Health Workers’ Perspectives on the Availability, Accessibility and Quality of Maternal Health Services for Adolescent Girls in Chiredzi District, Zimbabwe: A Cross-Sectional Study

Abstract

Background:

Adolescents in Africa are experiencing a significant epidemiological shift, characterised by earlier sexual debut and delayed marriage, leading to a longer period of sexual activity outside of marriage. In Chiredzi district, Zimbabwe, this often results in adolescent girls facing pregnancies without adequate access to tailored maternal health services.

Objectives:

This study aimed to gather quantitative data from health workers on the availability, accessibility and quality of adolescent maternal health services in Chiredzi district.

Design:

This study employed a quantitative, cross-sectional study.

Methods:

An exploratory study was conducted at Chiredzi General Hospital’s maternity ward, involving all 90 healthcare workers via census sampling. Participants completed a structured, pre-tested questionnaire uploaded to Kobo Collect. A pre-test was conducted on 10% (n = 9) of the sample size. Data analysis involved cross-tabulations and inferential statistics performed in Statistical Package for Social Sciences (SPSS).

Results:

All 90 targeted health workers completed the questionnaire, offering valuable insights into the challenges faced by adolescent mothers at the hospital. Key findings revealed that over half (53.3%) of facilities lacked specific protocols for pregnant adolescents. A significant gender disparity in training was found, with 70% of female staff receiving adolescent service training compared to only 42% of male staff (p = 0.008). Furthermore, a high proportion of ‘Not sure’ responses (up to 50%) regarding available services indicated critical gaps in staff awareness and communication.

Conclusion:

The study underscores the critical need for standardised adolescent-friendly protocols, mandatory and equitable staff training, and the implementation of mobile health services to improve care for adolescent mothers. Investment in these areas is essential to improve health outcomes.

Plain language summary

Understanding the challenges young pregnant girls face in getting healthcare in Chiredzi, Zimbabwe

This study, which surveyed the healthcare workers at a district hospital in Chiredzi, Zimbabwe, uncovered critical gaps in maternal care for pregnant adolescents. The researchers found a system lacking standardized guidelines for teenage mothers, inconsistent and unequal staff training, and widespread awareness among staff about available services. The healthcare workers identified stigma, cost, distance, and long waiting times as major barriers preventing young mothers from seeking care. To address this, they strongly recommended creating clear, adolescent-friendly protocols, ensuring all staff receive mandatory training, and most importantly, bringing care directly to communities through mobile health services to overcome access and financial barriers, thereby improving health outcomes for vulnerable young mothers and their babies.

Introduction

Adolescence is a dynamic and transformative phase of life, spanning from 10 to 19 years old, marked by profound physical, emotional and social changes. During this period, young people progress from childhood to adulthood, exploring their identities and forming new relationships. ¹ Globally, many adolescents are entering into sexual relationships at a younger age while delaying marriage. ² This means that they are spending a longer period of time navigating their sexuality and relationships outside of the traditional boundary of marriage. These changes mark a departure from the norms of previous generations, where marriage and sexual debut often occurred closer together. ²

The adolescent years are a transformative and pivotal stage of life, marked by a profound journey from childhood to adulthood, and during this period, young people undergo a kaleidoscope of changes that shape their identity, relationships and future. ¹ This period of transformation is multi-faceted, encompassing rapid physical growth, emerging sexuality, shifting psychological landscapes and evolving social connections. ¹ Teenage pregnancy poses significant health risks to both young mothers and their babies, increasing the likelihood of premature birth, low birth weight and life-threatening complications. ³ The debate continues as to whether the health challenges faced by adolescent mothers are primarily driven by their biological immaturity or are instead exacerbated by the socioeconomic inequalities and healthcare disparities that many of them experience. ³ Globally, adolescent pregnancy is a pressing health crisis, claiming far too many young lives and putting countless others at risk of serious health complications, disrupting their futures and well-being. ⁴ Every year, millions of adolescent girls worldwide, approximately one in five, become mothers before the age of 18, forever altering their childhood and futures. ⁵ In sub-Saharan Africa, a devastating reality unfolds as nearly one-third of adolescent girls face the life-altering consequences of pregnancy before reaching their 18th birthday. ¹ Despite global efforts to improve care, millions of adolescent girls continue to give birth in vulnerable and often life-threatening conditions, with a staggering 75% of deliveries taking place outside of formal healthcare settings, far from the safety and expertise of medical professionals. ¹

