Exploring the Challenges Facing Pregnant Teenagers in the Sustainable Development Goals Era: Qualitative study in Gauteng Province South Africa

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Early pregnancy and childbearing have consequences. The study aimed to explore the challenges facing pregnant teenagers during the Sustainable development Goals Era. Methods A qualitative phenomenological, exploratory and descriptive design underpinned this study to explore the challenges facing pregnant teenagers. A non-probability and purposive sampling technique was used to select pregnant teenagers, between the ages of 10–19 during antenatal care (ANC) visits in selected clinics. Data was collected through semi-structured interviews, questions were in English, Afrikaans and Isizulu language until data saturation was reached at participant number 16. Tesch’s method of data analysis was used to analyse the data. Results In this study, five themes and sub-themes were derived during data analysis in connection with the themes. This includes Physical experiences of pregnant teenagers, psychological experiences of pregnant teenagers, social experiences of pregnant teenagers, coping experiences of pregnant teenagers and recommendations to improve the well-being of pregnant teenagers. Conclusion The study revealed that even during the implementation of Sustainable Goals Era, there are hidden challenges experienced by pregnant teenagers, they are suffering in silence. The identified the need for support from school or fellow students, teachers, parents, family and community at large, this will enhance the best pregnancy outcomes aligning to the attainment of Sustainable development goals. Hence there is a need for financial, social and psychological support for a better outcome of pregnancy. Teenagers pregnancy and childbirth Background In 2015 all the nations committed themselves to achieve Sustainable development goals (SDGs) by 2030. Such goals include a major reduction in maternal, neonatal, and child mortality, and universal access to sexual and reproductive services. Ensure healthy lives and promote well-being for all at all ages including pregnant teenagers [ 1 ]. However, over 16 million girls and young women worldwide are affected by adolescent pregnancy and childbirth among women under the age of 20, which remains a serious global public health concern. Due to their biological immaturity, teenage pregnancies have been thought to carry a higher risk than adult pregnancies. One of the biggest problems facing the majority of nations in the world today is teenage pregnancy [ 2 ]. According to the World Health Organization (WHO,2020), there are over 12 million females between the ages of 15 and 19, and at least 777,000 of those girls give birth each year in developing countries and 10 million unwanted pregnancies annually. For girls aged 15 and 19, complications during pregnancy and childbirth are the greatest cause of maternal death worldwide. An estimated 3.9 million of 5,6 million abortions that teenage females between the ages of 15 and 19 have each year are unsafe. increasing maternal mortality, morbidity, and long-term health issues [ 1 ]. Teenage pregnancy has a prevalence rate of more than 25% in 24 African Countries, a rate reaching as higher as 48% in Niger, 44% in Chad and 43% in Equational Guinea. It is estimated that one in every 10 teenage girls in Africa becomes pregnant before reaching the age of 19 years. These teenagers often face stigma, rejection, or violation by their partner's families, parents, and peers [ 3 ]. Sub-Saharan Africa has the highest prevalence of teenage pregnancy in the world. Pregnant teenagers are at risk of medical, social, and economic challenges. Despite measures taken to avoid the risk, the issue of teenage pregnancy remains a public health concern [ 4 ]. In the context of this study, such challenges can be improved by implementing interventions, and programs, and improving sexual and reproductive health including HIV, mental health, and violence prevention among pregnant teenagers [ 5 ]. In South Africa, from 2017 to 2021 District Health Information System 2022 reported that the number of births by teenagers aged 10 to 14 years has increased by 48%. Many pregnant teenagers in South Africa drop out of school which impacts their educational and employment opportunities [ 6 ]. A total number of 23 226 teenagers pregnant has been recorded in Gauteng Province by the Gauteng Department of Health between 2020 April and March 2021. It has also been reported that teenage pregnancy is associated with health risks to both the mother and the child it also leads to poverty and school dropout [ 7 ]. Early pregnancy and childbearing have social consequences for girls including reduced status at home and community, stigmatization, rejection, violence by family members peers, and partners, and early miscarriages [ 6 ]. To mitigate these consequences and achieve the 2030 SDG goals, urgent measures are needed to improve the health and well-being of pregnant teenagers. All countries committed to achieving the Sustainable Development Goals (SDGs) by 2030 in 2015. To promote healthy lifestyles and well-being for everyone, including pregnant teenagers, these goals include drastically lowering maternal, neonatal, and child mortality as well as guaranteeing universal access to sexual and reproductive health services (WHO, 2020). Despite this dedication, approximately 16 million girls and young women globally are impacted by adolescent pregnancy and delivery among women under the age of 20, which continue to be serious global public health issues. Teenagers' biological immaturity makes teenage pregnancies more risky than adult pregnancies. This problem is one of the main issues that most nations are currently dealing with [ 2 ]. Hence the current study aims to explore the challenges experienced by the teenagers’ during pregnancy, taking into consideration that teenage pregnancy is on the rise in South Africa. Methods/Design Study design A phenomenological, exploratory and descriptive design underpinned this study to explore the challenges facing pregnant teenagers in advancing Health Outcomes in the Sustainable Development Goals Era. This research method was appropriate for the study as has helped the researcher obtain in-depth information about challenges pregnant teenagers faced during their pregnancy in First Avenue (Springs) Ekurhuleni Municipal Local Clinic Gauteng Province. Study setting The study was conducted in the Springs Municipal local clinic at Ekurhuleni local clinic located at Ekurhuleni District East in Springs Town. The local municipal clinic is located East Springs town. Springs Clinic is 3.8 km away from Springs Town to the Springs clinic, duration of 7 minutes using Olympia Road. A total number of 23 226 teenagers pregnant has been recorded in Gauteng Province by the Gauteng Department of Health between 2020 April and March 2021. It has also been reported that teenage pregnancy is associated with health risks to both the mother and the child it also leads to poverty and school dropout [ 7 ]. Population & Sampling The population group of 16 pregnant teenagers aged between 10 up to 19 years selected to represent the whole population of teenagers between this selected age. The study unpinned a non-probability and purposeful sampling technique. Data collection The researcher visited Springs Antenatal Clinic on certain days, and pregnant teenagers aged between 10 to 19 years were selected as they possess the criteria of inclusion. Those under 18 years were given consent forms to be signed by parents or guardians and were interviewed on their next antenatal visit. Those above 18 years and agreed to sign the concern form and be interviewed immediately. The interview guide is attached as Appendix 1. The researcher first talked to the Clinic Manager for permission to do the study about pregnant teenagers at Springs local clinic. After the Manager agreed all pregnant teenagers were addressed in detail about the study. Those above 18 years agreed to take part were given a concern form signed immediately and interviewed. Those below 18 years agreed to take part were given a concern form to be signed by parents or guardians and interviewed next visit. All interviews were conducting during antenatal care. This study opted for a semi-structured interview the interviewer has asked a specific number of questions and can also post additional ones. Both closed-ended questions and open-ended questions [ 8 ]. In this study, some questions arose in the middle of an interview and were added to the list of questions meaning the researcher was not limited to questions. Qualitatively pregnant teenagers were interviewed individually face to face in a closed room and anonymously. The interview question was on English, Setswana, and Isizulu because Springs Clinic caters to most of those languages as not all are literate. The whole process of interviewing pregnant teenagers never interfered with the routine at the clinic as they were participating in their subsequent visits. Data Analysis The method of data analysis to be opted for in this study was Tesch's method of data analysis as outlined by Cresswell [ 9 ].The primary researcher got a sense of the whole by reading all the transcriptions carefully and jotting down some ideas as they came to mind. The primary researcher picked one document the most interesting one, the shortest one, and the one on the top of the pile. The researcher has gone through one document trying to understand its meaning, the thoughts were written in the margin. The researcher has made a list and went back to the data. Abbreviated the topics as codes next to the appropriate segments of the next. When organizing see if new categories and codes emerged. The primary researcher found the most descriptive wording for the topics and turned them into categories. Grouped topics that are related to each other and draw lines between categories to show interrelations. Final decision was made on the abbreviation for each category and alphabetized these codes. The primary researcher assembled data material belonging to one another and performed a preliminary analysis. The researcher recorded existing data if necessary. There after a meeting was held with the supervisors who are experienced qualitative researchers to reach consensus agreement on the themes and sub-themes. Quality Assurance of Data To guarantee the accuracy of the findings, the following standards were followed. Dependability was ensured in this research where same questions were asked to the same participants in different ways and obtained similar results. The supervisor guided the primary researcher with interview skills with the first few pregnant teenagers. Transferability ensured as more information was gathered to answer the objectives and aims of the study. Confirmability was ensured in this study by using probing questions on pregnant teenagers about what they are facing during pregnancy and avoided leading questions, and the supervisor assessed the findings if they confirmed the generalization of this study. Results In this study, 16 pregnant teenagers were identified as participants and interviewed while recording with their consent until the data was saturated. Those under 18 years consented from parents or guardians, and they consented for themselves, as did those above 18 years. The themes are perceptions, experiences, feelings, values, and emotions residing in the minds of participants. To develop themes the researcher needs to ask questions [ 10 ]. The sub-themes are derived from the structural problem and are in connection with themes [ 11 ]. In this study, five themes and sub-themes were derived during data analysis in connection with the themes. Table 1 Summary of the Themes and Sub-themes reflecting experiences of pregnant teenagers. Themes Subthemes Physical experiences of pregnant teenagers Physical changes and symptoms Eating and sleeping disturbances and exhaustion Psychological experiences of pregnant teenagers Fear and stress about family responses Shame and fear of judgement Self-blame, self-hate, regret and disappointment Fear and concerns about the future Mood fluctuations and mixed emotions Social experiences of pregnant teenagers Responses from parents Responses from partner Social responses (peers and community) Financial challenges Educational consequences Coping experiences of pregnant teenagers Avoidant behaviour Distraction Social support Positive thoughts Recommendations to improve the well-being of pregnant teenagers Psychological support Healthcare and health education Social support Theme: Physical Experiences of Pregnant Teenagers Participants shared experiences of physical changes that is outlined in the sub-themes through interviews and emerged on the following sub-themes: Sub- theme: Physical Changes and Symptoms During the interview participants shared similar physical changes and symptoms they experienced during pregnancy. Another Participants said: “ Headache, if stand long I feel dizzy and fever, most of the time I rely on Google because when I am sick and want to take any pill before I consume. I have to consult with the doctor or nurse when I am sick”. Participant’s responses revealed that many experience slight bleeding and cramping, heightened sense of smell of various odours such as foods, perfume or cigarette smoke this causes nausea in pregnancy. Food cravings and dizziness due to hormonal changes. Sub-theme: Eating and sleeping disturbances and exhaustion Early in pregnancy, most do not have an appetite due to morning sickness of vomiting and end up lacking energy and becoming tired the whole time, and also this leads them to sleep throughout. Another participant said: “ No because it was not my plan, and I’m always hungry and craving