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

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Adolescent pregnancy is an issue of social and health inequity: it hinders young mothers’ chances of continuing with school, and is associated with higher exposure to domestic violence, HIV, and food insecurity. While schooling is a well-known determinant of health, an implementation gap exists in supportive provisions. While protective factors such as school engagement enable improved health outcomes and educational attainment for adolescent mothers, yet limited evidence exists on how school and community stakeholders can can adapt to support these learners. This formative, participatory research engaged young people's expertise to inform implementation priorities for supporting adolescent mothers' educational attainment. Methods This study aimed to co-construct potential support package components, in partnership with young people from a community-academic partnership called a “Teen Advisory Group”. We conducted participatory priority-setting research with a Teen Advisory Group (TAG) of young research advisors (n = 13, ages 21–25) in Eastern Cape, South Africa, over eight weeks in July-August 2022. Using a socio-ecological framework and positive youth development theory, data co-creation occurred across three stages: ( 1 ) introductory phone calls; ( 2 ) remote engagement through a closed Facebook group (n = 7) with weekly activities; and ( 3 ) a 3-day face-to-face participatory design workshop featuring gallery walks, gender-separated group interviews, and arts-based "dreamy care package" activities. Evidence-based comic storylines informed exploratory discussions. Activities were conducted in English and isiXhosa, and analyzed using reflexive thematic analysis combining deductive and inductive approaches, validated through member-checking with advisors (n = 10). Results Adolescent pregnancy exposed young mothers to various forms of stigma, at home, amongst peers, and from the community. Young research advisors described support figures such as social workers and healthcare professionals as important figures who would help them from dropping out of school and prevent further pregnancies. Family-level support mostly helped ease the burden of childcare for the young mother. Staying motivated and focused by setting goals for themselves also kept pregnant and mother learners motivated to continue with school. The young mothers suggested that the government could support adolescent mothers by subsidising formal childcare and some baby essentials during early motherhood. Conclusions Our findings emphasize a multi-faceted approach to supporting pregnant and mother learners. This includes stigma reduction interventions at the household and community level, enhanced teacher training to provide psychosocial and health support, and the provision of accessible and affordable childcare to facilitate a return to school. Furthermore, our results underscore the need for stronger social support systems, multi-sectoral collaboration to integrate healthcare and social work services in schools, and the adoption of youth-led participatory approaches to ensure interventions are relevant and effective. adolescent pregnancy adolescent mothers South Africa participatory research qualitative research education social support stigma policy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 BACKGROUND Despite that there was a worldwide decrease in the adolescent birth rate, there are still differences that were found. In 2021, Sub-Saharan Africa (SSA) experienced the highest volume of adolescent births, with 6,114,000 among 15–19-year-olds and 332,000 among 10–14-year-olds. This is a significant difference from Central Asia (68,000 births to 15–19-year-olds) and South-East Asia (22,000 births to 10–14-year-olds) ( 1 ). Between 2016–2021, teenage pregnancies in South Africa increased in all provinces and in each year ( 2 ), where 14% of all births in Eastern Cape province are to adolescents ( 3 , 4 ). Adolescent mothers face challenges that are a direct consequence of multiple systemic issues: South Africa has a high rate of socioeconomic inequality, where poor access to healthcare and education is common, and young people experience high rates of unemployment ( 5 ). When adolescent girls become pregnant, their schooling is affected, and their risk of exposure to violence, food insecurity, and HIV increases ( 6 ). Furthermore, poor health and well-being hinder their socioeconomic prospects ( 7 ). However, many known protective factors can enable school engagement and return:for young mothers, an enabling schooling environment is linked to higher educational attainment and improved health outcomes, including reduced maternal mortality( 8 – 13 ). Ensuring that adolescent mothers can continue their schooling contributes to their own and their children’s health and wellbeing as well as their future employment prospects ( 14 – 17 ). Recent research in the Eastern Cape with adolescent mothers and their children has identified challenges related to learner pregnancy and adolescent mothers' ability to return to school, affecting future generations and increased poverty ( 6 , 18 – 21 ). Protective factors such as enrolment during pregnancy, access to childcare post-birth, and a supportive school environment have been identified to encourage school return ( 8 , 63 ). However, a gap in implementation of supportive provisions and strategies exists: this research aims to address this gap, informed by young research advisors’ lived experience of young parenthood and recent evidence on learner pregnancy, to inform potential implementation package priorities that would support adolescent mothers' educational attainment. There is limited literature on how the school environment can adapt to be a more caring platform for adolescent mothers ( 19 , 20 ). South African research on adolescent pregnancy and motherhood have historically focused more on drivers and consequences of adolescent pregnancy as well as prevention strategies ( 22 – 24 ). More evidence is needed on how to ensure the protective benefit conferred by schooling can extend to adolescent mothers, including considerations for design of scalable implementation models that can be adapted, sustained in real-world settings ( 7 , 25 – 28 ). In 2021, the National Department of Basic Education (DBE) in South Africa launched a policy which aims to support pregnant and mother adolescents’ right to schooling during pregnancy and return after birth ( 75 ). Evidence from the African region points to the importance of involving adolescents in designing and planning interventions to strengthen skills through meaningful engagement, increasing the likelihood of programme acceptability and intervention success( 29 – 33 ). Our research invited young people's participation in formative research on the implementation of this policy, recognizing their expertise in shaping relevant and acceptable programming, and their great potential to contribute to society ( 34 , 35 ). This formative work was undertaken as part of a long-standing Community-Academic partnership between the Universities of Cape Town and Oxford and a “Teen Advisory Group” (TAG). TAG was established in the Eastern Cape, South Africa in 2019, and informed by eleven years of collaborative research with young advisors in the Western Cape, South Africa ( 36 ). Through this community-academic partnership, advisors have informed the direction of innovative, participatory, arts-based methodology and engagement approaches and co-generated empirical data on the health and development of adolescents and young people, which continued throughout strict COVID-19 lockdowns in South Africa ( 37 – 39 ) METHODS This formative research with TAG aimed to engage with advisors’ lived experience with and recent evidence on learner pregnancy, to inform potential implementation package priorities that would support adolescent mothers' educational attainment - a well-established social determinant of health (20,40) These priorities informed, and are further explored, in a multi-stage study which informed a training resource and ongoing intervention design aimed at educators, to improve support for pregnant and mother learners (13). Context Our collaborative research with advisors informed two phases of participatory priority-setting with Eastern Cape TAG members over eight weeks in July-August 2022: (1) remotely through weekly phone calls and a weekly collaborative activity in a closed, researcher-moderated Facebook Group (n=7); and (2) face-to-face through a weekend residential workshop (n=13). These combined methods were designed to facilitate the co-construction of support package priorities and design considerations in partnership with young people. Our participatory methods were discussed, reviewed and validated with TAG member-mothers and explored their priorities and provisions. Conceptual framework To explore the socio-ecological systems and factors that influence adolescent mothers' dropout and return to and progression in school, this research applied two conceptual frameworks depicted in figure 1 below: the social ecological systems of child and adolescent development (41,42) and socio-ecological theory, specifically examining adolescent mothers' school return after birth (8,43); and the theory of positive youth development, which focuses on building assets, agency, contribution, and enabling environment (44) for programme and research participation. Young Research Advisors TAG is a group of young research advisors (“young advisors”), first recruited in 2019 as part of a larger multi-site participatory, collaborative study on adolescent health, development, and well-being in South Africa, Kenya, Sierra Leone, and Uganda (45,46). Young advisors for the research described in this paper were recruited from the Eastern Cape TAG, were between the ages of 17 and 23 years when they first joined the study (n=18) and were initially recruited through snowballing methods from two existing observational cohorts based in the Eastern Cape that started in 2014 (36,38,47). In May 2022, after participating in remote research during strict COVID-19 lockdowns in South Africa (38,49,50), young research advisors from the Eastern Cape TAG were contacted to re-establish research relationships and to re-introduce them to a new team of researchers with whom they would be collaborating. The initial stages of engagement were remote, with the objective of building rapport and trust to prepare researchers and advisors for the upcoming face-to-face participatory design workshop. Procedures Engagement strategies used to communicate with advisors were similar to those recommended by and applied with TAGs in the past, building on what has been suggested by them and worked for them previously (38) and adapting to advisors' life stages as young adults with growing children, employment, and domestic responsibilities (36-38). Table 1. below presents the demographics of the advisors, column 1 presents the age of participants in 2022 and it was between ages: 23, 25 years. Column 2 shows the gender of the participants, male or female. Column 3 shows the Type of demographic area residing I - peri-urban areas are located on the outskirts of a city; rural areas are typically countryside or remote areas. Column 4 shows indicates whether the respondent is a parent in ‘Yes’ or ‘No’. Column 5 shows the numerical number of children the participant has. Column 6 shows the highest school grade passed. Column 7 shows the participants Interests and current engagements in 2022-2023 which were job searching, enrolment in college/university, and working. Advisors were encouraged and supported to express themselves in their first language (isiXhosa) during both remote and face-to-face methods. While some of the lead researchers were English speakers, most advisors could collaborate and communicate in their first language with other lead researchers and research assistants (51,52). This dynamic enabled the advisors to speak and share freely. In past gatherings and the workshop documented here, advisors were also invited to use art- and music-based mediums to communicate their experiences and perspectives (50,53). Data co-creation occurred in 3 stages: Stage 1: we conducted phone calls with advisors for introductions, to build relationships and begin a process of continuous informed consent. Stage 2: interactions took place through a closed, private Facebook group which select advisors consented to be added (n=7), and subsequently accepted invitations. Evidence from our past work has shown that using closed Facebook groups with young people has proved to be a comfortable and safe space, is convenient, and provides access to those who may not own personal phones or are using multiple devices (36,38). As a data collection tool, using Facebook usually does not require data bundles to use and can be used at no cost in South Africa and other African countries. To ensure consistent interaction on Facebook, we called advisors at least once a week. This was a way of checking in and building relationships, clarifying Facebook research activities and prompts, and obtaining feedback on the methodology, all in preparation for face-to-face interaction. During phone conversations, requests for and referrals to food and psychosocial support also occurred. This was the case for more than half of the group. Stage 3: took place through a face-to-face workshop. As we approached the time of the in-person workshop, an existing database of the teen advisory group was used to follow-up on the initial contact made before Facebook activities began. Due to the time lag between the last interaction and reconnecting with the team, some advisors' contact numbers were no longer in use. We were supported by fellow advisors to get contact details for those not reachable on the phone and Facebook. Through networking with advisors involved in the Facebook activities, additional advisors were recruited, who demonstrated interest in attending the in-person workshop and consented to participate (n=13). Table 1. Advisors’ socio-demographic characteristics and levels of participation Age in 2022 Gender Type of demographic area residing in Parent Number of children Highest school grade passed Interests and current engagements in 2022-2023 Participation stages in Design incubators methods (1, 2, 3) 23 Female Peri-urban Yes 1 9 Job searching and interested to open a fast foods business in the future 3 25 Male Peri-urban Yes 1 11 Job searching and a local hip hop artist. 