Teenage Mothers’ Resilience: Motherhood Experiences and Coping Strategies among First-Time Teenage Mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana. A Phenomenological Study

Teenage Mothers’ Resilience: Motherhood Experiences and Coping Strategies among First-Time Teenage Mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana. 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A Phenomenological Study Reuben Foster Twintoh, Florie Darteh, Eugene Kofuor Maafo Darteh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8145461/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background First-time teenage mothers often face distinct psychosocial and emotional challenges compared to adult mothers. Unlike adult mothers who are mature enough to accept responsibility for their actions and are resilient to function independently, the same cannot be said of first-time teenage mothers. Lacking adequate support and resilience, they become more vulnerable to the demands of early motherhood. The study explored the motherhood experiences and coping strategies of first-time teenage mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana. Methods This qualitative phenomenological study employed purposive sampling technique to select 30 first-time teenage mothers. A face-to-face in-depth interviews were conducted using a semi-structured interview guide. The interview data were managed using NVivo and thematically analysed. Results The findings revealed that teenage mothers’ sense of responsibility was influenced by the multifaceted challenges and complex realities of early motherhood. They reported experiencing emotional and maternal distress as well as feeling regret and neglected by baby fathers. These challenges often stemmed from limited psychological support, social stigma, and a lack of preparedness for parenting roles. Despite these challenges, they adopted various coping strategies (social, physical and religious), and sought support from family and peers as well as self-motivation. Conclusion Understanding the lived experiences of first-time teenage mothers in Ghana offers valuable insights for developing targeted interventions. These should include comprehensive adolescent sexual and reproductive health education, accessible family planning services, and the establishment of robust social support systems to ensure the well-being and long-term development of teenage mothers and their children. Resilience Teenage motherhood Coping strategies Psychological support Ghana Figures Figure 1 Figure 2 Introduction Globally, teenage pregnancy and childbirth remain major concerns for public health and development, given their profound implications on adolescent reproductive health and social well-being [ 1 ]. Teenage is the period between childhood and adulthood, spanning from 13–19 years, when major physical, behavioural, and social changes occur [ 1 – 3 ]. These changes are the foundation and crucial to establishing good health in later life and the cornerstones of adult well-being and happiness [ 4 ]. However, this seems unattainable for more than 50 percent of the world’s teenagers, who live in low- and middle-income countries (LMICs) [ 5 ]. Most of these teenagers (90%) have higher fertility rates than those in high-income countries [ 7 ]. Globally, 16 million adolescents give birth annually [ 5 ]. Teenage mothers give birth to one out of every ten babies, with more than 95 percent of these births occurring in LMICs [ 9 ]. In Ghana, adolescents make up approximately 22.4 percent of the national population [ 8 ], with teenagers accounting for 30 percent of all recorded births, and 15percent of women aged 15–19 years already having children [ 8 ]. Early experiences of parenting and motherhood vary by context and are shaped by the cultural norms and social environment surrounding the adolescent [ 10 ]. One of the key socio-economic challenges faced is dropping out of school, which results in reduced access to education and fewer opportunities for acquiring skills [ 11 ]. Early pregnancy and birth are also risk factors; stillbirth, low birth weight, and child mortality are all health problems for the newborn, whereas with the adolescent mother, fistula, depression, financial distress, malnutrition, and even mortality are serious concerns among teenage mothers in LMICs [ 1 – 9 ]. However, evidence challenges the assumption that teenage pregnancy has largely adverse consequences for teenage mothers and their infants, highlighting the need to understand teenage mothers' perspectives and experiences [ 12 ]. Regardless, after the baby is born, motherhood becomes a reality in societies where conventional gender norms still prevail, and many women’s lives centre around childbearing. Exploring a first-time teenage mother’s experience of motherhood can provide policymakers and healthcare providers with fresh insights, allowing them to respond more effectively to the issues that adolescent mothers face. Teenage mothers are impacted not only by the experiences of early motherhood itself, but also by the attitudes and responses of their parents, families, peers, educational institutions and the broader society [ 13 ]. Transitioning to motherhood requires a combination of physical, emotional, social, and cognitive preparedness; however, most teenage mothers lack the necessary readiness for this transition [ 14 ]. For those experiencing motherhood for the first time during their teenage years, the simultaneous demands of caregiving responsibilities and personal developmental changes often make the experience particularly challenging and overwhelming [ 15 ]. Thea are required to navigate adult social roles while simultaneously coping with the physical changes of puberty, significant neurological development, and the demands of caring for a newborn [ 16 ]. Because most first-time teenage mothers are of low socio-economic status, adjusting to motherhood is complex and problematic [ 17 ]. This study, therefore, explored motherhood experiences and coping strategies among first-time teenage mothers in the Komenda-Edina-Eguafo-Abrem Municipality in the central region of Ghana. The study interrogates the following questions: What are the first-time teenage mothers’ experiences of motherhood? what challenges do first-time teenage mothers face in performing their maternal roles and/or responsibilities? what are the coping strategies first-time teenage mothers adopt in light of their challenges? These questions were guided by the resiliency framework to explore the perspectives of first-time teenage mothers and provide a broader contextual understanding of their experiences of early motherhood. Conceptual framework This study was underpinned by Norman Garmezy’s resiliency theory, introduced in 1991. The theory identifies three types of protective factors: individual characteristics, supportive family relationships, and social support systems both within and outside the immediate home environment. These factors help young people cope with challenges and life stressors [ 18 ]. The present study focuses on first-time mothers and their resilience in managing maternal responsibilities, coping strategies, and the social support available to them. According to [ 19 ], teenage mothers face significant health risks and caregiving (e.g., being able to meet their baby's financial, physical, and health needs) with their own developmental needs. Some teen mothers show resilience, meeting their children's needs while continuing and engaging in entrepreneurial activities to support themselves financially. However, others struggle and experience significant emotional and psychological distress, including stress, anxiety and diminished self-esteem, as they navigate the challenges of early motherhood [ 20 ]. The influence of individual traits and methods on resilience helps individuals overcome adversity. It is viewed as a dynamic interplay between the individual’s (teenage mother) cognitive and behavioural response to adversity in her environment [ 19 , 21 ]. Coping strategies, resilience, and motherhood