and feel ashamed to ask my parents whatever I will be craving for as I feel I have disappointed them. Eating sweets is my coping makes me cope”. Another participant Said: “ I Sleep a lot, it isn't easy to wake up early in the morning, and I am no longer having periods”. Theme: Psychological experiences of pregnant teenagers Sub-theme: Fear and stress about family responses The study findings reveal that pregnant teenagers are stressed, scared how family will respond with painful hearts, regret and shows also depression as become suicidal, scared and thinking of doing an abortion without their parents “s consent. These pregnant teenagers kept secret others long of being pregnant to the family and this make them suffer alone in silent. Participant said “ I would feel bad because I knew that I was pregnant and scared to tell my mother. Stressed about what my family and people around me will say when they see my pregnancy ”. Participant said “I did not know what to expect from my family will they be angry with me and what will people say when they see me will they judge me. I was scared and sad not knowing how my mother will respond to me being pregnant”. Participant said “I did not tell my mother about this pregnancy because my mother is very toxic, I only tell my stepmother and my father, and I am scared of my mother she can do anything my mother is very dangerous”. Sub-theme: Shame and fear of judgment Participants as young as 13 said she is wearing a big jacket, so classmates don’t notice she is pregnant. These pregnant teenagers are aware that they are still too young to fall pregnant they are also not free to walk around as feeling ashamed. They are still young and still playing but now with caution afraid that other kids will touch their tummy anyhow and they end up being reserved and alone. Participant said “More scared and quieter I started leaving fights with my friends and I'm more emotional I cried a lot. I am afraid they will just touch me anyhow asking me why my tummy is growing. I'm scared of judgment”. Participant said “It feels hard because hiding it from friends is hard, I’m afraid to move around without wearing a big jacket try to hit my growing tummy scared of being judged”. Participant said “ It’s a private school they believe in purity and no sex before 21 years. I was scared of being judged by children and teachers at school”. Sub-theme: Self-blame, self-hate, regret, and disappointment During the interview teenager's responses revealed that most of them never thought could become pregnant, and they regretted it. What makes this worse is other parents who are angry at these teenagers for not getting support. They hate themselves, are always tearful, and feel disappointed and said it was not their intention to become pregnant at this early age and also thinking of abortion. Participant Said “ It feels emotionally draining my parents are always angry with me and I feel like I am walking on a path of self-hate. I am depressed and suicidal as I go days without talking to my parents. I feel like I have failed myself because I had plans for the future”. Participant Said “I was tearful and disappointed in myself. I thought my life is over because I cannot go to school and no work, and I thought people will judge me”. Participant Said “ Not going to school just because I have to focus on my pregnancy, and this is slowly ruining my life. I feel very bad every day thinking that I have disappointed my parents becoming a parent and still young”. The study findings are similar to the study done by Webb et al [ 12 ], which reveals that the emotions associated with loss of aspiration are family rejection. When parents reject this pregnant teenager, they feel bad, worrying and overthinking how to do right and rejected at home. The emotions expressed as physical sensations, feel pain in the head. When angry or disappointed, rejected and your body becomes weak. There are feelings of worthlessness and inappropriate guilt. The results of the study also similar to the study done by Duby et al. [ 13 ] which indicate that pregnant teenagers may exacerbate existing social and contextual stressors, by adding stressors such as interpersonal relationship challenges, regret around unintended pregnancies, and depression. Sub-theme: Fear and concerns about the future These pregnant teenagers are aware that at the end of being pregnant, they are going to be mothers now they are doubting if will they become good mothers to their babies. They are fearing it will they have enough breastmilk Will their babies not be allergic to breastmilk will they be able to take care of these babies generally like bathing or when the baby is crying will they be able to calm these babies? Al in all they are doubting if they are going to do the right things or be good mothers to the coming babies they are concern about tomorrow. Participant Said At first, I was not excited about being pregnant and going to be a young mother. I started doubting myself if I would be able to raise the baby and if I would be able to face the challenges that are waiting Participant Said “ On that moment I did not know what to think, my head did not know what to think, my head took some time processing the idea of being pregnant not realizing the struggles lies ahead. When the baby is on its way will I be able to give birth normal, is my baby going to be allergic to breastmilk would I have enough breastmilk, is everything going to be fine”. Participant Said “ It feels so bad because I did not think it will happen to me I didn’t take it well because is not nice to be pregnant while still young. To be a mother now there are things to learn and work for your child . “Young as I am I must learn to bath a newborn to feed taking care of the newborn generally and then I must go to work to support my child rightfully”. Sub-theme: Mood fluctuations and mixed emotions During the interview, participants said one time were excited to be pregnant and another cried a lot as they realized that it was still early to fall pregnant. Other participants hate the fact that they must stop taking alcohol due to pregnancy. Another participant said as she is still a teenager she will grow with the child and this coming child did not ask to be here. Another said people will judge and not approve as if pregnancy is very bad. Another one feels disappointed and happy at the same time Another participant said she is scared of how the parents will react after telling them about the pregnancy and at the same time she is happy to bring the little person into this world. Participant Said “My emotions are mixed very complicated one day. I am happy and excited the other day I’m scared and worried. I cry a lot I can just start crying if I do not feel well and feel irritable with my body”. Participant Said “ It’s kind of exciting because you get to grow with the child and that is an amazing experience. Sometimes it is hard because people judge you and people do not always approve of it is not that bad”. Participant Said “I feel happy excited nervous stressed like there is a lot of things do get done worry about but I feel very happy”. Theme: Social experiences of pregnant teenagers: Sub-theme Responses from parents Most of the participants' responses indicated that their parents did not expect their them to become pregnant at this early age. Another participant's parents found it hard to accept that their teenager is pregnant they judged her and threw her out of the house and when she came back there was still continuous tension between her parents and this pregnant teenager and this affected her in a bad way as she is stressed up. The relationship between parents and a pregnant teenager is so bad and has changed how they treat her is very bad as become angry at her even with smaller mistakes. Another parent although disappointed accepts this pregnancy and becomes supportive. Another parent advised the pregnant teenager to act maturely as she was going to be the mother. Participant Said “It has been a harsh time. I have experienced judgment by people close to me even those I don’t know. My parents are judging me, and I feel sad my relationship with my parents has changed”. Participant Said “ My parents threw me out of my home for 3 days. When I came back my relationship with my parents changed, there is tension, they became irritated by even small issues involving me”. Sub-theme: Responses from partner Participants’ partners as others are still very young and teenagers are scared but promise to be there for this pregnant teenager. Other partners are happy about the pregnancy and after telling his family, the family does not want this pregnancy and gave this pregnant teenager money to abort. Other partners started losing interest always fighting and cheating and are now in not good relationships because of this pregnancy. Participant Said “During the day I tell my boyfriend he did not believe and said I must send that positive pregnancy test and did not want because I thought he will be excited and tell his family and I did not want them to know so early but ended up sending through WhatsApp he was excited because is what he wanted and I said do not tell anyone until I am 3 months pregnant and my boyfriend started treating me well as we use to fight all the time I wanted to break up with him”. Participant Said “ Things have changed I have fought with my partner ever since I was pregnant, we don’t want one another at first when I told him I was pregnant he was happy then as time went on, he changed we became fighting we are staying together but very difficult because we don’t want one another”. Participant Said “ My partner has also cheated on me ever since I was pregnant, and I have caught up with him ”. Sub-theme: Social responses (peers and community) Pregnant teenagers are not free to walk around in the community because people gossip and laugh at them. They have been judged by the community. Their peers feel ashamed to associate with them as another participant’s friend advised her to have an abortion, and as she refused are no longer friends. As these pregnant teenagers are still children who are still playing, one participant has to leave school because they play roughly, and these children will harm their growing baby in the uterus. She is afraid they will, by mistake, kick her tummy and hurt the growing foetus Participant Said “ I had to leave school because of the harm that can happen to my baby children bumping at me even if you tell them I am pregnant they will still Bump at my tummy as usual and also fall as well and children at school will criticize me”. Participant Said “ At school my friends, even after I explained that I’m pregnant they bump at my tummy knowing very well that I’m pregnant not supporting me because I expected them to play gentle with me as I told them I am pregnant”. Sub-Theme: Financial challenges These teenagers are at an early age to be hired and get income most of them are still students depending on parents or guardians or a small amount of social grand. There is this one participant from another country, and she mentions that her partner is not working, and her parents are very angry with this pregnancy she is not sure whether her parents will support her in terms of finances. Another participant is a student getting only bursary money to study now she regrets that she has added a load by this pregnancy. Most of these participants are facing financial challenges. Participant Said “Right now, I even feel like I cannot afford to take care of my baby. I mean I’m from another country I don’t even qualify social grant I am not working neither my partner and I don’t know if my parents angry as they are will they be able to support me financially”. Participant Said “ Being a teenager and pregnant is hard because I don’t have income, I am depending on NSFAS and parental support”. Sub-theme: Educational consequences One participant has been embarrassed by the school rules whereby pregnant teenager has to stand in front of her classmates and announce that she is pregnant and after go to the staff room to teachers and announce her pregnancy is kind of reprimanding them so that other teenagers won't fall pregnant. Another participant had to leave school because of no money for transport to school as she used to walk to school now due to pregnancy will not manage to walk the distance. The other one does not have a babysitter after birth and will go to school when the baby is a bit grown up. For most of these participants, this pregnancy has cost them their education. Participant Said “My class teacher embarrasses me I have been told to stand in front of the whole class tell my classmates I am pregnant there after go to staffroom telling all the teachers I am pregnant that is how my school reprimand a pregnant teenager so that other teenagers will not fall into same trap”. Participant Said I have dropped out of school because my mother does not have money for transport to school as I cannot walk to school anymore. Participant Said “ Because of pregnancy I did not further my studies my family said I would go to school after the birth”. Theme: Coping experiences of pregnant teenagers: Sub-theme: Avoidant behaviour Participants choose to avoid the situation of being pregnant teenagers by isolating themselves, becoming reserved and not doing what they used to do. Some who are still attending school they choose to be quiet at school. Participant Said “ I am quieter in talks, and I am more emotional, and some people don’t understand. I prefer to be alone as I am not as usual. I no longer do what I use to do”. Participant Said “ For example, I always walk on the street with kids almost daily but nowadays I excuse myself from walking on the street and keep on postponing telling these kids lets walk the following day”. Participant Said “No at