“Will I survive this?“: A qualitative exploration of the wider impacts of the COVID-19 pandemic on the health and well-being of pregnant and parenting youth and their children in Canada

Abstract

Background

Pregnant and parenting youth in Canada face multiple challenges in fulfilling their parenting responsibilities while meeting their own unique needs. The COVID-19 pandemic and its associated public health restrictions exacerbated their challenges by reducing access to support networks, limiting opportunities to promote growth and well-being, and destabilizing their financial and economic standing. The impacts of the pandemic on the mental, physical, and emotional health of individuals are well-documented in the literature. However, there is limited research on how the pandemic influenced the lives, health, and well-being of pregnant and parenting youth and their children in Canada. Therefore, we aimed to examine the wider impacts (social and structural determinants that directly or indirectly impact health and well-being) of the pandemic and its implications for this population.

Methods

We used a constructivist grounded theory approach to explore the experiences of pregnant and parenting youth during the pandemic and how certain social determinants of health intersected to shape health outcomes and influence their ability to access services. We conducted qualitative interviews using a semi-structured interview guide over Zoom. Using grounded theory principles, we inductively analyzed the data and categorized our findings into themes.

Results

We recruited a total of 50 participants from different regions in Canada. The findings from the interviews were categorized into the following themes: (1) “They bear the burden alone”: Struggles of pregnant and parenting youth, (2) “How will I live the next day?”: Concerns and consequences arising from the pandemic, and (3) “Try to keep your mask on”: Navigating healthcare services while maintaining public health guidelines. Our findings highlight the various challenges encountered by the youth during the pandemic, particularly those associated with financial and economic constraints, lack of accessible health and social services, and increased stress from parenting responsibilities.

Conclusion

Pregnant and parenting youth in Canada encountered various barriers while accessing health and social services, maintaining their well-being, and connecting with reliable sources of support during the pandemic. Our study findings emphasize the urgent need for adaptable and comprehensive support systems explicitly catering to the needs of pregnant and parenting youth during crises, such as the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20705-4.

Background

Pregnant and parenting youth (15–24 years) are a unique and diverse group with particular physical and mental health needs who face several vulnerabilities in promoting their health and well-being. Transitioning from adolescence into emerging adulthood and completing developmental tasks such as identity formation, educational attainment, financial independence, and relationship building while being pregnant or parenting can be challenging [1]. As a result, this group is more vulnerable to adverse mental health outcomes, such as depression, substance use or post-traumatic stress disorders, as they try to cope with the increased responsibilities associated with parenting [2, 3]. Moreover, young mothers are at a higher risk of pregnancy complications (preeclampsia, eclampsia, premature rupture of membranes) and unfavourable neonatal outcomes (low birth weight, preterm birth) [4, 5]. The combined influence of multiple risk factors in this population contributes to their susceptibility to negative outcomes. The importance of addressing the needs of this population to support their and their children’s well-being is emphasized in research and practice. However, the onset of the COVID-19 pandemic disrupted essential services and support that pregnant and parenting youth required.

The COVID-19 pandemic created a global crisis, prompting lockdowns and profoundly impacting communities worldwide. The closure of essential services and implementation of public health pandemic control measures increased the pre-existing challenges (e.g., access to perinatal care, the stigma of early pregnancy) among pregnant and parenting youth who were already vulnerable to adverse outcomes, such as postpartum depression [5, 6]. The pandemic also introduced newer challenges, including the absence of support networks, limited availability of healthcare services, lack of affordable housing, and fewer employment opportunities [6–9]. The loss of employment avenues and social support negatively affected the financial and economic standing of many families, contributing to food insecurity, poverty, and uncertain living conditions among certain populations [7, 10]. These factors triggered anxiety, stress, and mental health issues as families tried to cope with limited resources to provide adequate nutrition and support for their children’s growth and development [6, 8].

With regard to the importance of childhood stages, the first 1000 days (conception to 2 years) are deemed a critical window of opportunity to influence and promote optimal growth and development [11]. Unfortunately, the challenges that the pandemic imposed are expected to have direct and indirect consequences on children’s social, emotional, and psychological development [12, 13]. Emerging research suggests that some of these consequences developed due to maternal mental health status and heightened stress levels, nutritional inadequacy, and loss of family and social engagement [6, 14]. Moreover, the closure of schools, health services, and community services resulted in the deprivation of necessary access to professional and community resources (e.g., childcare, counselling, education), which were critical for capacity building and supporting pregnant and parenting youth and their children [6, 8]. These challenges were intensified for individuals with existing and intersecting vulnerabilities (e.g., low socioeconomic status, visible minority, education status), highlighting the disproportionate impact of the pandemic on certain structurally marginalized populations [6, 12]. Recent literature has examined the effects of the pandemic on pregnant women and their children; however, these impacts are not well explored among pregnant and parenting youth in Canada. Understanding the effects of the pandemic on pregnant and parenting youth’s mental, physical, and social well-being is a crucial step toward informing effective policies, services, supports, and strategies to improve the overall health and well-being of young parents and their children now and to provide lessons learned for future disruptions of the healthcare and social support systems. Therefore, we aimed to investigate the impacts of the COVID-19 pandemic on pregnant and parenting youth and their children’s health in Canada. Our specific objectives were:

1) To understand the wider health (social and structural determinants that directly or indirectly impact health and wellbeing) impacts of the COVID-19 pandemic on pregnant and parenting youth and their children.

2) To understand the impact of public health measures on access to health services and social support services used by pregnant and parenting youth during the COVID-19 pandemic.

