Table 3.

Core issues flagged off by the MCH personnel and community health workers on challenges before pregnant adolescents

Thematic domain, group that voiced these	Underlying dimensions with illustrations
1. Pregnant adolescents and the key challenges “What do they know about their own body or caring for a baby? They need support!”-MCH nurse in charge, Kariobangi and Kangemi “Peer pressure also determines these early pregnancies.”-CHW, Kariobangi	“Their minds have been dealing with chemistry, maths and friendships …. To direct Ones mind to the care of the baby and discontinuation of studies is the key challenge with these pregnant adolescents or new mothers” “Support from other women in their lives esp. siblings, mothers, is important …. social support is so poor as their native homes may be far away from Nairobi ….” “ think peer pressure contributes a lot because you find a young girl has a friend who is married with a kid and what of her. When she goes to try out she finds it hard to sustain since she was going so as to be the same as her friend but find that it’s not the same.”
2. Issues of access and articulation of needs “We are approachable and can link them back to the health facility.”-male CHW in Kariobangi “We offer a shoulder to cry and link these girls and women to the right places.”-two female CHWs in Kariobangi and Kangemi	“If they have missed appointments or struggling to make end meet, we can be approached and we link these girls back to the health facility…the community too entrusts us with responsibilities when there are complicated circumstances in life of a person” “The men have to be educated about their role in looking after the health of their children, at the moment they have distanced themselves from this and are mainly looking at food to put on the table” “We refer them to the chief, take them for free dress making or hair weaving classes. There’s someone we find to connect them to when need be. We are there to support them, when they shed tears and are inconsolable we offer a friendly shoulder” “We have to work with both boys and girls to educate them about their rights.”
3. Various considerations around keeping the baby despite age Kariobangi	“I told her that God has a reason because there are many who wish to have kids but they can’t so she should persevere, I think you saw how she was walking weakly (mhh …. All prompt) she is thinking very much.” “We told her that women in our culture have to be brave and bring up children ourselves. So investing in elders and community advisors like us would help her bring up the baby.”
4. Need for support group “I would like to offer them an ongoing support group.”-MCH nurse in charge, Kariobangi	“I would like to be able to start a support group for these mothers. I would like to find a supporter (funder) who could provide resources for these girls to meet, discuss what they need for their future, their babies and for themselves. When women got money for transport or a plate of food on their returning appointment, relaxing and talking to one another became easy …” “In the HIV context, the mentor mother program has been a great success.” “There was a support group in existence last year …. don’t know how and why it died .… probably the funding faded away.”