first it was not easy at all always angry and not understanding and my coping mechanism I am always to quit and be choosy. Meaning I choose to be reserved and be alone”. Pregnant teenagers are not coping as revealed in interviews, one is depressed and no longer bathing or doing what she used to do as no interest, she does not ever look at herself in a mirror. When is too much she listens to the music and prays as a distraction. Another one said that not coping keeps herself busy with the house chores and shopping for baby staff just to keep herself busy the whole day. Participant Said “No, I’m not coping but on the nights that are too rough or intense to bear I pray. I think I am depressed I don’t take care of myself I don’t bath as usual, and when looking at myself in a mirror I don’t look at myself I am no longer doing what I used to do meaning no longer interested in things I used to do daily. I’m coping by prayer and listening to music”. Sub-theme: Social support Though most pregnant teenagers ‘parents are disappointed by their teenagers falling pregnant at an early age, they end up being supportive and taking good care of them as their responsibility. Another participant said her sister always accompanied her to the clinic and another one always came with her partner. Another participant mentioned that the mother to the boyfriend is happy because her boyfriend is the only child of her mother and that the coming baby will be the second child. Generally, family parents, siblings, partners, and friends of most of them are supportive. Participant Said “ Yes, my husband partner, Mother, Sister, and brother, we all live together and support each other where needed. They support me if I don’t feel well. My husband would make food, my sister would clean the house, and my parents support me if I felt down, they would cheer me up and take me out for lunch”. Theme: Recommendations to improve the well-being of pregnant teenagers Sub-theme: Psychological support All participants though that interviewing them was to collect data they were happy and appreciative to be interviewed, and they said they needed to talk with someone, and they felt relieved and counselled. They all be referred to a psychologist for further counselling after the interview. Another participant requested her whole family to be referred to see a psychologist for counselling because they are failing to accept that their teenager is pregnant, they are still angry at her. Another participant is aware that smoking could harm the growing baby inside of her but failed to stop the habit and was referred to see a psychologist. Participant Said “I will advise nurses and doctors to make us pregnant teenagers feel free and give us counselling”. Participant Said “ Proper counselling offered to pregnant teenagers and their hurting families in order to decrease chances of suicide, meaning my family also need counselling ”. Participant Said “I think talking to teenagers and counselling them without any judgment can improve the well-being of pregnant teenagers”. Sub-theme: Healthcare and Health Education Most of the participants explained health care workers nurses and doctors to have a good attitude towards them because if they have been shouted at, they will stop coming to attend antenatal care and end up having complications. Another participant requested nurses to advise pregnant teenagers about those supplements’ pills and how important for pregnancy and recommended they must be taught how to take care of their coming babies and what to buy for their coming babies. Another participant shared that nurses advise on a good healthy diet as teenagers do not know what to eat and to be advised on stopping bad habits like alcohol and the use of drugs. Generally, participants are requested to be informed about what to do and to avoid during pregnancy and the early parenting stage. Participant said “ By also telling us what to buy when the baby is born. Some they do not have parents to guide how to take care of the baby when is born so you should guide them and tell them what to do they will feel safe because they will know what to do and what to buy and also teach them how to feed the baby ”. Participant said “( She cried again ) Do not take me wrong the attitude of nurses towards pregnant teenagers is not good but ever since I have been attending Springs Clinic staff have been very nice but as of now I have been referred to the hospital to be seen by the doctor I have heard that at hospital nurses and doctors has bad attitude they do not care so I am thinking ( she cried again) and I do not know how to talk always emotional and some other people might end up not attending clinic regularly and that will affect the baby and also if this stressed pregnant women will lose their babies, People are complaining about the hospital and end up losing their babies”. Participant said “ You can always talk to the child and tell them better off doing one two three four five than doing this like just try to correct the wrong by doing write even if people are mad at you, but you are trying your best and because advise is the best”. Sub-theme: Social support Participants recommended social support from family, community, and social workers. Another one said as they are still teenagers not working suggested social workers recommend social grants and food parcels for pregnant teenagers. Another participant said the community must stop gossiping about them and support them. Parents must stop judging and comparing their pregnant teenagers with neighbour teenagers who are not pregnant. Participant said “ I think social workers must come in and support pregnant teenagers with food parcels and social grand because most of us are not working. pregnant teenagers need counselling”. Participant said “ And the family must gather and tell them what to do and tell you that you will be better as sometimes you feel as if they will throw you away you are lost, they must also give you some advice. The parents need to guide the child to see that she is going to be a parent and must tell them how to deal with and cope and you will feel that my parent love me though they might feel as if they do not love you is that what I think is going to help”. Discussion The study aimed to explore the challenges facing pregnant teenagers during the Sustainable development Goals Era. In 2015, every nation pledged to accomplish the Sustainable Development Goals (SDGs) by 2030. These objectives include ensuring universal access to sexual and reproductive health services and significantly reducing maternal, neonatal, and child mortality to promote healthy lifestyles and well-being for everyone, including pregnant teenagers (WHO, 2020). Theme Physical Experiences of Pregnant Teenagers Participant’s responses revealed that many experience slight bleeding and cramping, sometimes small amount of spotting or vaginal bleeding as one of the symptoms of pregnancy known as implantation and some women also experiences abdominal cramps. Some pregnant women experience heightened sense of smell of various odours such as foods, perfume or cigarette smoke this causes nausea in pregnancy. Food cravings due to hormonal changes. Headache also due to hormonal changes and dehydration while dizziness due to dilatation of blood vessels that drop blood pressure. The study results also similar to the study done by Wick [ 14 ] which indicate that pregnant women including pregnant teenager’s experiences symptoms such as tender, swollen tingly and sore breasts due to hormonal changes in early pregnancy. fatigue due to hormone progesterone. These findings are similar to the study of Davis [ 15 ] which indicates in teenage pregnancy Fatigue has a relationship in nutrition, stress, and general state of health. In early pregnancy fatigue is related to physiological adjustment and hormonal changes so serves the positive function of helping the mother rest and tune in to her changing needs. If fatigue if problematic after the first trimester review diet. Vaginal bleeding with lower abdominal cramping can lead to early pregnancy at loss. Vomiting decreases the incidence of pregnancy loss while nausea alone does not [ 15 ]. The study results are also similar to the study by Akter [ 16 ] which indicate that pregnant teenager’s pregnant teenagers in most cases do not get sufficient calories, protein, carbohydrates, vitamins and minerals during pregnancy suffer from malnutrition with some other illness like dizziness and poor level energy. Pregnant teenagers are not physically ready for pregnancy. Theme: Psychological experiences of pregnant teenagers The study findings reveal that pregnant teenagers are stressed, scared how family will respond with painful hearts, regret and shows also depression as become suicidal, scared and thinking of doing an abortion without their parents “s consent. These pregnant teenagers kept secret others long of being pregnant to the family and this make them suffer alone in silent. Tie study findings have similarities to the study done by Tang Xian et al . [ 17 ] which reveal that pregnant teenagers experienced risk factors for prenatal anxiety and depression include young age low levels of education, disharmony in the family relationship, low life satisfaction and lack of social support. The results are like the study done by Lewinsohn et al [ 18 ] which indicate that Pregnant teenagers experienced increased instability and conflict in sexual partner and family relationships due to unintended pregnancy led to stress. Pregnant teenagers experienced period of turmoil and stress as they faced fear of disclosing a pregnancy as this led to disruptions in family and partner social support structure. The results of the study are having similarities to the study done by Duby [ 13 ] which indicate that pregnant teenagers experience social stigma and fear of being judged and gossiped about. Pregnant teenagers feel sad some even attempt suicide because of hearing unpleasant things about their life spoken by other people. They have been teased and dropped out of school. The results of the study similar to the study done by Erasmus et al. [ 19 ] indicate that pregnant teenagers experience barriers to starting antenatal care often centred on the disclosure of pregnant teenagers being deviant, irresponsible, and shameful. Pregnant teenagers believe and are fearful of others “s reactions within their family, the community, at school, and antenatal clinics. Pregnant teenagers experience fear of disclosing pregnancy. During the interview teenager's responses revealed that most of them never thought could become pregnant, and they regretted it. What makes this worse is other parents who are angry at these teenagers for not getting support. They hate themselves, are always tearful, and feel disappointed and also said it was not their intention to become pregnant at this early age and also thinking of abortion. The study findings are similar to the study done by Webb et al. [ 12 ], which reveals that the emotions associated with loss of aspiration are family rejection. When parents reject this pregnant teenager, they feel bad, worrying and overthinking how to do right and rejected at home. The emotions expressed as physical sensations, feel pain in the head. When angry or disappointed, rejected and your body becomes weak. There are feelings of worthlessness and inappropriate guilt. Theme: Social experiences of pregnant teenagers: The results of the study has similarities with the study done by Aziato et al. [ 20 ] which reveals that some parents become embarrassed and isolate their pregnant teenagers from the community in which they live. Some parents send their pregnant teenagers to distant grandparents or friends to prevent embarrassment associated with adolescent pregnancy. pregnant teenagers take a long before telling their parents about pregnancy as they will be angry, sad, disappointed, unhappy, worried, disgraced, and ashamed. The results of the study are similar to the study done by Kumar et al. [ 21 ] findings reveal that pregnant teenagers faced domestic physical violence and were psychologically violated by parents, partners, and the community where they lived. Pregnant teenagers perceive their struggles during a period of transition from childhood to become pregnant. They reported more anxiety, low self-esteem, and difficult in accessing financial, moral, and material support from parents. Theme: Coping experiences of pregnant teenagers: The results of this study have similarities with the study by Lowdermilk et al. [ 22 ] which indicated that pregnant Teenagers, especially those under 16 years old, experience stress during pregnancy as they are in a typical developmental period. Teens' emotional levels are commonly characterized by impulsiveness and self-centred behaviour. The results of the study are similar to the study done by Kotoh et al [ 23 ] indicated avoidance as a coping strategy for pregnant teenagers not to go to public places and stay away from people. Pregnant teenagers stop going to school and others stop going to churches as usual. The findings of this study are similar to the study done by Wainaina et al [ 24 ] which indicate that pregnant teenagers do not cope with stress because of stigmatization, neglect from family and friends, negative feelings, and experiences towards pregnancy and motherhood. Besides avoiding people pregnant teenagers sleep as a coping mechanism as facing stress. Theme: Recommendations to improve the well-being of pregnant teenagers The results of the study are similar to the study done by Hornberger et al , [ 25 ] indicating that once a positive pregnancy test result has been shared with a pregnant teenager and at least one trusted adult has been identified as a support, the health worker or psychologist should proceed with counselling. Counselling may