styles (e.g., roles and responsibilities) are all significantly related to one another and create a complex interdependent dynamic as a first-time teenage mother is placed at the centre of the triangle to understand the relationship. Many studies have examined the relationships among resilience, coping strategies, social support, and self-esteem concerning how these factors protect young mothers in their situations and enable them to succeed in the face of adversity [ 22 , 23 ]. However, studies in the growing body of literature have examined the mediating role that first-time teenage mothers' coping strategies play in the relationship between motherhood styles and resilience, particularly in certain Ghanaian contexts. This study employed resilience theory to understand the experiences of motherhood and coping strategies among first-time teenage mothers. The focus of the research and conceptualisation of the theoretical framework explains the complex interplay of motherhood styles, coping strategies, and resilience. These factors (see Fig. 1 ) revolve around the first-time teenage mother and give her the ability to navigate life adversities or motherhood challenges. Methods and Materials This study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 24 ]. See Appendix A. Study Design This study adopted a phenomenological study design [ 25 ]. This approach was underpinned by Edmund Hussels’s philosophy [ 26 ] and explains that reality is socially constructed and that the teenage mother’s (individual) interaction with his or her experiences and environment involves the perception, knowledge and reality/life experiences of a phenomenon [ 27 ]. This study design is suitable and provides the understanding needed to explore lived experiences from the perspective of first-time teenage mothers. The study explored maternal responsibility, support systems and coping strategies that mothers adopted in response to the challenges they faced. With this design, the study was able to obtain pertinent information concerning the study’s research questions. Study Setting and Population The study was conducted in the KEEA Municipality, one of the densely populated municipalities in the Central Region of Ghana. The KEEA municipality was selected because most of its community members are predominantly low-income earners. The major economic activity is fishing (Fisher Folks), and these factors contribute to a high prevalence of teenage pregnancy and childbirth in the municipality [29; 30]. The study setting was grouped into five zones following the capital towns of traditional communities. A sub-community was selected from each zone: Dutch Komenda in Komenda (zone A), Besease in Kissi (zone B), Abrehyia in Abrem-Agona (zone C), Ntranoa in Ankaful (zone D), and Teterkessim in Elmina (zone E). The primary target population for this study comprised first-time teenage mothers aged 13–19 years. The participants were recruited based on specific criteria: the participant must be a first-time teenage mother aged 13–19 years, and she had to have had a child for at least two years (not in care, fostering, or adoption), but biological. This age group was chosen because the literature contains limited data on childbirths among teenage mothers aged 10 to 19 years, and first-time pregnancies are more likely to occur before the age of 15 years [ 28 ]. Additionally, pregnancy-related socio-cultural and risk factors among adolescents have been commonly reported in the KEEA Municipality, particularly among females younger than 19 years [ 29 ]. Hence, the study purposively selected first-time-teenage mothers aged 13–19 years to elicit their motherhood experiences and coping strategies Sampling Procedure A purposive sampling approach was employed to recruit participants for the study, specifically targeting first-time teenage mothers. To enhance the selection process, homogeneous sampling was used to ensure that participants shared similar characteristics relevant to the study's objectives [ 27 ]. This sampling strategy facilitated the recruitment of 30 first-time teenage mothers from various sub-communities within the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality in Ghana’s Central Region, including Dutch Komenda (Komenda), Besease (Kissi), Abrehyia (Abrem-Agona), Ntranoa (Ankaful), and Teterkessim (Elmina). In line with community entry protocols, potential participants were engaged. Those who met the inclusion criteria were identified, screened, and interviewed in their place of convenience (homes). Appointments (date and time) were scheduled for teenage mothers who voluntarily agreed to take part in the study. This approach was necessary due to the absence of a predefined framework for accessing participants from the selected communities. Data saturation was determined based on the guideline by Marshall and colleagues, which suggests that theoretical saturation typically occurs between 10 and 30 interviews. Reflecting the iterative nature of phenomenological inquiry, the sample size was not pre-specified but developed as the richness and depth of experiential data unfolded in response to the saturation point suggested by [ 31 ]. Beyond reaching saturation, the researcher ensured that high-quality data or insights were captured. The recruitment of participants was facilitated by three field assistants (all female nursing students) who were final-year undergraduate students at Cape Coast Nursing and Midwifery Training College in the Central Region of Ghana. These field assistants helped organise meetings, screen, and schedule dates and times for the selected interview participants. Even though the field assistants had considerable experience in organising and conducting qualitative interviews, they had five hours of training each day for three days to acquaint them with community entry/gatekeepers, data collection methods, and ethical issues. Data collection Data were collected from first-time teenage mothers using a semi-structured in-depth interview (IDI) guide. The guide comprised two main sections. Section A focused on capturing the socio-demographic profiles of the adolescent mothers, including variables such as age, level of education, religious affiliation, marital status, current occupation, and other relevant background information. Section B focused on the main questions concerning motherhood experiences, maternal roles and/or responsibilities, support and coping strategies for first-time teenage mothers. The main questions were based on the objectives of the study. Probes were added to specific questions to obtain the pertinent information needed or in-depth knowledge of the phenomenon. Data collection was conducted over a 20-day period. The initial five days were dedicated to a reconnaissance survey, which involved community entry activities and logistical preparations for fieldwork. During the main phase of data collection, the purpose of the study was clearly explained to each participant prior to the commencement of their interview. Additionally, a clinical psychologist was made available to prepare the minds of the participants to overcome any form of emotional or mental discomfort that may have occurred during the interviews. This approach aims to minimise harm or risk. All participants were assured of their right to anonymity and confidentiality by the investigator, ensuring that their identities were not linked to the data or disclosed in the study’s report. The participants willingly agreed to take part in the study. To support informed participation, the investigator read and explained both the assent and informed consent forms in the local language, Fante, which the participants were more comfortable with, to ensure understanding. The participants were also required to sign or thumbprint a consent form stating their willingness to take part in the study (voluntary participation). The face-to-face interview approach was employed to collect data in the participants' homes to ensure that they feel comfortable, understood completely and could reply appropriately to the questions. This