidenced:

‘‘I wouldn’t have made it without my mother’’ [69].

Shame, rejection and abandonment

Many participants, with unplanned pregnancies, shared fears of families finding out about the pregnancy, bringing shame on the family, parental reactions and subsequent serious adverse consequences [63, 70, 72, 79], for example:

"… I have a very harsh father. I fear that if I tell him he can beat me up… at times when you are not willing to leave home, he sends you away" [63].

Pregnancy caused strained and damaged family relationships for many participants, particularly with parents [23, 62, 63, 66, 70, 72, 74, 75], with widely reported experiences of neglect, physical violence and being forced to leave the family home, for example:

“My parents do not trust me anymore. They abandoned and treated me badly, abusing and chasing me away...” [74]

Denial, rejection and abandonment by partners, also had significant implications, with participants reporting unmet emotional, financial and practical needs [23, 62, 68, 72, 74]:

"The father of this child after making me pregnant denied it. So… I started living with my grandmother….the baby’s father lives in same village but does not give any support” [68].

Respectful and disrespectful care

Health care professionals

Fear of health care providers poor treatment was a deterrent to accessing health care services [62, 63, 68]. While reports of health care providers’ poor attitudes and behaviours, such as having a rude manner, being judgemental or discriminatory, and physical violence and aggression, directly contributed to negative experiences [40, 62, 63, 68,69,70,71, 76], for example:

“The nurses treated me badly during my pregnancy. They embarrassed me at my first antenatal visit. The doctors can also be judgmental….” [41].

Health care provider prejudices against adolescents, particularly those that were unmarried, meant some participants were denied or experienced delayed care [39, 62, 71, 76]:

“…they give first priority to those women who come with their husbands… even when they come late for antenatal care” [39].

Interactions with health care providers who were, kind, gentle and friendly had a positive impact on adolescent’s experiences [39, 40, 69, 70, 76], with some participants pleasantly surprised by their positive experiences:

“There's some nurses that's nice to you and show you respect and they always helpful, talk to you, ask you questions …Treat you with love and respect…” [76]

Husbands and Mothers-in-law had the greatest impact on care seeking and care utilisation, among married adolescents [38, 77, 78]. However, not wanting to be cared for by male doctors, because of religious prohibitions [77] or shyness [78] was also a deterrent:

“…I heard male doctor will be in a medical (hospital or clinic) it makes me feeling shy!” [77]

Older women

Positive or negative experiences of health care services were also influenced by adolescent’s interactions with adult women [39, 40, 62, 71, 76]. Being shamed or intimidated by older women [39, 62, 71, 76], prevented adolescents from accessing care services and resulted in negative experiences when they did, as evidenced.

“I overheard some women talking in a mocking manner…This made me to feel uncomfortable and ashamed of myself. They were even laughing at me” [39].

The value and desire for adolescent specific services was reflected in two studies, with participants sharing the benefits of being able to speak and interact freely without feeling constrained by older women [40, 62]. However, most participants in the study in Zambia [39] reported healthy relationships with older women, acknowledging them to be friendly, supportive and a source of guidance:

“l ask them pregnancy related questions… They teach me on how to take care of my pregnancy…They teach me things l don’t know” [39].

Line of argument

The myriad of emotions and profound psychological implications for adolescents who experienced pregnancy in LMICs was seemingly driven by socio-cultural and religious expectations. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and all too often a lack of needed support. Even when pregnancy in adolescence was wanted, planned, and acceptable within communities, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Other peoples’ responses and actions significantly contributed to adolescent’s experiences, mental and practical preparedness and empowerment to make decisions about their personal and pregnancy needs. Access, utilisation and experiences of care were also significantly impacted by adolescents’ relationships with others, with negative experiences overwhelmingly associated with a lack of respectful and adolescent friendly services.


This review aimed to analyse, interpret and synthesise qualitative studies to provide a current comprehensive understanding of the needs and experiences of adolescents who become pregnant in LMICs. The described themes and associated core concepts contributed to the subsequent line of argument.

There were notable differences in how adolescents felt about their pregnancies between married and unmarried adolescents and between culturally diverse regions. The predominantly negative emotions experienced by unmarried adolescents [62, 67, 70] reflected the influence of religion, culture and societal norms on perceptions, experiences and behaviours cited in wider literature [80,81,82]. Ambivalence to religious prohibitions on premarital sex has been suggested to decrease the suicide risk among pregnant adolescents [83]. However, in countries where culture and religion have such a distinct influence and control over lived experiences, ambivalence to these expectations is less likely than in high-income countries (HICs) where individualism, autonomy and choice are acceptable and encouraged [84].