occur at the diagnostic visit and continue over several visits. The findings of the study are similar to the study done by Laurenzi et al , [ 26 ] despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes there is critical evidence gap related to the effectiveness of psychological interventions in improving mental health, preventing disorders, self-harm, and other risk behaviour among pregnant teenagers. There is an urgent need to adapt and design new psychological interventions that can be pilot-tested and scaled for pregnant teenagers. The study has similarities of the study done by Erfina, Widyawati, Mckenna, Reisenhofer & Ismail [ 27 ] which reveals that social support is important for pregnant teenagers becoming mothers they need family support. Pregnant teenagers living with extended family may provide multiple benefits for pregnant teenager and their infants for they will be able to go back to school, meet their own developmental needs, and become skilled mothers in a supportive environment [ 8 ]. Family can provide a positive environment for pregnant teenagers to become good mothers who can perform and gain confidence in their maternal role promoting better childcare and positive child development The results of the study are similar to the study done by Wainaina et al. [ 24 ] which indicate that the support that these pregnant teenagers wanted to see their lives and the lives of other teenagers in similar situations including financial support to start businesses to go back to school or vocational training. They also indicated receiving information on birth preparedness, problem-solving, and confidence–building skills would be a great support for pregnant teenagers on how to take care of themselves and the coming babies. Conclusion Pregnant teenagers during data collection indicated that they are experiencing social and psychological challenges of which most of them came up with the recommendation of all pregnant teenagers aged 10 years up to 19 years to receive counselling to enhance better health outcome. That is in line with SDG 3 which aims to ensure healthy lives and promote well-being for all at all ages including pregnant teenagers. Pregnant teenagers end up dropping out of the school as peers are judging and embarrassing them also some teachers judged them, this is contrary to SDG4 which aims to ensure inclusive and equitable quality and promote lifelong learning opportunities for all including pregnant teenagers. Maternal guides recommend counselling pregnant teenagers up to 17 years and does not include family and parents hence some parents end up being disappointed by this early pregnancy whereby they will be tension between pregnant teenagers and parents throughout pregnancy. The research findings reveal that pregnant teenagers are suffering in silence, they need somebody to voice their concern through counselling in several sessions. Current guidelines state that only those pregnant teenagers below 17 years are suitable for counselling, but the study recommended all pregnant teenagers aged 10 years up to 19 to be referred for counselling throughout pregnancy. Participants requested their family members to be referred for counselling also. The study also reveals that to enhance the best outcome of pregnant teenager’s they need to be listened to. School or fellow students, teachers, parents, family and community at large need to be addressed by health workers to support pregnant teenagers. All in all, these pregnant teenagers need financial, social and psychological support for a better outcome of pregnancy. Study limitations This was a qualitative study conducted in one clinic at Ekurhuleni District in Gauteng the results cannot be generalized to other Provinces. Initially during data collections there was a struggle to get participants to reach saturation. It was only one clinic at Ekurhuleni Department of Health contacted and added several clinics at Ekurhuleni. Declarations Ethics approval and consent to participate Ethics approval for this study was obtained from the Ethics Committee and the Department of Health. Ethic number: TREC/121/2024: PG. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants aged 18 years and older before participation. Consent forms were available in Setswana, isiZulu, English, and Afrikaans and were explained in simple language to ensure understanding. For participants under 18 years of age, written consent was obtained from parents or legal guardians, and assent was obtained from the adolescents prior to participation Consent for publication Written informed consent was obtained from all participants for publication of their anonymised quotes. Competing interests The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Mphahlele RJ, Bopape MA, Malema R and Muthelo L, all authors contributed equally to the article. Acknowledgement We would like to thank all the pregnant teenagers who participated in the study and the Springs Municipal local clinics at Ekurhuleni District. The authors further acknowledge the support from the University of Limpopo research office when conducting the study. Data Availability The datasets generated and analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request References Adolescent pregnancy [Internet]. [cited 2025 Dec 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy ACERWC - African Committee of Experts on the. Rights and Welfare of the Child [Internet]. [cited 2025 Dec 12]. Available from: https://www.acerwc.africa/en/search/node?keys=Teenage+pregnancy Gunawardena N, Fantaye AW, Yaya S. Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis. BMJ Glob Health. 2019;4(3):e001499. George A, Jacobs T, Ved R, Jacobs T, Rasanathan K, Zaidi SA. 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AIDS Behav. 2021;25(2):344–53. Wick MJ. Mayo Clinic guide to a healthy pregnancy [Internet]. Rosetta Books; 2020 [cited 2026 Jan 15]. Available from: https://books.google.com/books?hl=en&lr=&id=kSsAEAAAQBAJ&oi=fnd&pg=PT15&dq=MJ+Wick+(2018)+pregnant+women&ots=GB3mW8kfSx&sig=XqjqvfN1Mq_MrX_LV3z14wnPtAQ Davis DA. Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing. Med Anthropol [Internet]. 2019 Oct 3 [cited 2026 Jan 15];38(7):560–73. Available from: https://www.tandfonline.com/doi/full/ 10.1080/01459740.2018.1549389 Akter M. Physical and psychological vulnerability of adolescents during pregnancy period as well as post traumatic stress and depression after child birth. Open J Soc Sci. 2019;7(01):170. Tang Xian TX, Lu Zhuo LZ, Hu DiHui HD, Zhong XiaoNi ZX. Influencing factors for prenatal stress, anxiety and depression in early pregnancy among women in Chongqing, China. 2019 [cited 2025 Dec 12]; Available from: https://www.cabidigitallibrary.org/doi/full/ 10.5555/20193475228 Lewinsohn R, Crankshaw T, Tomlinson M, Gibbs A, Butler L, Smit J. This baby came up and then he said,I give up! The interplay between unintended pregnancy, sexual partnership dynamics and social support and the impact on women’s well-being in KwaZulu-Natal, South Africa. Midwifery. 2018;62:29–35. Erasmus MO, Knight L, Dutton J. Barriers to accessing maternal health care amongst pregnant adolescents in South Africa: a qualitative study. Int J Public Health. 2020;65(4):469–76. Aziato L, Hindin MJ, Maya ET, Manu A, Amuasi SA, Lawerh RM, et al. Adolescents’ responses to an unintended pregnancy in Ghana: a qualitative study. J Pediatr Adolesc Gynecol. 2016;29(6):653–8. Kumar M, Huang KY, Othieno C, Wamalwa D, Madeghe B, Osok J, et al. Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders. Glob Soc Welf. 2018;5(1):11–27. Lowdermilk DL, Perry SE, Cashion K, Alden KR, Olshansky E. Cuidados en enfermería materno-infantil [Internet]. Elsevier Health Sciences; 2020 [cited 2025 Dec 12]. Available from: https://books.google.com/books?hl=en&lr=&id=SQj2DwAAQBAJ&oi=fnd&pg=PP1&dq=Lowdermilk,+Perry,+Cashion,+Alden,+and+Olshansky+(2020)+&ots=m47Yrlzlm1&sig=U0u_qGXiCQuwgVy2Am36odGqlP4 Kotoh AM, Sena Amekudzie B, Opoku-Mensah K, Baku EA, Glozah FN. Pregnant adolescents’ lived experiences and coping strategies in peri-urban district in Southern Ghana. BMC Public Health. 2022;22(1):901. Wainaina CW, Sidze EM, Maina BW, Badillo-Amberg I, Anyango HO, Kathoka F, et al. Psychosocial challenges and individual strategies for coping with mental stress among pregnant and postpartum adolescents in Nairobi informal settlements: a qualitative investigation. BMC Pregnancy Childbirth. 2021;21(1):661. Hornberger LL, Adolescence C on, Breuner CC, Alderman EM, Garofalo R, Grubb LK et al. Options counseling for the pregnant adolescent patient. Pediatrics. 2017;140(3):e20172274. Laurenzi CA, Gordon S, Abrahams N, Du Toit S, Bradshaw M, Brand A, et al. Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review. Reprod Health. 2020;17(1):65. Erfina E, Widyawati W, McKenna L, Reisenhofer S, Ismail D. Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families. Midwifery [Internet]. 2022 [cited 2026 Jan 15];104:103170. Available from: https://www.sciencedirect.com/science/article/pii/S0266613821002503 Erfina E, Widyawati W, McKenna L, Reisenhofer S, Ismail D. Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families. Midwifery. 2022;104:103170. Additional Declarations No competing interests reported. Supplementary Files Appendix1Mphahlele.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers invited by journal 28 Jan, 2026 Editor assigned by journal 22 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 21 Jan, 2026 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. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8610559","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581607126,"identity":"cdb78b9f-df01-40f9-b6e9-4036b3636aeb","order_by":0,"name":"Mphahlele RJ","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Mphahlele","middleName":"","lastName":"RJ","suffix":""},{"id":581607127,"identity":"a55bb235-103e-4f53-9d19-9deaaada67fa","order_by":1,"name":"Bopape MA","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"Bopape","middleName":"","lastName":"MA","suffix":""},{"id":581607128,"identity":"732b996c-99e1-4152-83d7-8799bc609add","order_by":2,"name":"R Malema","email":"","orcid":"","institution":"University of Limpopo","correspondingAuthor":false,"prefix":"","firstName":"R","middleName":"","lastName":"Malema","suffix":""},{"id":581607129,"identity":"e4a157b1-5dcb-4403-8443-2849d13344d4","order_by":3,"name":"L Muthelo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIie3NMUvDQBTA8RcOLoPveuuFSvsVDgR1kHyWhkAmEcFJFJrpdan6AUT8DEUojhcCcYl7xaXg2kEXx+oZW1RI0tXh/sNxD96PB+By/cM6DHj1qV4vhW3wU8+0Ef6HZCkgoIF2slr+riJqsIH4uPsiKDzqwFbSfbs/QBkstIHzEPqjeskZ7u0Iik84iKnKygSD60NLihi88aCB8KQrpiyiilCO+vmLcAMMWslwTT5QP5WWLK2S8wbCCkvyNTGoZ6iNRwZQNV1hRXCzfIiIibv9R4oxGCfHJrqMUan6K1JmpBblWXQ7upjMTinsST+fzF/fw17/qv7KT+z3YJdxw77L5XK5WvoEgIlSLkPYdlsAAAAASUVORK5CYII=","orcid":"","institution":"University of Limpopo","correspondingAuthor":true,"prefix":"","firstName":"L","middleName":"","lastName":"Muthelo","suffix":""}],"badges":[],"createdAt":"2026-01-15 12:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8610559/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8610559/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101943058,"identity":"9efeb08b-9401-4e6d-8fef-c84810359f67","added_by":"auto","created_at":"2026-02-05 09:40:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1212000,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8610559/v1/71d80127-ac43-4402-b3a7-f1f5df92c148.pdf"},{"id":101531024,"identity":"324b2abc-f9c2-40a4-9248-52b0f4632ee0","added_by":"auto","created_at":"2026-01-30 20:14:41","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15535,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1Mphahlele.docx","url":"https://assets-eu.researchsquare.com/files/rs-8610559/v1/b0b643f9190d2003b806d617.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Challenges Facing Pregnant Teenagers in the Sustainable Development Goals Era: Qualitative study in Gauteng Province South Africa","fulltext":[{"header":"Background","content":"\u003cp\u003eIn 2015 all the nations committed themselves to achieve Sustainable development goals (SDGs) by 2030. Such goals include a major reduction in maternal, neonatal, and child mortality, and universal access to sexual and reproductive services. Ensure healthy lives and promote well-being for all at all ages including pregnant teenagers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, over 16\u0026nbsp;million girls and young women worldwide are affected by adolescent pregnancy and childbirth among women under the age of 20, which remains a serious global public health concern. Due to their biological immaturity, teenage pregnancies have been thought to carry a higher risk than adult pregnancies. One of the biggest problems facing the majority of nations in the world today is teenage pregnancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the World Health Organization (WHO,2020), there are over 12\u0026nbsp;million females between the ages of 15 and 19, and at least 777,000 of those girls give birth each year in developing countries and 10\u0026nbsp;million unwanted pregnancies annually. For girls aged 15 and 19, complications during pregnancy and childbirth are the greatest cause of maternal death worldwide. An estimated 3.9\u0026nbsp;million of 5,6\u0026nbsp;million abortions that teenage females between the ages of 15 and 19 have each year are unsafe. increasing maternal mortality, morbidity, and long-term health issues [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTeenage pregnancy has a prevalence rate of more than 25% in 24 African Countries, a rate reaching as higher as 48% in Niger, 44% in Chad and 43% in Equational Guinea. It is estimated that one in every 10 teenage girls in Africa becomes pregnant before reaching the age of 19 years. These teenagers often face stigma, rejection, or violation by their partner's families, parents, and peers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Sub-Saharan Africa has the highest prevalence of teenage pregnancy in the world. Pregnant teenagers are at risk of medical, social, and economic challenges. Despite measures taken to avoid the risk, the issue of teenage pregnancy remains a public health concern [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of this study, such challenges can be improved by implementing interventions, and programs, and improving sexual and reproductive health including HIV, mental health, and violence prevention among pregnant teenagers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In South Africa, from 2017 to 2021 District Health Information System 2022 reported that the number of births by teenagers aged 10 to 14 years has increased by 48%. Many pregnant teenagers in South Africa drop out of school which impacts their educational and employment opportunities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA total number of 23 226 teenagers pregnant has been recorded in Gauteng Province by the Gauteng Department of Health between 2020 April and March 2021. It has also been reported that teenage pregnancy is associated with health risks to both the mother and the child it also leads to poverty and school dropout [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Early pregnancy and childbearing have social consequences for girls including reduced status at home and community, stigmatization, rejection, violence by family members peers, and partners, and early miscarriages [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. To mitigate these consequences and achieve the 2030 SDG goals, urgent measures are needed to improve the health and well-being of pregnant teenagers.