Ensuring marginalised women receive high-quality maternal care is crucial to saving lives and achieving the ambitious goal of fewer than 70 maternal deaths per 100,000 live births by 2030. ¹ Rural Zimbabwe, particularly the Chiredzi district, faces alarming maternal health challenges. Adolescent pregnancy is rampant, with 104 births per 1000 girls aged 15–19, and a staggering maternal mortality rate of 443 deaths per 100,000 live births. ⁶ Despite these grim statistics, there is a glaring lack of research and services tailored to adolescent girls’ maternal needs. As a result, many young girls are forced to navigate early pregnancies without adequate support, perpetuating a cycle of risk and vulnerability. ⁶

Despite various initiatives aimed at improving maternal health services, family planning and human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention, adolescent pregnancies remain a persistent challenge in Chiredzi district. Recent data reveal that 20% of deliveries between 2021 and 2024 involved adolescent mothers, putting them at heightened risk of morbidity and mortality. ⁶ Adolescent pregnancies have severe and far-reaching consequences, including high maternal mortality rates, reproductive health complications and socioeconomic challenges such as forced school dropout and community stigma. ⁶

This study employed a quantitative, exploratory design to gather health workers’ perspectives on the availability, accessibility and quality of maternal health services for adolescent girls. The specific objectives are (1) to assess the availability of adolescent-specific protocols and staff training; (2) to identify the key barriers and facilitators faced by adolescent mothers when accessing maternal health services and (3) to evaluate the perceived quality of existing maternal health services for adolescent girls. Achieving these objectives will generate evidence to inform targeted interventions and policy decisions to improve maternal health outcomes for this vulnerable group.

Methods

Study setting

The study was conducted in Masvingo Province, specifically in Chiredzi district. The district borders Chipinge, Mwenezi and Masvingo districts. With a population of 275,311 and a median age of 19, the district is primarily inhabited by the Shangani people, who have distinct cultural practices. These practices, including initiation ceremonies, which are traditional rites of passage that often instruct adolescents on adult roles, sexuality and marital responsibilities, may contribute to early sexual activity among adolescents. Despite having 23 health centres, Chiredzi faces concerning maternal and adolescent issues, including high mortality, fertility and unmet family planning needs, highlighting the significant impact of cultural factors on sexual and reproductive health. ⁶ The study map is shown in Figure 1.

Figure 1.

Study area map – Chiredzi district, Zimbabwe.

Study design

This study employed a quantitative, exploratory design to gather health workers’ perspectives on the availability, accessibility and quality of maternal health services for adolescent girls. The study was conducted from August 2024 to June 2025. After a 6-month preparation phase for protocol and tool development, data collection began in March 2025 following ethical approval (NUST/IRB/2025/38). The goal of quantitative research is to use numerical data to reveal statistical associations, forecast future outcomes and develop evidence-based generalisations, thereby illuminating theoretical structures and pragmatic applications. ⁷ Quantitative methods helped in measuring the frequency and patterns of maternal healthcare service utilisation, accessibility and quality. Quantitative data were used to describe marital status, education level, occupation, income, residence, and identify correlations and associations between socio-demographic characteristics, maternal healthcare utilisation, accessibility and quality. This was done through the collection and statistical analysis of numerical data. This research seeks to inform evidence-based practices and policy decisions. The reporting of this study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies (see Supplemental File 1). ⁸

Target population

The study population consisted of nurses and midwives with more than 6 months of working experience at the hospital. The inclusion criteria were (1) being a nurse or midwife, (2) employed at the maternity department of Chiredzi General Hospital and (3) having more than 6 months of work experience at the facility. The exclusion criterion was having less than 6 months of experience at the hospital. The hospital has 40 midwives and 50 nurses who are currently working in the maternity department. It is important to note that the study captures the perspectives of healthcare providers and does not include the direct experiences of adolescent mothers, which is alimitation discussed in the limitations and strengths section.