enabled the participants to reflect on and then discuss their experiences concerning motherhood, support systems, and coping strategies. All the interviews were taped or recorded, and field notes were also taken throughout the data collection process. Each interview lasted between 40 and 75 minutes on average. Handwritten notes and audio recorders helped to ensure that interviews did not decline accidentally, should any of the interview equipment (recorder) break down during the interview process. The investigator did not establish any form of relationship with the participants before or after the fieldwork. However, the participants were informed that the data collection formed part of the author’s MPhil thesis requirements. Reflexivity To ensure reflexivity, an independent check of the codes was conducted to ensure data coding reliability. The supervisor (EKMD), who is also a qualitative researcher, reviewed all the coded data to check whether the main themes and the subthemes corresponded/reflected the actual meaning depicted in the data, focusing on the selected quotes from the participants to ensure that the analysis of the data was coherent and clear. This approach was adopted to enhance the inter-rater reliability of the data. It was informed by Birks and colleagues’ assertion that reflexivity in qualitative research can be achieved through recognising prior assumptions and experiences, maintaining analytic memos, ensuring coding reliability, and comparing data both within and across the dataset [ 35 ]. Furthermore, the analysis and presentation of findings were guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (see Appendix A), as recommended by [ 24 ]. Trustworthiness In qualitative research, dealing with questions of credibility and rigour is critical. In contrast to a quantitative study [ 27 ], generalisability and dependability play a minimal role in qualitative research [ 27 , 36 ]. To prevent researcher and participant biases, potential risks to the trustworthiness of qualitative research, such as credibility, transferability, dependability, and conformability, were addressed and proven in this study. For example, following each interview, the participants were allowed to summarise and validate the important views expressed in line with the questions to ensure that their views/responses were accurately recorded as a way of member checking [ 36 ]. Data Analyses First, all audio-recorded interviews were transcribed verbatim from one of the Ghanaian languages spoken by the members in the study area (Fante dialect) and translated into the English language together with the field notes that were already written in the English language, which were typed into Microsoft Word and then introduced/uploaded into the software (QSR NVivo 12 Pro qualitative software). To demonstrate the important issues that were identified from the data for analysis, autocoding was first performed to obtain a sense of the data in the software [ 32 ]. Data memos were also used to edit some of the transcripts (proofreads) and ensure that the issues were prepared, described, summarised, and structured for analysis [ 32 , 33 ]. To indicate all parts of the textual discourse that comprised one or more categories, a numeric coding technique was used (classification). For example, ‘1’ was used to code 'coping strategies,' 2’ was used to code ‘social support,' 3’ was used to code ‘motherhood responsibility,' and so on. These categories were then whittled down to a manageable size by grouping comparable and related themes to create new ones. This was performed simultaneously with qualitative data analysis experts (supervisor). To obtain an intuitive sense of the data and to define our method of organising and categorising the data rather than having it controlled purely by the software, we employed systematic qualitative-oriented text analysis to develop a framework for analysis. As a result, we used the software's "query" tool to look for certain words and phrases that were important to the identified themes [ 33 , 34 ]. Approximately 30 quotes/codes and 18 categories/subthemes were obtained during the analytical process. Identifier numbers, for instance, PD1, PD2,...to PD30, were created and assigned to each participant's quotations or views. Even though RFT performed the coding and generated themes, to ensure intercoder(ing) reliability, a supervisor also performed confirmatory coding of the data independently. Themes were compared, and where needed, the main and subthemes were refined and defined properly to capture the essence of each theme. The descriptive narratives of the themes were used to contextualise the analysis. Finally, statements from the participants (verbatim) were used to represent the participants' points of view to illustrate the findings. This, on the other hand, did not affect the meaning of the participants' subjective viewpoints or actual expressions. All the participants' conceptual expressions were categorised in a way that represented the important and subtle meanings they connected to their views. Frequencies (N) and percentages (%) were used to represent the socio-demographic characteristics of the participants (Table 1 ). The results of the study were presented in a thematic framework (see Fig. 2 ) using systematic qualitative-oriented text analysis [ 33 ]. Results Table 1 presents the background characteristics of the participants. The ages of those interviewed ranged from 17 to 19 years, with half (50%) being 19 years old. None of the participants younger than 17 years had experienced childbirth. In terms of education and marital status, only three participants (10%) had completed high school and were married, while the majority of participants (63%) were single. Regarding religious affiliation, most participants (90%) identified as Christians. Employment data showed that half of the participants (50%) were unemployed. Among those engaged in income-generating activities, six (20%) were involved in petty trading, while others worked in vocational fields such as sewing (13%) and hairdressing (10%), with a few (7%) participating in mobile banking services. Table 1 Socio-demographic characteristics of the participants Variable Frequency (N) (N = 30) Percentage (100%) Age (in completed years) 17 7 23.3 18 8 26.7 19 15 50.0 Level of Education Primary 9 30.0 Junior High School (JHS) 18 60.0 Senior High School (SHS) 3 10.0 Marital Status Never married 19 63.3 Cohabiting 8 26.7 Married 3 10.0 Religion Christianity 27 90.0 Islam 3 10.0 Occupation Not working 15 50.0 Petty trading 6 20.0 Seamstress 4 13.3 Hairdresser 3 10.0 Mobile banking/Transfer 2 6.7 Source : Fieldwork/data Thematic Results Figure 2 presents the themes and subthemes derived from the analyses conducted. Three main themes were realised: teenage motherhood coping strategies; accepting motherhood responsibility as a mother; support activities; and sources of support for teenage mothers, with subthemes including social, physical emotional, and spiritual coping support; a sense of being a teenage mother; caring for new-borns; a sense of feeling regret; a sense of feeling happy; combining maternal roles with others; partner’s neglect; teenage mother's plan; and planning for the child's future or aspirations. Sources of support were categorised as self-motivation, family support; friend/peer support; and baby father support. In addition, physical, social, and emotional support were categorised as support activities for first-time teenage mothers. Coping strategies Most pregnancies and births in this study were unplanned, regardless of whether the births were desired. According to the findings, teenage mothers lacked the necessary preparation to handle the responsibilities of motherhood/parenting. Owing to their lower capacity to cope with stress as first-time teenage mothers, and their limited knowledge of acceptable childcare practices and skills, mothers have potentially adverse health outcomes for their children [ 30 ]. First-time teenage mothers had many responsibilities and roles, such as caring for