1,2,3 21 Female Peri-urban No 0 12 Enrolled in college studying Mechanical engineering 1,2,3 21 Male Peri-urban No 0 8 Job searching and participates in voluntary and paid part-time work in his community 3 25 Female Rural Yes 1 11 Job searching and expecting a second child 3 24 Female Peri-urban Yes 1 11 1,2,3 23 Female Peri-urban No 0 11 Job searching 1,2,3 23 Male Peri-urban Yes 1 12 Working as a waiter and planning to go back to school 1,2,3 21 Female Peri-urban No 0 12 Working in the Gauteng province 3 22 Male Rural No 0 12 Currently enrolled in college studying Business management 1,2,3 25 Male Rural No 0 Job searching and participates in voluntary and paid part-time work in his community 1, 2, 3 22 Female Peri-urban Yes 1 12 Planning to enrol in University in 2025 3 22 Female Peri-urban Yes 1 11 Job searching and interested in participating in community development work. 1, 2, 3 Note: The table above shows the following: Column - 1 presents the age of participants in 2022 and it was between ages: 23, 25 years. Column 2 shows the gender of the participants, male or female. Column 3 shows the Type of demographic area residing I - peri-urban areas are located on the outskirts of a city; rural areas are typically countryside or remote areas. Column 4 shows indicates whether the respondent is a parent in ‘Yes’ or ‘No’. Column 5 shows the numerical number of children the participant has. Column 6 shows the highest school grade passed. Column 7 shows the participants Interests and current engagements in 2022-2023 which were job searching, enrolment in college/university, and working. Remote methods Each comic strip-style storyline was developed directly from quantitative findings from the HEY BABY longitudinal cohort (20,48). These were accompanied by short vignettes to encourage discussion about Anathi's circumstances and what might happen next in her story as depicted in figure 2 below. See Supplementary files 1-2 for more details. Face-to-face participatory design workshop The 3-day face-to-face gathering began with a social meal to reconnect; the group also explored previous and set new ground rules to build space for speaking openly and shifting participation means as needed. Building transparency, trust, and capabilities is an important principle of participatory research with young people. While all advisors except one new TAG member previously received training during their induction into TAG on the research process, power relations, and participation techniques, the group had not been in person together for >2 years. A participatory session on "what is research?" was facilitated in small groups, where advisors were invited to choose a research topic of interest to their age group and community, developing research questions and methods of interest. Community and other stakeholder engagement was also discussed, which provided a helpful primer for the focus of the upcoming participatory sessions focused on DBE's new policy on preventing and managing learner pregnancy. This session concluded with small-group discussions on informed consent, what we mean by consent in these face-to-face activities, and why it is important. Thereafter, the "gallery walk" and "talking wall" activity was introduced by exploring knowledge co-created in TAG’s past research encounters, while also re-orienting the group to considerations for adolescent pregnant and mother learners and the DBE’s policy priorities. This activity situated advisors in the current collaborative priority setting activity and conveyed the significance of the opportunity to influence implementation of the DBE’s new policy and support future pregnant and mother learners to continue their schooling. Group interviews were conducted in separate groups: fathers, mothers, young men who were not fathers, and young women who were not mothers. In preparing for the workshop, we reviewed proposed methods with advisors and mothers preferred to have a private group setting where they could express themselves more freely. Group interviews were moderated by research assistants who matched the gender of their group, guided by a semi-structured question, encouraging discussion amongst each other but not restricted to a formal interview or focus group discussion guide; limitations to focus group and interview techniques include risks of social desirability bias and challenges associated with building rapport (54,55). Group interviews elicited emotional reactions, which required facilitators to navigate motherhood experiences with great sensitivity, pausing, and excusing some members who wished to have a break and eventually return (55). The final activity, called the "dreamy care package," - aimed to develop and explore possible support package components and design considerations, answering the “what, when, where and who” of possible delivery strategies of priority provisions for pregnant and mother learners (33,56). This arts-based, multi-media activity included a series of prompts to work through in small groups, as well as collage materials, and open-ended materials where participants engaged with to draw, and used written text to elaborate on their drawings. Each group had a small box that they had to populate with goods or services they felt pregnant learners needed; they also closed and wrapped the package, and in so doing, solidified their contribution in a complete, physical “package”. Activities were conducted in both English and isiXhosa and transcribed verbatim into English. Ethical approvals were provided by the University of Cape Town (HREC REF: 226/2017) and the University of Oxford (IDREC approval: R53899/RE003). See supplementary file 3 for more information. Analysis We utilized a combined deductive and inductive approach that is both critical and constructivist, enabling us to elucidate the social structures underpinning pregnant and mother learners' experiences (57-59). Our inductive analysis remained open to discovering unexpected aspects of the Advisors' experiences and generating new theories, which we operationalized using open coding. Our deductive approach enabled us to be guided by the multi-layered lives of adolescents and young people, capturing the multi-level influences on their schooling and parenthood shaped by socio-ecological systems and temporality theorized in our conceptual framework. Group thematic analysis was overseen by a senior qualitative researcher, supported by two other qualitative researchers and two research assistants who participated in remote and in-person data co-generation with TAG young advisors. Thematic analysis began with collaborative inductive coding of Facebook group posts and discussions, the talking wall, group interviews and visual data from the 'dreamy care package' activity. We followed updated guidance on reflexive thematic analysis (RFA) guidance (60) which recognises the group’s diverse interpretations of the dataset, our assumptions during the analysis process, and the analytical skills and resources of each researcher (60). We followed a step-by-step process of 1) data familiarisation; 2) generation of initial codes; 3) refining codes, generating themes; 4) discussing and reviewing themes collaboratively; 5) defining and naming themes; and 5) writing (60). Member-checking Member-checking was conducted after analyzing co-generated data (61,62) to invite advisors to review and validate our preliminary findings. Building on previous research with TAG (38) , results were presented to TAG advisors in 1:1 phone call with one researcher, ranging from 6-25 mins, depending on how much elaboration they wished to provide. (n=10). These calls enabled us to check the accuracy and trustworthiness of the results and how the results resonated with them. The procedure for member checking was as follows: developing a script summarizing the findings generated from our online and in-person activities. Iconography was created to accompany the script, with the hope of sharing with the advisor before this call. However, we ended up not sharing the script as it was decided that the content might be overwhelming for the advisors. One of the team members reached the advisor on WhatsApp to inform them about the upcoming phone calls on member-checking. Our research team contacted each advisor and talked through each finding in the preferred language, isiXhosa, and then asked the participant a series of questions exploring their level of familiarity with the finding, and whether they confirmed it. For young mother advisors, we invited them to explain their experience differently, if it disagreed with how our findings were shared. We used, if there anything they would add about their experience or clarify what we shared as findings; we also asked if we captured their meaning of their perspectives the way they intended to express and convey them. RESULTS The themes and subthemes that emerge from this data are presented according to the groupings of the socioecological framework (see Table 2 below). Table 2 . Themes mapped to adapted socio-ecological framework Conceptual framework Theme Subtheme Method of data collection/Activity Participant type Individual factors Judgement and stigma Judgement at school Group interview Young mother Family shame Group interview Young male advisor- not a father Self-motivation Facebook Young male advisor- not a father Family and partner level support Family and partner-level support Family support Group interviews Adolescent mothers Partner support Group interviews Adolescent mothers Formal and informal childcare Informal childcare Facebook Adolescent mother Formal childcare Facebook Adolescent mother Community service factors Community stakeholder support Group interviews Adolescent father Young male advisor- not a father School based support Friends at school Talking wall Adolescent mothers Supportive teachers Group interviews Young male advisor- not a father Macro-level factors Systemic enablers Government grant for daycare and essential supplies Group interviews Adolescent father Visits by social workers and healthcare workers at schools Facebook Young male advisor- not a father Availing adult education as an option to pregnant and learner mothers Facebook Young male advisor- not a father Individual factors The first theme of the framework is the individual level factors. This theme relates to the individual level experiences of how the adolescent mothers simultaneously experienced and navigated the complexities of early motherhood and schooling, including experiences of judgement and stigma but also more positive experiences of self-motivation. Judgement and stigma Advisors described the process of social scrutiny by various figures in their families, schools and communities: parents, community members, peers and educators. Advisors described their own experiences of judgment, and how this can contribute to stigma enacted on and felt by a pregnant learner, and its ramifications for their health, education and wellbeing. Judgement at school Some advisors expressed that their peers gossiped and separated themselves as they did not want to be associated with young mother learners. This behaviour extended to adult educators, where one advisor expressed judgement from teachers which eventually led her to drop out of school: “Yes! I didn’t get any, because they used to make fun of me, that I got pregnant young, even the female teachers. So, I was forced to drop out of school, and I quit. From the community, number one!” [23-year-old female, mother] Family shame Emphasis was placed on the community who were identified as neighbours and the level of influence they had over learners’ parents. This came more from male advisors than female advisors and could be based on the experiences of someone close to them or what they had observed around them. One advisor mentioned how the community would judge pregnant learners and how this experience reflected negatively on her family. “When the community is looking at you in that way like that you’ve disappointed your parents and then like so ever if you’re walking in the street like they judge you they do funny things to you .” [ 22-year-old, male, not a father] “And then from the community there was no one because they are gossipers only…”. [23-year-old female, mother] Advisors who had been a young father during adolescence felt they adolescent pregnancy was a disgrace to their family. They were concerned about how the family would come to terms with the adolescent pregnancy at a young age in the family. The young father further spoke about how This led to some families or parents would make things difficult for the pregnant learner at the beginning of the pregnancy. It became challenging to report the pregnancy to parents because they felt they had brought disgrace to their family. One advisor shared, "You see at home? They would never just forgive you whilst they know they know they send you to school...you just show up with a belly...They'll give you some difficulty first..." [24-year-old male, father] The "power" of the community demonstrates how societal norms are deeply embedded in how judgment is passed on others. If the community treats the family badly because of the pregnancy, the parents might turn their anger toward the pregnant learner. Even if they forgive her, she may feel that she has made the community look down on her family. One advisor explained: "When the community is looking at you in that way...you've made people look down on them now, their dignity is no longer there." [ 22-year-old, male, not a father] Self-motivation Being self-motivated helped the young mothers to overcome difficulties or cope during the difficulty of a being adolescent pregnancy and motherhood. Self-motivation was identified as one of the necessary strategies learner mothers explored to ensure they were able to cope with adolescent pregnancy and returned to school after having a baby. The advisors suggested that the pregnant learner should set goals for themselves by making use of tools such as study timetables (which work around the baby's schedule), reminders, and multitasking to keep up with schoolwork. One participant mentioned the importance of creating goals and trying to stick to them: " Hey guys, I really like how motivated [learner mother] is...she needs to implement little steps that will help her achieve her goals and stick with them...If you fail to plan, you plan to fail easy ." [23-year-old, male, father] Family and Partner-level support In line with the socioecological framework, this theme focuses on the family level support from family members who help lessen the burden of pregnancy and motherhood so that the learner can focus on school and not get overwhelmed, tired, or sick (physically and mentally) and end up dropping out of school. This is a support system that the pregnant learner and learner mother can rely on, confide in, report pregnancy to and turn to when in need. Sub-themes that fall under this theme are family support, siblings and the partner or father of the baby. Family Support Family came across as a strong form of support for the pregnant and mothering adolescent girl. Family support significantly influenced the learner’s pregnancy experience and her ability to continue and focus on school during pregnancy and after having a baby. Advisors alluded to various measures of family support provided by different family members. This form of support makes up household support by family members like parents, aunts, other caregivers and siblings. This was through financial support and caring for the child while the learner mother needed to return to school. “There is only one person who could help me, it’s my sister, because she is the person who cares about me, even though she doesn’t stay here but she calls me constantly and even when I lack something, she would send me money, so that I could buy that thing that I want, you see.” [22-year-old, female, mother] “The person who was supporting me, was my mother at home, she used to do everything for me, accompany me to the clinic and everything else. At school they did not even notice that I was pregnant and then when I was going to give birth, I stayed for a short while and then decided to go back to school during examinations. And then the deputy president from school handled all of that…” [22-year-old, female, mother] One advisor described how supportive all her family members were toward her when she was pregnant: "Yoh! I got support from home! All of it! All of it! I got it from home. At school hey! I did not get any...The whole family, mom, dad, aunt, grandmother, and Aunt (from the father's side)." [23-year-old, female, mother] An advisor expressed that when parents were supportive, the learner would be able to focus better on school during her pregnancy and after having a child. Figure 3. below presents a comic strip of Anathi’s story on how she navigates finding the balance between motherhood and her schoolwork. “Something that can make them pass is if their parents are supportive and encourage them that school is important, I think they would feel better and be more focused on their schoolwork…” [22-year-old, male, not a father]. Partner Support from father of the baby Although only half of the young mother advisors had support from the father of their baby, some mentioned how the father provided support during pregnancy. One advisor shared her experience by saying the following: “It’s my person, someone from outside was the father. Uhm, at school he takes me, he was my friend.” [22-year-old female, mother] Another advisor spoke about how the father of the baby supported her financially when she was pregnant: “Oh, and the father of my child, ah shame he supported me. When it comes to things that have to do with money and everything.” [22-year-old, female, mother] Formal and informal childcare Participants further expressed that having access to childcare enabled them, and could enable other young mothers, to return to school after having a baby. Childcare experiences varied according to participants' preference, and which one was more accessible to them. Some participants preferred formal childcare whilst others preferred informal childcare. Informal childcare Family members such as mothers and the father’s family can help with childcare. Advisors found this preference of childcare safer than taking the child to daycare. Daycare was perceived to be riskier as the baby needs extra care and attention. For example, when the child is sick and cannot attend daycare centre they can remain at home with a caregiver so that the young mother does not have to miss school to care for the baby: “I think this thing of taking [the baby] to creche [daycare] will help her for a short time first [the baby] is 3 months old and a baby that young needs a lot of looking after and there are a lot of children that are being looked after at that creche [daycare] there are a lot of things that could go wrong while the teachers are looking after the other children and a baby gets sick especially a young one which could force [the learner mother] to end her school day early for taking the baby to the clinic so it's best she gets a family member who can stay with the child .” [24-year-old, female, mother] Formal childcare As much as there were advisors that perceived daycare as an unsafe option for childcare, other advisors regarded formal childcare as a safer option. Advisors also mentioned that the mother