Methods

Theoretical framework

The Commission on Social Determinants of Health Conceptual Framework (CSDH) presented by the World Health Organization (WHO) proposes that individuals’ vulnerability and exposure to health-compromising situations vary according to their socioeconomic positions. Factors such as education, employment, race, gender, and living conditions influence individuals’ health outcomes, which are shaped by the socioeconomic and political environment (e.g., pandemic policies) [15]. The perceived impacts of the pandemic on health outcomes have been distributed inequitably among populations, depending on the socioeconomic position of individuals within society and their social determinants of health (SDoH) [16]. We used this framework to understand the wider and long-term impacts of the COVID-19 pandemic on pregnant and parenting youth and their children, including health behaviours, mental health, child health and development, and access to services and social support. The framework includes three core components (Fig. 1) that impact equity in health and well-being: (1) socioeconomic and political context; (2) structural determinants of health inequities; and (3) intermediary determinants of health [15].

Fig. 1.

Commission on social determinants of health conceptual framework [15] (Used with permission)

Study design

We used a social constructivist grounded theory (CGT) approach to develop a rich theoretical understanding of the experiences of pregnant and parenting youth during the pandemic. CGT is a qualitative research methodology that focuses on generating or refining theory through the systematic collection and analysis of data, with an emphasis on the co-construction of knowledge [17]. This approach allowed us to get comprehensive interpretations from the participants’ narratives and analyze how and why various social, economic, personal, and healthcare factors intersected to shape health outcomes amidst the pandemic to refine our understanding of SDoH [17, 18]. In addition to using the CSDH conceptual framework, we referred to the Dahlgren-Whitehead model of health determinants, which illustrates the various layers of influence on an individual’s health [19]. This helped us to undertake an integrated approach to understanding the complexities of health disparities in the presence of multiple influencers and develop knowledge that reflects the significance of addressing these factors to reduce inequities. The knowledge generated through this approach will be utilized in the future development of a pandemic response framework that would provide guidance and assistance to pregnant and parenting youth in navigating future crises.

We conducted individual qualitative interviews with participants to explore the wider impacts of the COVID-19 pandemic. The interview questions included open-ended discussion topics, focusing on issues such as the impact of the COVID-19 pandemic on access to health services, access to social support, mental health support, impact on educational attainment, economic situation, childcare, child health and development, family dynamics, and sources of support. This paper reports on the findings from the qualitative interviews.

Participants and recruitment

We used a two-phase sampling strategy, which started with purposeful sampling to recruit participants from diverse backgrounds, ethnicities, population centres (e.g., rural, urban), genders, socioeconomic status, and provinces/territories in Canada. This was followed by theoretical sampling as we progressed with data collection and identified the gaps in the data to expand our understanding and refine our categories. We utilized a multifaceted community-based recruitment strategy, including social media marketing campaigns (e.g., Facebook, Instagram), posters, approaching community service organizations, and snowball sampling. We recruited participants who were 15–24 years old, were pregnant or parenting during the pandemic, and were living in Canada. We ensured diversity in our sample by including participants from all socioeconomic backgrounds, ethnicities, immigration status, BIPOC (Black, Indigenous, and people of colour) communities, and gender identities.

Data collection

We obtained ethics approval from the University Research Ethics Board and started data collection in December 2022, which concluded in October 2023. After giving an overview of the study, its objectives, risks and benefits, and implications, we obtained informed consent from all the participants. We emphasized experiential knowledge as a primary source of insight, paying attention to both commonality and individual differences within a shared collection of experiences [17, 20]. We collected data through a semi-structured interview guide (supplementary file). The PI (SM), having expertise in qualitative methodology, mentored and trained research assistants (AH, SN) who performed qualitative interviews. Interviews were conducted online via Zoom and lasted for 30–60 min. Interviews were audio-recorded and transcribed verbatim by an external transcriptionist. The research assistants also kept a reflective log to collect field notes and reflective memos to develop codes early in the research process [17].

Data analysis

Utilizing the CSDH framework and grounded theory principles, we adopted an inductive approach to analyze the data. Research assistants (AH, SN) and the coordinator (MA), who were trained by the PI, led the analysis process. First, all the members individually read all the de-identified transcripts and made notes to identify properties of emerging concepts (initial coding). Next, we used qualitative analysis software NVivo 12 to perform focused coding and then organized the codes into batches of similar or related phenomena. Through constant comparison of the developed categories and grounding our analysis in the data, we explored the relationships between the codes and categories and developed preliminary themes (thematic coding) [20]. We discussed the preliminary codebook and themes with the whole team and sought feedback and interpretations from the data to achieve conceptual and semantic congruency. After a discussion of the interpretations and revision of the codebook, we finalized our themes.

Rigour

We aimed to ensure rigour by establishing philosophical coherence, demonstrating clarity of intent, and maintaining integrity within the methodology, processes, and outcomes of the study. The reliability and consistency of the analytic procedures were ensured through a transparent research process [21]. All the researchers in the study had expertise with qualitative research processes and were guided by the PI at each step to guarantee methodological command. To mitigate bias, an inductive analysis method was employed, and multiple researchers (MA, AH, SN) independently reviewed the transcribed interviews and memos. Codes, subcategories, and categories were iteratively discussed until a consensus was reached [22]. We consistently cross-checked emerging concepts with participants’ references to keep our findings grounded in the data. Additionally, we scrutinized the data for alternative interpretations with the whole team, which strengthened our findings.

Results

We recruited a total of 50 pregnant and parenting youth for this study, who were from various geographical locations within Canada. The demographic characteristics of participants are presented in Table 1.

Table 1.