Sampling of participants

Since the total population of healthcare workers in the maternity department is small (90), census sampling was used, where every individual in the population was included in the study. Census sampling ensures that all healthcare workers’ perspectives are captured, providing a comprehensive understanding of their experiences and opinions. Including every individual, census sampling eliminates sampling bias, ensuring the results are representative of the entire population. ⁹ Census sampling provides an accurate representation of the population, as every individual has an equal chance of participating. ¹⁰

Data collection tool

For this research, the researcher designed a questionnaire based on a review of relevant literature. The instrument contained 17 items across six key thematic sections: socio-demographic information, available maternal health services, staff training and capacity, quality assurance mechanisms, barriers and facilitators to care, and recommendations. It utilised a mix of question formats, including multiple-choice, Likert scales (e.g. a 5-point scale from ‘Not Effective’ to ‘Very Effective’ for quality assurance) and open-ended questions. The questionnaire was uploaded to Kobo Collect and was mobile-friendly. All the 90 health workers who work at the maternity ward participated. The full questionnaire is provided in Supplemental File 2.

Validity and reliability

The study, including data collection tools, was approved by the University of Science and Technology’s Institutional Review Board (IRB; see Supplemental File 3). Furthermore, written informed consent was obtained from all participating health workers (Supplemental File 4). To ensure content validity, the questionnaire was reviewed by a panel of three experts in public health and maternal care. A pre-test was conducted on 10% of the sample size (nine health workers from a different but comparable facility) using Kobo Collect, in which potential issues and challenges in the administration of the data collection tools were identified, and adjustments and fine-tuning were done, ensuring seamless data collection and minimising the risk of incomplete or missing data.

Data management and analysis

Data collected from the study were presented using tables, graphs and pie charts. Data collected through questionnaires was meticulously managed to ensure accuracy, completeness and confidentiality. Furthermore, these data were automatically uploaded to the Kobo Collect server. Daily backups were performed to prevent data loss. Data cleaning was done, which included reviewing questionnaires for completeness and consistency, and verifying transcripts for accuracy.

Statistical analysis

The cleaned data were then analysed using the Statistical Package for Social Sciences (SPSS) version 28.0 (IBM Corp., Armonk, NY, USA). Statistical analysis included descriptive statistics (frequencies and cross-tabulations) as well as inferential statistics (chi-square tests and logistic regression), which were conducted to elucidate the relationship between variables. Descriptive statistics were used to summarise the socio-demographic characteristics of the participants and their responses regarding service availability, barriers and facilitators. These results are presented in tables and figures. For inferential statistics, cross-tabulations were generated to explore relationships between categorical variables. The chi-square test of independence was used to determine whether there were statistically significant associations between demographic factors (such as sex, age and years of experience) and key outcome variables (such as staff training status). Additionally, the chi-square test was applied to assess the relationship between staff training and the perceived effectiveness of different quality assurance mechanisms (regular supervision, peer review and patient feedback).

To quantify the strength and direction of significant associations identified in the cross-tabulations, binary logistic regression analyses were performed. Odds ratios (ORs) along with their 95% confidence intervals (CIs) were calculated. For instance, logistic regression was used to model the odds of not having received training based on the sex of the healthcare worker, controlling for other variables. A p value of less than 0.05 (p < 0.05) was considered statistically significant for all tests.

Results

Demographics

All 90 targeted health workers participated, resulting in a 100% response rate. The sample of 90 respondents demonstrates a fair distribution of younger and middle-aged people, with 18% (n = 16) of the population over 50 and 32% (n = 29) of the population between 40 and 50. Of the participants, only 18% (n = 16) are above 50, with the bulk being 50 or younger. The dataset reveals a slight majority of males (56%, n = 50) compared to females (44%, n = 40). The dataset is evenly split between Certificate holders (50.0%, n = 45) and Diploma holders (50.0%, n = 45). See Tables 1 and 2.

Table 1.

Socio-demographic characteristics of participating healthcare workers (N = 90) at Chiredzi General Hospital, Zimbabwe.

Socio-demographic characteristic	Frequency (N)	Percentage (%)
Age
30–40	27	30
40–50	29	32
Above 50	16	18
Below 30	18	20
Level of education
Certificate	45	50
Diploma	45	50
Sex
Males	50	56
Female	40	44
Experience
Less than 5 years	20	22
5–10 years	24	27
10–20 years	25	28
More than 20 years	21	23
Total	90	100

Table 2.