would stress less and be able to concentrate on school when the child was at daycare. The picture below depicts part of the story boards from Anathi’s story, used during our remote methods. It shows Anathi leaving her child at daycare before going to school. The quote following Figure 4 below is one of the contributions by advisors in our engagements about Anathi, leaving her child at daycare when she must attend school. “I think that [learner mother] should leave [the baby] at creche [daycare] then [learner mother’s] family helps [the learner mother] with picking [the baby] up from creche [daycare] so that [the learner mother] is not stressed about her child whilst at school.” [22-year-old female, mother] Community service factors Our conceptual framework also considers support that can be outside the family. In this study, neighbours in the community, the school and church were identified as important role-players in the community-level support system for pregnant and mother learners. Community stakeholder support This theme refers to the support received from stakeholders outside the family. These are stakeholders that assist pregnant and mother learners to cope at school and to be able to provide needs and childcare for the baby. The advisors also mentioned that community entities such as the church and neighbours in the community could assist with supporting them with baby supplies such as clothing, food and nappies while they were pregnant and after having a baby. “A neighbour can help me, a woman from church can also help me if I am a churchgoer, it could happen that we are not church goers. Or a church that can support children that are pregnant, including myself who is pregnant, in the community. It can help me maybe by bringing me food, helping me with diapers.” [ 25-year-old, male, father ] While family came across as a more preferred and trusted support system when it came to childcare and child’s needs, this was not the case with all advisors. One advisor said they sought help with childcare outside the family. Neighbours were also identified as trusted individuals that the young mother would seek support from. “It’s my neighbour. Because I trust them so much and my family doesn’t care, especially my father. So, I would ask my neighbor.” [23-year-old, female, not a mother] School-based support The sections below present subthemes which are related to support found in the school environment, including support from friends and teachers. Friends at school Friends and peers were identified as some of the people who made it easy for pregnant and learner mothers to be at school during pregnancy and after having a child. A supportive and respectful environment from friends, who did not make fun of them, fostered trust and enabled one advisor to continue her education throughout pregnancy and after having a baby: “A friend that you trust at school, someone who won’t make fun of you. A close friend that won’t get tired of you or someone you can trust that will not get tired to help you. The school stuff and learners are responsible for each other on how they treat and accommodate one another, so they must be considerate of each other.” [Talking Wall, anonymous] Supportive teachers This refers to the role and impact that teachers can play in the school environment that enabled pregnant and mother learners to keep up with school. Teachers were perceived as role models and parents while they were in a school environment. One advisor said that teachers who were approachable made it easy for the learners to open to them when they needed to talk about their problems: There are teachers that [are] approachable, then you can go tell your problem to her and then she, as a parent, because she is a parent [22-year-old, male, not a father] Another advisor mentioned that motivating the learners should not only be the learner's responsibility. The school can also have competitions to encourage learners to focus on their schoolwork and meet their academic goals. They suggested that schools could implement programs that will keep the adolescent mothers motivated to do well at school: “…at schools there could be a competition with other schools the highest will represent their school after they win the competition, they can be awarded something, if there are awards at school at the end of every term I think can help [learner mother] be more focused as well.” [22 year old, male, not a father] Systemic enablers Macrolevel enablers refers to the government driven solutions that affect pregnant and learner mother’s ability to return and stay in school. These are solutions that ensure that all relevant actors and services required are available and the school environment is conducive to the pregnant and mother learner. These enablers were identified as government grants, involvement of social workers and healthcare workers at school including alternative learning methods for the pregnant and learner mother. Most of the suggestions or views quoted in this section were by young men, including those who were adolescent fathers. Government grant for creche and essential supplies Advisors raised the point that the government could make funding or grants available for daycare for adolescent mothers that were still at school. This form of government support also included the government providing baby essentials that the baby would need to survive on the first few days after the baby leaves hospital. One advisor reported that government could support the adolescent mothers by supplying them with baby porridge and toiletries just after the baby has been born: To have a list of those who struggle to make ends meet where they can, with that baby that will have been born, to be able to take her to school, to that creche and pay for her at those creches that will require payment… So, it’s mostly resting …on a social worker and the government.” [25 year old, male, father] Figure 5. presents the Dreamy care package items including “SASSA” (Social Security of South African Social Security Agency) and the responsibilities of the Department of Social Development. On a purple sticky note, mothers describing the process of applying for a child support grant through SASSA and how it could be used by mother learners; essential items included were also referenced in interviews [23, 25, 26 year old females, all mothers] Visits by social workers and healthcare workers at schools Having access to mental and health care support was identified as essential for the wellbeing and ability of the pregnant and learner mother to continue with school. Nurses and healthcare workers were identified as those who provide motivational support at schools by empowering pregnant and mother learners to be able to continue with school and helping them prevent repeated pregnancies. Social workers would intervene in encouraging learners to stay in schools and provide psychosocial support to pregnant and mother learners. “[Learner mother] needs assistance from a social worker because a social worker …can help her find counselling so she can express herself and be free around other children.” [22 year old, male, not a father] Healthcare workers would provide reproductive health education related talks in school. Advisors also said that healthcare workers could provide advice about unplanned pregnancy and the importance of contraception for pregnancy prevention: “Nurses go to schools to speak to learners about teenage pregnancy, they must explain and tell the learners that have not fallen pregnant yet that they mustn’t be weary of using a condom.” [22 year old, male, not a father] Availing adult education as an option to pregnant and learner mothers Advisors suggested that adult based education (ABET) could be provided as an option to adolescent mothers that are likely to drop out and not return to school. This was to accommodate learners that are too embarrassed to return to school as some would feel that they were too old for school: “Government can advertise ABET schools to dropouts because for some it is difficult to return to school because of age, they say they are old and are embarrassed to wear a school uniform, so they advertise and release posts for registration and call people for explaining how it works, to give the student” [22 year old, male, not a father] DISCUSSION This study explored design considerations for educational policies supporting pregnant and mothering learners in South Africa, drawing on the insights of young research advisors. Our findings highlight the critical need for comprehensive support systems that address the multifaceted challenges faced by these young mothers within their families, schools, and communities. Consistent with previous research ( 13 , 63 ), our study emphasized the importance of both family and institutional support for young mothers returning to school. However, we found that internalized and externalized stigma, often rooted in religious and cultural beliefs, posed significant barriers to accessing this support. Young mothers reported feeling judged and unsupported, leading to disengagement from school and reliance on informal support networks within their communities. This underscores the need for interventions that address stigma and promote understanding and acceptance within families, schools, and communities. Social workers were identified as key facilitators in mediating these complex situations and ensuring young mothers receive the support they need. The central role of social workers is outlined in the Children's Amendment Act 41 of 2007 ( 64 , 76 ), yet the scarce number of registered social work professionals relative to the population they need to serve challenges their ability to deliver comprehensive, supportive services ( 77 ). According to the Parliamentary Monitoring Group of South Africa, in 2024, it was estimated that ± 44,848 registered social workers ( 78 ) were managing a caseload of 1:100 per month in all provinces, however Norms and Standards for Social Welfare Services outlines an ideal caseload of 1:60 ( 78 ) – approximately 10,000 additional workers are envisioned by the national development plan by 2030 ( 79 , 80 ). Our findings also reinforce the findings of previous research ( 20 ) that has identified childcare, caregiver relationships, and socioeconomic factors as crucial predictors of school return and retention. However, our study further revealed the nuanced ways in which these factors intersect to create unique challenges for young mothers. Lack of access to affordable and reliable childcare, coupled with strained family relationships and financial insecurity, often forced young mothers to prioritize childcare over education. This highlights the urgent need for government-subsidized childcare services and financial assistance to alleviate the economic burden on young mothers and facilitate their return to school ( 65 ). Furthermore, our study sheds light on how early motherhood can exacerbate existing socioeconomic vulnerabilities ( 66 , 67 ). Young mothers in our study reported experiencing heightened financial strain, strained family relationships, and limited access to mental health support. These findings underscore the need for integrated support services that address the complex interplay of social, economic, and health challenges faced by young mothers, particularly those living with HIV. This study contributes to the growing body of literature advocating for the meaningful involvement of young people in the design of interventions that affect them ( 35 , 68 ). This research provides valuable insights for policymakers and educators seeking to create supportive and inclusive learning environments for pregnant and mothering learners. Limitations In this study, participatory methods generated valuable formative insights for our Community-Academic partnership and shaped the development of a new research project( 38 ) which leveraged our methodological and empirical findings. However, there are inherent limitations when applying participatory methods to sensitive topics such as adolescent pregnancy and schooling, especially in mixed-gender groups. First, power dynamics present in adult-adolescent research encounters can be further complicated by gendered norms, potentially influencing disclosure and reinforcing social desirability bias( 69 ).. While we chose to employ both remote and in-person methods to be responsive to advisors’ co-design suggestions, online environments may exacerbate power dynamics leading to apprehension or self-censorship, especially for young women invited to speak about sexual and reproductive health matters, on which they may face greater stigma than their male peers ( 70 ). When we interacted with our participants who were young women and men who participated in conversations on topics such as adolescent pregnancy and schooling, there was more participation from young men than women. During the remote activities, there were three young men who participated more than young women. Two were adolescent fathers while one was not a parent. This was surprising as the expectation would be that young women who had more lived experiences of adolescent parenting than the young men might actively participate in the conversations. This observation may be related to males having better access to digital devices compare to females, due to various socioeconomic factors such as education, income and demographic factors ( 71 ); however more intensive participation of males compared to female participants we observed in this study differed from other studies, which found that women were more likely to participate health and social science research ( 72 , 73 ). This dynamic changed when research shifted to face-to-face activities, where more equitable participation appeared possible, as activities were adjusted by creating separate groups for male and female advisors, including groups specifically for mothers and fathers to encourage comfort, safety, and open communication. Our mixed gender cohort was a strength of this study as it drew on perspectives of young mothers and fathers as well as young people generally. However, with males contributing more during the various sessions, there were times where research team members felt that it would have been more meaningful if the group were more of or only young mothers who experienced adolescent motherhood. Secondly, our blended remote and face-to-face methods may have created gendered inequities in participation, where some advisors may have had better access, control and comfort during online activities while others may have a different level of comfort with and access to technology ( 71 ). Intersecting factors such as socioeconomic status, digital literacy and gendered norms around household- or partner-mediated technology use may have skewed representation in our remote methods ( 74 ); for example, some advisors reported poor reception in their communities which made it difficult for them to complete phone calls uninterrupted or be reached altogether. Finally, researcher positionality may have compounded a sense of already existing unfamiliarity for some of the participants. While we overcame this with intensive rapport-building time and intentional activities, this may have led to varying levels of participation in both remote and face-to-face research encounters, which we mainly saw amongst female advisors. The research team included isiXhosa speaking researchers, as well as Afrikaans and English-speaking researchers, who all joined the group after the TAG was established. There was isiXhosa speaking researcher from the previous group of research who was part of the new research team. The presence of the older team fostered trust and a sense of continuity for the advisors. It also contributed to some ease to interact with the new researchers. For some advisors, it was not difficult to adapt to a new research team, while for others it was a challenge. Some advisors found it challenging to accept the new isiXhosa speaking researchers as they had grown comfortable with the previous research team. This particularly became a challenge for advisors when they had to have regular remote interactions about their personal lives. However, over time advisors grew comfortable with new researchers and having isiXhosa speaking researchers in the team made it possible to translate the remote and in person activities in a way that made it easy for the participants to understand. CONCLUSIONS Adolescent pregnancy remains a significant public health concern in South Africa, with detrimental impacts on young mothers' educational attainment and overall well-being. This study highlights the urgent need for comprehensive and multi-sectoral interventions that address the complex challenges faced by pregnant and mother learners. By prioritizing the voices of young research advisors in a community-academic partnership, this research offers valuable guidance for the development of effective policies and programs that support young mothers in achieving their