Demographic characteristics of participants (n = 50)

Characteristics	n	%
Gender
Female	42	(84)
Female, Two-Spirit	1	(2)
Male	6	(12)
Transgender	1	(2)
Age
15–17 years	1	(2)
18–19 years	5	(10)
20–21 years	12	(24)
22–24 years	32	(64)
Country of Birth
Canada	43	(86)
Haiti	1	(2)
Kenya	1	(2)
Colombia	1	(2)
Germany	1	(2)
Qatar	1	(2)
United States	1	(2)
India	1	(2)
Place of Residence
Alberta	34	(68)
Ontario	9	(18)
British Columbia	7	(14)
f Population Centre
Urban	45	(90)
Rural	5	(10)
Ethnicity
White (Caucasian)	11	(22)
Indigenous	2	(4)
Black	29	(58)
Japanese	2	(4)
Korean	1	(2)
Latin American	2	(4)
South Asian	2	(4)
Number of Years in Canada
Between 4 to 9 years	2	(4)
10 years or more	8	(16)
Lived in Canada all or most of my life	40	(80)
Current Educational Status
Not attending any educational institution	11	(22)
Grade 11	1	(2)
Grade 12	4	(8)
Post Secondary School (e.g., University)	34	(68)

Key findings

Using the CSDH framework as a conceptual model and integrating the Dahlgren-Whitehead model of health determinants, we identified the influences of SDoH factors (e.g., employment, housing, socioeconomic status) on the health and well-being of pregnant and parenting youth. Through our interviews, we understood how such factors are associated with determining health outcomes, identifying sources of support, and navigating through difficult situations. During the pandemic, pregnant and parenting youth and their children had significant interruptions in economic stability, access to healthcare, social and community support, and educational opportunities. Figure 2 presents the conceptualization of the identified factors through our qualitative interviews in association with the CSDH conceptual framework.

Fig. 2.

SDoH and factors influencing pandemic response and health outcomes among pregnant and parenting youth [15, 19].

We categorized our findings into three broad themes to portray the experiences of pregnant and parenting youth during the COVID-19 pandemic: (1) “They bear the burden alone”: Struggles of pregnant and parenting youth, (2) “How will I live the next day?”: Concerns and consequences arising from the pandemic, and (3) “Try to keep your mask on”: Navigating healthcare services while maintaining public health guidelines. These themes were further divided into sub-themes, which are presented below.

1) “They bear the burden alone”: Struggles of pregnant and parenting youth

As they are a vulnerable group prone to adverse outcomes, we explored the nature of the challenges and struggles that pregnant and parenting youth faced during the COVID-19 pandemic. Some of these challenges were pre-existing but were exacerbated due to the public health measures and resulting disruption to services during the pandemic. Most of the challenges were found to be associated with conceiving a child at an early age, the stigma attached to early life pregnancy, and the abandonment of the child by their partner. Participants also talked about the role of community and social support at such a demanding time.

Stigma and insecurities of early pregnancy

Youth who conceived at an early age expressed feeling judged by others for getting pregnant, including their family, friends, and community. Participants communicated their frustration about the constant remarks and stigma that they encountered:

Stigma, it’s when society looks at you like you are a young mother, and they’re like, “You are supposed to be in school. Why are you pregnant? Yeah, parenting, it’s not of your age”. They look down upon you. (P-07, Female, 23 years)

Along with feeling blamed, participants shared that these remarks and situations made them feel alone in their journey and also led to negative thoughts. Some participants also shared that this stigma was exacerbated during the pandemic as they tried to access services and resources to meet their needs. One participant mentioned socializing with a support group for mothers but not being able to connect with individuals who were in a similar situation:

It feels a little lonely, or sometimes even a little judgey, when you tell other people that you’re a young mom, because they go like, “Oh, was that a mistake?” I’m like, No, right? You know, sometimes it feels lonely. It feels like I’m the one and only one, especially because most of my mom friends are either 27 or 30, 35. (P-06, Female, 22 years)

Moreover, some participants were unable to receive any sort of acceptance from their family, or friends due to their pregnancy. One participant shared how her mother and partner left her on her own to care for a child with no resources and awareness, leading to the development of suicidal ideations:

When my mom learned I was pregnant, she was like, “I’ll throw you out of this house. You go get your own place. Know how you’ll feed your kid.” At some point, I became suicidal, so mentally, physically, socially, I was not okay. Some of my friends didn’t want anything to do with me, so there was the stigma. Many parents do not want their children to associate with you, so I ended up losing so many of my friends. (P-14, Female, 21 years)

Challenges of single parenting

While exploring the experiences of pregnant and parenting youth, we came across participants who were single parents and were raising their children on their own. A few of these participants talked about how their partners did not want to be associated with a child at a young age so they had to raise their child alone:

Well, he didn’t take responsibility at the time. He was like, “You need to abort that kid. I’m not having a kid. I’m young.” We were the same age, so I totally understood his decision. I didn’t get an abortion, so I let him walk away. (P-14, Female, 21 years)

Many participants talked about the unique challenges that youth face while parenting; however, these issues were seen to be much more severe for young people who were parenting alone. The onset of the pandemic marginalized youth from necessary services, leaving them to deal with everything by themselves. One participant talked about dealing with her predicaments (e.g., eviction, unemployment) during the pandemic alone:

Most teenage mothers or young mothers, they bear the burden alone. They take care of the children alone. So, they just need somebody to like tell them, or assure them that it’s going to be okay. (P-08, Female, 19 years)

Before the pandemic, single mothers were able to access other sources of support, such as daycare services and cleaning services, to manage their workload and parenting responsibilities. However, as soon as the pandemic hit, they had to do everything with no help, leaving them no time to focus on themselves:

I was struggling with two kids with nobody in the household with me to assist, my childcare system, I wasn’t able to access it immediately. I needed help. So, I was just going back and forth, and I was really stressed and depressed too, and lonely. (P-01, Female, 20 years)