The concept of not being ready for motherhood was most strongly reflected among married adolescents. Although adult women in these regions experience the socio-cultural norms and expectations to bear children [82, 85, 86], the sentiments of lost childhood, developing too quickly and not being ready for motherhood [38, 68, 73, 78], identified in this review, are age specific. Similar sentiments were identified among adolescents with planned and unplanned pregnancies in HICs [45, 46, 87], but were not distinctly associated with marital status. The findings of this review support the concern expressed by other authors that planned pregnancies are not always chosen by adolescents or wanted by them in this life stage [3, 82] and that global efforts to prevent unwanted pregnancies in adolescence should remain a priority.

Feeling unprepared and fearful of childbirth was identified in both married and unmarried adolescents. Likely due to a societal hesitancy, associated with socio-cultural and religious beliefs, which discourage and prevent discussions about sexual and reproductive health with adolescents, as well as reluctance from adolescents to engage in these conversations [5, 15, 88]. Feelings of being unprepared, linked to a lack of financial means to purchase the materials required for birth, were only reported in the low-income countries of Malawi [40] and Uganda [62, 74]. Studies in high-income regions have identified financial challenges for pregnant adolescents but note the benefits of welfare support [45, 46, 89] which, while available in some LMICs, is less likely to be available in low-resource contexts. There is a need for states and other stakeholders to consider how pregnant adolescents in low-income countries can be better supported to meet their daily and pregnancy related needs.

The need for support and nurturing is expected of individuals in this life-stage [90, 91], yet this review found an important unmet need for love, care and support in personal relationships. Findings that adolescents feared or experienced family and partner harm, rejection, and abandonment, with the associated short and long-term physical, psycho-social and economic consequences [23, 62, 68, 72, 74], are consistent with outcomes for adolescents described in wider literature [24, 25, 37]. Reports from adolescents experiencing pregnancy in other contexts, that being loved, supported and encouraged, helped them to manage their pregnancy, have some positive pregnancy experiences and feel more prepared for motherhood [45, 46], speak to the benefit of addressing this unmet need.

Even when adolescents were cared for and supported within a family unit, this review recognised a lack of autonomy and decision-making. Adolescents need to be empowered to make whatever choices they can. Women’s lack of agency in decision-making and access to care is not exclusive to adolescents, with Mothers-in-law and Husbands commonly reported as the decision-makers in South Asia, the Middle East and North Africa, and parts of sub-Saharan Africa [92,93,94]. Engaging families in measures to improve care provision could increase care-seeking among adolescents and enhance the family’s role as a source of support. Education is a key aspect of empowerment, giving individuals control of their reproductive health [95]. Adolescent focussed health care provision, with supportive health workers, may help to empower pregnant adolescents through education, and support for choices made. A reluctance to access services was also identified, either for religious reasons [77] or because of shyness, embarrassment, and an increasing desire for privacy [5, 78]. This review supports the recommendation that care must be attentive to the religious, cultural and developmental needs of service users [80]. Accommodating this need for privacy is an essential component of care provision and could improve care-seeking.

Disrespectful attitudes and behaviours of health care providers and other service users, were all reported from sub-Saharan Africa [39, 62, 63, 68,69,70,71, 76], which reflects the findings of other authors that disrespectful care remains a considerable challenge in this region [96]. The experiences of disrespectful care identified are consistent with reports from older women [97,98,99,100]. As well as positive interactions with health care providers, being merely the absence of harmful attitudes and behaviours [101, 102]. However, this review found age specific experiences including adolescents being treated differently to adult women and experiencing poor treatment from older women [39, 62, 71, 76], that suggest they face a double burden of discrimination related to both gender and age. Poor treatment of adolescents has been acknowledged by health care providers, citing a lack of knowledge and training as reasons for this behaviour [94, 102, 103]. Yet the importance of positive attitudes, knowledge and skills of health care providers to engage with adolescents is widely acknowledged [5, 104,105,106]. This review contributes additional evidence to this body of research, supporting a need for more training to enable health care providers to meet the support needs of adolescents who are pregnant in LMICs.

