Bridging the implementation gap: youth-led priorities for supporting pregnant and mothering adolescents’ wellbeing and schooling

Background Globally, there were approximately 21 million adolescent pregnancies in 2019, of which half were unplanned. Adolescent pregnancy is an issue of social and health inequity: it hinders young mothers’ chances of continuing with school, and is associated with higher exposure to domestic violence, HIV, and food insecurity. While schooling is a well-known determinant of health, an implementation gap exists in supportive provisions. While protective factors such as school engagement enable improved health outcomes and educational attainment for adolescent mothers, yet limited evidence exists on how school and community stakeholders can can adapt to support these learners. This formative, participatory research engaged young people's expertise to inform implementation priorities for supporting adolescent mothers' educational attainment. Methods This study aimed to co-construct potential support package components, in partnership with young people from a community-academic partnership called a “Teen Advisory Group”. We conducted participatory priority-setting research with a Teen Advisory Group (TAG) of young research advisors (n = 13, ages 21–25) in Eastern Cape, South Africa, over eight weeks in July-August 2022. Using a socio-ecological framework and positive youth development theory, data co-creation occurred across three stages: (1) introductory phone calls; (2) remote engagement through a closed Facebook group (n = 7) with weekly activities; and (3) a 3-day face-to-face participatory design workshop featuring gallery walks, gender-separated group interviews, and arts-based "dreamy care package" activities. Evidence-based comic storylines informed exploratory discussions. Activities were conducted in English and isiXhosa, and analyzed using reflexive thematic analysis combining deductive and inductive approaches, validated through member-checking with advisors (n = 10). Results Adolescent pregnancy exposed young mothers to various forms of stigma, at home, amongst peers, and from the community. Young research advisors described support figures such as social workers and healthcare professionals as important figures who would help them from dropping out of school and prevent further pregnancies. Family-level support mostly helped ease the burden of childcare for the young mother. Staying motivated and focused by setting goals for themselves also kept pregnant and mother learners motivated to continue with school. The young mothers suggested that the government could support adolescent mothers by subsidising formal childcare and some baby essentials during early motherhood. Conclusions Our findings emphasize a multi-faceted approach to supporting pregnant and mother learners. This includes stigma reduction interventions at the household and community level, enhanced teacher training to provide psychosocial and health support, and the provision of accessible and affordable childcare to facilitate a return to school. Furthermore, our results underscore the need for stronger social support systems, multi-sectoral collaboration to integrate healthcare and social work services in schools, and the adoption of youth-led participatory approaches to ensure interventions are relevant and effective.