Importance of social support

Participants in our study stressed upon the importance of having a support network to rely on and seek guidance from. The findings from the interviews highlight the intricate role of social support as a key determinant of health. This was especially true for young mothers, who required assistance and advice on raising their children and promoting their development:

You know, that excitement is still there but you don’t have anyone to help you with that. You also want someone to guide you what you need for baby, because at times, when you’re a new mom, most of the things you cannot know. (P-03, Female, 23 years)

These support networks included family members, grandparents, social circles, and religious or community groups. During the pandemic, some participants still had access to some of these networks; for example, parents and grandparents visited their children often while undertaking all the necessary precautions, or families interacted virtually on Zoom. However, participants who were already estranged from their families before, due to their lack of acceptance of the pregnancy, for instance, experienced additional difficulties navigating through this phase of social isolation:

I didn’t really have help from excess sources, and while my husband was working, I was alone with the baby, with my son. And so, I didn’t have all those extra sources so my mental health dropped a lot during at least the first year of my son’s birth. (P-31, Female, 23 years)

One participant with a physical disability expressed how the loss of social support impacted her well-being and her ability to perform daily activities:

Being a young parent and having this disability together became very challenging. I felt like I was totally helpless. All the care and love I enjoyed from my family and friends who came around to take the child to school, to help in the daily activities, cleaning, were almost eliminated. (P-36, Female, 21 years)

For some participants, their partner became their only source of support, especially when family members or friends were distanced from them. Participants shared how they navigated through this phase with the mutual support of their partner, even when situations got challenging (e.g., unemployment, physical illness). One adolescent talked about how her partner, who was not yet stable in his life, became her only source of support after her family disowned her:

After I had my kid, he [dad] kicked me out, because he felt like I was a disappointment. So I had to move in with my boyfriend at the time, and he was also a kid. He still wasn’t that stable, so now we were in the pandemic, and we have a child that we have to take care of, and so it was just a lot to deal with. (P-35, Female, 18 years)

2) “How will I live the next day?”: Concerns and consequences arising from the pandemic

We explored the direct and indirect impacts of the pandemic on pregnant and parenting youth’s health as well as other aspects of life. Our findings indicate the dynamic interplay of the SDoH factors in determining the health outcomes of individuals. Along with putting a halt on the day-to-day activities of individuals, the pandemic also interrupted the financial, educational, and developmental progress of pregnant and parenting youth and their children.

Financial and economic hardships

The majority of the participants in our study reported that the pandemic negatively affected their family’s financial situation, leading to uncertainty and feelings of hopelessness. Many participants were laid off from their jobs, had to dip into their savings to make ends meet, and also went into a lot of debt: “We had very few money. We had to use savings. We had to also sacrifice some of the luxuries, so it was like living hand to mouth” (P-03, Female, 23 years).

Housing instability exacerbated financial strain and anxiety, intensifying challenges for young parents who were already struggling to maintain a secure environment for their children. One participant also commented that they had to sell some assets and look for affordable housing to be able to manage their expenses:

I had to sell my car because it became so hard to fill it and to move around with it. I also had to move to a cheaper house and a cheaper house to somewhere where it was more convenient for me with my pocket. (P-43, Female, 24 years)

Due to the financial crises and economic constraints, participants had to limit their expenditures for daily living, such as food, to fulfill other responsibilities (e.g., rent and medicines). Some participants reported that they had to utilize food banks and other community resources to counter food insecurity. The lack of quality food and nutrition led to the development of physical health issues for participants and their children:

The pandemic brought a lot of negative impact on the financial sector in our life, in our family. And this led us in a lack of sometimes food, personally I lacked food to give to my kid. (P-07, Female, 23 years)

For youth who had yet to establish financial and economic stability in life, the pandemic gave a serious blow to their livelihood. Being a single parent and taking care of a child, one participant shared her struggles of how she was uncertain if she would survive the next day to take care of her child:

After I lost my job, the main worry was, “How am I going to take care of my baby?” how am I going to live the next day?” I was alone. I got a notice to evict, I had to move out and stay with my grandma and I thought as if I’m being a burden, my baby and I moving in together, staying with her… So, you wake up hoping every day that everything is going to be better, but then it doesn’t change. It didn’t change for a long while, and I thought that maybe that was the last day. (P-08, Female, 19 years)

Mental health and physical well-being, loneliness, and isolation

The effects of the pandemic on the participant’s various sectors of life had severe consequences on their mental health and well-being. The public health restrictions that led families to isolate, children to avoid social encounters, and participants to manage household responsibilities alone resulted in heightened stress, emotional turmoil, and uncertainty about the future. Almost all the participants in our study indicated that their mental health was impacted in some way due to anxiety, fear, and loneliness, which prompted them to seek professional help:

It really threatened our mental health, as in life you cannot survive alone, and loneliness was really killing us, I and my baby, because we didn’t have our family members close to us. We didn’t have our friends, and we couldn’t break the [social distancing] rules. Yeah, so the anxiety and the stress was too much on us. (P-07, Female, 23 years)

Several participants reported that the trauma and psychological distress resulting from the fear of illness, loneliness, isolation measures, and passing of loved ones led to the development of mental health disorders, which impacted their quality of life and caused their children to be affected as well:

I developed a mental health challenge, which a psychiatrist referred to as a personality disorder. The pandemic put me through a lot of mental stress. It also made me worry. It put me in a lot of difficult situations. I thought of a lot of things I didn’t want to think. (P-36, Female, 21 years)

One participant communicated that the pressure and stress resulting from the challenges pushed her to adopt negative coping mechanisms: “The pandemic brought a lot of difficulties, and I resorted to substance use as a way of dealing with those difficulties.” (P-27, Female, 21 years).