Findings suggest adolescents’ experiences of health care were more positive when services were tailored to accommodate their needs and preferences [40, 62] and that adolescents can and would like to influence the care they receive [39, 40, 62]. Specialist antenatal care for adolescents has not historically been associated with better objective outcomes than traditional antenatal care in other contexts [107]. However, components of this approach including continuity of care, speciality training for professionals and the emotional and social support gained through relationships with other adolescent services users, have been recognised as beneficial interventions in some HICs [107,108,109], and may be transferrable to LMICs. The varying contexts of LMICs mean no one single intervention can be recommended. Strategies need to be considered in the context of country specific opportunities and challenges. Creating opportunities for adolescents to be involved in care-planning and providing adolescents with choices, such as offering both routine antenatal care and adolescent specific services, could help meet adolescent specific needs.

This review had some limitations. Studies with a quality grading C, with flaws which may affect trustworthiness, were included in the synthesis. Although consistent with the approach of other authors undertaking qualitative synthesis [56,57,58], the lack of detail in the papers, meant methodological flaws which may affect the trustworthiness of findings could not be definitively excluded. Including English language papers only meant 12 papers were excluded which could have provided valuable insight, particularly from the countries in Latin America and the Caribbean. Only three low-income countries are represented in the review and few studies were from countries reporting the highest known incidence of adolescent pregnancy, reflecting the well cited recognition that research in low-resource settings remains a challenge [110,111,112], and that further research is needed. Male adolescents are not well represented. Research focused on their experiences would also be helpful in considering how to meet their needs. Finally, the ages of primary study participants were not reported by all authors. Based on the information provided, the youngest adolescents were not well represented. This could be due to poor reporting or because there are fewer pregnancies in this age range, but these adolescents are also least likely to have the agency to engage in research. Better understanding of their experiences would be beneficial considering this is the age of most significant change and development.


Measures to reduce pregnancy incidence should remain a priority of the international community, particularly as many married adolescents do not yet want to be mothers. Adolescents who do experience pregnancy in LMICs want and need support to meet their personal and pregnancy related needs. Efforts must be made to increase the support available to adolescents through personal and professional relationships to allow this need to be met. Reducing the stigma of adolescent pregnancy, in regions where pregnancy remains unacceptable outside of marriage, is needed to improve the support available to adolescents in their personal relationships.

Increasing the availability of adolescent friendly and respectful care is integral to meeting the needs of adolescents who are pregnant. This requires more and better training of health care providers to have the knowledge and skills to provide respectful care to adolescents. Wherever possible adolescents should also be involved in the planning of health care services and efforts should be taken to offer traditional and adolescent focused services. Adolescents should then be supported to make decisions about their care. Creating opportunities for family members to collaborate on efforts to improve care provision could increase care-seeking among adolescents who have less control over decision-making and improve the family’s role as a source of support. The vast differences across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.


  1. World Health Organization. Adolescent Pregnancy: World Health Organization; 2020 [Available from:

  2. The World Bank. Adolescent fertility rate (births per 1,000 women ages 15–19) 2019 [Available from:

  3. Presler-Marshall E, Jones N. Charting the future Empowering girls to prevent early pregnancy. London: Overseas Development Institute, Save the Children; 2012.

    Google Scholar 

  4. UNFPA. Girlhood, Not Motherhood; Preventing Adolescent Pregnany. UNFPA; 2015.

  5. Patton G, Sawyer S, Santelli J, Ross D, Afifi R, Allen N, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;11(387):2423–78.

    Article  Google Scholar 

  6. United Nations. Fertility among young adolescents aged 10 to 14 years. New York: United Nations; 2020.

    Google Scholar 

  7. United Nations. World Fertility. New York: United Nations; 2019.

    Google Scholar 

  8. Pradhan R, Wynter K, Fisher J. Factors associated with pregnancy among adolescents in low-income and lower middle-income countries: a systematic review. J Epidemiol Community Health. 2015;69(9):918.

    Article  PubMed  Google Scholar 

  9. Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis. Reprod Health. 2018;15(1):195.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chung HW, Kim EM, Lee J-E. Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review. J Adolesc. 2018;69:180–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sully E, Biddlecom A, Darroch JE, Riley T, Ashfoprd LS, Lince-Deroche N, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019. Guttmacher Institutue 2020.