educational goals and realizing their full potential. Our findings emphasize the need for: Stigma reduction social and behaviour change interventions : To address internalized and externalized stigma within families, schools, and communities with support from civil society. Enhanced teacher training and support : To equip educators with the skills to provide psychosocial support and sexual and reproductive health information to learners. Accessible and affordable childcare : To alleviate the burden of childcare on young mothers and enable their return to school. Strengthened social support systems : To provide financial assistance, case management by social workers in collaboration with educators and mental health support to young mothers. Multi-sectoral collaboration and service integration : Improved visibility of and access to psychological and healthcare professionals or services in the school environment. Youth-led participatory approaches : To ensure that interventions are relevant, acceptable, and effective in meeting the needs of young mothers. By implementing these recommendations, South African schools can create a more supportive and inclusive educational environment for pregnant and mothering learners, empowering them to overcome the challenges of early motherhood and achieve their educational aspirations. Declarations All manuscripts must contain the following sections under the heading 'Declarations': Ethics approval and consent to participate Ethical approvals were provided by the University of Cape Town Human Research Ethics Committee (HREC) under the following reference number HREC 226/2017, version7.0 and the University of Oxford Social Sciences and Humanities Interdivisional Research Ethics Committee (IDREC) under the following reference number IDREC R48876/RE003. During in-person interactions, participants were then asked to read the consent form and sign it to ensure written informed consent was attained from those agreeing to participate in accordance with the Declaration of Helsinki. All the participants that were informed about the study signed a consent form, which stated that participation was completely voluntary and they could withdraw from the study anytime they wanted to without giving a reason. We did not recruit any participants under the age of 16, therefore parental or legal guardian consent was not sought. We requested to record our conversations over the telephone and in-person to allow for analysis later . The information they shared was kept entirely confidential and used only by our research team. Any information collected about the participant and their child was done using password protected recorders, phones and laptops. No one else had access to their personal data. Third party transcriptions services may be used to help us transcribe the recordings, but we will not share any of your personal details with them. Anonymised datasets would be shared for non-profit use following United Kingdom and South African data guidelines. There are limited risks associated with the participants data, such as if the researchers recorder, phone or laptop gets stolen. If this happened, we ensure them that we had strong back-up and security systems to minimize the chances of others opening our files. Consent for publication Not applicable. Availability of data and materials Qualitative data is not available to protect the anonymity of participants. Competing interests The authors declare that they have no competing interests. Funding This research was funded by the UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1); the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (n° 771468); Oak Foundation [Grant Number: OFIL-20-057]; and the National Research Foundation: Human and Social Dynamics for Development 2022 [Grant number: 136531]. Authors' contributions CC and HM wrote the main manuscript text and prepared tables and figures. CC conceptualised the study with activity development contributions from YP and HM. CC, HM, YP, MT, YD and LS undertook data co-generation with the Teen Advisory Group. JK critically reviewed the manuscript. LC and ET provided supervision and were responsible for funding acquisition. All authors reviewed the manuscript. Acknowledgements The authors wish to extend thanks to the adolescents and young people of the Eastern Cape Teen Advisory Groups for generously sharing their experiences and perspectives on learner pregnancy and the experience of being young parents with us. Authors thank and acknowledge the crucial support of the research and support teams based at the Universities of Cape Town and Oxford. We acknowledge and thank Dr Lesley Gittings, Dr Rebecca Hodes, Ms Mildred Thabeng, Dr Jenny Doubt, Dr Inge Wessels and Dr Carine Asnong for their long-term involvement and support of the Teen Advisory Groups study on which this work builds. Foremost thanks to Professors Lucie Cluver and Elona Toska’s long-standing commitment to meaningful engagement of adolescents in the research process, as the founder of TAG, and, as Adolescent Accelerators Research Hub PI, providing funding for TAG activities before, during and following COVID-19. We also thank designer Orli Setton for her commitment to a collaborative process of visual knowledge translation. Young advisors were recruited through the Mzantsi Wakho and HEY BABY studies, and we are grateful to the research teams from these studies. References World Health Organisation. Adolescent pregnancy [Fact heet]. 2024 Apr. Barron P, Subedar H, Letsoko M, Makua M, Pillay Y. 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Cape Town: HSRC Press. 432-451. http://hdl.handle.net/20.500.11910/5645 http://hdl.handle.net/20.500.11910/5645 South Africa. Department of Social Development. [Cited: 20 October 2025]. Available from: https://pmg.org.za/committee-question/26887/ Gray M, Lombard A. Progress of the social service professions in South Africa's developmental social welfare system: Social work, and child and youth care work. Int J Soc Welf. 2023;32(4):429-441 National Planning Commission. Chapter 3: Economy and employment. In: National Development Plan 2030: Our future - make it work . Pretoria: Government Printer; 2012. Additional Declarations No competing interests reported. Supplementary Files Supplementary1TAGFBSoPpostsAug2022.docx Supplementary2illustrationsforTAGclosedFBposts.pdf Supplementary3designIncubatorprogramme2628August2022FINAL23082022.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers agreed at journal 06 Jan, 2026 Reviewers invited by journal 06 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Editor invited by journal 15 Dec, 2025 Submission checks completed at journal 11 Dec, 2025 First submitted to journal 11 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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16:18:48","extension":"xml","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":192326,"visible":true,"origin":"","legend":"","description":"","filename":"e85cf0f9264342b89a1b8c4dc7322e691structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/22f42cd3c2b5b155c7da1cb2.xml"},{"id":100070978,"identity":"8bd9675d-a996-4b99-8e45-03d233eb706d","added_by":"auto","created_at":"2026-01-12 16:18:56","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":214341,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/b1e20c9370660aa1f5bd0d6b.html"},{"id":100071004,"identity":"058eda94-9a5f-44a1-811b-df8339e69a55","added_by":"auto","created_at":"2026-01-12 16:18:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169859,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual framework for school return (Singh and Mukherjee, 2018 adapted by Jochim et al., 2021)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/f0b9875f7162d838b836c40f.png"},{"id":100070956,"identity":"0ac7f791-d1ee-4f74-8305-7c1fd3059a43","added_by":"auto","created_at":"2026-01-12 16:18:53","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57277,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnathi’s story was developed in collaboration with South African illustrator Orli Setton. \u003c/strong\u003e(20,48)\u003c/p\u003e\n\u003cp\u003eNote: Each incomplete story-board was developed directly from quantitative findings from the cross-sectional study on which this formative research is based (20,48). These story-boards were accompanied by short vignettes to encourage discussion, commentary and questioning about Anathi’s circumstances and what might happen next in her story, and how she could be supported. In this example, the first set of panels captures continued attendance at school during pregnancy, and the second set of panels captures confidence and a sense of future orientation. See Findings section for additional examples.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/41a5eb2fa1eccd69e2d84f87.jpeg"},{"id":100071008,"identity":"0c9824ce-3de8-4c76-899a-98cdaed518c2","added_by":"auto","created_at":"2026-01-12 16:18:58","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":157608,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnathi's story\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/2d542235848ca856a79647d5.jpeg"},{"id":100071017,"identity":"2a626e32-7a54-4cff-8cd4-0c1f7e10a3eb","added_by":"auto","created_at":"2026-01-12 16:19:00","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":133142,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnathi's story\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/008e6cb0e86f94688971f62c.jpeg"},{"id":100070856,"identity":"20e99fbc-48fb-483c-92c9-2007ed8200ca","added_by":"auto","created_at":"2026-01-12 16:18:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":552176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDreamy care package (young mother group)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/88bca97315e06fbd2b5f5980.png"},{"id":100071162,"identity":"3dcfbad8-cbef-41a8-b188-18fa4184c058","added_by":"auto","created_at":"2026-01-12 16:19:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2660108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/fb7e7b26-17c9-46c7-913b-1ba5c65d955d.pdf"},{"id":100071002,"identity":"e5f0c804-735d-465a-b223-3d7ca1f76943","added_by":"auto","created_at":"2026-01-12 16:18:57","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":798858,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary1TAGFBSoPpostsAug2022.docx","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/8fc7fcc11bef4776e244bd24.docx"},{"id":100071009,"identity":"120d8674-bd29-41ac-8e90-7e29c116d8f1","added_by":"auto","created_at":"2026-01-12 16:18:58","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2382463,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary2illustrationsforTAGclosedFBposts.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/514865110eaa442266630bf8.pdf"},{"id":100071019,"identity":"32a1207d-a974-4df2-ac02-0b1e04df78c4","added_by":"auto","created_at":"2026-01-12 16:19:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":795363,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary3designIncubatorprogramme2628August2022FINAL23082022.docx","url":"https://assets-eu.researchsquare.com/files/rs-8104657/v1/f7a4240e3293e93b06e2df5c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging the implementation gap: youth-led priorities for supporting pregnant and mothering adolescents’ wellbeing and schooling","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDespite that there was a worldwide decrease in the adolescent birth rate, there are still differences that were found. In 2021, Sub-Saharan Africa (SSA) experienced the highest volume of adolescent births, with 6,114,000 among 15\u0026ndash;19-year-olds and 332,000 among 10\u0026ndash;14-year-olds. This is a significant difference from Central Asia (68,000 births to 15\u0026ndash;19-year-olds) and South-East Asia (22,000 births to 10\u0026ndash;14-year-olds) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Between 2016\u0026ndash;2021, teenage pregnancies in South Africa increased in all provinces and in each year (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), where 14% of all births in Eastern Cape province are to adolescents (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdolescent mothers face challenges that are a direct consequence of multiple systemic issues: South Africa has a high rate of socioeconomic inequality, where poor access to healthcare and education is common, and young people experience high rates of unemployment\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). When adolescent girls become pregnant, their schooling is affected, and their risk of exposure to violence, food insecurity, and HIV increases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, poor health and well-being hinder their socioeconomic prospects (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, many known protective factors can enable school engagement and return:for young mothers, an enabling schooling environment is linked to higher educational attainment and improved health outcomes, including reduced maternal mortality(\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Ensuring that adolescent mothers can continue their schooling contributes to their own and their children\u0026rsquo;s health and wellbeing as well as their future employment prospects (\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent research in the Eastern Cape with adolescent mothers and their children has identified challenges related to learner pregnancy and adolescent mothers' ability to return to school, affecting future generations and increased poverty (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Protective factors such as enrolment during pregnancy, access to childcare post-birth, and a supportive school environment have been identified to encourage school return (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). However, a gap in implementation of supportive provisions and strategies exists: this research aims to address this gap, informed by young research advisors\u0026rsquo; lived experience of young parenthood and recent evidence on learner pregnancy, to inform potential implementation package priorities that would support adolescent mothers' educational attainment.\u003c/p\u003e \u003cp\u003eThere is limited literature on how the school environment can adapt to be a more caring platform for adolescent mothers (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). South African research on adolescent pregnancy and motherhood have historically focused more on drivers and consequences of adolescent pregnancy as well as prevention strategies (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). More evidence is needed on how to ensure the protective benefit conferred by schooling can extend to adolescent mothers, including considerations for design of scalable implementation models that can be adapted, sustained in real-world settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2021, the National Department of Basic Education (DBE) in South Africa launched a policy which aims to support pregnant and mother adolescents\u0026rsquo; right to schooling during pregnancy and return after birth (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Evidence from the African region points to the importance of involving adolescents in designing and planning interventions to strengthen skills through meaningful engagement, increasing the likelihood of programme acceptability and intervention success(\u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Our research invited young people's participation in formative research on the implementation of this policy, recognizing their expertise in shaping relevant and acceptable programming, and their great potential to contribute to society (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis formative work was undertaken as part of a long-standing Community-Academic partnership between the Universities of Cape Town and Oxford and a \u0026ldquo;Teen Advisory Group\u0026rdquo; (TAG). TAG was established in the Eastern Cape, South Africa in 2019, and informed by eleven years of collaborative research with young advisors in the Western Cape, South Africa (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Through this community-academic partnership, advisors have informed the direction of innovative, participatory, arts-based methodology and engagement approaches and co-generated empirical data on the health and development of adolescents and young people, which continued throughout strict COVID-19 lockdowns in South Africa (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis formative research with TAG aimed to engage with advisors\u0026rsquo; lived experience with and recent evidence on learner pregnancy, to inform potential implementation package priorities that would support adolescent mothers\u0026apos; educational attainment - a well-established social determinant of health (20,40) These priorities informed, and are further explored, in a multi-stage study which informed a training resource and ongoing intervention design aimed at educators, to improve support for pregnant and mother learners (13).