\u003c/p\u003e \u003cp\u003eAll countries committed to achieving the Sustainable Development Goals (SDGs) by 2030 in 2015. To promote healthy lifestyles and well-being for everyone, including pregnant teenagers, these goals include drastically lowering maternal, neonatal, and child mortality as well as guaranteeing universal access to sexual and reproductive health services (WHO, 2020). Despite this dedication, approximately 16\u0026nbsp;million girls and young women globally are impacted by adolescent pregnancy and delivery among women under the age of 20, which continue to be serious global public health issues. Teenagers' biological immaturity makes teenage pregnancies more risky than adult pregnancies. This problem is one of the main issues that most nations are currently dealing with [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hence the current study aims to explore the challenges experienced by the teenagers\u0026rsquo; during pregnancy, taking into consideration that teenage pregnancy is on the rise in South Africa.\u003c/p\u003e"},{"header":"Methods/Design","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA phenomenological, exploratory and descriptive design underpinned this study to explore the challenges facing pregnant teenagers in advancing Health Outcomes in the Sustainable Development Goals Era. This research method was appropriate for the study as has helped the researcher obtain in-depth information about challenges pregnant teenagers faced during their pregnancy in First Avenue (Springs) Ekurhuleni Municipal Local Clinic Gauteng Province.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in the Springs Municipal local clinic at Ekurhuleni local clinic located at Ekurhuleni District East in Springs Town. The local municipal clinic is located East Springs town. Springs Clinic is 3.8 km away from Springs Town to the Springs clinic, duration of 7 minutes using Olympia Road. A total number of 23 226 teenagers pregnant has been recorded in Gauteng Province by the Gauteng Department of Health between 2020 April and March 2021. It has also been reported that teenage pregnancy is associated with health risks to both the mother and the child it also leads to poverty and school dropout [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003ePopulation \u0026 Sampling\u003c/h3\u003e\n\u003cp\u003eThe population group of 16 pregnant teenagers aged between 10 up to 19 years selected to represent the whole population of teenagers between this selected age. The study unpinned a non-probability and purposeful sampling technique.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe researcher visited Springs Antenatal Clinic on certain days, and pregnant teenagers aged between 10 to 19 years were selected as they possess the criteria of inclusion. Those under 18 years were given consent forms to be signed by parents or guardians and were interviewed on their next antenatal visit. Those above 18 years and agreed to sign the concern form and be interviewed immediately. The interview guide is attached as Appendix 1.\u003c/p\u003e \u003cp\u003eThe researcher first talked to the Clinic Manager for permission to do the study about pregnant teenagers at Springs local clinic. After the Manager agreed all pregnant teenagers were addressed in detail about the study. Those above 18 years agreed to take part were given a concern form signed immediately and interviewed. Those below 18 years agreed to take part were given a concern form to be signed by parents or guardians and interviewed next visit. All interviews were conducting during antenatal care.\u003c/p\u003e \u003cp\u003eThis study opted for a semi-structured interview the interviewer has asked a specific number of questions and can also post additional ones. Both closed-ended questions and open-ended questions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study, some questions arose in the middle of an interview and were added to the list of questions meaning the researcher was not limited to questions. Qualitatively pregnant teenagers were interviewed individually face to face in a closed room and anonymously. The interview question was on English, Setswana, and Isizulu because Springs Clinic caters to most of those languages as not all are literate. The whole process of interviewing pregnant teenagers never interfered with the routine at the clinic as they were participating in their subsequent visits.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe method of data analysis to be opted for in this study was Tesch's method of data analysis as outlined by Cresswell [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The primary researcher got a sense of the whole by reading all the transcriptions carefully and jotting down some ideas as they came to mind. The primary researcher picked one document the most interesting one, the shortest one, and the one on the top of the pile. The researcher has gone through one document trying to understand its meaning, the thoughts were written in the margin. The researcher has made a list and went back to the data. Abbreviated the topics as codes next to the appropriate segments of the next. When organizing see if new categories and codes emerged. The primary researcher found the most descriptive wording for the topics and turned them into categories. Grouped topics that are related to each other and draw lines between categories to show interrelations. Final decision was made on the abbreviation for each category and alphabetized these codes. The primary researcher assembled data material belonging to one another and performed a preliminary analysis. The researcher recorded existing data if necessary. There after a meeting was held with the supervisors who are experienced qualitative researchers to reach consensus agreement on the themes and sub-themes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuality Assurance of Data\u003c/h2\u003e \u003cp\u003eTo guarantee the accuracy of the findings, the following standards were followed. Dependability was ensured in this research where same questions were asked to the same participants in different ways and obtained similar results. The supervisor guided the primary researcher with interview skills with the first few pregnant teenagers. Transferability ensured as more information was gathered to answer the objectives and aims of the study. Confirmability was ensured in this study by using probing questions on pregnant teenagers about what they are facing during pregnancy and avoided leading questions, and the supervisor assessed the findings if they confirmed the generalization of this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, 16 pregnant teenagers were identified as participants and interviewed while recording with their consent until the data was saturated. Those under 18 years consented from parents or guardians, and they consented for themselves, as did those above 18 years. The themes are perceptions, experiences, feelings, values, and emotions residing in the minds of participants. To develop themes the researcher needs to ask questions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The sub-themes are derived from the structural problem and are in connection with themes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In this study, five themes and sub-themes were derived during data analysis in connection with the themes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the Themes and Sub-themes reflecting experiences of pregnant teenagers.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical experiences of pregnant teenagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePhysical changes and symptoms\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEating and sleeping disturbances and exhaustion\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePsychological experiences of pregnant teenagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFear and stress about family responses\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eShame and fear of judgement\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSelf-blame, self-hate, regret and disappointment\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFear and concerns about the future\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMood fluctuations and mixed emotions\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSocial experiences of pregnant teenagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eResponses from parents\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eResponses from partner\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSocial responses (peers and community)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFinancial challenges\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEducational consequences\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCoping experiences of pregnant teenagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAvoidant behaviour\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDistraction\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSocial support\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePositive thoughts\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRecommendations to improve the well-being of pregnant teenagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePsychological support\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHealthcare and health education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSocial support\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eTheme: Physical Experiences of Pregnant Teenagers\u003c/h3\u003e\n\u003cp\u003eParticipants shared experiences of physical changes that is outlined in the sub-themes through interviews and emerged on the following sub-themes:\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSub- theme: Physical Changes and Symptoms\u003c/h2\u003e \u003cp\u003eDuring the interview participants shared similar physical changes and symptoms they experienced during pregnancy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnother Participants said:\u003c/h2\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eHeadache, if stand long I feel dizzy and fever, most of the time I rely on Google because when I am sick and want to take any pill before I consume. I have to consult with the doctor or nurse when I am sick\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant\u0026rsquo;s responses revealed that many experience slight bleeding and cramping, heightened sense of smell of various odours such as foods, perfume or cigarette smoke this causes nausea in pregnancy. Food cravings and dizziness due to hormonal changes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Eating and sleeping disturbances and exhaustion\u003c/h2\u003e \u003cp\u003eEarly in pregnancy, most do not have an appetite due to morning sickness of vomiting and end up lacking energy and becoming tired the whole time, and also this leads them to sleep throughout.\u003c/p\u003e \u003cp\u003eAnother participant said:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eNo because it was not my plan, and I\u0026rsquo;m always hungry and craving and feel ashamed to ask my parents whatever I will be craving for as I feel I have disappointed them. Eating sweets is my coping makes me cope\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAnother participant Said:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI Sleep a lot, it isn't easy to wake up early in the morning, and I am no longer having periods\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Psychological experiences of pregnant teenagers\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Fear and stress about family responses\u003c/h2\u003e \u003cp\u003e The study findings reveal that pregnant teenagers are stressed, scared how family will respond with painful hearts, regret and shows also depression as become suicidal, scared and thinking of doing an abortion without their parents \u0026ldquo;s consent. These pregnant teenagers kept secret others long of being pregnant to the family and this make them suffer alone in silent.