  12. Kanku T, Mash R. Attitudes, perceptions and understanding amongst teenagers regarding teenage pregnancy, sexuality and contraception in Taung : original research. South African Family Practice. 2010;52(6):563–72.

    Article  Google Scholar 

  13. Govender D, Naidoo S, Taylor M. “My partner was not fond of using condoms and I was not on contraception”: understanding adolescent mothers’ perspectives of sexual risk behaviour in KwaZulu-Natal, South Africa. BMC Public Health. 2020;20(1):366.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ajayi AI, Odunga SA, Oduor C, Ouedraogo R, Ushie BA BA, Wado YD. “I was tricked”: understanding reasons for unintended pregnancy among sexually active adolescent girls. Reproductive Health. 2021;18(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health. 2018;15(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gunawardena N, Fantaye AW, Yaya S. Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis. BMJ Glob Health. 2019;4(3):e001499.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reprod Health. 2014;11(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. MacQuarrie KLD, Mallick L, Allen C. Sexual and reproductive health in early and later adolescence: DHS data on youth Age 10–19. Rockville, Maryland, USA: ICF; 2017.

  19. Shahabuddin ASM, Nöstlinger C, Delvaux T, Malabika S, Bardají A. Brouwere Vd et al What influences adolescent girls’ decision-making regarding contraceptive methods use and childbearing? A qualitative exploratory study in Rangpur district Bangladesh PLoS ONE. 2016;11(6):e0157664.

  20. Crivello G, Roest J, Uma V, Renu S, Winter F. Marital and fertility decision-making: the lived experiences of adolescents and young married couples in Andhra Pradesh and Telangana, India. Oxford, UK: Young Lives; 2018.

    Google Scholar 

  21. Henry EG, Lehnertz NB, Alam A, Ali NA, Williams EK, Rahman SM, et al. Sociocultural factors perpetuating the practices of early marriage and childbirth in Sylhet district. Bangladesh International Health (RSTMH). 2015;7(3):212–7.

    Google Scholar 

  22. Mchunu G, Peltzer K, Tutshana B, Seutlwadi L. Adolescent pregnancy and associated factors in South African youth. Afr Health Sci. 2012;12(4):426–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Gyesaw NYK, Ankomah A. Experiences of pregnancy and motherhood among teenage mothers in a suburb of Accra, Ghana: a qualitative study. Int J Womens Health. 2013;5:773–80.

    PubMed  PubMed Central  Google Scholar 

  24. Ekefre EN, Ekanem SA, Esien OEE. Teenage Pregnancy and Education in Nigeria: A Philo-Sociological Management Strategy. Journal of Educational and Social Research; Vol 4, No 3 (2014): May 2014. 2014.

  25. Mgbokwere D, Esienumoh E, Uyana D. Perception and attitudes of parents towards teenage pregnancy in a rural community of Cross river state, Nigeria. Global J Pure Appl Sci. 2015;21:181.

    Article  Google Scholar 

  26. World Health Organization. Adolescent Health: World Health Organization 2021 [Available from:

  27. Vogel JP, Pileggi-Castro C, Chandra-Mouli V, Pileggi VN, Souza JP, Chou D, et al. Millennium Development Goal 5 and adolescents: looking back, moving forward. Arch Dis Child. 2015;100(1):S43–7.

    Article  PubMed  Google Scholar 

  28. Grønvik T, Fossgard SI. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. PLoS ONE. 2018;13(9):e0204327.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Azevedo WFd, Diniz MB. Fonseca ESVB Azevedo LMRd Evangelista CB Complications in adolescent pregnancy: systematic review of the literature. Einstein (Sao Paulo). 2015;13(4):618–26.

    Article  Google Scholar 

  30. Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. Lancet Glob Health. 2014;2(3):e155–64.

    Article  PubMed  Google Scholar 

  31. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. Br J Obstet Gynaecol. 2014;121(1):40–8.

    Article  Google Scholar 

  32. Neal S, Mahendra S, Bose K, Camacho AV, Mathai M, Nove A, et al. The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature. BMC Pregnancy Childbirth. 2016;16(1):352.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Konje JC, Palmer A, Watson A, Hay DM, Imrie A, Ewings P. Early teenage pregnancies in Hull. Br J Obstet Gynaecol. 1992;99(12):969–73.