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eContext\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eOur collaborative research with advisors informed two phases of participatory priority-setting with Eastern Cape TAG members over eight weeks in July-August 2022: (1) remotely through weekly phone calls and a weekly collaborative activity in a closed, researcher-moderated Facebook Group (n=7); and (2) face-to-face through a weekend residential workshop (n=13).\u0026nbsp;These combined methods were designed to facilitate the co-construction of support package priorities and design considerations in partnership with young people.\u0026nbsp;Our participatory methods were discussed, reviewed and validated with TAG member-mothers and explored their priorities and provisions.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eConceptual framework\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eTo explore the socio-ecological systems and factors that influence adolescent mothers\u0026apos; dropout and return to and progression in school, this research applied two conceptual frameworks depicted in figure 1 below: \u0026nbsp;the social ecological systems of child and adolescent development (41,42) and socio-ecological theory, specifically examining adolescent mothers\u0026apos; school return after birth (8,43); and the theory of positive youth development, which focuses on building assets, agency, contribution, and enabling environment (44) for programme and research participation. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYoung Research Advisors\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTAG is a group of young research advisors (\u0026ldquo;young advisors\u0026rdquo;), first recruited in 2019 as part of a larger multi-site participatory, collaborative study on adolescent health, development, and well-being in South Africa, Kenya, Sierra Leone, and Uganda (45,46). \u0026nbsp;Young advisors for the research described in this paper were recruited from the Eastern Cape TAG, were between the ages of 17 and 23 years when they first joined the study (n=18) and were initially recruited through snowballing methods from two existing observational cohorts based in the Eastern Cape that started in 2014 (36,38,47). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn May 2022, after participating in remote research during strict COVID-19 lockdowns in South Africa (38,49,50), young research advisors from the Eastern Cape TAG were contacted to re-establish research relationships and to re-introduce them to a new team of researchers with whom they would be collaborating. The initial stages of engagement were remote, with the objective of building rapport and trust to prepare researchers and advisors for the upcoming face-to-face participatory design workshop. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eProcedures\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eEngagement strategies used to communicate with advisors were similar to those recommended by and applied with TAGs in the past, building on what has been suggested by them and worked for them previously (38) and adapting to advisors\u0026apos; life stages as young adults with growing children, employment, and domestic responsibilities (36-38). \u0026nbsp;Table 1. below presents the demographics of the advisors, column 1 presents the age of participants in 2022 and it was between ages: 23, 25 years. Column 2 shows the gender of the participants, male or female. Column 3 shows the Type of demographic area residing I - peri-urban areas are located on the outskirts of a city; rural areas are typically countryside or remote areas. Column 4 shows indicates whether the respondent is a parent in \u0026lsquo;Yes\u0026rsquo; or \u0026lsquo;No\u0026rsquo;. Column 5 shows the numerical number of children the participant has. Column 6 shows the highest school grade passed. Column 7 shows the participants Interests and current engagements in 2022-2023 which were job searching, enrolment in college/university, and working. Advisors were encouraged and supported to express themselves in their first language (isiXhosa) during both remote and face-to-face methods. \u0026nbsp; While some of the lead researchers were English speakers, most advisors could collaborate and communicate in their first language with other lead researchers and research assistants (51,52). \u0026nbsp;This dynamic enabled the advisors to speak and share freely. In past gatherings and the workshop documented here, advisors were also invited to use art- and music-based mediums to communicate their experiences and perspectives (50,53).\u003c/p\u003e\n\u003cp\u003eData co-creation occurred in 3 stages:\u003c/p\u003e\n\u003cp\u003eStage 1: we conducted phone calls with advisors for introductions, to build relationships and begin a process of continuous informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStage 2: interactions took place through a closed, private Facebook group which select advisors consented to be added (n=7), and subsequently accepted invitations. Evidence from our past work has shown that using closed Facebook groups with young people has proved to be a comfortable and safe space, is convenient, and provides access to those who may not own personal phones or are using multiple devices (36,38). As a data collection tool, using Facebook usually does not require data bundles to use and can be used at no cost in South Africa and other African countries. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo ensure consistent interaction on Facebook, we called advisors at least once a week. This was a way of checking in and building relationships, clarifying Facebook research activities and prompts, and obtaining feedback on the methodology, all in preparation for face-to-face interaction. During phone conversations, requests for and referrals to food and psychosocial support also occurred. This was the case for more than half of the group. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStage 3: took place through a face-to-face workshop. As we approached the time of the in-person workshop, an existing database of the teen advisory group was used to follow-up on the initial contact made before Facebook activities began. Due to the time lag between the last interaction and reconnecting with the team, some advisors\u0026apos; contact numbers were no longer in use. We were supported by fellow advisors to get contact details for those not reachable on the phone and Facebook. \u0026nbsp;Through networking with advisors involved in the Facebook activities, additional advisors were recruited, who demonstrated interest in attending the in-person workshop and consented to participate (n=13). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 1. Advisors\u0026rsquo; socio-demographic characteristics and levels of participation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of demographic area residing in\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Parent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest school grade passed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterests and current engagements in 2022-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation stages in Design incubators methods (1, 2, 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching and interested to open a fast foods business in the future\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching and a local hip hop artist.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eEnrolled in college studying Mechanical engineering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching \u0026nbsp;and participates in voluntary and paid part-time work in his community\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching and expecting a second child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eWorking as a waiter and planning to go back to school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eWorking in the Gauteng province\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eCurrently enrolled in college studying Business management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1,2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching and participates in voluntary and paid part-time work in his community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1, 2, 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003ePlanning to enrol in University in 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 7.3955%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9149%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6934%;\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6463%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4148%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3987%;\"\u003e\n \u003cp\u003eJob searching and interested in participating in community development work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7203%;\"\u003e\n \u003cp\u003e1, 2, 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: The table above shows the following: Column - 1 presents the age of participants in 2022 and it was between ages: 23, 25 years. Column 2 shows the gender of the participants, male or female. Column 3 shows the Type of demographic area residing I - peri-urban areas are located on the outskirts of a city; rural areas are typically countryside or remote areas. Column 4 shows indicates whether the respondent is a parent in \u0026lsquo;Yes\u0026rsquo; or \u0026lsquo;No\u0026rsquo;. Column 5 shows the numerical number of children the participant has. Column 6 shows the highest school grade passed. Column 7 shows the participants Interests and current engagements in 2022-2023 which were job searching, enrolment in college/university, and working.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eRemote methods\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eEach comic strip-style storyline was developed directly from quantitative findings from the HEY BABY longitudinal cohort (20,48). These were accompanied by short vignettes to encourage discussion about Anathi\u0026apos;s circumstances and what might happen next in her story as depicted in figure 2 below. \u0026nbsp;See Supplementary files 1-2 for more details.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFace-to-face participatory design workshop\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe 3-day face-to-face gathering began with a social meal to reconnect; the group also explored previous and set new ground rules to build space for speaking openly and shifting participation means as needed. Building transparency, trust, and capabilities is an important principle of participatory research with young people. While all advisors except one new TAG member previously received training during their induction into TAG on the research process, power relations, and participation techniques, the group had not been in person together for \u0026gt;2 years. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA participatory session on \u0026quot;what is research?\u0026quot; was facilitated in small groups, where advisors were invited to choose a research topic of interest to their age group and community, developing research questions and methods of interest. Community and other stakeholder engagement was also discussed, which provided a helpful primer for the focus of the upcoming participatory sessions focused on DBE\u0026apos;s new policy on preventing and managing learner pregnancy. This session concluded with small-group discussions on informed consent, what we mean by consent in these face-to-face activities, and why it is important. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThereafter, the \u0026quot;gallery walk\u0026quot; and \u0026quot;talking wall\u0026quot; activity was introduced by exploring knowledge co-created in TAG\u0026rsquo;s past research encounters, while also re-orienting the group to considerations for adolescent pregnant and mother learners and the DBE\u0026rsquo;s policy priorities. This activity situated advisors in the current collaborative priority setting activity and conveyed the significance of the opportunity to influence implementation of the DBE\u0026rsquo;s new policy and support future pregnant and mother learners to continue their schooling.\u003c/p\u003e\n\u003cp\u003eGroup interviews were conducted in separate groups: fathers, mothers, young men who were not fathers, and young women who were not mothers. In preparing for the workshop, we reviewed proposed methods with advisors and mothers preferred to have a private group setting where they could express themselves more freely. Group interviews were moderated by research assistants who matched the gender of their group, guided by a semi-structured question, encouraging discussion amongst each other but not restricted to a formal interview or focus group discussion guide; limitations to focus group and interview techniques include risks of social desirability bias and challenges associated with building rapport (54,55). \u0026nbsp; Group interviews elicited emotional reactions, which required facilitators to navigate motherhood experiences with great sensitivity, pausing, and excusing some members who wished to have a break and eventually return (55).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe final activity, called the \u0026quot;dreamy care package,\u0026quot; - aimed to develop and explore possible support package components and design considerations, answering the \u0026ldquo;what, when, where and who\u0026rdquo; of possible delivery strategies of priority provisions for pregnant and mother learners (33,56). This arts-based, multi-media activity included a series of prompts to work through in small groups, as well as collage materials, and open-ended materials where participants engaged with to draw, and used written text to elaborate on their drawings. \u0026nbsp; \u0026nbsp;Each group had a small box that they had to populate with goods or services they felt pregnant learners needed; they also closed and wrapped the package, and in so doing, solidified their contribution in a complete, physical \u0026ldquo;package\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eActivities were conducted in both English and isiXhosa and transcribed verbatim into English. Ethical approvals were provided by the University of Cape Town (HREC REF: 226/2017) and the University of Oxford (IDREC approval: R53899/RE003). See supplementary file 3 for more information.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAnalysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eWe utilized a combined deductive and inductive approach that is both critical and constructivist, enabling us to elucidate the social structures underpinning pregnant and mother learners\u0026apos; experiences (57-59). Our inductive analysis remained open to discovering unexpected aspects of the Advisors\u0026apos; experiences and generating new theories, which we operationalized using open coding. Our deductive approach enabled us to be guided by the multi-layered lives of adolescents and young people, capturing the multi-level influences on their schooling and parenthood shaped by socio-ecological systems and temporality theorized in our conceptual framework. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGroup thematic analysis was overseen by a senior qualitative researcher, supported by two other qualitative researchers and two research assistants who participated in remote and in-person data co-generation with TAG young advisors. Thematic analysis began with collaborative inductive coding of Facebook group posts and discussions, the talking wall, group interviews and visual data from the \u0026apos;dreamy care package\u0026apos; activity. \u0026nbsp; We followed updated guidance on reflexive thematic analysis (RFA) guidance (60) which recognises the group\u0026rsquo;s diverse interpretations of the dataset, our assumptions during the analysis process, and the analytical skills and resources of each researcher (60). We followed a step-by-step process of 1) data familiarisation; 2) generation of initial codes; 3) refining codes, generating themes; 4) discussing and reviewing themes collaboratively; 5) defining and naming themes; and 5) writing (60).\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eMember-checking\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eMember-checking was conducted after analyzing co-generated data (61,62) to invite advisors to review and validate our preliminary findings. \u0026nbsp;Building on previous research with TAG (38) , results were presented to TAG advisors in 1:1 phone call with one researcher, ranging from 6-25 mins, depending on how much elaboration they wished to provide. \u0026nbsp; \u0026nbsp;(n=10). These calls enabled us to check the accuracy and trustworthiness of the results and how the results resonated with them.