Table 3 Interview themes with corresponding relevant quotations

Pregnancy, Adverse Childhood Experience and Rejection from family and relatives

 Pregnancy related health difficulties

I was stressed [some silence] because I used to wake up in the morning feeling tired, vomiting (AD07KG, 18 years)

Yes, headache, fever, I was feeling cold throughout (AD07KG, 18 years)

Vomiting, laziness; you don't feel like doing anything, getting tired quickly whenever you do something (AD11KG, 18 years)

Morning sickness, tiredness, fever and headache

“Pregnancy didn’t like him (partner)”…. Myth?

 Adverse Childhood experiences

The process of carrying the pregnancy was just okay [Inaudible] it used to reach a time then he just gets angry so I could try to talk to him but he is just angry and I wondered what it was; I thought of getting out of his house but I thought it was not a good thing; I told my sister from my other mother is the one who came to help me. She told me that my pregnancy didn't like him but when I give birth things would be fine, that is when I became fine (AD09KG,17 years)

Growing up in a polygamous family with limited resource

 Experiences of rejection

My father has two wives and my mother is the second wife; now the first wife's children were studying in boarding schools and he was paying their whole amount of school fees but for me I was in a day school and I was being sent away from school so it affected me so much (AD13KG, 18 years)

Then for example farming we used to do together but whenever we harvest, all the food used to go to the first wife (AD13KG, 18 years)

Currently it is just that you know when mum gets angry, she never talks to you (AD11KG, 18 years)

He got angered and even denied that he is not responsible for the pregnancy (AD08KG, 18 years)

He started saying that he was not responsible. I just told him if it belongs to someone else then it is okay (AD01KG, 18 years)

They asked me to abort it or else they would beat me up (AD01KG, 18 years)

They never accepted it at first (AD05KG, 18 years)

Rejection from mother; the father of unborn child denies responsibility

Family members rejecting the unborn baby and wanting abortion

Experience and understanding of depression

 Experiences of depression

It is too much thinking (AD02KG, 18 years)

Depression is like stress, right? Thoughts, thinking too much (AD07KG, 18 years)

Depression is being stressed so much until you stay at the same place; kind of you feel that there is a hole at that same place (AD11KG, 18 years)

Being stressed (AD08KG, 18 years)

It is being shocked (AD03KG, 18 years)

Somebody who is stressed (AD13KG, 18 years)

Depression [Silence] depression is like when you are alone, and nobody is supporting you (AD12KG, 18 years)

I have no idea (AD01KG, 18 years)

This is when one is so much stressed to a point of having negative impacts (AD05KG, 18 years)

It is too much thinking (AD02KG, 18 years)

Summarized it as feeling of anger, quarrelling and feeling stressed up

 Understanding of depression

Depression is like stress, right? Thoughts, thinking too much (AD07KG, 18 years)

It is being shocked (AD03KG, 18 years)

Somebody who is stressed (AD13KG, 18 years)

Depression [Silence] depression is like when you are alone, and nobody is supporting you (AD12KG, 18 years)

I have no idea. (AD01KG, 18 years)

This is when one is so much stressed to a point of having negative impacts (AD05KG, 18 years)

Two statements were commonly used to describe depression; 1. Thinking too much 2. Being stressed

Also lack of support while in distress was associated with depression

 Denying experience of depression associated with lack of knowledge or willingness to engage

It is not there (AD02KG, 18 years)

No, I haven't gone through [depression] (AD07KG, 18 years)

I have never; maybe blood pressure (AD11KG, 18 years)

No (AD12KG, 18 years)

They may not have depression or there is a knowledge gap (they do not understand depression) or not well probed

Interpersonal problem areas

 Grief

Yes; mum passed on (AD08KG, 18 years)

You know we were raised by uncle; mum's brother. Mum died in two thousand and four (AD13KG, 18 years)

Death of a parent and being raised by a relative/guardian

 Role transition

Obviously, I was not expecting (the pregnancy) (AD02KG, 18 years)

Pregnant while still in school (AD08KG, 18 years)

I cannot go back home while I am pregnant (AD03KG, 18 years)

I used to go to school while pregnant but when my mother noticed that, I decided to move out (AD01KG, 18 years)

the issues of girls not paying attention to the parents, running around with boys, so my sister took me and brought me here so that I study from here; I came here in the same twenty seventeen then I again went to live with another sister of mine that is when I became pregnant (AD09KG, 17 years)

Role transition was experienced especially by those who were in school transitioning to early motherhood. (Others probably were already in marriage or not in school and therefore it did not come out

 Interpersonal role disputes

He was worried because my parents could come anytime to pick me up. it was just the parents being frustrated they quarreled because I had not completed my studies (AD07KG, 18 years)

He said that I should abort to show that the child is his, so I decided it is better that I forget him (AD11KG, 18 years)

continued…………It was not that easy because there are things that we went through; sometimes mum doesn't talk to you because she is also disappointed (AD11KG, 18 years)