their children and meeting their needs. In addition, caring for a child at that teenage was a difficult task, especially for new/first-time teenage mothers who were unprepared or unplanned to have a child at that age; nonetheless, the majority of them met the challenge with tenacity and fortitude. Teenage mothers were likely to adjust to their new role as mothers and cope with it. Issues such as social coping, physical coping, and emotional and religious coping emerged as subthemes. Social coping One of the coping strategies that first-time teenage mothers adopted was social networking and interaction among peers/friends, family members, and neighbours. A few of them had friends with whom they shared their experiences (stress, worries, problems) to help them cope well after childbirth. Some of the teen mothers also engaged in conversation with others to help them overcome their challenges. The following quote summarises their responses: “At first, it was difficult for me to go out and engage my friends in conversation, but I realised that the more I talk to some of my friends and neighbours, the more I feel that I am becoming an adult. Talking to my friends helped me to free my mind and let me go of my past… Besides, I am not the only teenager who has given birth, so I feel sound and cope well with my social life. I am okay now…” - PD 21, 19 years with 9- month child. Peer support served not only as an outlet for emotional expression but also as a mechanism for normalising their experiences. Through social interaction, these young mothers found reassurance and a renewed sense of identity. Another participant affirmed this sentiment, saying: “When I speak with other girls like me, I do not feel judged. They understand what I go through. Sometimes, we laugh, cry, and share advice—it helps me not to feel lonely. It gives me strength to go on.” — PD 10, 18 years with 7-month child Physical coping Proper childcare or motherhood helps to strengthen the bond between mothers and children. The majority of teenage mothers talked about how they had adjusted to life after having a child as a physical coping strategy. Some of the participants shared their views on how they dealt with motherhood for the sake of their children. One of the participants expressed herself as follows: ‘‘After I gave birth, I did my best to find something to do so I could provide for myself and my child, I don’t get anything from anybody not even from my baby’s father since he neglected the child after he got me pregnant but I am managing physically as if there is no problem[…] I am trying to do my best as a mother…’’ ¬PD4; 19 years with 19- month child. Some of the first-time teenage mothers often had to rely on their own strength and adaptability to ensure their children were cared for. This physical resilience was characterised by taking on household duties, finding ways to earn a living, and maintaining routines for their babies despite limited external support. Another young mother reinforced this narrative: “…I wake up early every day to wash, cook, and feed my baby. It is not easy, but I know my baby depends on me, and I have to be strong. No one else will do it for me…” — PD16, 18 years with 11-month child Emotional coping Teenage mothers relate their emotional support to advice and talking to help them feel sound and build strong resilience to stress, pain, and other complications after childbirth. Some of them also expressed that they were depressed and cried almost every night because their boyfriends or partners had issues with them. Some even ended up rejecting or ignoring them, which affected them emotionally. This is what one participant had to say: “I cried almost every night […] I was in pain and worried when I determined that I was pregnant; my boyfriend told me he was not responsible for the pregnancy, hmm. [She sighed]… At first, I didn’t know how to tell my parent about it… until finally, my friend advised me to inform my mother and apologise to her. Surprisingly, my mother comforted me emotionally and advised me positively, so I felt loved again after childbirth” - PD 29;19 years with a 5-month-old child. Another teen mother shared a similar experience of emotional struggle and the critical role of support in her recovery: “I became so quiet and didn’t talk to anyone after giving birth. I felt like I had failed myself. But my aunt spoke to me almost every day. She told me that I still have a future and that the baby is a blessing, not a mistake. That really helped me to stop blaming myself and start thinking positively.” — PD12, 18 years with a 6-month-old child. Religious coping First-time teenage mothers were primarily given spiritual support by offering gratitude or praise to God for their success childbirth. They believe that a supreme being gifted them with a child because of hope and faith; they have to withstand any adversity as a coping approach to caring for their babies. Some of the participants believed that bearing a child is a gift/blessing from God. This belief helps most teenage mothers to give birth instead of abortion. Even some of them were ignored by their boyfriend after impregnating them. Some of them indicated that their boyfriend introduced them to abortion, but did not abort the child, even though some attempted. This is what one participant said: ‘‘ I believe that the child is a gift from God, so I don’t have to say it is a bad thing to give birth at this age and abort it [...] I listen to gospel music and the word of God to overcome my emotions as a coping mechanism[…] I didn’t plan the pregnancy, but it happened, and I cannot abort it[…], but I will tell other teenagers to avoid having sex at this age and avoid intimate relationships...’’ ¬PD 14; 19 years with 9- month child. Accepting responsibility as a mother Compared with other crucial roles as an unborn adolescent, a first-time mother's new maternal role/responsibility is extremely challenging [ 37 ]. Some teen mothers described the difficulties they had in reconciling motherhood (as a responsibility) with being a mother (a new maternal role). As a result, some teenage mothers were forced to manage their multiple roles. Other important duties associated with raising children were mentioned by the young mothers: they had to make difficult decisions about whether to stay at home or take care of their children when they wanted to do something else, such as going to church, school, or work/trade. Some of the participants had the following conclusions: ‘‘… Every day I am with my baby […] as a young mother, I manage to take full responsibility for my baby as adult mothers do […] just that, there were lots of places I used to go, but when I gave birth, I stopped because I know I have a baby. Therefore, I stay home 24/7 [every day of the week] to take care of my baby …’’ ¬PD1; 17 years with a 6-month child. Some of the participants believed it was their obligation to care for their children, and the sense of accepting motherhood was crucial to them. Some of them recalled that from the initial stage of pregnancy to childbirth was a nightmare; they had sleepless nights, overthinking how to accept and perform the motherhood roles and responsibilities of adult mothers. Consequently, they were too young to do it. Most of the time, however, they had to accept it in good faith and build a motherhood mindset; to be good, caring and responsible mothers. One participant said: ‘‘…I knew I had to cater for my baby by myself, I have a motherhood mindset now. Even though I am young, I can still take full responsibility like an adult mother…’’ ¬PD4; 19 years with 19-month-old child. Partner’s neglect First-time teenage mothers emphasised that ‘partner’s neglect’ affects them emotionally, physically, and financially. In most cases, partners fail to meet their needs and withhold their affection, time, and attention toward them and their babies. The majority of the participants reported that baby fathers/partners neglected them because they were not ready to take responsibility. They denied responsibility for the pregnancy and