\u003c/p\u003e\n\u003cp\u003eThe procedure for member checking was as follows: developing a script summarizing the findings generated from our online and in-person activities.\u0026nbsp;Iconography was created to accompany the script, with the hope of sharing with the advisor before this call.\u0026nbsp;However, we ended up not sharing the script as it was decided that the content might be overwhelming for the advisors.\u0026nbsp;One of the team members reached the advisor on WhatsApp to inform them about the upcoming phone calls on member-checking.\u003c/p\u003e\n\u003cp\u003eOur research team contacted each advisor and talked through each finding in the preferred language, isiXhosa, and then asked the participant a series of questions exploring their level of familiarity with the finding, and whether they confirmed it. For young mother advisors, we invited them to explain their experience differently, if it disagreed with how our findings were shared. We used, if there anything they would add about their experience or clarify what we shared as findings; we also asked if we captured their meaning of their perspectives the way they intended to express and convey them.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe themes and subthemes that emerge from this data are presented according to the groupings of the socioecological framework (see Table 2 below). \u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e. Themes mapped to adapted socio-ecological framework\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConceptual framework\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod of data collection/Activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eIndividual factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eJudgement and stigma\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eJudgement at school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung mother\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFamily shame\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eSelf-motivation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFacebook\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eFamily and partner level support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eFamily and partner-level \u0026nbsp;support\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent mothers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePartner support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFormal and informal childcare\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eInformal childcare\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFacebook\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent mother\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFormal childcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFacebook\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent mother\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eCommunity service factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eCommunity stakeholder support\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent father\u003c/p\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eSchool based support\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFriends at school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTalking wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSupportive teachers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMacro-level factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cem\u003eSystemic enablers\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGovernment grant for daycare and essential supplies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGroup interviews\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAdolescent father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eVisits by social workers and healthcare workers at schools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFacebook\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eAvailing adult education as an option to pregnant and learner mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFacebook\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYoung male advisor- not a father\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eIndividual factors\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe first theme of the framework is the individual level factors. This theme relates to the individual level experiences of how the adolescent mothers simultaneously experienced and navigated the complexities of early motherhood and schooling, including experiences of judgement and stigma but also more positive experiences of self-motivation.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eJudgement and stigma\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAdvisors described the process of social scrutiny by various figures in their families, schools and communities: parents, community members, peers and educators. Advisors described their own experiences of judgment, and how this can contribute to stigma enacted on and felt by a pregnant learner, and its ramifications for their health, education and wellbeing.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eJudgement at school\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eSome advisors expressed that their peers gossiped and separated themselves as they did not want to be associated with young mother learners. This behaviour extended to adult educators, where one advisor expressed judgement from teachers which eventually led her to drop out of school:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes! I didn\u0026rsquo;t get any, because they used to make fun of me, that I got pregnant young, even the female teachers. So, I was forced to drop out of school, and I quit. From the community, number one!\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;[23-year-old female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u0026nbsp;\u003cem\u003eFamily shame\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eEmphasis was placed on the community who were identified as neighbours and the level of influence they had over learners\u0026rsquo; parents. This came more from male advisors than female advisors and could be based on the experiences of someone close to them or what they had observed around them. One advisor mentioned how the community would judge pregnant learners and how this experience reflected negatively on her family.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When the\u0026nbsp;\u003c/em\u003e\u003cem\u003ecommunity\u003c/em\u003e\u003cem\u003e\u0026nbsp;is looking at you in that way like that you\u0026rsquo;ve disappointed your parents and then like so ever if you\u0026rsquo;re walking in the street like they judge you they do funny things to you\u003c/em\u003e\u003cem\u003e.\u0026rdquo; [\u003c/em\u003e\u003cem\u003e22-year-old, male, not a father]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And then from the community there was no one because they are gossipers only\u0026hellip;\u0026rdquo;. [23-year-old female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdvisors who had been a young father during adolescence felt they adolescent pregnancy was a disgrace to their family. They were concerned about how the family would come to terms with the adolescent pregnancy at a young age in the family. The young father further spoke about how This led to some families or parents would make things difficult for the pregnant learner at the beginning of the pregnancy. It became challenging to report the pregnancy to parents because they felt they had brought disgrace to their family. One advisor shared,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;You see at home? They would never just forgive you whilst they know they know they send you to school...you just show up with a belly...They\u0026apos;ll give you some difficulty first...\u0026quot; [24-year-old male, father]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u0026quot;power\u0026quot; of the community demonstrates how societal norms are deeply embedded in how judgment is passed on others. If the community treats the family badly because of the pregnancy, the parents might turn their anger toward the pregnant learner. Even if they forgive her, she may feel that she has made the community look down on her family. One advisor explained:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;When the community is looking at you in that way...you\u0026apos;ve made people look down on them now, their dignity is no longer there.\u0026quot;\u0026nbsp;\u003c/em\u003e[\u003cem\u003e22-year-old, male, not a father]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003eSelf-motivation\u003c/h2\u003e\n\u003cp\u003eBeing self-motivated helped the young mothers to overcome difficulties or cope during the difficulty of a being adolescent pregnancy and motherhood. Self-motivation was identified as one of the necessary strategies learner mothers explored to ensure they were able to cope with adolescent pregnancy and returned to school after having a baby. The advisors suggested that the pregnant learner should set goals for themselves by making use of tools such as study timetables (which work around the baby\u0026apos;s schedule), reminders, and multitasking to keep up with schoolwork. One participant mentioned the importance of creating goals and trying to stick to them:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eHey guys, I really like how motivated [learner mother] is...she needs to implement little steps that will help her achieve her goals and stick with them...If you fail to plan, you plan to fail easy\u003c/em\u003e.\u0026quot; \u003cem\u003e[23-year-old, male, father]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFamily and Partner-level support\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIn line with the socioecological framework, this theme focuses on the family level support from family members who help lessen the burden of pregnancy and motherhood so that the learner can focus on school and not get overwhelmed, tired, or sick (physically and mentally) and end up dropping out of school. This is a support system that the pregnant learner and learner mother can rely on, confide in, report pregnancy to and turn to when in need.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSub-themes that fall under this theme are family support, siblings and the partner or father of the baby. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFamily Support\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eFamily came across as a strong form of support for the pregnant and mothering adolescent girl. Family support significantly influenced the learner\u0026rsquo;s pregnancy experience and her ability to continue and focus on school during pregnancy and after having a baby. \u0026nbsp;Advisors alluded to various measures of family support provided by different family members. This form of support makes up household support by family members like parents, aunts, other caregivers and siblings. This was through financial support and caring for the child while the learner mother needed to return to school.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There is only one person who could help me, it\u0026rsquo;s my sister, because she is the person who cares about me, even though she doesn\u0026rsquo;t stay here but she calls me constantly and even when I lack something, she would send me money, so that I could buy that thing that I want, you see.\u0026rdquo; [22-year-old, female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The person who was supporting me, was my mother at home, she used to do everything for me, accompany me to the clinic and everything else. At school they did not even notice that I was pregnant and then when I was going to give birth, I stayed for a short while and then decided to go back to school during examinations. And then the deputy president from school handled all of that\u0026hellip;\u0026rdquo; [22-year-old, female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;One advisor described how supportive all her family members were toward her when she was pregnant:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Yoh! I got support from home! All of it! All of it! I got it from home. At school hey! I did not get any...The whole family, mom, dad, aunt, grandmother, and Aunt (from the father\u0026apos;s side).\u0026quot; \u0026nbsp; [23-year-old, female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAn advisor expressed that when parents were supportive, the learner would be able to focus better on school during her pregnancy and after having a child. Figure 3. below presents a comic strip of Anathi\u0026rsquo;s story on how she navigates finding the balance between motherhood and her schoolwork.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Something that can make them pass is if their parents are supportive and encourage them that school is important, I think they would feel better and be more focused on their schoolwork\u0026hellip;\u0026rdquo; [22-year-old, male, not a father].\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003ePartner Support from father of the baby\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAlthough only half of the young mother advisors had support from the father of their baby, some mentioned how the father provided support during pregnancy. One advisor shared her experience by saying the following: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s my person, someone from outside was the father. Uhm, at school he takes me, he was my friend.\u0026rdquo; [22-year-old female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother advisor spoke about how the father of the baby supported her financially when she was pregnant:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Oh, and the father of my child, ah shame he supported me. When it comes to things that have to do with money and everything.\u0026rdquo; [22-year-old, female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFormal and informal childcare\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;Participants further expressed that having access to childcare enabled them, and could enable other young mothers, to return to school after having a baby. Childcare experiences varied according to participants\u0026apos; preference, and which one was more accessible to them. Some participants preferred formal childcare whilst others preferred informal childcare.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eInformal childcare\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eFamily members such as mothers and the father\u0026rsquo;s family can help with childcare. Advisors found this preference of childcare safer than taking the child to daycare. Daycare was perceived to be riskier as the baby needs extra care and attention. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;For example, when the child is sick and cannot attend daycare centre they can remain at home with a caregiver so that the young mother does not have to miss school to care for the baby:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think this thing of taking [the baby] to creche [daycare] will help her for a short time first [the baby] is 3 months old and a baby that young needs a lot of looking after and there are a lot of children that are being looked after at that creche [daycare] there are a lot of things that could go wrong while the teachers are looking after the other children and a baby gets sick especially a young one which could force [the learner mother] to end her school day early for taking the baby to the clinic so it\u0026apos;s best she gets a family member who can stay with the child .\u0026rdquo; [24-year-old, female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFormal childcare\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAs much as there were advisors that perceived daycare as an unsafe option for childcare, other advisors regarded formal childcare as a safer option. \u0026nbsp;Advisors also mentioned that the mother would stress less and be able to concentrate on school when the child was at daycare. \u0026nbsp;The picture below depicts part of the story boards from Anathi\u0026rsquo;s story, used during our remote methods. It shows Anathi leaving her child at daycare before going to school. The quote following Figure 4 below is one of the contributions by advisors in our engagements about Anathi, leaving her child at daycare when she must attend school.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think that [learner mother] should leave [the baby] at creche [daycare] then [learner mother\u0026rsquo;s] family helps [the learner mother] with picking [the baby] up from creche [daycare] so that [the learner mother] is not stressed about her child whilst at school.