Some participants in our study reported that their physical health was also impacted during the pandemic, which was associated with the lack of accessible and timely healthcare services and the ability to reach healthcare facilities. Participants who were pregnant were in a constant state of fear of harm to their child if they ever got infected: “I had a lot of fear that my baby would develop complications, or that I would lose him” (P-13, Female, 19 years). Few participants contracted the virus and had to be hospitalized to manage complications. Participants were also overwhelmed by watching their loved ones in their families and communities fall victim to the disease, which led to further feelings of despair and agony. One participant shared the traumatic experience of her spouse passing away:

I had to be isolated from my husband because he was sick. Then he was later isolated from us. It wasn’t a good one because I had to tell the kids a lot of things…I was down. I cried lots and my kids, they were in bad condition. He was admitted into the hospital. He died in the hospital (P-17, Female, 24 years).

As financial insecurities grew and put a strain on the resources of families, participants reported that they saw the physical impacts of such challenges. Some parents indicated that their children did not get adequate nutrition, which resulted in lower immunity to common illnesses. Few participants indicated that severe food shortage resulted in weight loss and nutritional deficiencies: “Yeah, she had challenges with getting adequate nutrition, like this food insecurity, and it resulted in her emaciating” (P-05, Male, 24 years).

Challenges and opportunities for growth

Participants talked about how the pandemic influenced their personal and professional growth and presented them with opportunities and challenges that impacted their future plans. The pandemic and its associated restrictions limited the opportunities for youth to further their academic and professional growth. The switch to a remote format for educational classes forced some participants to drop out of their program as they were unable to keep up with new formats. The changes in the educational system also affected the performance of children, as parents indicated that the virtual classes did not satisfy the educational needs of children as they did in traditional classrooms: “To some extent, my children were now going down. They were not really that bright anymore” (P-18, Female, 22 years). Another participant indicated:

The tutors couldn’t come home. Holiday lessons, those things were drastically reduced. In fact, they were almost not available. So, it affected my child’s academics negatively. Then for my wife, she had to take more of virtual classes, so she would not go for those virtual classes, but it came as a necessity, so she had to go. She didn’t have any choice and it affected her grade badly then. (P-05, Male, 24 years)

While some participants’ educational prospects were impacted negatively, few of them indicated that the virtual classes helped them balance their household responsibilities and educational workload. One participant highlighted how she was provided with an opportunity to pursue her degree along with being provided with economic support:

The thing is that when I got pregnant I was still in university, and I was working in sales. And what happened was that they said, “You know what? Stay home. We’ll take your classes to you online. You don’t need to go to work. We’re going to give you economic support.” So I was able to stay home, take care of myself, study, earn money, all while not having to leave my house. (P-06, Female, 22 years)

Apart from the impact on personal growth, we found that the pandemic had profound impacts on the dynamics within families. Some participants reported that the challenges created conflicts within families concerning managing finances or dealing with sudden situations while others emphasized the positive influences that they generated. One participant indicated that the restrictions helped her family to get closer and strengthened their relationship:

It really brought closeness, a lot of closeness to me and my family. I’m not saying that pandemic is the best, but the truth remains that the pandemic helped me to reunite with my family again. I was able to bring that closeness back, that closeness that was not there for a very long time, but pandemic helped me to go back to my family and the bond became stronger again. (P-29, Female, 20 years)

Attending to children’s needs, health, and development

We explored the impact of the pandemic on pregnant and parenting youth’s children and how their challenges influenced the outcomes for their children. Participants who gave birth during the pandemic expressed that their child spent the early years in lockdowns, away from any kind of social interaction. The results of such limited social interactions were observable in their developmental milestones (e.g., delayed speech, interacting with others). In some cases, the impact was not obvious until the restrictions eased, and parents were able to send their children to daycare, after which they observed a remarkable improvement in their development:

He stayed home with me for his first year and a half of life, and then when we finally were able to like start daycare I’ve noticed a change. He’s now two and he talks so much now, and before, he was having speech delays. Once he was able to finally start daycare, get to know people, socialize, then he just like skyrocketed. (P-06, Female, 22 years)

While some children were able to catch on to their developmental milestones, other parents reported that limited social interactions and isolation during the early years had lasting effects on their child’s ability to interact with others or make friends. This was especially true for parents who were alone and had limited to no family support:

I keep on thinking maybe if the pandemic was not there, there was no lockdown or isolation maybe she would have grown to have friends or something. Because right now my daughter doesn’t talk to everyone. She’s learning how to talk but she can’t even say hi to anyone. Like I feel like her world revolves around me. I’m the only person she has known, ever since she was young. (P-14, Female, 21 years)

The restrictions of the pandemic and the resultant isolation and loneliness significantly affected the mental health and well-being of children. With the inability to go outside and engage in play, the personality of children altered from being social to being isolated: “Before the pandemic, he was a very active boy, very social, very talkative. He could meet with others, play with the toys together” (P-01, Female, 20 years). Moreover, parents found it difficult to explain the restrictions to their children as they were unable to process and understand why they were not allowed to do their routine activities:

It affected them badly because they’ve never been used to being caged around the house, not going anywhere, not talking to a friend. At first it was very difficult for me to see how I could convince them; tell them this was happening. It’s every day, “Mom, are we going out today? Mom, are we not going to see a movie? Mom, are we now going to play football?” It was so difficult for me to try to make them see that this was happening in the world. (P-22, Female, 23 years)

Parents highlighted that as they tried to protect their children from potential exposure to the virus and limited their activities, it generated feelings of resentment in their children. Incapable of understanding the reasoning behind the measures, children became agitated and rebellious toward their parents as they thought their parents did not want them to have fun and that they were the reason for their loneliness:

My child started becoming antagonistic. He felt like he wasn’t loved. He felt a lot of sadness, and he hated me so much. But he didn’t know I was just trying to protect him from the harm of the pandemic. (P-27, Female, 21 years)

3) “Try to keep your mask on”: Navigating healthcare services while maintaining public health guidelines

The healthcare structure changed drastically during the pandemic to maintain public health restrictions and prevent the spread of the virus. In response to the urgent pandemic needs, the healthcare system became difficult to access for other routine concerns (e.g., perinatal care, delivery), which exacerbated existing disparities within populations. We explored participants’ views on access to healthcare services and their challenges while navigating the system during the pandemic. While dealing with public restrictions during her delivery, one participant voiced her personal healthcare experience:

I was already struggling breathing, obviously. I have a big baby coming out of me. And they were like, “Yeah, try to keep your mask on.” I’m like, “No, dude, I don’t want to. I can’t breathe.” They were judgey in that sense (P-06, Female, 22 years).

Difficulty in accessing healthcare

Most of the participants in our study reported that they encountered barriers to accessing quality and timely healthcare services (e.g., post-natal care and childbirth). This was of particular concern to pregnant youth, who had to get regular screenings and antenatal visits. Few participants expressed that due to the fear and anxiety of healthcare environments, they never visited healthcare professionals and instead gave birth at home. Other participants expressed their dissatisfaction with the healthcare services as they were not allowed to bring their partner with them to regular appointments, with many feeling frustrated as they had to give birth alone and their partner missing major life events (e.g., birthing, hearing heartbeat on ultrasound):

During the delivery of the baby, he was not even allowed to see me or see the baby until a certain time reached when the doctor told him that he can now come and see us. (P-07, Female, 23 years)

Another participant expressed similar grievances as they were pregnant for the first time:

The only time that I started having to go see a physician was when I found out I was pregnant, and for my OB checkups I wasn’t allowed to bring my spouse with me, which was very upsetting, because it’s our first child. It’s my first child (P-23, Female, 22 years).

As participants dealt with restrictions, they encountered several challenges in reaching healthcare services. If there was an urgent need to visit a healthcare provider, participants indicated that they had to wait for a long time to be able to secure an in-person appointment. Moreover, they had to navigate through different facilities as some were not accepting patients, whereas others diverted their operations:

Most of the health centres which were near, some were closed, and some were far from here to get the services, so affording transport was a problem, and also going with the baby, still it was a big challenge. (P-28, Female, 20 years)

Many participants also expressed their discontentment with not getting the services or the provider that they had access to before the pandemic. They were uncomfortable with accessing new providers and services that they were not familiar with, which further contributed to the stress associated with visiting a healthcare facility in the middle of a deadly pandemic. Additionally, several participants shared their exasperation with delayed appointments, communication barriers, and fluctuations in medical care availability for prenatal, postnatal, and pediatric appointments. One participant highlighted the shared struggle faced by many during this period:

Because of the lockdown, we couldn’t actually get to a hospital you wanted to go to. So majorly, you just have to go to any hospital around you. Like you’re not comfortable with the services, but you do not have a choice, because that is the only option you have at the moment. So, I feel like it really did affect the services she [pregnant partner] was getting after that. (P-15, Female, 22 years)

Remote consultations, restrictions, and unmet needs

As the pandemic progressed, healthcare services adapted to continue to provide services to populations through online consultations, virtual appointments, and telehealth services. Participants reported that they accessed mental health services, routine follow-ups, and child health services virtually. Although participants appreciated that the healthcare systems were adapting to meet their needs, they were still skeptical about the effectiveness and quality of these virtual services. They highlighted the gaps in virtual services, especially when there was a need for a physical examination. Instead, they had to perform these examinations on themselves while virtually interacting with a provider (e.g., checking pulse, or examining a child). One participant indicated:

Your healthcare provider had to see you physically, to see if maybe there are some tests to run, and there are some, you know, some examinations to be carried on, but virtually there was no such things like that (P-18, Female, 22 years).

Participants who used virtual services for mental health sessions or counselling expressed that they did not feel comfortable interacting with a healthcare provider in a virtual capacity, as they were not sure about their confidentiality. Moreover, participants also communicated that meeting with a provider virtually for mental health needs did not feel appropriate as mental health concerns are best discussed with a therapist in person:

The platforms with which these services were provided, Zoom, Google Meet, I felt like they didn’t protect my privacy. I felt like I should be in closed doors with my therapist, where I could tell my therapist whatever I needed to tell him, without someone, you know, overhearing us (P-36, Female, 21 years).

This issue was also significant for children, as many parents shared that children were unable to communicate effectively with providers virtually. Many parents were unable to secure the necessary in-person services for their children to attend to their needs (e.g., respiratory illnesses, developmental services). They also highlighted the crucial role of pediatricians and health professionals who are proficient in understanding the needs of children but are limited in what they can do for their children virtually:

Children can’t really express themselves with respect to how they feel inside of them. You need to take a pediatrician who is well skilled in his job to cross examine a child and to ask questions and examine the child to know if there is any healthcare challenge by the behaviours displayed by these children. So the COVID-19 pandemic really created a bigger gap between pediatricians and these children, and trust me, putting these children into these virtual meetings with pediatricians wasn’t good enough to get them the adequate treatment and healthcare they needed. (P-05, Male, 24 years).