Availability of specific protocols for pregnant adolescents among healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Protocols for pregnant adolescents	Frequency	Percent	Cumulative percent
No	48	53.3	53.3
Yes	42	46.7	100
Total	90	100

Maternal health services

Figure 2 presents health workers’ perceptions of available services. The most frequently reported available services were delivery services (reported by 98%, n = 88), followed by postnatal care (96%, n = 86) and prenatal care (94%, n = 85). HIV/STI testing was available according to 91% (n = 82) of respondents. However, specific adolescent-friendly services, such as dedicated counselling (reported by 45%, n = 41) and peer education programmes (32%, n = 29), were less commonly available. The survey reveals a high demand for delivery services, breastfeeding support, STI/HIV testing and treatment, postnatal and prenatal care, family planning and nutrition counselling. Delivery services are a top priority, with skilled birth attendants, maternity wards and emergency obstetric care being essential. Breastfeeding support is also a significant need, with respondents seeking lactation consultants, breastfeeding education and support groups. Sexual health services are also important, with a significant interest in screening, treatment programmes and educational campaigns. Prenatal care is also crucial, with more prenatal check-ups, postpartum recovery programmes and maternal mental health support needed. Family planning is a priority, with access to birth control methods, counselling and awareness programmes. Nutrition counselling is important but less prioritised, suggesting integrating it into prenatal and postnatal programmes could improve maternal and child health (see Figure 2).

Figure 2.

Health workers’ perceptions of available maternal health services for adolescent girls at Chiredzi General Hospital (N = 90).

Barriers and facilitators to accessing maternal health services

Protocols in place

The majority of respondents, 48 out of 90 (53.3%), reported no specific protocols for pregnant adolescents available, while 46.7% (42 out of 90) acknowledged existing protocols in place.

Staff training on youth-friendly adolescent service provision

The majority of healthcare staff have received training on adolescent services, with 54.4% (n = 49) having received it, but a significant gap of 45.6% (n = 41) has not (see Table 3). This indicates a lack of consistency in training implementation at Chiredzi Hospital, potentially impacting the quality of adolescent care and service provision.

Table 3.

Association between demographic characteristics and staff training on adolescent services among healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Demographics	Staff training on adolescent services		Total	Chi-square	Odds ratio (OR)	95% CI	p Value
	No	Yes
Sex
Female	12	28	40	0.008*	***	***	***
Male	29	21	50		3.031	1.179–7.796	0.021
Total	41	49	90
Years in maternity department
10–20 years	9	16	25	0.243	***	***	0.235
5–10 years	15	9	24		1.122	0.308–4.084	0.861
Less than 5 years	9	11	20		0.317	0.085–1.189	0.089
More than 20 years	8	13	21		0.775	0.207–2.896	0.704
Total	41	49	90
Age
25–30	8	10	18	0.784	***	***	0.947
31–35	5	11	16		1.103	0.259–4.692	0.894
36–40	5	6	11		1.808	0.362–9.039	0.471
41–45	7	6	13		1.244	0.233–6.654	0.798
46–50	9	7	16		0.756	0.158–3.625	0.727
51+	7	9	16		0.918	0.192–4.394	0.914
Total	41	49	90

^***Represents Comparison Group.

Sex and staff training

A statistically significant association was found between Sex and Staff Training on Adolescent Services (chi-square = 0.008, p < 0.05). A significantly higher proportion of female staff (70%, 28/40) had received training compared to male staff (42%, 21/50). The OR for males was 3.031 (95% CI: 1.179–7.796) with a significant p value = 0.021, suggesting that male staff had three times the odds of not having received training compared to female staff. This shows that there is a significant gender disparity in training at Chiredzi Hospital, with female staff more likely to be trained on adolescent services.

Years in the maternity department and staff training

No significant association was observed between years in the maternity department and staff training (chi-square = 0.243, p = 0.235). ORs for all experience groups had wide confidence intervals that include 1 and were not statistically significant, for example, less than 5 years’ experience: OR = 0.317 (95% CI: 0.085–1.189, p = 0.089). However, while not significant, participants with less than 5 years and those with more than 20 years of experience appeared slightly more likely to have been trained. This shows that years of experience in the maternity department do not significantly influence training status.

Age and staff training

No significant association between age groups and staff training (chi-square = 0.784, p = 0.947) was observed. All age categories showed non-significant ORs with wide confidence intervals, for example, Age 36–40: OR = 1.808 (95% CI: 0.362–9.039, p = 0.471). Generally, training distribution was even across age groups. Thus, age does not significantly predict whether staff have received training on adolescent services.

The only significant demographic factor associated with training was sex, with females significantly more likely to be trained. Years of experience and age did not show significant associations.