    Article  CAS  PubMed  Google Scholar 

  34. Mahfouz AA. el-Said MM al-Erian RA Hamid AM Teenage pregnancy: are teenagers a high risk group? European Journal of Obstetrics and Gynecology and Reproductive Biology. 1995;59(1):17–20.

    Article  CAS  PubMed  Google Scholar 

  35. Scholl TO, Hediger ML, Belsky DH. Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis. J Adolesc Health. 1994;15(6):444–56.

    Article  CAS  PubMed  Google Scholar 

  36. Odimegwu C, Mkwananzi S. Factors Associated with Teen Pregnancy in sub-Saharan Africa: A Multi-Country Cross-Sectional Study. Afr J Reprod Health. 2016;20(3):94–107.

    Article  PubMed  Google Scholar 

  37. UNFPA. Motherhood in Childhood, Facing the challenge of adolescent pregnancy. 2013.

  38. Al-Kloub MI, Al-Zein HJ, Abdalrahim MS, Abed MA. Young women’s experience of adolescent marriage and motherhood in Jordan. Cult Health Sex. 2019;21(4):462–77.

    Article  PubMed  Google Scholar 

  39. Bwalya BC, Sitali D, Baboo KS, Zulu JM. Experiences of antenatal care among pregnant adolescents at Kanyama and Matero clinics in Lusaka district, Zambia. Reproductive Health. 2018;15(1):124.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chikalipo MC, Nyondo-Mipando L, Ngalande RC, Muheriwa SR, Kafulafula UK. Perceptions of pregnant adolescents on the antenatal care received at Ndirande Health Centre in Blantyre, Malawi. Malawi medical journal : the journal of Medical Association of Malawi. 2018;30(1):25–30.

    Article  Google Scholar 

  41. Govender D, Naidoo S, Taylor M. "I have to provide for another life emotionally, physically and financially": understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa. BMC Pregnancy and Childbirth. 2020;20(620).

  42. Finfgeld-Connett D. A Guide to Qualitative Meta-synthesis. New York: Routledge; 2018.

    Book  Google Scholar 

  43. Sandelowski M. “Meta-Jeopardy”: the crisis of representation in qualitative metasynthesis. Nurs Outlook. 2006;54(1):10–6.

    Article  PubMed  Google Scholar 

  44. Bekaert S, SmithBattle L. Teen Mothers’ experience of Intimate Partner Violence; a metasynthesis. Adv Nurs Sci. 2016;39(3):272–90.

    Article  Google Scholar 

  45. Macutkiewicz J, MacBeth A. Intended Adolescent Pregnancy: A Systematic Review of Qualitative Studies. Adolescent Research Review. 2017;2(2):113–29.

    Article  Google Scholar 

  46. Spear HJ, Lock S. Qualitative research on adolescent pregnancy: a descriptive review and analysis. J Pediatr Nurs. 2003;18(6):397–408.

    Article  PubMed  Google Scholar 

  47. Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. California: Sage; 1988.

    Book  Google Scholar 

  48. The World Bank. World Bank Country and Lending Groups The World Bank, ; 2021 [Available from:

  49. Cooke A, Smith D, Booth A. Beyond PICO: The SPIDER Tool for Qualitative Evidence Synthesis. Qual Health Res. 2012;22(10):1435–43.

    Article  PubMed  Google Scholar 

  50. Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):181.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Flemming K, Briggs M. Electronic searching to locate qualitative research: evaluation of three strategies. J Adv Nurs. 2007;57(1):95–100.

    Article  PubMed  Google Scholar 

  52. Atkins S, Lewin S, Smith H, Engel M, Fretheim A, Volmink J. Conducting a meta-ethnography of qualitative literature: Lessons Learnt. BMC Medical Research Methodology. 2008;16(8):21.

    Article  Google Scholar 

  53. Walsh D, Downe S. Appraising the quality of qualitative research. Midwifery. 2006;22(2):108–19.

    Article  PubMed  Google Scholar 

  54. Dixon-Woods M, Shaw RL, Agarwal S, Smith JA. The problem of appraising qualitative research. Quality and Safety in Healthcare. 2004;13(3):223–5.