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI would feel bad because I knew that I was pregnant and scared to tell my mother. Stressed about what my family and people around me will say when they see my pregnancy\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I did not know what to expect from my family will they be angry with me and what will people say when they see me will they judge me. I was scared and sad not knowing how my mother will respond to me being pregnant\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I did not tell my mother about this pregnancy because my mother is very toxic, I only tell my stepmother and my father, and I am scared of my mother she can do anything my mother is very dangerous\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Shame and fear of judgment\u003c/h2\u003e \u003cp\u003eParticipants as young as 13 said she is wearing a big jacket, so classmates don\u0026rsquo;t notice she is pregnant. These pregnant teenagers are aware that they are still too young to fall pregnant they are also not free to walk around as feeling ashamed. They are still young and still playing but now with caution afraid that other kids will touch their tummy anyhow and they end up being reserved and alone.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;More scared and quieter I started leaving fights with my friends and I'm more emotional I cried a lot. I am afraid they will just touch me anyhow asking me why my tummy is growing. I'm scared of judgment\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It feels hard because hiding it from friends is hard, I\u0026rsquo;m afraid to move around without wearing a big jacket try to hit my growing tummy scared of being judged\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt\u0026rsquo;s a private school they believe in purity and no sex before 21 years. I was scared of being judged by children and teachers at school\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Self-blame, self-hate, regret, and disappointment\u003c/h2\u003e \u003cp\u003eDuring the interview teenager's responses revealed that most of them never thought could become pregnant, and they regretted it. What makes this worse is other parents who are angry at these teenagers for not getting support. They hate themselves, are always tearful, and feel disappointed and said it was not their intention to become pregnant at this early age and also thinking of abortion.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt feels emotionally draining my parents are always angry with me and I feel like I am walking on a path of self-hate. I am depressed and suicidal as I go days without talking to my parents. I feel like I have failed myself because I had plans for the future\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was tearful and disappointed in myself. I thought my life is over because I cannot go to school and no work, and I thought people will judge me\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eNot going to school just because I have to focus on my pregnancy, and this is slowly ruining my life. I feel very bad every day thinking that I have disappointed my parents becoming a parent and still young\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe study findings are similar to the study done by Webb \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which reveals that the emotions associated with loss of aspiration are family rejection. When parents reject this pregnant teenager, they feel bad, worrying and overthinking how to do right and rejected at home. The emotions expressed as physical sensations, feel pain in the head. When angry or disappointed, rejected and your body becomes weak. There are feelings of worthlessness and inappropriate guilt.\u003c/p\u003e \u003cp\u003eThe results of the study also similar to the study done by Duby \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] which indicate that pregnant teenagers may exacerbate existing social and contextual stressors, by adding stressors such as interpersonal relationship challenges, regret around unintended pregnancies, and depression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Fear and concerns about the future\u003c/h2\u003e \u003cp\u003eThese pregnant teenagers are aware that at the end of being pregnant, they are going to be mothers now they are doubting if will they become good mothers to their babies. They are fearing it will they have enough breastmilk Will their babies not be allergic to breastmilk will they be able to take care of these babies generally like bathing or when the baby is crying will they be able to calm these babies? Al in all they are doubting if they are going to do the right things or be good mothers to the coming babies they are concern about tomorrow.\u003c/p\u003e \u003cp\u003eParticipant Said\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAt first, I was not excited about being pregnant and going to be a young mother. I started doubting myself if I would be able to raise the baby and if I would be able to face the challenges that are waiting\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eOn that moment I did not know what to think, my head did not know what to think, my head took some time processing the idea of being pregnant not realizing the struggles lies ahead. When the baby is on its way will I be able to give birth normal, is my baby going to be allergic to breastmilk would I have enough breastmilk, is everything going to be fine\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt feels so bad because I did not think it will happen to me I didn\u0026rsquo;t take it well because is not nice to be pregnant while still young. To be a mother now there are things to learn and work for your child\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Young as I am I must learn to bath a newborn to feed taking care of the newborn generally and then I must go to work to support my child rightfully\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Mood fluctuations and mixed emotions\u003c/h2\u003e \u003cp\u003eDuring the interview, participants said one time were excited to be pregnant and another cried a lot as they realized that it was still early to fall pregnant. Other participants hate the fact that they must stop taking alcohol due to pregnancy. Another participant said as she is still a teenager she will grow with the child and this coming child did not ask to be here. Another said people will judge and not approve as if pregnancy is very bad. Another one feels disappointed and happy at the same time Another participant said she is scared of how the parents will react after telling them about the pregnancy and at the same time she is happy to bring the little person into this world.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;My emotions are mixed very complicated one day. I am happy and excited the other day I\u0026rsquo;m scared and worried. I cry a lot I can just start crying if I do not feel well and feel irritable with my body\u0026rdquo;.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt\u0026rsquo;s kind of exciting because you get to grow with the child and that is an amazing experience. Sometimes it is hard because people judge you and people do not always approve of it is not that bad\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel happy excited nervous stressed like there is a lot of things do get done worry about but I feel very happy\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Social experiences of pregnant teenagers:\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme Responses from parents\u003c/h2\u003e \u003cp\u003e Most of the participants' responses indicated that their parents did not expect their them to become pregnant at this early age. Another participant's parents found it hard to accept that their teenager is pregnant they judged her and threw her out of the house and when she came back there was still continuous tension between her parents and this pregnant teenager and this affected her in a bad way as she is stressed up. The relationship between parents and a pregnant teenager is so bad and has changed how they treat her is very bad as become angry at her even with smaller mistakes. Another parent although disappointed accepts this pregnancy and becomes supportive. Another parent advised the pregnant teenager to act maturely as she was going to be the mother.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It has been a harsh time. I have experienced judgment by people close to me even those I don\u0026rsquo;t know. My parents are judging me, and I feel sad my relationship with my parents has changed\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy parents threw me out of my home for 3 days. When I came back my relationship with my parents changed, there is tension, they became irritated by even small issues involving me\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Responses from partner\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; partners as others are still very young and teenagers are scared but promise to be there for this pregnant teenager. Other partners are happy about the pregnancy and after telling his family, the family does not want this pregnancy and gave this pregnant teenager money to abort. Other partners started losing interest always fighting and cheating and are now in not good relationships because of this pregnancy.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;During the day I tell my boyfriend he did not believe and said I must send that positive pregnancy test and did not want because I thought he will be excited and tell his family and I did not want them to know so early but ended up sending through WhatsApp he was excited because is what he wanted and I said do not tell anyone until I am 3 months pregnant and my boyfriend started treating me well as we use to fight all the time I wanted to break up with him\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eThings have changed I have fought with my partner ever since I was pregnant, we don\u0026rsquo;t want one another at first when I told him I was pregnant he was happy then as time went on, he changed we became fighting we are staying together but very difficult because we don\u0026rsquo;t want one another\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy partner has also cheated on me ever since I was pregnant, and I have caught up with him\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Social responses (peers and community)\u003c/h2\u003e \u003cp\u003ePregnant teenagers are not free to walk around in the community because people gossip and laugh at them. They have been judged by the community. Their peers feel ashamed to associate with them as another participant\u0026rsquo;s friend advised her to have an abortion, and as she refused are no longer friends. As these pregnant teenagers are still children who are still playing, one participant has to leave school because they play roughly, and these children will harm their growing baby in the uterus. She is afraid they will, by mistake, kick her tummy and hurt the growing foetus\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI had to leave school because of the harm that can happen to my baby children bumping at me even if you tell them I am pregnant they will still Bump at my tummy as usual and also fall as well and children at school will criticize me\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eAt school my friends, even after I explained that I\u0026rsquo;m pregnant they bump at my tummy knowing very well that I\u0026rsquo;m pregnant not supporting me because I expected them to play gentle with me as I told them I am pregnant\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme: Financial challenges\u003c/h2\u003e \u003cp\u003e These teenagers are at an early age to be hired and get income most of them are still students depending on parents or guardians or a small amount of social grand. There is this one participant from another country, and she mentions that her partner is not working, and her parents are very angry with this pregnancy she is not sure whether her parents will support her in terms of finances. Another participant is a student getting only bursary money to study now she regrets that she has added a load by this pregnancy. Most of these participants are facing financial challenges.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Right now, I even feel like I cannot afford to take care of my baby. I mean I\u0026rsquo;m from another country I don\u0026rsquo;t even qualify social grant I am not working neither my partner and I don\u0026rsquo;t know if my parents angry as they are will they be able to support me financially\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eBeing a teenager and pregnant is hard because I don\u0026rsquo;t have income, I am depending on NSFAS and parental support\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Educational consequences\u003c/h2\u003e \u003cp\u003eOne participant has been embarrassed by the school rules whereby pregnant teenager has to stand in front of her classmates and announce that she is pregnant and after go to the staff room to teachers and announce her pregnancy is kind of reprimanding them so that other teenagers won't fall pregnant. Another participant had to leave school because of no money for transport to school as she used to walk to school now due to pregnancy will not manage to walk the distance. The other one does not have a babysitter after birth and will go to school when the baby is a bit grown up. For most of these participants, this pregnancy has cost them their education.