the obligations ahead. These are excerpts from some of the participants; “…Issues started coming up the moment I got pregnant. I knew that because he could not take responsibility for the pregnancy, that is why he quits the relationship and neglected us” ¬PD30; 19 years with a 9-month-old child “[…] in our community, it seems the guys are almost the same, the moment they impregnate you, they neglect you to carry your pregnancy/baby alone…” ¬PD4; 19 years with 19- month child. “Hmm! […] because He denied the pregnancy, He doesn’t know how to talk to me or visit the baby, so he had to neglect us…” ¬PD8; 19 years with an 11-month-old child Combining maternal roles/responsibilities Evidence indicates that bearing a child while still a teenager has significant adverse health effects [ 16 , 17 , 29 , 30 ]. Combining maternal roles as a first-time teen mother comes with numerous challenges, especially when trying to balance the unmet needs of a child as the primary caregiver while ensuring optimal caregiving practices often becomes a difficult task. Doubling up with the roles and responsibilities of motherhood, such as being able to meet newborns’ and infants’ needs and that of the mother’s physical, mental and social well-being while going through the motherhood transition as a teenager. Most teenage mothers reported interest in integrating motherhood roles with other responsibilities, such as continuing their education, finding work/ trading, and/or balancing motherhood obligations. Some of the participants had this to say: ‘‘... It’s going to be hard because I have not cut [stopped] breastfeeding my child, I wish I could wait for maybe some years before I can continue with my education, but I have to combine school with my maternal role …’’ ¬PD13; 19 years with a 5-month child The participants were asked, ‘What do you do to support yourself and your baby?’. A considerable number of views were expressed; engaging in petty trading (selling) was one of the things that most first-time teenage mothers suggested and planned to earn a living/income. Taking items such as secondhand clothing, vegetables, and fish from owners and shops to sell was perceived to be easy. One of the participants, whose partner was less supportive and struggled to sell something (petty trade) to support herself, had this to say: ‘‘Life is difficult for me because if I don’t sell, I will not get money to cater for myself and my baby. My baby is growing and eats a lot […] my boyfriend is stingy about giving me money unless I tell him that my baby is sick, before he will bring small money….’’ ¬PD10; 19 years with a 20-month child. A sense of being a first-time teenage mother The desire to become a first-time teenage mother or to have a baby was also brought up as a genuine way for teen mothers to regard themselves as adults. Some of the teenage mothers were overjoyed to have a baby at such a young age, whereas others were disappointed. Although some of the pregnancies were unintentional or unplanned, more than half of the teen mothers who chose to have babies did so because they wanted to be mothers. Therefore, some had no problems giving birth or feeling like mothers when asked about how they felt as first-time teenage mothers. These were the views of some participants: ‘‘Ooh! Hm [she sighed] I was disappointed in myself when I conceived. I was not happy initially; I told my friend, and she also told me that those giving birth are not better than I, so since then, I also made up my mind that I can take care of the baby. Therefore, I didn’t see anything wrong with becoming a mother because I am only my mother’s child, so becoming a mother was a good thing, my mother has a grandson now, and she’s happy too’’¬ PD1; 18 years with a 6-month child. In contrast, a teenage mother aged 18 years noted that being a mother means a lot to her because most of her age mates in her community have babies. The participant realised that having a baby is a blessing, even though she did not expect pregnancy at that age, she still never regretted having a baby. She said, ‘‘It was unplanned, but I have not regretted having a baby. The reason is that my boyfriend was working, so he gave me hope and told me he would take care of me so I could take good care of myself and my baby, so from day one, I have been blessed as a mother…’’¬ PD6; 18 years with a 4- month child Caring for new-borns/babies Recognising and understanding the maternal function, as well as being a healthy mother, gave the participants a sense of caring for their newborns as mothers. When they became mothers, the majority of teen mothers said they received care and love from their newborns and relatives. Some people expressed their contentment by expressing concern about their newborns. Some teenage mothers reported the following: ‘‘…Being a mother?... I will say I am happy and feel good because I am blessed with a child, but I have to do the best for my baby to be happy as well. Although I was too young to have a baby, I wanted to be a good mother. I had to get up early to prepare everything for my baby before she woke up... ¬PD23; 18 years with a 13-month-old child. This was further corroborated by a teenage mother aged 18 years: ‘‘… I do not feel like I am young, I feel like I am getting old. I feel like I’m a mother, a woman, and I like it… [Her hardest struggles included the baby’s crying and not getting sleep]. In the morning and at night, I don’t get much sleep when the baby cries. When I wake up, I don’t feel fine[well] because I get so tired...’’ ¬PD7; 18 years with a 3- month child. A sense of feeling regret Maternal responsibilities gave some of the participants a sense of regret in caring for their newborns as mothers. Some of the teenage mothers expressed some concern about their regret for newborns because some of them had to stay home all day to care for their babies and disassociate themselves from friends and parties. One of the participants had this to say: ‘‘…I have regretted hmm [she sighed…], because there are many responsibilities on me that I can’t accept anymore, I don’t party [go out with friends] as much as I used to […], I can’t leave my baby, and that is what I don’t like about having a baby now. I have gotten to stay at home and can’t go anywhere, meanwhile, at first, if I go out, I get money from my friends…’’ ¬PD11; 19 years with a 4-month child. Another participant who had mixed-sense feelings about childbirth had this to say: ‘‘I will not say I have regretted having a baby at this time, nor will I say I am happy. This is because since I had my baby , I tried not to associate myself with too many people […], I think once you have a baby, your mindset should change. I have to focus and think about the responsibility ahead of me’’ ¬PD2; 19 years with a 3-week child A sense of feeling adulthood Other teen mothers shared their feelings about transition to adulthood and were unhappy and unhealthy as first time teen mothers. Despite their weird feelings and numerous difficulties, they believed that having a child is more important than anything else. This is what one participant had to say: ‘‘…Ooh yeah, I was unhappy when I gave birth to my baby, my life changed, because I found myself not doing things that I know that I should not be doing. I think and act like an adult… It makes me a lot more careful as a mother now...’’ ¬ PD9; 19 years with a 7-month child. Teen mothers’ plans for their children Teenage mothers who had completed senior high school (SHS) expressed a desire to continue their education. Some of them had plans to visit a nursing school or university in the next five years. Higher education, they believe, will give them more options to help them take excellent care of themselves and their baby. Nearly all teenage mothers had beautiful plans for their children’s future. They were very optimistic about plans/aspirations for their children. Some of the participants mentioned that being a first-time teenage mother has prepared them for motherhood. They also expressed their desire and plans for their babies/children to grow up free of the unpleasant experiences they [teenage mothers] had from childhood through to motherhood. Many teenage mothers expressed high hopes for their children’s future, viewing their success as a reward for the sacrifices they were making in the present. One participant shared her aspiration for her child’s education and future status: “… I want my baby to grow up very well and become somebody better than I do, I will help my baby to go to school and become a great person like a lawyer, teacher, doctor, etc., in the future to take care of me when I am also old…” — PD21, 19 years with a 9-month child. In a similar vein, another young mother linked her hopes for financial security and care in later life to the future success of her child: “…my child should be a great person, he should be rich to take care of me when I’m old because I struggle to cater for him…” — PD23, 18 years with a 13-month-old child. For some, their dreams extended beyond personal benefits, envisioning their children as influential figures capable of transforming their families and communities. As one participant put it: “…my sweat will not be in vain, I wish my child becomes a leader like a president or member of parliament [MP] in future to take good care of me in my old age, help my family and other needy people…” — PD14, 19 years with a 9-month-old child Activities and Support Social, physical, and emotional support can be used to define support activities. Emotional and instrumental (social, physical) factors were two of the categories. In the literature, emotional support is defined as acts that provide care, love, trust, and concern. In contrast, instrumental support refers to direct assistance such as money, in-kind assistance, labour, and time when a person is in need [ 38 ]. The need for social support in assisting teenage mothers in coping with and adapting to the predicament of becoming mothers was stressed. A teenage mother aged 19 years mentioned this: ‘‘My mother gave me a lot of support [physical and social], especially when I gave birth, she taught me how to take care of my stomach so that it doesn’t become big. She also taught me how to take care of my body and keep my baby neat as well. She most of the time holds my baby and sings for my baby to sleep whenever my baby cries so hard.’’ ¬PD8; 19 years with an 11-month-old child. A teenage mother aged 19 years who received massive support (emotionally and physically) from her father had this view to share: ‘‘I get both emotional and physical support from my father […] when I gave birth, my mother got angry with me, so I went and stayed with my father [separated from his wife]. He was the one giving me money to buy food, clothes, and medicine for my baby. He makes sure I breastfeed and bathe my baby well. At night, when the baby cries, my father takes the baby and walks inside the room until the baby sleeps” ¬PD13; 19 years with a 5-month child The participants stated that their primary source of social support was their family/relatives/parents, peers/friends, and self-motivation. A few of them also mentioned the father of the child/partner. More than half of the participants said that their families were extremely supportive, whereas others said that their friends/peers were somewhat supportive. Family support Family support was seen as the immediate support given to teenage mothers. Some of the teenage mothers moved out of their parents’ homes when they realised that they were pregnant. This was one of the approaches teen mothers used to show regret, disappointment and seek forgiveness to attract some support from their families and relatives. This is what one of the participants had to say: ‘‘I moved to stay with my friend when I got pregnant because I knew I had disappointed my parent and had to move out to avoid insults […] but Immediately I came back from the hospital my mother bought me some of the items I would need, my big sister also bought clothes for my child when she heard that I had given birth. My Uncle has been giving me money because they know my baby’s father is a student and not working. Thus far, my family supports me very well.’’ ¬PD14;19 years with a 9- month child. Support from the father of the child In a few instances, some of the participants mentioned that their baby's fathers provided some support for them after both families had settled their relationship/pregnancy-related issues. It was further revealed that this support was not even enough to take care of themselves and their babies. One of the participants had this to say: “[…] He [the baby's father] ignored me for some time during pregnancy until childbirth. Later, my parent went to see the family. His family advised him to accept the baby and take care of the child, so he started visiting us. He brings a little money, but that’s not enough to take care of the child.’’ ¬PD3; 18 years with a 9-month child. Peers/Friends support Almost all the teenage mothers interviewed had friends who were familiar with their pregnancies. Teenage mothers reported that they had significant support from friends/peers during and after childbirth. Most participants had emotional and physical (financial) support from their friends/peers. This was mentioned by one of the participants: “My friend never disappointed me; she stood by my side and provided me with some form of emotional and financial support. She motivates me and gives me little money for food and sometimes buys me a gift, which makes me feel that she has my back [she is there for me] ...’” ¬PD23, 18 years with a 13-month child. Another participant also emphasised the critical role her close friend played during her time of need, highlighting the value of peer solidarity: “Even when my parents were angry at me, my best friend never left me. She would come to check on me, help with the baby, and remind me that I am not alone. She was like a sister to me when I needed one most.” — PD17, 19 years with a 10-month child. Self-motivation The well-known saying, “experience is the best teacher,” was reflected in the narratives of teenage mothers who, drawing from their own journey, offered advice to their peers—particularly those who had not yet become mothers. They used their experiences as a platform to motivate other adolescents to pursue their life goals and reject the notion that teenage pregnancy marks the end of one’s potential. Their reflections also served as a form of personal empowerment, demonstrating a determination and redefine their futures. Some participants shared the following: ‘‘…I will say that it is not easy to give birth so they [other teenage girls] should concentrate on their education and not have babies at this time like me and they should also assess their boyfriends well before giving themselves to them [engaging in sexual intercourse] because some of the boys are very bad and may ignore you when you get pregnant…’’ ¬ PD1; 17 years with a 6-month child. Some participants also indicated that they preferred to give birth early so that their children could grow up to become close companions later in life their friends: ‘‘[My little advice] … is that we should not give up [as teenage mothers] because we have given birth, it is even good to have a child at this time so that my child can grow up so quickly and become my friend…at least when I get to my old age my child can also take care of me. I will make sure I take good care of my child…’’ ¬PD 8; 19 years with a 10-month child. Another participant corroborated: "...Sometimes I feel it's better that I had my baby early. By the time I am in my thirties, my child will be grown, and we can talk like sisters. I don’t want to be too old when my child is still young. At least, she can support me when I’m older..." — PD 12; 18 years old with an 11-month child Discussion Underpinned by resilience theory [ 18 ], this study explored motherhood experiences and coping strategies among first-time teenage mothers in the KEEA municipality in the Central Region of Ghana. The study participants were between the ages of 13 and 19 years, with a mean age of 18 years. This