Training effectiveness review

The chi-square test findings revealed the relations between training and quality assurance as reviewed by the patients. The result showed a significant difference between the quality of adolescent girls’ service provision for those who were trained, who are inclined to be more effective, as compared to staff who had never received training. Trained staff were significantly more likely to receive ‘Effective’ or ‘Very Effective’ ratings from patient feedback compared to untrained staff (p = 0.02). The researcher concluded that there was a relationship between the training and the quality of service provision. See Tables 4 and 5.

Table 4.

Association between staff training on adolescent services and perceived effectiveness of quality assurance mechanisms at Chiredzi General Hospital, Zimbabwe (N = 90).

Staff training status	Quality assurance – regular supervision					Total	Chi-square
	Not effective	Slightly effective	Moderately effective	Effective	Very effective
Staff training on adolescent services
No	12	12	7	6	4	41	0.283
Yes	7	24	9	6	3	49
Total	19	36	16	12	7	90
	Quality assurance – peer review
Staff training on adolescent services
No	4	19	4	9	5	41	0.035
Yes	9	11	15	7	7	49
Total	13	30	19	16	12	90
	Quality assurance – patient feedback
Staff training on adolescent services
No	6	20	10	4	1	41	0.02
Yes	8	17	5	7	12	49
Total	14	37	15	11	13	90

Table 5.

Perceptions of sufficient staff and resources for adolescent services among healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Sufficient staff and resources
Frequency			Percent	Valid percent	Cumulative percent
Valid	No	46	51.1	51.1	51.1
	Yes	44	48.9	48.9	48.9
	Total	90	100	100	100

Training frequency

The majority of training in adolescent services occurs on an ‘as needed’ basis, with 33.3% (n = 30) of respondents reporting that training is conducted only when necessary. Quarterly training is the second most common, with 25.6% (n = 23). Annual (16.7%, n = 15) and bi-annual (10.0%, n = 9) training is less common, as they may be too infrequent to keep up with changing guidelines and emerging adolescent health issues. There was inconsistency in the way training was conducted, showing a lot of disparity and a lack of a universal standard across the district (Figure 3).

Figure 3.

Frequency of staff training on adolescent services at Chiredzi General Hospital, Zimbabwe (N = 90).

Sufficient staff and ample resources

The majority of respondents (51.1%, n = 46) believe there is insufficient staff and resources to effectively support adolescent services during pregnancy. However, 48.9% (n = 44) believe resources are adequate; there was some disparity in terms of resources among the different health centres.

Barriers and facilitators

As shown in Figure 4, the most common barriers faced by adolescent mothers include stigma (reported by 78%, n = 70), long waiting times (72%, n = 65), lack of information (68%, n = 61), distance (65%, n = 58) and cost (60%, n = 54). These barriers are often attributed to social and cultural attitudes towards adolescent mothers, which can lead to inefficiencies in service delivery. The lack of information about available healthcare services is another significant barrier, particularly in rural or underserved areas. Distance and cost are also significant issues, indicating financial constraints in accessing maternal health services. Comparisons show that stigma and lack of information are often linked, and that transportation and financial constraints also limit access. Long waiting times are mentioned across multiple responses, indicating a systemic issue in service delivery (see Figure 4).

Figure 4.

Barriers to accessing maternal health services for adolescent girls as reported by healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Regarding facilitators, mobile health services were the most frequently suggested strategy (reported 59 times), followed by financial incentives (55 times), community outreach programmes (53 times), youth-friendly clinic hours (53 times) and peer education (53 times; Table 6). Mobile health service is the most frequently mentioned strategy, followed closely by the others, which are equal in occurrence. The study highlights the importance of mobile health services for adolescent girls, highlighting the significant impact of transportation barriers and geographical distance on accessing maternal health services. Financial incentives, such as subsidies, vouchers or free services, are also crucial in reducing barriers to accessing these services. Community outreach programmes are essential in raising awareness and providing education about available services, while flexible clinic hours cater to the schedules of many girls. Peer education also plays a significant role in increasing awareness and trust among adolescents, highlighting the importance of youth-led initiatives in promoting maternal health services. A multi-faceted approach is ideal to improve access to maternal health services for adolescent girls, including bringing services closer to them, reducing financial barriers through financial incentives, raising awareness through outreach and peer education, and making services accessible at convenient times through youth-friendly clinic hours. Table 6 shows the frequency of each strategic factors that facilitate access to maternal health services for adolescent girls.

Table 6.

Frequency of facilitator strategies suggested by healthcare workers to improve access to maternal health services for adolescent girls at Chiredzi General Hospital, Zimbabwe (N = 90).