They became angry because they never thought that I was in form four, they thought that I am in form two; so upon realizing that I was in form four they got angry (AD08KG, 18 years)

They wanted me to go back home so that they can take me for a course, but I refused (AD03KG, 18 years)

This was a dominant theme in the 4 PT problem areas – Parents/guardians disagreed and disappointed with the decision of the pregnant adolescent. This caused tension and frustration

 Interpersonal deficits

I don't usually have friends within (AD11KG, 18 years)

As in I did not want to see anybody I just wanted to stay alone (AD13KG, 18 years)

Experienced difficulty in forming relationships

 Circumstances leading to first sexual experience

No; I was obviously seduced (AD02KG, 18 years)

He didn't give me alcohol, he just talked to me (AD07KG, 18 years)

It is just wanting because even that relationship started as a result of peer pressure; you want to be seen (AD11KG, 18 years)

It is just the way you hear that others have done it and you also want to try it (AD08KG, 18 years)

You just know life sometimes you don't have pads, you don't have whatever - books, whatever; so you get somebody who tells you "I will buy for you," that way (AD13KG, 18 years)

It was just because of peer pressure (AD12KG, 18 years)

That boy convinced me, and I couldn't resist because I was in love with him (AD09KG, 18 years)

Peer pressure was identified as a cause for first sexual experience

Also lack of basic necessities; books, pads (sanitary towels)

Coping with depression

 Viewpoint on coping with depression

They just have to accept themselves (AD02KG, 18 years)

Just stop thinking and give birth rather than aborting because aborting itself is a problem and you will be adding stress to yourself (AD07KG, 18 years)

You just try to share whatever is in your mind with your closest person …………..Or you try to seek advice from maybe a certain counselor (AD11KG, 18 years)

Making them to form groups where they can help each other (AD08KG, 18 years)

They should pray so much to God to help them (AD11KG, 18 years)

I can say that if there is a person who wants to help them can assist them because most girls we find ourselves in certain problems because we don't have the potential I mean you don't have somebody to assist you (economically) (AD13KG, 18 years)

continued: If they have somebody who can sit with them to have stories or if they have something to do. You know the more you stay alone is when you start to think of several things, yeah; (AD13KG, 18 years)

Several viewpoints came up:

Accepting and moving on/avoid abortion

Religion/prayer

Talking to close friend

Seeking professional counselor

Group support

Livelihood support

Socio economic experiences

 Economic challenges

It is a challenge, but we are just trying; if I get out and get something (AD11KG, 18 years)

I just used to feed on what they ate ……………in jobs I am told that I must have a certificate so as to qualify (AD08KG, 18 years)

My uncle is the one who was paying for me but he reached a point where he got overwhelmed (AD13KG, 18 years)

Sometimes we lack money until he is forced to take food on credit from some shops (AD01KG, 18 years)

Unable to afford balanced meals

Inability to secure job after dropping out of school

 Medical challenges

HIV…………Yes, I told him that "I am positive so I don't know if we will break," but he told me, "no, we will just go on" (AD02KG, 18 years)

When I went for ANC clinic, I was told to go for ANC profile, and it was one thousand five hundred, yet I did not have money (AD08KG, 18 years)

Like when I fall sick sometimes there is lack of money (AD03KG, 18 years)

HIV (AD01KG, 18 years)

Respondents highlighted HIV and also lack of money to pay for clinic as some of the challenges

Support system and social support

 Support system

I stay with my mother (AD02KG, 18 years)

My mother told me not to worry that is how life is, so I just accepted (AD07KG, 18 years)

Yes. So when I came out of the clinic I told him that, "they have confirmed I am pregnant" [some silence] I told him, "they have confirmed I am pregnant," then he was like, "are you serious?" I told him, "it is true, here is the report written to me, and even the doctor will tell you," he said, "it is alright (AD07KG, 18 years)

just the other insurance (AD11KG, 18 years)

I went through a lot, I had difficult time, because by that time we had already separated with the father of the child so I was wondering about who would help me; but I was helped by my brother though I was just staying in the house, I was not going to school (AD08KG, 18 years)

He said, "if you are pregnant then let us get married," and that is how it happened (AD03KG, 18 years)

I just told him that, "I am feeling weird, I don't want food," then he told me that, "we will go to hospital," so after that he got happy (AD12KG, 18 years)

Mum's NHIF then for the child I had Linda Mama (AD12KG, 18 years)

He was happy, in fact he told me that he was responsible for the pregnancy, it made him feel happy (AD09KG, 17 years)

Family support especially mother

Support from partner/boyfriend

NHIF

 Support and acceptance

Just good; they are okay with that (AD02KG, 18 years)

They were happy; I even gave birth while at my parents' home. (AD07KG, 18 years)

He said, "if you are pregnant then let us get married," and that is how it happened (AD03KG, 18 years)

They treated me well (AD13KG, 18 years)

He got happy then took me to their home and introduced me to his parents (AD12KG, 18 years)

Acceptance and offering social and emotional support