is because none of the first-time teenage mothers interviewed was younger than 16 years, even though young/early adolescents were more likely to have experienced sexual intercourse or pregnancy due to their limited knowledge of sexual education, adolescent sexual and reproductive health, and the socio-cultural and risk factors for teenage pregnancy in the study areas [ 29 , 39 ]. Additionally, the level of education reported by teenage mothers was low, with the majority in primary and junior high schools. The results revealed that most first-time teenage mothers cater to themselves and provide optimal care for their babies, with aspirations and motives to attain a high level of education (e.g., tertiary). Few of them also indicated that they must engage in businesses, vocational skills, and petty trading to earn income to provide for their children and themselves. The results also revealed that the majority of the teenage mothers were Christians. The study also revealed that the majority were never married with a few of them cohabiting. These findings may be related to the fact that in typical Ghanaian communities, teenagers are more likely to reproduce more children while single because of the borrowed Western cultures such as weddings which prevent most of them from using traditional approaches to get married to reduce premarital sex and unplanned pregnancies and childbirth [ 40 ]. The results of the study revealed that first-time teenage mothers often struggled to meet their babies’ needs while managing their own, with some engaging in petty trading to support their roles and making critical decisions to meet their financial demands and overcome their challenging childcare and motherhood responsibilities and needs. This finding aligns with that of [ 29 ], who reported that adolescent mothers face significant challenges affecting their development and ability to accept motherhood responsibilities. Focusing on support from fathers in alleviating financial hardships is consistent with [ 41 ] assertion that fathers involved in childcare reduce the emotional and psychological stress on teen mothers, aiding their transition to parenthood. The results of the study revealed that accepting maternal roles and responsibilities was challenging at the initial stage of life, and most first-time teenage mothers were unhappy and regretted having babies, but eventually built capacity and resilience as mothers. This aligns with the findings of [ 42 ], who reported the mother’s initial unhappiness and fear during childbirth. Despite these challenges, the teen mothers in our study claimed to have good plans and aspirations, striving for success for themselves and their children. The findings from the study corroborate those of the studies conducted by [ 29 , 37 ], highlighting the significant demands on adolescent mothers’ development and adaptation to motherhood. The results of the study revealed that most of the first-time teenage mothers had interrupted life plans due to pregnancy and its accompanying financial burdens. Some of them had plans and aspirations after childbirth, which were related mainly to education and vocational careers. They also showed tenacity and optimism for themselves and aspired to great professions such as teachers, lawyers, and doctors for their children's future, echoing [ 43 ], who discovered that people can remain strong and achieve positive outcomes despite adversity. Teen mothers’ confidence in their plans supports [ 44 ], who reported that teenage mothers are resilient and capable of overcoming pregnancy and birth challenges. This finding also supports [ 20 ], affirming that teenage mothers can meet their own and their children's developmental needs through resilience. The findings of the study indicated that teenage mothers view motherhood as a significant part of their lives and strive to meet their children's needs as adult mothers. Even combining maternal roles as first-time teen mothers accompanied by pregnancy-related challenges, including maternal stress, financial strains, and neglect by their partners, particularly when they balance their unmet needs as primary caregivers and provide optimal caregiving practices for their infants, sometimes becomes extremely cumbersome [ 45 ]. Doubling up with the roles and responsibilities of motherhood and meeting their physical, mental, and social well-being while going through the motherhood transitions as teenagers [ 46 ]. However, some of the first-time teenage mothers developed motherhood skills, knowledge, purpose identification, and positive life improvements through self-motivation. The findings of the study affirm [ 29 ] that young mothers often become more autonomous and feel elevated to adult status. While partners reacted negatively, parents were shocked, unhappy, and sad upon learning about their daughter's pregnancy. Fathers particularly refused to accept the news, although mothers were unconcerned with the pregnancy's result, echoing findings by [ 42 ]. [ 51 ] affirms the findings of this study, where many teenage mothers make deliberate decisions to keep their infants, accept motherhood, and continue to thrive in life regardless of the pain and stress they go through when the fathers of their babies neglect them. The findings of the study also corroborate the findings of the previous study by [ 52 ] on the relationship dynamics between adolescent mothers and their children’s biological fathers where many adolescent mothers desired more resilience to take responsibility for their children, recognise and understand the maternal function, as well as being a healthy mother, gave them a sense of caring for their new-borns as mothers without their baby fathers [ 52 ]. The study also revealed that most teenage mothers are competent, caring, and responsible. One must still consider whether motherhood as a young adolescent/teenager under the age of 20 years is preferable, or it constrains adolescent opportunities, and the potential negative influence on children [ 50 ]. The findings also highlight various types of support (social, physical and emotional support) from the support systems such as parents/family, relatives, friends/peers and the fathers through conversation, problem-sharing, and material and financial support for first-time teenage mothers. This affirms the evidence of [ 29 ], who emphasises the need for community involvement in supporting young mothers. Lander also underscores the essential role of support from parents, friends, and teachers of teenage mothers who need unique social, emotional and psychological support to negotiate many changes and transitions early [ 47 ]. The findings from the study showed that in addition to social and emotional support activities, which were intangible, physical support activities were tangible to teenage mothers and also helped them access some financial, medical, business opportunities and material resources to overcome some of their challenges after childbirth. This affirms the findings of a study by [ 48 ], where physical support is a way of overcoming adversity and necessitates the assistance of young mothers. The study further revealed that although teenage mothers from diverse social backgrounds share aspirations aligned with societal expectations regarding education and vocational success, only those who possess the necessary knowledge, abilities, and resources can effectively pursue these goals and secure a better future for themselves and their children [ 48 ]. The findings of this study indicated that the primary sources of support for first-time teenage mothers included family members, friends or peers, and personal motivation. These results align with those of [ 43 ], who identified friends as a significant source of support for pregnant or parenting adolescents. Friends not only offer emotional reassurance but also serve as companions for sharing everyday experiences. Furthermore, the same study highlighted that peer social support is closely linked to a reduction in parenting-related stress, especially when emotional support is