Maternal health services for adolescent girls	Frequency
Mobile health services	59 times
Financial incentives	55 times
Community outreach programmes	53 times
Youth-friendly clinic hours	53 times
Peer education	53 times

Intervention access to maternal health services by pregnant girls

Comparison of quality assurance mechanisms: Regular supervision versus peer review versus patient feedback

A majority of respondents (61.1%, n = 15) found regular supervision to be limited in effectiveness, with only 17.8% (n = 16) rated it as moderately effective, 13.3% (n = 12) as effective and 7.8% (n = 7) as very effective. This suggests that current supervision practices may not be meeting expectations or ensuring consistent quality improvements. The low ratings indicate a need for stronger oversight, as nearly two-thirds of respondents see supervision as minimally effective. Recommendations for strengthening supervision include enhancing supervisor training, increasing frequency and depth of supervision, making supervision more supportive and action-oriented, and regularly monitoring and evaluating its impact. These recommendations aim to improve the quality of adolescent maternal health services and ensure consistent quality improvements (Figure 5).

Figure 5.

Comparison of perceived effectiveness of quality assurance mechanisms for adolescent maternal health services at Chiredzi General Hospital, Zimbabwe (N = 90).

Facility availability of standard operating procedures for adolescent maternal health services

The majority of facilities, 53.3% (n = 48), do not have standardised guidelines for adolescent maternal care, indicating a lack of consistency in services delivered to adolescent mothers. This lack of consistency may lead to service gaps, as facilities without SOPs may rely on informal practices, resulting in poor adherence to best practices and variations in service quality (Figure 6).

Figure 6.

Availability of SOPs for adolescent maternal health services at Chiredzi General Hospital, Zimbabwe (N = 90).

SOP, standard operating procedure.

Interventions that improve access to maternal health services

The findings highlighted the importance of mobile health services in overcoming transportation and accessibility barriers for adolescent girls. Financial incentives, such as free services and transport subsidies, are also crucial in reducing costs. Community outreach programmes, which increase awareness and trust about available maternal health services, are vital in breaking cultural taboos. Youth-friendly clinic hours are beneficial for many girls with school or family obligations. Peer education, which encourages utilisation, is also a vital strategy. The study concludes that a comprehensive approach is needed to improve access to maternal health services for adolescent girls, including bringing healthcare closer, reducing financial constraints, educating communities and peers, and ensuring flexible clinic hours (Figure 7).

Figure 7.

Interventions that improve access to maternal health services for adolescent girls as suggested by healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Priority intervention

Responses reveal that mobile health services are the most effective or preferred intervention, with 30 votes in Rank 1 (high priority). Peer mentorship programmes and community outreach programmes follow closely behind, with 20 votes each and balanced support across other ranks. Youth-friendly clinic hours and digital health platforms receive lower priority, with fewer votes and higher rankings in Rank 4 and 5. The distribution of rankings is dominated by mobile health services, peer mentorship programmes and community outreach programmes, showing a strong preference for direct, on-the-ground interventions. Digital health platforms and youth-friendly clinic hours are considered lower priorities, with a more even distribution showing moderate support for multiple interventions (Table 7).

Table 7.

Ranking of priority interventions for improving healthcare access for adolescent mothers, as reported by healthcare workers at Chiredzi General Hospital, Zimbabwe (N = 90).

Intervention	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5
Youth-friendly clinic hours and services	20	18	17	19	16
Peer mentorship programmes	18	19	16	20	17
Community outreach programmes	15	15	18	16	19
Digital health platforms	15	16	20	17	22
Mobile health services	30	21	15	14	10

Discussion

This study provides quantitative insights from healthcare workers on the availability, accessibility and quality of maternal health services for adolescent girls in Chiredzi district, Zimbabwe. A key finding was the lack of standardised protocols, with over half (53.3%) of facilities reporting no specific guidelines for pregnant adolescents. This aligns with the work of Nunu et al. in Zimbabwe, who also highlighted the need for clear, universally applied guidelines to ensure consistent and confidential care for this vulnerable group. ¹¹ Healthcare institutions and policymakers should create standardised guidelines for adolescent pregnancy care, enhance awareness and training for healthcare providers, educators and social workers, improve access to adolescent-friendly services, strengthen comprehensive sexual and reproductive health education, provide psychosocial and economic support for pregnant adolescents, engage families and communities, and monitor and evaluate protocol implementation.

