Table 3.

Emergent themes from qualitative evaluations of mental health among pregnant adolescents and young women in Sub-Saharan Africa (N = 9).

Author, year published, Country	Study population	Mental health outcome(s)	Emergent themes	Recommendations to address service gaps	Bioecological level(s) identified
Carbone et al. 2019, Malawi4	13–19 year old parenting adolescent girls and young women (AGYW) mothers	Barriers and facilitators to PMTCT.	Barriers: Poverty, stigma, food insecurity, lack of transport, and absence of psychosocial support Facilitators: resilience and self-efficacy Need:- tailored, age-appropriate services, support services delivered by adolescent HIV-infected mentor mothers who have successfully navigated the PMTCT	Evaluate the intervention and its outcomes for the population.	Individual Microsystem
Field et al. (2020), South Africa8	15–19 year old adolescents mothers who were part of a Perinatal Mental Health Project (PMHP) during pregnancy and 6–12 weeks after delivery	Barriers and facilitators to mental health among AGYW mothers	Experience of using the mental health service: Mental health literacy, screening, resistance to referral, expectations and experiences of counseling, stigma, confidentiality, access, coordinated appointment times, disclosure of attending counseling and social support	Need to integrate routine mental health screening into existing obstetric services to minimize stigma.	Macrosystem
Govender et al. 2020 (2), South Africa5	16–19 year old postpartum AGYW	Anxiety, psychological issues (guilt, stress), suicidal ideation	Different reactions to adolescents’ pregnancies by family such as rejection that resulted in loss of support, anger, disappointment, and other psychosocial issues e.g. suicidal ideation, guilt, loneliness, anxiety, and stress. Experiences of financial constraints, difficulty in returning to school, and stigmatization in society.	Need for a multidisciplinary approach in caring for adolescent mothers.	Individual Microsystem
Kaye (2008), Uganda9	14–19 year old AGYW followed from pregnancy to 6 weeks postpartum	Mental health challenges: Anxiety, loss of self-esteem, financial challenges, moral/material support from parents or partners, and stigmatization by health workers, coping mechanisms	Coping Mechanisms: a)Utilizing opportunities for change (thriving) b)Accommodating challenges and tolerating the lack of support (bargaining and surviving) c)Failure to handle stress in their lives leading to being overwhelmed by the struggle (despairing).	Need to assess for various coping mechanisms before developing flexible interventions/goals of care.	Individual
Kola et al. (2020), Nigeria11	18+ year old postpartum AGYW (Mean age 22+/- 1•1), health care providers	Help-seeking behavior for perinatal depressive symptoms	Presence of care for perinatal depression despite presence of stigma from health care providers.	Training was helpful for care givers in the management or perinatal depression among population thus need to improve more supportive healthcare settings	Macrosystem
Kumar et al. (2018), Kenya12	15–18-year-old pregnant adolescents, 15–18-year-old AGYW mothers, Caregivers/partners accompanying AGYW, Health care workers (HCWs) from MCH	Mental health challenges among pregnant adolescents	Five themes emerged about mental health challenges among pregnant adolescents: Social stigma Lack of emotional support Stress based on new life adjustments Poor health care access Planning for the future Challenges in providing mental health services to pregnant adolescents in MCH contexts: Standard treatment in MCH services is not adequate for pregnant/parenting adolescents Lack of sexual/reproductive health education among adolescents Absence of mental health prevention and treatment programs for pregnant/parenting adolescents Challenges with engaging male community members in discussions/education about adolescent pregnancy/parenting	Need for follow-up on pregnant adolescents who visit the MCH facility and the provision of support to CHWs Need for risk assessment of the adolescent's family condition and support mechanisms in communities and involvement of child welfare services when need arises.	Individual Microsystem Exosystem Macrosystem
Musyimi et al. (2020), Kenya13	13–19 year old pregnant and early postpartum AGYW, HCW, traditional birth attendants, community health workers	Suicidal behavior risk among pregnant/postpartum adolescents	Five main themes about suicidal behavior risks among adolescent mothers: Chronic physical illness (e.g., HIV/AIDS) Intimate partner violence Family rejection Social isolation and stigma from community Poverty	Explore ways of addressing IPV, economic empowerment and access to youth friendly health care for chronic physical conditions in adolescent mothers. Address Substance use as causing IPV in families through inclusive, integrated approaches	Individual Microsystem Exosystem
Osok et al. (2018, 1), Kenya15	15–19 year old pregnant adolescents screened with score ≥5 on Patient Health Questionnaire-9; Caregivers/ partners	Depressive symptoms during pregnancy	Four major themes for adversities and mental health needs of pregnant adolescents: Depression, anxiety, and stress around the pregnancy Denial of the pregnancy Lack of basic needs, provisions, and care Restricted opportunities for personal development post-pregnancy	“-Presentation of “idioms” of depression -Strengthening sexual and reproductive health education -Training health workers in identifying mental health problems in high-risk adolescents -Implementation of adolescent friendly services at community, school, and health facility”	Individual Microsystem Exosystem
Thabethe et al. (2020), South Africa17	19–23 year old pregnant AGYW	Psychological experiences of pregnant university students	Four themes for psychosocial experiences of pregnant university students: Maternal stress and anxiety Inability to cope Poor concentration Low self-esteem	Higher educational institutions provide psychological support, including counselling to pregnant students and health facilities at the institutions provide antenatal care services.	Individual