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;My class teacher embarrasses me I have been told to stand in front of the whole class tell my classmates I am pregnant there after go to staffroom telling all the teachers I am pregnant that is how my school reprimand a pregnant teenager so that other teenagers will not fall into same trap\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI have dropped out of school because my mother does not have money for transport to school as I cannot walk to school anymore.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eBecause of pregnancy I did not further my studies my family said I would go to school after the birth\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTheme: Coping experiences of pregnant teenagers:\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eSub-theme: Avoidant behaviour\u003c/h2\u003e \u003cp\u003eParticipants choose to avoid the situation of being pregnant teenagers by isolating themselves, becoming reserved and not doing what they used to do. Some who are still attending school they choose to be quiet at school.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI am quieter in talks, and I am more emotional, and some people don\u0026rsquo;t understand. I prefer to be alone as I am not as usual. I no longer do what I use to do\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eFor example, I always walk on the street with kids almost daily but nowadays I excuse myself from walking on the street and keep on postponing telling these kids lets walk the following day\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;No at first it was not easy at all always angry and not understanding and my coping mechanism I am always to quit and be choosy. Meaning I choose to be reserved and be alone\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePregnant teenagers are not coping as revealed in interviews, one is depressed and no longer bathing or doing what she used to do as no interest, she does not ever look at herself in a mirror. When is too much she listens to the music and prays as a distraction. Another one said that not coping keeps herself busy with the house chores and shopping for baby staff just to keep herself busy the whole day.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;No, I\u0026rsquo;m not coping but on the nights that are too rough or intense to bear I pray. I think I am depressed I don\u0026rsquo;t take care of myself I don\u0026rsquo;t bath as usual, and when looking at myself in a mirror I don\u0026rsquo;t look at myself I am no longer doing what I used to do meaning no longer interested in things I used to do daily. I\u0026rsquo;m coping by prayer and listening to music\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Social support\u003c/h2\u003e \u003cp\u003e Though most pregnant teenagers \u0026lsquo;parents are disappointed by their teenagers falling pregnant at an early age, they end up being supportive and taking good care of them as their responsibility. Another participant said her sister always accompanied her to the clinic and another one always came with her partner. Another participant mentioned that the mother to the boyfriend is happy because her boyfriend is the only child of her mother and that the coming baby will be the second child. Generally, family parents, siblings, partners, and friends of most of them are supportive.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eYes, my husband partner, Mother, Sister, and brother, we all live together and support each other where needed. They support me if I don\u0026rsquo;t feel well. My husband would make food, my sister would clean the house, and my parents support me if I felt down, they would cheer me up and take me out for lunch\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Recommendations to improve the well-being of pregnant teenagers\u003c/h2\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Psychological support\u003c/h2\u003e \u003cp\u003e All participants though that interviewing them was to collect data they were happy and appreciative to be interviewed, and they said they needed to talk with someone, and they felt relieved and counselled. They all be referred to a psychologist for further counselling after the interview. Another participant requested her whole family to be referred to see a psychologist for counselling because they are failing to accept that their teenager is pregnant, they are still angry at her. Another participant is aware that smoking could harm the growing baby inside of her but failed to stop the habit and was referred to see a psychologist.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I will advise nurses and doctors to make us pregnant teenagers feel free and give us counselling\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eProper counselling offered to pregnant teenagers and their hurting families in order to decrease chances of suicide, meaning my family also need counselling\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eParticipant Said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think talking to teenagers and counselling them without any judgment can improve the well-being of pregnant teenagers\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Healthcare and Health Education\u003c/h2\u003e \u003cp\u003eMost of the participants explained health care workers nurses and doctors to have a good attitude towards them because if they have been shouted at, they will stop coming to attend antenatal care and end up having complications. Another participant requested nurses to advise pregnant teenagers about those supplements\u0026rsquo; pills and how important for pregnancy and recommended they must be taught how to take care of their coming babies and what to buy for their coming babies. Another participant shared that nurses advise on a good healthy diet as teenagers do not know what to eat and to be advised on stopping bad habits like alcohol and the use of drugs. Generally, participants are requested to be informed about what to do and to avoid during pregnancy and the early parenting stage.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eBy also telling us what to buy when the baby is born. Some they do not have parents to guide how to take care of the baby when is born so you should guide them and tell them what to do they will feel safe because they will know what to do and what to buy and also teach them how to feed the baby\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;( She cried again ) Do not take me wrong the attitude of nurses towards pregnant teenagers is not good but ever since I have been attending Springs Clinic staff have been very nice but as of now I have been referred to the hospital to be seen by the doctor I have heard that at hospital nurses and doctors has bad attitude they do not care so I am thinking ( she cried again) and I do not know how to talk always emotional and some other people might end up not attending clinic regularly and that will affect the baby and also if this stressed pregnant women will lose their babies, People are complaining about the hospital and end up losing their babies\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eYou can always talk to the child and tell them better off doing one two three four five than doing this like just try to correct the wrong by doing write even if people are mad at you, but you are trying your best and because advise is the best\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Social support\u003c/h2\u003e \u003cp\u003eParticipants recommended social support from family, community, and social workers. Another one said as they are still teenagers not working suggested social workers recommend social grants and food parcels for pregnant teenagers. Another participant said the community must stop gossiping about them and support them. Parents must stop judging and comparing their pregnant teenagers with neighbour teenagers who are not pregnant.\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI think social workers must come in and support pregnant teenagers with food parcels and social grand because most of us are not working. pregnant teenagers need counselling\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant said\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eAnd the family must gather and tell them what to do and tell you that you will be better as sometimes you feel as if they will throw you away you are lost, they must also give you some advice. The parents need to guide the child to see that she is going to be a parent and must tell them how to deal with and cope and you will feel that my parent love me though they might feel as if they do not love you is that what I think is going to help\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study aimed to explore the challenges facing pregnant teenagers during the Sustainable development Goals Era. In 2015, every nation pledged to accomplish the Sustainable Development Goals (SDGs) by 2030. These objectives include ensuring universal access\u003c/p\u003e \u003cp\u003eto sexual and reproductive health services and significantly reducing maternal, neonatal, and child mortality to promote healthy lifestyles and well-being for everyone, including pregnant teenagers (WHO, 2020).\u003c/p\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003eTheme Physical Experiences of Pregnant Teenagers\u003c/h2\u003e \u003cp\u003eParticipant\u0026rsquo;s responses revealed that many experience slight bleeding and cramping, sometimes small amount of spotting or vaginal bleeding as one of the symptoms of pregnancy known as implantation and some women also experiences abdominal cramps. Some pregnant women experience heightened sense of smell of various odours such as foods, perfume or cigarette smoke this causes nausea in pregnancy. Food cravings due to hormonal changes. Headache also due to hormonal changes and dehydration while dizziness due to dilatation of blood vessels that drop blood pressure. The study results also similar to the study done by Wick [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] which indicate that pregnant women including pregnant teenager\u0026rsquo;s experiences symptoms such as tender, swollen tingly and sore breasts due to hormonal changes in early pregnancy. fatigue due to hormone progesterone.\u003c/p\u003e \u003cp\u003eThese findings are similar to the study of Davis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] which indicates in teenage pregnancy Fatigue has a relationship in nutrition, stress, and general state of health. In early pregnancy fatigue is related to physiological adjustment and hormonal changes so serves the positive function of helping the mother rest and tune in to her changing needs. If fatigue if problematic after the first trimester review diet. Vaginal bleeding with lower abdominal cramping can lead to early pregnancy at loss. Vomiting decreases the incidence of pregnancy loss while nausea alone does not [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study results are also similar to the study by Akter [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] which indicate that pregnant teenager\u0026rsquo;s pregnant teenagers in most cases do not get sufficient calories, protein, carbohydrates, vitamins and minerals during pregnancy suffer from malnutrition with some other illness like dizziness and poor level energy. Pregnant teenagers are not physically ready for pregnancy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme: Psychological experiences of pregnant teenagers\u003c/h3\u003e\n\u003cp\u003eThe study findings reveal that pregnant teenagers are stressed, scared how family will respond with painful hearts, regret and shows also depression as become suicidal, scared and thinking of doing an abortion without their parents \u0026ldquo;s consent. These pregnant teenagers kept secret others long of being pregnant to the family and this make them suffer alone in silent. Tie study findings have similarities to the study done by Tang Xian \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] which reveal that pregnant teenagers experienced risk factors for prenatal anxiety and depression include young age low levels of education, disharmony in the family relationship, low life satisfaction and lack of social support.\u003c/p\u003e \u003cp\u003eThe results are like the study done by Lewinsohn \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] which indicate that Pregnant teenagers experienced increased instability and conflict in sexual partner and family relationships due to unintended pregnancy led to stress. Pregnant teenagers experienced period of turmoil and stress as they faced fear of disclosing a pregnancy as this led to disruptions in family and partner social support structure.\u003c/p\u003e \u003cp\u003eThe results of the study are having similarities to the study done by Duby [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] which indicate that pregnant teenagers experience social stigma and fear of being judged and gossiped about. Pregnant teenagers feel sad some even attempt suicide because of hearing unpleasant things about their life spoken by other people. They have been teased and dropped out of school.\u003c/p\u003e \u003cp\u003eThe results of the study similar to the study done by Erasmus \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] indicate that pregnant teenagers experience barriers to starting antenatal care often centred on the disclosure of pregnant teenagers being deviant, irresponsible, and shameful. Pregnant teenagers believe and are fearful of others \u0026ldquo;s reactions within their family, the community, at school, and antenatal clinics. Pregnant teenagers experience fear of disclosing pregnancy.