The study also identified significant barriers from the healthcare workers’ perspective. Stigma was the most prevalent barrier (78%), followed by long waiting times (72%) and lack of information (68%). These findings corroborate studies in other sub-Saharan African contexts, which identify social stigma and health system inefficiencies as major deterrents for adolescents seeking care.^2,11,12 These issues are often attributed to social and cultural attitudes, leading to inefficiencies in service delivery. In rural or underserved areas, a lack of information about available healthcare services is a significant barrier. Financial constraints (cost and distance) were also prominent, reported by 60% and 65% of workers, respectively, reinforcing the known socioeconomic challenges faced by adolescent mothers.^5,13

A critical finding was the disparity in staff training. While 54.4% of staff had received training on adolescent services, a significant proportion (45.6%) did not. Furthermore, a strong gender disparity was evident, with male staff having three times the odds of not being trained compared to female staff (OR = 3.031). This inequity in training could lead to inconsistent quality of care, particularly if male staff are less equipped to address the specific needs of adolescent girls. The data further revealed that trained staff were significantly more likely to receive positive feedback from patients (p = 0.02), underscoring the value of this training. Staff training in adolescent services is crucial to ensure consistency in adolescent care.^9,14,15 The ad hoc nature of training (‘as needed’ basis, 33.3%) points to a lack of a standardised, policy-driven approach, an issue noted by Denno et al. ¹⁶

In terms of resources, 51.1% of health workers believed there was insufficient staff and resources, indicating a need for improved resource allocation. This is consistent with recommendations from Nunu et al. for workforce assessments and equitable distribution of supplies. ¹¹ Equitable distribution of essential supplies, equipment and funding should be ensured. Task-sharing strategies can help reduce workload burdens. Policymakers should advocate for more funding to improve staffing and resource availability.

When asked for solutions, healthcare workers strongly endorsed mobile health services as the top priority intervention. This directly addresses the identified barriers of distance and cost. Other preferred strategies included peer mentorship and community outreach, highlighting a demand for community-centred and peer-led approaches to improve access and trust. This multifaceted strategy is supported by the literature as essential for improving adolescent maternal health. ¹¹

The absence of standard operating procedures (SOPs) in 53.3% of facilities, coupled with the finding that regular supervision was largely perceived as ineffective (61.1%), reveals significant gaps in quality assurance. For guidelines to be effective, they must not only exist but be supported by consistent training, supportive supervision and robust enforcement mechanisms.^11,15 Recommendations for improvement include mandating SOPs in all facilities, developing national or regional guidelines for adolescent maternal care, ensuring all healthcare facilities have documented SOPs in place, regularly training staff on SOP implementation, conducting regular refresher courses and compliance monitoring, and monitoring SOP effectiveness and compliance through routine assessments and implementing a feedback mechanism for healthcare workers and adolescent patients.

Limitations and strengths

This study has several limitations. Firstly, the findings are based solely on the perspectives of health workers and do not include the direct experiences of adolescent mothers, which are crucial for a complete understanding of service access and quality. Secondly, the study was conducted in a single district hospital, which may limit the generalisability of the findings to other settings. Finally, as with all self-reported data, there is potential for social desirability bias, where respondents may have provided answers, they believed were expected rather than reflecting the absolute reality.

Despite these limitations, this study also has notable strengths. The use of a census sampling approach ensured a 100% response rate from all 90 healthcare workers in the maternity department, eliminating sampling bias and providing a comprehensive and representative view of the situation at Chiredzi General Hospital. The robust methodology, including a pre-tested, structured questionnaire and the use of inferential statistics, strengthens the validity and reliability of the findings. Furthermore, the study provides crucial, previously unavailable baseline data on health workers’ perspectives regarding adolescent maternal health services in Chiredzi district, which can inform future interventions and policy.

Conclusion

The study highlights critical gaps in the provision of maternal health services for pregnant adolescents, driven by the absence of standardised protocols, insufficient training, unequal resource distribution and persistent social barriers. These challenges not only compromise the quality of care but also contribute to poor health outcomes for adolescent mothers. Addressing these issues requires a coordinated, multisectoral response that includes the development and enforcement of clear guidelines, sustained investment in staff training, improved access to adolescent-friendly services and active community engagement. Prioritising adolescent maternal health in policy and practice, stakeholders can ensure that pregnant adolescents receive the care, support and protection they need to thrive.