Although the virtual services provided opportunities for continuity of care and access to services for most participants, access was not possible or challenging for participants with limited access to technology. This highlights the impact of certain social determinants (e.g., socioeconomic status, living conditions, employment) that increase disparities and prevent certain populations from accessing services to meet their needs. One participant highlighted her struggle to secure prenatal care and include her partner in her care:

I couldn’t go to any prenatal birthing classes, because they were all online, and we don’t have a computer. So that was really, really hard. We wanted both of us to go to appointments all the appointments together as a form of bonding with our son. He wasn’t allowed to go to the ultrasound appointments, which made it sad, because the first time he heard the heartbeat was when I was 24 weeks [gestation] and I had to go to the hospital due to a scare. (P-31, Female, 23 years)

This highlights the disparities in service access due to technological divides, especially for young parents from lower socioeconomic backgrounds.

Discussion

Our study explores the direct and indirect impacts of the COVID-19 pandemic on pregnant and parenting youth and their children in association with their SDoH. Applying the CSDH conceptual framework and through the lens of the Dahlgren-Whitehead model, our findings highlight how certain factors in our study population influenced their health (physical, mental, emotional) outcomes, their access to services, and their response to the pandemic (Fig. 2), considering the unique role of intermediary determinants, social capital and cohesion, and structural determinants of health inequities [15]. Moreover, our findings underline the positive and negative influence of the pandemic on the educational attainment, growth, and development of children, as well as the financial and economic disparities within this group.

Youth in our study faced several challenges as they tried to navigate their daily life with parenting responsibilities and COVID-19 restrictions. Many participants in our study who were pregnant or gave birth during the pandemic reported significant challenges to maintaining their quality of life standards, accessing healthcare resources, and promoting their and their children’s optimal development. These challenges were directly related to their age (young parents), degree of social support (e.g., single parent) during the pandemic, status of financial and economic stability, and reach to services and resources (e.g., community support), which also aligns with other studies [6, 23, 24]. Young parents, especially single mothers, have encountered reduced availability of social support structures during the pandemic, resulting in increased stress levels arising from balancing multiple responsibilities with impacts near term and long term for their children [6, 23]. First-time expectant mothers and single parents expressed their concerns and insecurities about early pregnancy, experiencing increased stigma during the pandemic, and the feeling of being ill-prepared to care for a newborn. With many in-person services (e.g., perinatal classes, birthing classes) unavailable during the pandemic, stress, anxiety, and excessive worrying were highly prevalent among our participants. These findings are consistent with studies conducted with pregnant youth reporting heightened levels of anxiety, stress, and uncertainty regarding pregnancy outcomes during the pandemic [12, 24]. This also led to the development of mental health disorders, such as substance use and personality disorders, among youth in our study.

Our study participants reported that their mental health was negatively impacted during the pandemic, with many individuals feeling depressed, isolated, and constantly anxious. In addition to the pandemic and its restrictions, these outcomes were also associated with their financial, economic, and living situation, employment status, and family dynamics. Many studies have documented the financial and economic impact of the pandemic on families, with individuals seeking alternative forms of income (e.g., remote work), cutting back on expenses, and changing their lifestyles [25, 26]. Participants in our study expressed having to limit their expenditures on essential items, such as quality food, which contributed to nutritional problems and physical health challenges for some participants and their children. These impacts were more pronounced among youth who were not financially secure (e.g., unemployed, estranged from family, lower socioeconomic status), highlighting the intricate relationship between social determinants and health inequities [6, 15].

The direct and indirect impacts of the pandemic and its associated challenges were reflected in the growth and development of children. Maternal stress and limited social stimulus during the pandemic caused delayed developmental milestones among infants [13, 14, 27]. Our study echoed similar findings as children remained in social isolation during the early years of life, and parents reported the impacts of these measures on their developmental outcomes. The restrictions on social interactions, outdoor activities, and schooling negatively impacted the emotional, mental, and psychological health of older children. As a result of these restrictions, many parents also highlighted changes in their child’s personality and behaviour (e.g., more irritable and anxious). Furthermore, the shift from traditional schooling to online learning impacted children’s academic performance and reduced opportunities for positive learning environments [28], which was also reflected in our findings.

Pregnant and parenting youth reported severe disruptions in their access to healthcare services, precipitated by the closure of many healthcare facilities, unavailability of care providers, lack of transportation measures, communication barriers, and the switch to remote consultations. Participants expressed their disappointment with having to attend antenatal appointments alone and their partner missing out on important life events, such as childbirth. This finding is corroborated by other studies, where young mothers were overwhelmed with attending checkups alone, and partners felt excluded and concerned due to a lack of information [12, 24]. The delays in securing appointments and providers of choice, along with reduced quality of care and fear of the virus, resulted in some participants choosing to give birth at home [29]. The healthcare system adapted to provide virtual services for pre-natal, antenatal, post-natal care, and mental health services; however, pregnant or parenting individuals did not find these services comparable to face-to-face care services [12]. Moreover, participants in our study indicated that remote consultations were not ideal for children who have complex needs or for individuals who have limited access to technology. This creates further challenges and disparities and distances individuals with limited resources and capabilities from the healthcare system. Further research is necessary to evaluate how certain socioeconomic groups can benefit from the changes to the healthcare system during crises like the COVID-19 pandemic.

Implications

The findings of this qualitative constructivist grounded theory study highlight the multifaceted impacts of the COVID-19 pandemic on pregnant and parenting youth in Canada, revealing important health impacts (physical, mental, social) as well as educational and financial challenges. Addressing the significant disruption to essential health services for pregnant youth, participants highlighted the need for continued access to health services, especially at a vulnerable and physically demanding time. For example, one participant shared her struggle to secure prenatal care and the difficulty of involving her partner in appointments, as restrictions prevented him from attending ultrasounds and other significant moments (P-31) ​. These experiences reinforce the need to develop best-practice guidelines that facilitate virtual and in-person options tailored to the unique needs of pregnant and parenting youth.