    Article  CAS  Google Scholar 

  55. Downe S, Simpson L, Trafford K. Expert intrapartum maternity care: a meta-synthesis. J Adv Nurs. 2007;57(2):127–40.

    Article  PubMed  Google Scholar 

  56. Hodgkinson EL, Smith DM, Wittkowski A. Women’s experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis. BMC Pregnancy Childbirth. 2014;14(1):330.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Finlayson K, Crossland N, Bonet M, Downe S. What matters to women in the postnatal period: A meta-synthesis of qualitative studies. PLoS ONE. 2020;15(4):e0231415.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Mills TA, Ricklesford C, Cooke A, Heazell AE, Whitworth M, Lavender T. Parents’ experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis. Br J Obstet Gynaecol. 2014;121(8):943–50.

    Article  CAS  Google Scholar 

  59. Campbell R, Pound P, Morgan M, Dakaar-White G, Britten N, Pill R, et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technology Assessment. 2011;15(43):1–164.

    Article  CAS  PubMed  Google Scholar 

  60. France EF, Uny I, Ring N, Turley RL, Maxwell M, Duncan EAS, et al. A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases. BMC Med Res Methodol. 2019;19(1):35.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Sattar R, Lawton R, Panagioti M, Johnson J. Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis. BMC Health Serv Res. 2021;21(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Apolot RR, Tetui M, Nyachwo EB, Waldman L, Morgan R, Aanyu C, et al. Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District- Uganda. International Journal for Equity in Health. 2020;19(1):191.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Atuyambe L, Mirembe F, Johansson A, Kirumira EK, Faxelid E. Experiences of pregnant adolescents - voices from Wakiso district. Uganda African Health Sciences. 2005;5(4):304–9.

    PubMed  Google Scholar 

  64. Görgen R, Maier B, Diesfeld HJ. Problems related to schoolgirl pregnancies in Burkina Faso. Stud Fam Plann. 1993;24(5):283–94.

    Article  PubMed  Google Scholar 

  65. Mohler D, Liberarti A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.

    Article  Google Scholar 

  66. Asnong C, Fellmeth G, Plugge E, Wai N, Pimanpanarak M, Paw M, et al. Adolescents’ perceptions and experiences of pregnancy in refugee and migrant communities on the Thailand-Myanmar border. a qualitative study Reproductive Health. 2018;15(1):83.

    Article  PubMed  Google Scholar 

  67. Astuti AW, Hirst J, Bharj KK. Indonesian adolescents’ experiences during pregnancy and early parenthood: a qualitative study. J Psychosom Obstet Gynaecol. 2020;41(4):317–26.

    Article  PubMed  Google Scholar 

  68. Atuyambe L, Mirembe F, Annika J, Kirumira EK, Faxelid E. Seeking safety and empathy: adolescent health seeking behavior during pregnancy and early motherhood in central Uganda. J Adolesc. 2009;32(4):781–96.

    Article  PubMed  Google Scholar 

  69. Duggan R, Adejumo O. Adolescent clients’ perceptions of maternity care in KwaZulu-Natal, South Africa. Women and birth : Journal of the Australian College of Midwives. 2012;25(4):e62–7.

    Article  Google Scholar 

  70. Erasmus MO, Knight L, Dutton J. Barriers to accessing maternal health care amongst pregnant adolescents in South Africa: a qualitative study. Int J Public Health. 2020;65(4):469–76.

    Article  PubMed  Google Scholar 

  71. James S, Rall N, Strümpher J. Perceptions of pregnant teenagers with regard to the antenatal care clinic environment. Curationis. 2012;35:E1–8.

    Article  Google Scholar 

  72. Mashala P, Esterhuizen R, Basson W, Nel K. Qualitative Exploration of the Experiences and Challenges of Adolescents during Pregnancy. J Psychol Afr. 2012;22(1):49–55.

    Article  Google Scholar 

  73. Mohammadi N, Montazeri S, Alaghband Rad J, Ardabili HE, Gharacheh M. Iranian pregnant teenage women tell the story of “fast development”: A phenomenological study. Women and birth : journal of the Australian College of Midwives. 2016;29(4):303–9.

    Article  Google Scholar 

  74. Nabugoomu J, Seruwagi GK, Corbett K, Kanyesigye E, Horton S, Hanning R. Needs and Barriers of Teen Mothers in Rural Eastern Uganda: Stakeholders’ Perceptions Regarding Maternal/Child Nutrition and Health. Int J Environ Res Public Health. 2018;15(12):2776.