\u0026rdquo; [22-year-old female, mother]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCommunity service factors\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOur conceptual framework also considers support that can be outside the family. In this study, neighbours in the community, the school and church were identified as important role-players in the community-level support system for pregnant and mother learners.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eCommunity stakeholder support\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThis theme refers to the support received from stakeholders outside the family. These are stakeholders that assist pregnant and mother learners to cope at school and to be able to provide needs and childcare for the baby. The advisors also mentioned that community entities such as the church and neighbours in the community could assist with supporting them with baby supplies such as clothing, food and nappies while they were pregnant and after having a baby.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A neighbour can help me, a woman from church can also help me if I am a churchgoer, it could happen that we are not church goers.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eOr a church that can support children that are pregnant, including myself who is pregnant, in the community. It can help me maybe by bringing me food, helping me with diapers.\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e [\u003cem\u003e25-year-old, male, father\u003c/em\u003e] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile family came across as a more preferred and trusted support system when it came to childcare and child\u0026rsquo;s needs, this was not the case with all advisors. One advisor said they sought help with childcare outside the family. Neighbours were also identified as trusted individuals that the young mother would seek support from. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s my neighbour.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eBecause I trust them so much and my family doesn\u0026rsquo;t care, especially my father. So, I would ask my neighbor.\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;[23-year-old, female, not a mother]\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eSchool-based support\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe sections below present subthemes which are related to support found in the school environment, including support from friends and teachers.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eFriends at school\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eFriends and peers were identified as some of the people who made it easy for pregnant and learner mothers to be at school during pregnancy and after having a child. A supportive and respectful environment from friends, who did not make fun of them, fostered trust and enabled one advisor to continue her education throughout pregnancy and after having a baby:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A friend that you trust at school, someone who won\u0026rsquo;t make fun of you.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eA close friend that won\u0026rsquo;t get tired of you or someone you can trust that will not get tired to help you.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe school stuff and learners are responsible for each other on how they treat and accommodate one another, so they must be considerate of each other.\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;[Talking Wall, anonymous]\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eSupportive teachers\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThis refers to the role and impact that teachers can play in the school environment that enabled pregnant and mother learners to keep up with school. \u0026nbsp;Teachers were perceived as role models and parents while they were in a school environment. One advisor said that teachers who were approachable made it easy for the learners to open to them when they needed to talk about their problems: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are teachers that [are] approachable, then you can go tell your problem to her and then she, as a parent, because she is a parent [22-year-old, male, not a father]\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother advisor mentioned that motivating the learners should not only be the learner\u0026apos;s responsibility. The school can also have competitions to encourage learners to focus on their schoolwork and meet their academic goals. They suggested that schools could implement programs that will keep the adolescent mothers motivated to do well at school:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;at schools there could be a competition with other schools the highest will represent their school after they win the competition, they can be awarded something, if there are awards at school at the end of every term I think can help [learner mother] be more focused as well.\u0026rdquo; [22 year old, male, not a father]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSystemic enablers\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMacrolevel enablers refers to the government driven solutions that affect pregnant and learner mother\u0026rsquo;s ability to return and stay in school. These are solutions that ensure that all relevant actors and services required are available and the school environment is conducive to the pregnant and mother learner. These enablers were identified as government grants, involvement of social workers and healthcare workers at school including alternative learning methods for the pregnant and learner mother. Most of the suggestions or views quoted in this section were by young men, including those who were adolescent fathers.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eGovernment grant for creche and essential supplies\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAdvisors raised the point that the government could make funding or grants available for daycare for adolescent mothers that were still at school. This form of government support also included the government providing baby essentials that the baby would need to survive on the first few days after the baby leaves hospital. One advisor reported that government could support the adolescent mothers by supplying them with baby porridge and toiletries just after the baby has been born: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTo have a list of those who struggle to make ends meet where they can, with that baby that will have been born, to be able to take her to school, to that creche and pay for her at those creches that will require payment\u0026hellip; So, it\u0026rsquo;s mostly resting \u0026hellip;on a social worker and the government.\u0026rdquo; [25 year old, male, father]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFigure 5. presents the \u0026nbsp;Dreamy care package items including \u0026ldquo;SASSA\u0026rdquo; (Social Security of South African Social Security Agency) and the responsibilities of the Department of Social Development. On a purple sticky note, mothers describing the process of applying for a child support grant through SASSA and how it could be used by mother learners; essential items included were also referenced in interviews [23, 25, 26 year old females, all mothers]\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eVisits by social workers and healthcare workers at schools\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eHaving access to mental and health care support was identified as essential for the wellbeing and ability of the pregnant and learner mother to continue with school. Nurses and healthcare workers were identified as those who provide motivational support at schools by empowering pregnant and mother learners to be able to continue with school and helping them prevent repeated pregnancies. \u0026nbsp;Social workers would intervene in encouraging learners to stay in schools and provide psychosocial support to pregnant and mother learners.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;[Learner mother] needs assistance from a social worker because a social worker \u0026hellip;can help her find counselling so she can express herself and be free around other children.\u0026rdquo; [22 year old, male, not a father]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare workers would provide reproductive health education related talks in school. Advisors also said that healthcare workers could provide advice about unplanned pregnancy and the importance of contraception for pregnancy prevention: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Nurses go to schools to speak to learners about teenage pregnancy, they must explain and tell the learners that have not fallen pregnant yet that they mustn\u0026rsquo;t be weary of using a condom.\u0026rdquo; [22 year old, male, not a father]\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAvailing adult education as an option to pregnant and learner mothers\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAdvisors suggested that adult based education (ABET) could be provided as an option to adolescent mothers that are likely to drop out and not return to school. This was to accommodate learners that are too embarrassed to return to school as some would feel that they were too old for school:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Government can advertise ABET schools to dropouts because for some it is difficult to return to school because of age, they say they are old and are embarrassed to wear a school uniform, so they advertise and release posts for registration and call people for explaining how it works, to give the student\u0026rdquo; [22 year old, male, not a father]\u003c/em\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explored design considerations for educational policies supporting pregnant and mothering learners in South Africa, drawing on the insights of young research advisors. Our findings highlight the critical need for comprehensive support systems that address the multifaceted challenges faced by these young mothers within their families, schools, and communities.\u003c/p\u003e \u003cp\u003eConsistent with previous research (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), our study emphasized the importance of both family and institutional support for young mothers returning to school. However, we found that internalized and externalized stigma, often rooted in religious and cultural beliefs, posed significant barriers to accessing this support. Young mothers reported feeling judged and unsupported, leading to disengagement from school and reliance on informal support networks within their communities. This underscores the need for interventions that address stigma and promote understanding and acceptance within families, schools, and communities. Social workers were identified as key facilitators in mediating these complex situations and ensuring young mothers receive the support they need. The central role of social workers is outlined in the Children's Amendment Act 41 of 2007 (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e), yet the scarce number of registered social work professionals relative to the population they need to serve challenges their ability to deliver comprehensive, supportive services (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). According to the Parliamentary Monitoring Group of South Africa, in 2024, it was estimated that \u0026plusmn;\u0026thinsp;44,848 registered social workers (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e) were managing a caseload of 1:100 per month in all provinces, however Norms and Standards for Social Welfare Services outlines an ideal caseload of 1:60 (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e) \u0026ndash; approximately 10,000 additional workers are envisioned by the national development plan by 2030 (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings also reinforce the findings of previous research (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) that has identified childcare, caregiver relationships, and socioeconomic factors as crucial predictors of school return and retention. However, our study further revealed the nuanced ways in which these factors intersect to create unique challenges for young mothers. Lack of access to affordable and reliable childcare, coupled with strained family relationships and financial insecurity, often forced young mothers to prioritize childcare over education. This highlights the urgent need for government-subsidized childcare services and financial assistance to alleviate the economic burden on young mothers and facilitate their return to school (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, our study sheds light on how early motherhood can exacerbate existing socioeconomic vulnerabilities (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Young mothers in our study reported experiencing heightened financial strain, strained family relationships, and limited access to mental health support. These findings underscore the need for integrated support services that address the complex interplay of social, economic, and health challenges faced by young mothers, particularly those living with HIV.\u003c/p\u003e \u003cp\u003eThis study contributes to the growing body of literature advocating for the meaningful involvement of young people in the design of interventions that affect them (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). This research provides valuable insights for policymakers and educators seeking to create supportive and inclusive learning environments for pregnant and mothering learners.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eIn this study, participatory methods generated valuable formative insights for our Community-Academic partnership and shaped the development of a new research project(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) which leveraged our methodological and empirical findings. However, there are inherent limitations when applying participatory methods to sensitive topics such as adolescent pregnancy and schooling, especially in mixed-gender groups. First, power dynamics present in adult-adolescent research encounters can be further complicated by gendered norms, potentially influencing disclosure and reinforcing social desirability bias(\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e).. While we chose to employ both remote and in-person methods to be responsive to advisors\u0026rsquo; co-design suggestions, online environments may exacerbate power dynamics leading to apprehension or self-censorship, especially for young women invited to speak about sexual and reproductive health matters, on which they may face greater stigma than their male peers (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). When we interacted with our participants who were young women and men who participated in conversations on topics such as adolescent pregnancy and schooling, there was more participation from young men than women. During the remote activities, there were three young men who participated more than young women. Two were adolescent fathers while one was not a parent. This was surprising as the expectation would be that young women who had more lived experiences of adolescent parenting than the young men might actively participate in the conversations. This observation may be related to males having better access to digital devices compare to females, due to various socioeconomic factors such as education, income and demographic factors (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e); however more intensive participation of males compared to female participants we observed in this study differed from other studies, which found that women were more likely to participate health and social science research (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). This dynamic changed when research shifted to face-to-face activities, where more equitable participation appeared possible, as activities were adjusted by creating separate groups for male and female advisors, including groups specifically for mothers and fathers to encourage comfort, safety, and open communication.\u003c/p\u003e \u003cp\u003eOur mixed gender cohort was a strength of this study as it drew on perspectives of young mothers \u003cem\u003eand\u003c/em\u003e fathers as well as young people generally. However, with males contributing more during the various sessions, there were times where research team members felt that it would have been more meaningful if the group were more of or only young mothers who experienced adolescent motherhood.