The health of pregnant individuals can deteriorate suddenly and in the absence of adequate resources, they can face severe negative consequences. The healthcare system while adapting to respond to emergencies also needs to develop guidelines to effectively address the needs of pregnant and parenting youth to ensure that care (e.g., perinatal, post-natal, pediatric) is uninterrupted while providing them with evidence-based resources to navigate such situations [30, 31]. This also requires continued support and funding for services and institutions that cater to youth so that they can perform to their optimal capacity. Moreover, participants in our study emphasized the need for enhanced and accessible mental health support for them and their children during the pandemic as stress, anxiety, and emotional distress were widespread. The lack of accessible mental health services profoundly impacted many participants, with remote options often proving inadequate for discussing sensitive issues. One participant expressed discomfort with virtual counselling due to privacy concerns, illustrating the critical need for mental health services that respect confidentiality and offer in-person options when feasible (P-36)​. By addressing such gaps through comprehensive policies, healthcare providers can better support youth who experience elevated anxiety, stress, and isolation during challenging times. These services need to consider the unique mental health concerns of pregnant and parenting youth and their children and develop interventions that would translate well with this demographic.

The influence of SDoH factors on access to such services also needs to be evaluated and future efforts should focus on how to minimize the influence of such factors on healthcare access, target marginalized populations and guarantee continued access to services during crises [32]. These measures are essential not only for mitigating the immediate impacts of the pandemic but also for fostering long-term resilience and well-being among pregnant and parenting youth and their children, and learning how best to support these populations for future disruptions. The findings from this study will inform the development of a knowledge translation toolkit for pregnant and parenting youth while offering a foundation for informed policy development and the implementation of comprehensive support systems that align with Sustainable Development Goals. This toolkit will help young parents support their children’s growth and development in future public health emergencies.

Strengths and limitations

The constructivist grounded theory approach provides a deep and comprehensive understanding of complex social phenomena, particularly evident in its exploration of the experiences of pregnant and parenting youth amidst the pandemic. By integrating the CSDH framework, this approach not only enriches the study’s theoretical foundations but also widens the scope of analysis to consider a broader range of contextual factors influencing health outcomes. Additionally, the in-depth individual interviews conducted as part of the study methodology provide a detailed and nuanced exploration of the participants’ personal experiences, offering valuable insights for policy and program development in this area.

However, our study also had certain limitations. First, our study’s sample size of 50 participants, though sufficient to achieve theoretical saturation, may not have fully captured the diversity of experiences across Canada, particularly among Indigenous populations and individuals living in remote areas. Although we aimed to recruit individuals from diverse backgrounds, the majority of participants were from urban areas (90%), which may limit the generalizability of our findings to specific contexts and underrepresent the narratives of individuals from rural communities. Our focus on a specific age group (15–24 years) may also limit the generalizability of the findings to wider populations, and the reliance on self-reported data inherent in qualitative research might introduce subjectivity and potential biases in participants’ responses. Most participants in our study were over the age of 20 years (older young parents) which may have constricted the portrayal of experiences and challenges to that group. Also, we did not collect numerical data on the household income bracket of all the participants; it might have been beneficial to link the qualitative experiences of the participants with their reported income or financial status. Furthermore, our study primarily captures a snapshot of the experiences during the pandemic, potentially overlooking the longitudinal effects and the evolving nature of these impacts. Future research using a longitudinal approach can be conducted, which would allow researchers to examine how individuals’ experiences and health outcomes change over specific stages of the pandemic. Lastly, as the interviews were conducted on Zoom, it may have led to some participants feeling hesitant to share their experiences and for interviewers to not effectively comprehend non-verbal cues. Despite these challenges, the study’s inclusive participant selection, the depth of individual experiences, and interviewing strategies (empathy, active listening) contribute significantly to understanding the multifaceted effects of the COVID-19 pandemic on pregnant and parenting youth in Canada, providing essential insights for future interventions and policy formulation.

Conclusion

The COVID-19 pandemic significantly affected the lives of pregnant and parenting youth and their children in Canada, exerting profound impacts on their physical, mental, and social well-being. With the loss of support networks, accessible healthcare and childcare services, financial and economic constraints, and reduced opportunities to enhance development, participants encountered several challenges in fulfilling their parenting responsibilities and promoting their and their children’s health and well-being. Limited social interactions, isolation, and emotional turmoil not only affected the mental health of youth but also impacted their children, leading to heightened anxiety, stress, and behavioural issues. The healthcare needs of pregnant and parenting youth remained the same; however, resources and services to meet those needs were insufficient or unavailable during the pandemic. These needs were directly associated with their SDoH, and such factors gave rise to the health inequities and disparities that youth encountered. It is necessary to address the unique needs of this population equitably, especially during public health crises like the pandemic, and provide them with adequate resources (e.g., mental health support and employment avenues) to improve their well-being, build their resilience, and further their advancement and development.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

S.M. conceived this study, A.H., M.A., S.N. conducted the interviews and performed data analysis, A.I.R., M.A., A.H., S.N., S.M. developed the first draft of the manuscript. All authors (S.M., A.I.R., M.A., A.H., S.N., S.L., S.Munro, C.A., Z.S.L., A.V., H.S., W.V.N.) contributed to the development of the manuscript and commented on all drafts of the manuscript.

Funding

This work was supported by the Canadian Institute of Health Research (CIHR) grant (Project ID: RES0057209).

Data availability

The datasets and materials used in this study are available upon request from the corresponding author.

Declarations

Ethics approval and consent to participate

Ethics approval was obtained from the University of Alberta Health Research Ethics Board (Pro00118543). Informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.