\u003c/p\u003e \u003cp\u003eDuring the interview teenager's responses revealed that most of them never thought could become pregnant, and they regretted it. What makes this worse is other parents who are angry at these teenagers for not getting support. They hate themselves, are always tearful, and feel disappointed and also said it was not their intention to become pregnant at this early age and also thinking of abortion.\u003c/p\u003e \u003cp\u003eThe study findings are similar to the study done by Webb \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which reveals that the emotions associated with loss of aspiration are family rejection. When parents reject this pregnant teenager, they feel bad, worrying and overthinking how to do right and rejected at home. The emotions expressed as physical sensations, feel pain in the head. When angry or disappointed, rejected and your body becomes weak. There are feelings of worthlessness and inappropriate guilt.\u003c/p\u003e\n\u003ch3\u003eTheme: Social experiences of pregnant teenagers:\u003c/h3\u003e\n\u003cp\u003eThe results of the study has similarities with the study done by Aziato \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] which reveals that some parents become embarrassed and isolate their pregnant teenagers from the community in which they live. Some parents send their pregnant teenagers to distant grandparents or friends to prevent embarrassment associated with adolescent pregnancy. pregnant teenagers take a long before telling their parents about pregnancy as they will be angry, sad, disappointed, unhappy, worried, disgraced, and ashamed.\u003c/p\u003e \u003cp\u003eThe results of the study are similar to the study done by Kumar \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] findings reveal that pregnant teenagers faced domestic physical violence and were psychologically violated by parents, partners, and the community where they lived. Pregnant teenagers perceive their struggles during a period of transition from childhood to become pregnant. They reported more anxiety, low self-esteem, and difficult in accessing financial, moral, and material support from parents.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Coping experiences of pregnant teenagers:\u003c/h2\u003e \u003cp\u003eThe results of this study have similarities with the study by Lowdermilk \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] which indicated that pregnant Teenagers, especially those under 16 years old, experience stress during pregnancy as they are in a typical developmental period. Teens' emotional levels are commonly characterized by impulsiveness and self-centred behaviour.\u003c/p\u003e \u003cp\u003eThe results of the study are similar to the study done by Kotoh \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] indicated avoidance as a coping strategy for pregnant teenagers not to go to public places and stay away from people. Pregnant teenagers stop going to school and others stop going to churches as usual.\u003c/p\u003e \u003cp\u003eThe findings of this study are similar to the study done by Wainaina \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] which indicate that pregnant teenagers do not cope with stress because of stigmatization, neglect from family and friends, negative feelings, and experiences towards pregnancy and motherhood. Besides avoiding people pregnant teenagers sleep as a coping mechanism as facing stress.\u003c/p\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003eTheme: Recommendations to improve the well-being of pregnant teenagers\u003c/h2\u003e \u003cp\u003eThe results of the study are similar to the study done by Hornberger \u003cem\u003eet al\u003c/em\u003e, [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] indicating that once a positive pregnancy test result has been shared with a pregnant teenager and at least one trusted adult has been identified as a support, the health worker or psychologist should proceed with counselling. Counselling may occur at the diagnostic visit and continue over several visits.\u003c/p\u003e \u003cp\u003eThe findings of the study are similar to the study done by Laurenzi \u003cem\u003eet al\u003c/em\u003e, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes there is critical evidence gap related to the effectiveness of psychological interventions in improving mental health, preventing disorders, self-harm, and other risk behaviour among pregnant teenagers. There is an urgent need to adapt and design new psychological interventions that can be pilot-tested and scaled for pregnant teenagers.\u003c/p\u003e \u003cp\u003eThe study has similarities of the study done by Erfina, Widyawati, Mckenna, Reisenhofer \u0026amp; Ismail [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] which reveals that social support is important for pregnant teenagers becoming mothers they need family support. Pregnant teenagers living with extended family may provide multiple benefits for pregnant teenager and their infants for they will be able to go back to school, meet their own developmental needs, and become skilled mothers in a supportive environment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Family can provide a positive environment for pregnant teenagers to become good mothers who can perform and gain confidence in their maternal role promoting better childcare and positive child development\u003c/p\u003e \u003cp\u003eThe results of the study are similar to the study done by Wainaina \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] which indicate that the support that these pregnant teenagers wanted to see their lives and the lives of other teenagers in similar situations including financial support to start businesses to go back to school or vocational training. They also indicated receiving information on birth preparedness, problem-solving, and confidence\u0026ndash;building skills would be a great support for pregnant teenagers on how to take care of themselves and the coming babies.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePregnant teenagers during data collection indicated that they are experiencing social and psychological challenges of which most of them came up with the recommendation of all pregnant teenagers aged 10 years up to 19 years to receive counselling to enhance better health outcome. That is in line with SDG 3 which aims to ensure healthy lives and promote well-being for all at all ages including pregnant teenagers. Pregnant teenagers end up dropping out of the school as peers are judging and embarrassing them also some teachers judged them, this is contrary to SDG4 which aims to ensure inclusive and equitable quality and promote lifelong learning opportunities for all including pregnant teenagers. Maternal guides recommend counselling pregnant teenagers up to 17 years and does not include family and parents hence some parents end up being disappointed by this early pregnancy whereby they will be tension between pregnant teenagers and parents throughout pregnancy.\u003c/p\u003e \u003cp\u003eThe research findings reveal that pregnant teenagers are suffering in silence, they need somebody to voice their concern through counselling in several sessions. Current guidelines state that only those pregnant teenagers below 17 years are suitable for counselling, but the study recommended all pregnant teenagers aged 10 years up to 19 to be referred for counselling throughout pregnancy. Participants requested their family members to be referred for counselling also. The study also reveals that to enhance the best outcome of pregnant teenager\u0026rsquo;s they need to be listened to. School or fellow students, teachers, parents, family and community at large need to be addressed by health workers to support pregnant teenagers. All in all, these pregnant teenagers need financial, social and psychological support for a better outcome of pregnancy.\u003c/p\u003e \u003cdiv id=\"Sec40\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eThis was a qualitative study conducted in one clinic at Ekurhuleni District in Gauteng the results cannot be generalized to other Provinces. Initially during data collections there was a struggle to get participants to reach saturation. It was only one clinic at Ekurhuleni Department of Health contacted and added several clinics at Ekurhuleni.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e Ethics approval for this study was obtained from the Ethics Committee and the Department of Health. Ethic number: TREC/121/2024: PG. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants aged 18 years and older before participation. Consent forms were available in Setswana, isiZulu, English, and Afrikaans and were explained in simple language to ensure understanding. For participants under 18 years of age, written consent was obtained from parents or legal guardians, and assent was obtained from the adolescents prior to participation\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from all participants for publication of their anonymised quotes.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMphahlele RJ, Bopape MA, Malema R and Muthelo L, all authors contributed equally to the article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all the pregnant teenagers who participated in the study and the Springs Municipal local clinics at Ekurhuleni District. The authors further acknowledge the support from the University of Limpopo research office when conducting the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdolescent pregnancy [Internet]. [cited 2025 Dec 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACERWC - African Committee of Experts on the. 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Reprod Health. 2020;17(1):65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErfina E, Widyawati W, McKenna L, Reisenhofer S, Ismail D. Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families. Midwifery [Internet]. 2022 [cited 2026 Jan 15];104:103170. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0266613821002503\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0266613821002503\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErfina E, Widyawati W, McKenna L, Reisenhofer S, Ismail D. Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families. Midwifery. 2022;104:103170.\u003c/span\u003e\u003c/li\u003e\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":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Teenagers, pregnancy and childbirth","lastPublishedDoi":"10.21203/rs.3.rs-8610559/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8610559/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAdolescent pregnancy and childbirth among women under 20 continue to be a major global public health concern. Early pregnancy and childbearing have consequences. The study aimed to explore the challenges facing pregnant teenagers during the Sustainable development Goals Era.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative phenomenological, exploratory and descriptive design underpinned this study to explore the challenges facing pregnant teenagers. A non-probability and purposive sampling technique was used to select pregnant teenagers, between the ages of 10\u0026ndash;19 during antenatal care (ANC) visits in selected clinics. Data was collected through semi-structured interviews, questions were in English, Afrikaans and Isizulu language until data saturation was reached at participant number 16. Tesch\u0026rsquo;s method of data analysis was used to analyse the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this study, five themes and sub-themes were derived during data analysis in connection with the themes. This includes Physical experiences of pregnant teenagers, psychological experiences of pregnant teenagers, social experiences of pregnant teenagers, coping experiences of pregnant teenagers and recommendations to improve the well-being of pregnant teenagers.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study revealed that even during the implementation of Sustainable Goals Era, there are hidden challenges experienced by pregnant teenagers, they are suffering in silence. The identified the need for support from school or fellow students, teachers, parents, family and community at large, this will enhance the best pregnancy outcomes aligning to the attainment of Sustainable development goals. Hence there is a need for financial, social and psychological support for a better outcome of pregnancy.\u003c/p\u003e","manuscriptTitle":"Exploring the Challenges Facing Pregnant Teenagers in the Sustainable Development Goals Era: Qualitative study in Gauteng Province South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 20:14:36","doi":"10.21203/rs.3.rs-8610559/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T07:06:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T17:55:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T15:26:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153454489767352588663926043082688006727","date":"2026-02-11T14:37:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134480008591080518607814263858511533106","date":"2026-02-11T13:07:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T07:39:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T06:32:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T01:16:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2026-01-21T06:56:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"013b87b8-ded7-48f5-9238-8e101784aab5","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T07:09:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 20:14:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8610559","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8610559","identity":"rs-8610559","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}