\u003c/p\u003e \u003cp\u003eSecondly, our blended remote and face-to-face methods may have created gendered inequities in participation, where some advisors may have had better access, control and comfort during online activities while others may have a different level of comfort with and access to technology (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Intersecting factors such as socioeconomic status, digital literacy and gendered norms around household- or partner-mediated technology use may have skewed representation in our remote methods (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e); for example, some advisors reported poor reception in their communities which made it difficult for them to complete phone calls uninterrupted or be reached altogether.\u003c/p\u003e \u003cp\u003eFinally, researcher positionality may have compounded a sense of already existing unfamiliarity for some of the participants. While we overcame this with intensive rapport-building time and intentional activities, this may have led to varying levels of participation in both remote and face-to-face research encounters, which we mainly saw amongst female advisors. The research team included isiXhosa speaking researchers, as well as Afrikaans and English-speaking researchers, who all joined the group after the TAG was established. There was isiXhosa speaking researcher from the previous group of research who was part of the new research team. The presence of the older team fostered trust and a sense of continuity for the advisors. It also contributed to some ease to interact with the new researchers. For some advisors, it was not difficult to adapt to a new research team, while for others it was a challenge. Some advisors found it challenging to accept the new isiXhosa speaking researchers as they had grown comfortable with the previous research team. This particularly became a challenge for advisors when they had to have regular remote interactions about their personal lives. However, over time advisors grew comfortable with new researchers and having isiXhosa speaking researchers in the team made it possible to translate the remote and in person activities in a way that made it easy for the participants to understand.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAdolescent pregnancy remains a significant public health concern in South Africa, with detrimental impacts on young mothers' educational attainment and overall well-being. This study highlights the urgent need for comprehensive and multi-sectoral interventions that address the complex challenges faced by pregnant and mother learners. By prioritizing the voices of young research advisors in a community-academic partnership, this research offers valuable guidance for the development of effective policies and programs that support young mothers in achieving their educational goals and realizing their full potential.\u003c/p\u003e \u003cp\u003eOur findings emphasize the need for:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStigma reduction social and behaviour change interventions\u003c/b\u003e: To address internalized and externalized stigma within families, schools, and communities with support from civil society.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEnhanced teacher training and support\u003c/b\u003e: To equip educators with the skills to provide psychosocial support and sexual and reproductive health information to learners.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAccessible and affordable childcare\u003c/b\u003e: To alleviate the burden of childcare on young mothers and enable their return to school.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStrengthened social support systems\u003c/b\u003e: To provide financial assistance, case management by social workers in collaboration with educators and mental health support to young mothers.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMulti-sectoral collaboration and service integration\u003c/b\u003e: Improved visibility of and access to psychological and healthcare professionals or services in the school environment.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eYouth-led participatory approaches\u003c/b\u003e: To ensure that interventions are relevant, acceptable, and effective in meeting the needs of young mothers.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eBy implementing these recommendations, South African schools can create a more supportive and inclusive educational environment for pregnant and mothering learners, empowering them to overcome the challenges of early motherhood and achieve their educational aspirations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll manuscripts must contain the following sections under the heading \u0026apos;Declarations\u0026apos;:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approvals were provided by the University of Cape Town Human Research Ethics Committee (HREC) under the following reference number HREC 226/2017, version7.0 and the University of Oxford Social Sciences and Humanities Interdivisional Research Ethics Committee (IDREC) under the following reference number IDREC R48876/RE003. During in-person interactions, participants were then asked to read the consent form and sign it to ensure written informed consent was attained from those agreeing to participate in accordance with the Declaration of Helsinki.\u0026nbsp;All the participants that were informed about the study signed a consent form, which stated that participation was completely voluntary and they could withdraw from the study anytime they wanted to without giving a reason.\u0026nbsp;We did not recruit any participants under the age of 16, therefore parental or legal guardian consent was not sought. We requested to record our conversations over the telephone and in-person to allow for analysis later . The information they shared was kept entirely confidential and used only by our research team. Any information collected about the participant and their child was done using password protected recorders, phones and laptops. No one else had access to their personal data. Third party transcriptions services may be used to help us transcribe the recordings, but we will not share any of your personal details with them. \u0026nbsp;\u0026nbsp;Anonymised datasets would be shared for non-profit use following United Kingdom and South African data guidelines.\u003c/p\u003e\n\u003cp\u003eThere are limited risks associated with the participants data, such as if the researchers recorder, phone or laptop gets stolen. If this happened, we ensure them that we had strong back-up and security systems to minimize the chances of others opening our files. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data is not available to protect the anonymity of participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the UKRI GCRF Accelerating Achievement for Africa\u0026apos;s Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1); the European Research Council (ERC) under the European Union\u0026rsquo;s Horizon 2020 research and innovation programme (n\u0026deg; 771468); Oak Foundation [Grant Number: OFIL-20-057]; and the National Research Foundation: Human and Social Dynamics for Development 2022 [Grant number: 136531].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCC and HM wrote the main manuscript text and prepared tables and figures. CC conceptualised the study with activity development contributions from YP and HM. CC, HM, YP, MT, YD and LS undertook data co-generation with the Teen Advisory Group. JK critically reviewed the manuscript. LC and ET provided supervision and were responsible for funding acquisition. All authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to extend thanks to the adolescents and young people of the Eastern Cape Teen Advisory Groups for generously sharing their experiences and perspectives on learner pregnancy and the experience of being young parents with us. Authors thank and acknowledge the crucial support of the research and support teams based at the Universities of Cape Town and Oxford. We acknowledge and thank Dr Lesley Gittings, Dr Rebecca Hodes, Ms Mildred Thabeng, Dr Jenny Doubt, Dr Inge Wessels and Dr Carine Asnong for their long-term involvement and support of the Teen Advisory Groups study on which this work builds. Foremost thanks to Professors Lucie Cluver and Elona Toska\u0026rsquo;s long-standing commitment to meaningful engagement of adolescents in the research process, as the founder of TAG, and, as Adolescent Accelerators Research Hub PI, providing funding for TAG activities before, during and following COVID-19. We also thank designer Orli Setton for her commitment to a collaborative process of visual knowledge translation. Young advisors were recruited through the Mzantsi Wakho and HEY BABY studies, and we are grateful to the research teams from these studies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organisation. Adolescent pregnancy [Fact heet]. 2024 Apr. \u003c/li\u003e\n\u003cli\u003eBarron P, Subedar H, Letsoko M, Makua M, Pillay Y. Teenage births and pregnancies in South Africa, 2017 - 2021 - a reflection of a troubled country: Analysis of public sector data. South African Medical Journal. 2022;112(4):252\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSekopa RP, Risenga PR, Mboweni SH. Factors contributing to rise in teenage pregnancy in Sekhukhune district, Limpopo province. Curationis. 2024 May 10;47(1). \u003c/li\u003e\n\u003cli\u003eMaluleke R. Profiling health challenges faced by adolescents (10-19 years) in South Africa Statistics South Africa [Internet]. Pretoria; 2022. Available from: www.statssa.gov.za\u003c/li\u003e\n\u003cli\u003eMatyana M. \u0026ldquo;Unemployment and poverty in South Africa: Assessing the National Development Plan 2030 predictions. 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SSRN Electronic Journal. 2022; \u003c/li\u003e\n\u003cli\u003eAffleck W, Glass K, Macdonald ME. The Limitations of Language. Am J Mens Health. 2013 Mar 22;7(2):155\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eOtufowora A, Liu Y, Young H, Egan KL, Varma DS, Striley CW, et al. Sex Differences in Willingness to Participate in Research Based on Study Risk Level Among a Community Sample of African Americans in North Central Florida. J Immigr Minor Health. 2021 Feb 23;23(1):19\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eCeia V, Nothwehr B, Wagner L. Gender and Technology: A rights-based and intersectional analysis of key trends. 2021 May. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSouth Africa. \u003c/strong\u003eDepartment of basic education: \u003cem\u003ePrevention and management of learner pregnancy in schools\u003c/em\u003e. [Cited: 20 October 2025]. Available from: https://www.health.gov.za/wp-content/uploads/2023/05/Policy-on-prevention-and-Management-of-Learner-Pregnanacy-in-schools-Gazetted-Final-Version-December-2021.pdf\u003c/li\u003e\n\u003cli\u003eSouth Africa. The Presidency. Children\u0026apos;s Amendment Act, 2007 (Act No. 41 of 2007). Government Gazette No. 30884\u003c/li\u003e\n\u003cli\u003eEarle, N. (2008) Social workers. In: Kraak, A. \u0026amp; Press, K. (eds).\u003cem\u003eHuman resources development review 2008: education, employment and skills in South Africa\u003c/em\u003e. Cape Town: HSRC Press. 432-451. http://hdl.handle.net/20.500.11910/5645 http://hdl.handle.net/20.500.11910/5645\u003c/li\u003e\n\u003cli\u003eSouth Africa. Department of Social Development. [Cited: 20 October 2025]. Available from: https://pmg.org.za/committee-question/26887/\u003c/li\u003e\n\u003cli\u003eGray M, Lombard A. Progress of the social service professions in South Africa\u0026apos;s developmental social welfare system: Social work, and child and youth care work. Int J Soc Welf. 2023;32(4):429-441\u003c/li\u003e\n\u003cli\u003eNational Planning Commission. Chapter 3: Economy and employment. In: \u003cem\u003eNational Development Plan 2030: Our future - make it work\u003c/em\u003e. Pretoria: Government Printer; 2012.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adolescent pregnancy, adolescent mothers, South Africa, participatory research, qualitative research, education, social support, stigma, policy","lastPublishedDoi":"10.21203/rs.3.rs-8104657/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8104657/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobally, there were approximately 21\u0026nbsp;million adolescent pregnancies in 2019, of which half were unplanned. Adolescent pregnancy is an issue of social and health inequity: it hinders young mothers\u0026rsquo; chances of continuing with school, and is associated with higher exposure to domestic violence, HIV, and food insecurity. While schooling is a well-known determinant of health, an implementation gap exists in supportive provisions. While protective factors such as school engagement enable improved health outcomes and educational attainment for adolescent mothers, yet limited evidence exists on how school and community stakeholders can can adapt to support these learners. This formative, participatory research engaged young people's expertise to inform implementation priorities for supporting adolescent mothers' educational attainment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study aimed to co-construct potential support package components, in partnership with young people from a community-academic partnership called a \u0026ldquo;Teen Advisory Group\u0026rdquo;. We conducted participatory priority-setting research with a Teen Advisory Group (TAG) of young research advisors (n\u0026thinsp;=\u0026thinsp;13, ages 21\u0026ndash;25) in Eastern Cape, South Africa, over eight weeks in July-August 2022. Using a socio-ecological framework and positive youth development theory, data co-creation occurred across three stages: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) introductory phone calls; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) remote engagement through a closed Facebook group (n\u0026thinsp;=\u0026thinsp;7) with weekly activities; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) a 3-day face-to-face participatory design workshop featuring gallery walks, gender-separated group interviews, and arts-based \"dreamy care package\" activities. Evidence-based comic storylines informed exploratory discussions. Activities were conducted in English and isiXhosa, and analyzed using reflexive thematic analysis combining deductive and inductive approaches, validated through member-checking with advisors (n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAdolescent pregnancy exposed young mothers to various forms of stigma, at home, amongst peers, and from the community. Young research advisors described support figures such as social workers and healthcare professionals as important figures who would help them from dropping out of school and prevent further pregnancies. Family-level support mostly helped ease the burden of childcare for the young mother. Staying motivated and focused by setting goals for themselves also kept pregnant and mother learners motivated to continue with school. The young mothers suggested that the government could support adolescent mothers by subsidising formal childcare and some baby essentials during early motherhood.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur findings emphasize a multi-faceted approach to supporting pregnant and mother learners. This includes stigma reduction interventions at the household and community level, enhanced teacher training to provide psychosocial and health support, and the provision of accessible and affordable childcare to facilitate a return to school. Furthermore, our results underscore the need for stronger social support systems, multi-sectoral collaboration to integrate healthcare and social work services in schools, and the adoption of youth-led participatory approaches to ensure interventions are relevant and effective.\u003c/p\u003e","manuscriptTitle":"Bridging the implementation gap: youth-led priorities for supporting pregnant and mothering adolescents’ wellbeing and schooling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 16:13:45","doi":"10.21203/rs.3.rs-8104657/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-18T07:28:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"363300021241642906558227261800920865","date":"2026-01-12T16:44:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257578320982436417013838341666336016722","date":"2026-01-06T16:07:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-06T15:22:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T11:57:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-15T10:42:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-11T12:39:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-11T12:30:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"602454b6-90dd-4782-88d3-e304ca65c72b","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:13:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 16:13:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8104657","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8104657","identity":"rs-8104657","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}