    Article  PubMed Central  Google Scholar 

  75. November L, Sandall J. 'Just because she's young, it doesn't mean she has to die': exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study. Reproductive Health. 2018;15(31).

  76. Sewpaul R, Crutzen R, Dukhi N, Sekgala D, Reddy P. A mixed reception: perceptions of pregnant adolescents' experiences with health care workers in Cape Town, South Africa. Reproductive Health. 2021;18.

  77. Shahabuddin A, Nöstlinger C, Delvaux T, Sarker M, Delamou A, Bardají A, et al. Exploring maternal health care-seeking behavior of married adolescent girls in Bangladesh: a social-ecological approach. PLoS ONE. 2017;12(1): e0169109.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  78. Shahabuddin ASM, Delvaux T, Nöstlinger C, Sarker M, Bardají A, Sharkey A, et al. Maternal health care-seeking behaviour of married adolescent girls: a prospective qualitative study in Banke District. Nepal PLoS ONE. 2019;14(6):e0217968.

    Article  CAS  PubMed  Google Scholar 

  79. Tatum C, Rueda M, Bain J, Clyde J, Carino G. Decisionmaking regarding unwanted pregnancy among adolescents in Mexico City: a qualitative study. Stud Fam Plann. 2012;43(1):43–56.

    Article  PubMed  Google Scholar 

  80. Hordern J. Religion and culture. Medicine (Abingdon). 2016;44(10):589–92.

    Google Scholar 

  81. UNFPA. Global Goals Indicaor 5.6.1, Research on factors that determine women’s ability to make decisions about sexual and reproductive health and rights. 2019.

  82. UNFPA. My Body is my Own, State of the World Population. UNFPA; 2021.

  83. Chan LF, Mohamad Adam B, Norazlin KN, Siti Haida MI, Lee VY, Norazura AW, et al. Suicidal ideation among single, pregnant adolescents: The role of sexual and religious knowledge, attitudes and practices. J Adolesc. 2016;52:162–9.

    Article  CAS  PubMed  Google Scholar 

  84. Triandis HC. Collectivism and Individualism: Cultural and Psychological Concerns. In: Wright JD, editor. International Encyclopedia of the Social & Behavioral Sciences. 2nd ed. Oxford: Elsevier; 2015. p. 206–10.

    Chapter  Google Scholar 

  85. Daibes MA, Safadi RR, Athamneh T, Anees IF, Constantino RE. “Half a woman, half a man; that is how they make me feel”: a qualitative study of rural Jordanian women’s experience of infertility. Cult Health Sex. 2018;20(5):516–30.

    Article  PubMed  Google Scholar 

  86. Amroussia N, Hernandez A, Vives-Cases C, Goicolea I. “Is the doctor God to punish me?!” An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia. Reprod Health. 2017;14(1):32.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Clemmens D. Adolescent Motherhood: A meta-synthesis of qualitative studies. American Journal of Maternal and Child Nursing. 2003;28(2):93–9.

    Article  Google Scholar 

  88. Shaw D. Access to sexual and reproductive health for young people: bridging the disconnect between rights and reality. Int J Gynaecol Obstet. 2009;106(2):132–6.

    Article  PubMed  Google Scholar 

  89. Hanna B. Negotiating motherhood: the struggles of teenage mothers. J Adv Nurs. 2001;34(4):456–64.

    Article  CAS  PubMed  Google Scholar 

  90. Blakemore S-J, Mills KL. Is Adolescence a Sensitive Period for Sociocultural Processing? Annu Rev Psychol. 2014;65(1):187–207.

    Article  PubMed  Google Scholar 

  91. Blum RW, Astone NM, Decker MR, Mouli VC. A conceptual framework for early adolescence: a platform for research. Int J Adolesc Med Health. 2014;26(3):321–31.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Choudry SNM. Intervention research on pregnancy and postpartum programme for the first-time young parents in Bangladesh: preliminary observations. In: Bott S, Jejeebhoy S, Shah I, Puri C, editors. Adolescent sexual and reproductive health in South Asia: an overview of findings from the 2000 Mumbai conference; Mumbai. Geneva: World Health Organization; 2003. p. 59–61.

    Google Scholar 

  93. World Health Organization. Adolescent pregnancy –Unmet needs and undone deeds, A review of the literature and programmes. Geneva: World Health Organization; 2007.

    Google Scholar 

  94. Mathur S, Malhotra A, Mehta M. Adolescent girls’ life aspirations and reproductive health in Nepal. Reprod Health Matters. 2001;9(17):91–100.

    Article  CAS  PubMed  Google Scholar 

  95. Nkhoma DE, Lin CP, Katengeza HL, Soko CJ, Estinfort W, Wang YC, et al. Girls’ Empowerment and Adolescent Pregnancy: A Systematic Review. Journal of Environmental Research and Public Health. 2020;17(5):1664.

    Article  Google Scholar 

  96. Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1):71.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med. 2015;12(6):e1001847.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. Br J Obstet Gynaecol. 2018;125(8):932–42.

    Article  CAS  Google Scholar 

  99. Orpin J, Puthussery S, Davidson R, Burden B. Women’s experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria. BMC Pregnancy Childbirth. 2018;18(1):213.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Kanengoni B, Andajani S, Holroyd E. Women’s experiences of disrespectful and abusive maternal health care in a low resource rural setting in eastern Zimbabwe. Midwifery. 2019;76:125–31.

    Article  PubMed  Google Scholar 

  101. Loxton D, Williams JS, Adamson L. Barriers to service delivery for young pregnany women and mothers. Austrailia: National Youth Affairs Research Scheme; 2007.

  102. Mekonnen T, Dune T, Perz J. Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review. BMC Pregnancy Childbirth. 2019;19(1):366.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Zabin LS, Kiragu K. The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa. Stud Fam Plann. 1998;29(2):210–32.

    Article  CAS  PubMed  Google Scholar 

  104. Kangaude G. Enhancing the role of health professionals in the advancement of adolescent sexual health and rights in Africa. Int J Gynaecol Obstet. 2016;132(1):105–8.

    Article  PubMed  Google Scholar 

  105. Govender D, Naidoo S, Taylor M. Nurses’ perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal. African Journal of Primary Health Care and Family Medicine. 2019;11(1):e1–11.

    Article  PubMed  Google Scholar 

  106. Christie D, Viner R. Adolescent development. Br Med J (Clin Res Ed). 2005;330(7486):301–4.

    Article  Google Scholar 

  107. Morris DL, Berenson AB, Lawson J, Wiemann CM. Comparison of adolescent pregnancy outcomes by prenatal care source. J Reprod Med. 1993;38(5):375–80.

    CAS  PubMed  Google Scholar 

  108. Silva MO, Cabral H, Zuckerman B. Adolescent pregnancy in Portugal: effectiveness of continuity of care by an obstetrician. Obstet Gynecol. 1993;81(1):142–6.

    CAS  PubMed  Google Scholar 

  109. Powers ME, Takagishi J. Care of Adolescent Parents and ther Children. Paediatrics. 2021;147(5).

  110. Acharya KP, Pathak S. Applied Research in Low-Income Countries: Why and How? Front Res Metr Anal. 2019;4:3-.

  111. Maher D, Aseffa A, Kay S, Tufet BM. External funding to strengthen capacity for research in low-income and middle-income countries: exigence, excellence and equity. BMJ Glob Health. 2020;5(3):e002212.

    Article  PubMed  PubMed Central  Google Scholar 

  112. Uthman OA, Wiysonge CS, Ota MO, Nicol M, Hussey GD, Ndumbe PM, et al. Increasing the value of health research in the WHO African Region beyond 2015—reflecting on the past, celebrating the present and building the future: a bibliometric analysis. BMJ Open. 2015;5(3):e006340.

    Article  PubMed  PubMed Central  Google Scholar 

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This review was partly funded by the NIHR (16/137/53) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.

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TL and CB developed the concept for the review, contributed to the development of the search strategy, reviewed full texts if there was a question of suitability for inclusion, quality assessed 25% of the papers and contributed to the development of the themes and final line of argument. RC formulated the search strategy, conducted the searches, reviewed all the papers, generated the original themes, core concepts and line of argument, and prepared the manuscript. All authors contributed to and approved the final manuscript.

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Correspondence to Rachel Crooks.

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Supplementary Information

Additional file 1:

S1 - Search strategy for each database. S2 - Table created to display checklist authored by Walsh and Downe. S3- Summary of Quality Assessment of Studies.

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Crooks, R., Bedwell, C. & Lavender, T. Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies. BMC Pregnancy Childbirth 22, 702 (2022).

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