consistently available [ 43 ]. The theoretical framework underpinning the study postulates that the coping strategies (social, emotional, physical and religious) of first-time teenage mothers are crucial in understanding how teenage mothers manage and overcome maternal stresses and challenges they face in childbirth and childcare practices (motherhood responsibilities) [ 18 – 23 , 30 ]. Similarly, [ 21 ], explained coping as "a person's continually changing cognitive and behavioural effort utilised to manage specific external and internal demands that are assessed as taxing or beyond the person's resources." Teenage mothers observe a variety of coping strategies to thrive after childbirth. This finding corroborates that of [ 46 ], who also reported that in terms of stress during pregnancy and parenthood, teenagers typically choose an emotion-focused coping method. Acceptance of adolescent pregnancy, along with social, material, and financial support, is recognised as a key coping strategy employed by adolescent mothers [ 18 ]. Kaye further suggests that acknowledgement of paternity plays a significant role in how teenage mothers cope with early motherhood. This finding is supported by several studies indicating that many young women express a strong desire and willingness to embrace motherhood despite their age and circumstances [ 48 – 51 ]. Conclusion Understanding the experiences of first-time teenage mothers in the Ghanaian context may offer insights for improving targeted interventions such as adolescent sexual and reproductive health information and family planning services aimed at assisting teenagers in preventing unplanned pregnancies and childbirth. The study highlights the complexities surrounding motherhood, responsibilities and coping strategies among first-time teenage mothers, emphasising the critical roles of resilience and social support systems in their ability to navigate the challenges they face. The results revealed first-time teenage mothers’ resilience as a key factor enabling them to manage the emotional, social and financial demands of raising their children. While some first-time teen mothers demonstrated significant inner strength in performing their motherhood responsibilities, the role of social support—particularly from family, peers, and partner networks—emerged as a crucial element in enhancing their coping strategies. There is a need for interventions that strengthen both personal resilience and the social fabric of support systems that are crucial for helping these teen mothers achieve positive health outcomes for themselves and their babies. Additionally, a holistic approach not only targets improving access to girl‒child education and family planning services but also fosters a supportive environment that values and nurtures young mothers by addressing their needs and provide adequate social, physical and emotional support with strong intrapersonal resilience; where teenage mothers can cope well and build the capacity to navigate the multifaceted nature of motherhood challenges and support them in fulfilling their adulthood or maternal responsibilities. Abbreviations COREQ Consolidated Criteria for Reporting Qualitative Research IDI In-Depth Interview KEEA Komenda-Edina-Eguafo-Abrem LMICs Low- and Middle-Income Countries GSS Ghana Statistical Service GHS Ghana Health Service SHS Senior High School JHS Junior High School SDGs Sustainable Development Goals SQOTA Systematic Qualitative-Oriented Text Analysis LAR Legally Authorised Representation UNFPA United Nations Population Fund WHO World Health Organisation Declarations This study was conducted following the ethical principles outlined in the Declaration of Helsinki [53]. The priniciple of non-maleficence, anonymity and confidentiality were given prominence in this study. Ethical clearance was obtained before data collection, informed consent was obtained from all participants. As none of the participants were minors (under 16 years of age), written consent from parents, guardians, or legally authorised representatives (LARs) was not required. Consent for Publication Not Applicable. Ethics approval and consent to participate The University of Cape Coast Institutional Review Board granted ethical approval/clearance (UCCIRB/CHLRB/2019/09). Permission was sought from the municipal health directorate. All of the community entry protocols were critically followed with the approval letter. The parents and guardians of teen mothers were also informed about the purpose of the study to obtain their consent. This did not have any influence on the data. Finally, the participants’ informed consent was obtained from teenage mothers before the interview. A clinical psychologist was made available to be consulted to help overcome any form of emotional or mental discomfort that may have occurred during the interviews. This was a measure or approach to minimise harm or risk during and after the study. Availability of data and materials All relevant data supporting the findings of this study are included within the article. Full interview transcripts can be made available upon reasonable request from the first author through the Department of Population and Health, University of Cape Coast, via email at [email protected] , or by contacting the first author directly. Competing interests The authors declare that there are no competing interests related to this study. Funding This research did not receive any funding. Authors’ contributions This paper is based on MPhil research conducted by R.F.T., who conceptualised the study, developed the methodology, collected and analysed the data, and prepared the initial draft of the manuscript. E.K.M.D. supervised the research. R.F.T., F.D., and E.K.M.D. collaboratively reviewed and revised the manuscript to enhance its scientific rigour and approved the final version for publication. Acknowledgements The authors express their sincere gratitude to the teenage mothers who participated in the study for their consent and willingness to share their lived experiences. 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Supplementary Files APPENDIX.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Jan, 2026 Reviews received at journal 15 Dec, 2025 Reviews received at journal 12 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviews received at journal 09 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 06 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers invited by journal 03 Dec, 2025 Editor invited by journal 01 Dec, 2025 Editor assigned by journal 19 Nov, 2025 Submission checks completed at journal 19 Nov, 2025 First submitted to journal 18 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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10:27:55","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":172661,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8145461/v1/9fb993f3b92a5165eadc029a.html"},{"id":97687650,"identity":"1290cacb-1be4-43c1-86fe-74baaadea53c","added_by":"auto","created_at":"2025-12-08 10:27:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28003,"visible":true,"origin":"","legend":"\u003cp\u003eA conceptual framework depicting the teenage mother’s relationship between motherhood style, coping strategies, and resilience.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8145461/v1/b19dfbbe99cb5414a720b608.png"},{"id":97687651,"identity":"c0b2fd1b-6268-4b23-a802-44ba968f2c71","added_by":"auto","created_at":"2025-12-08 10:27:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79978,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of main themes and categorization of issues/sub-theme\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8145461/v1/3023fab552149924ece59516.png"},{"id":97902443,"identity":"40037abc-3c92-4fab-b162-64269acc401f","added_by":"auto","created_at":"2025-12-10 15:52:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1081525,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8145461/v1/98c10ec5-2bc9-43d7-8258-806510bdbb35.pdf"},{"id":97687649,"identity":"d1c279cf-4dc9-425c-9a46-ba1369a9c2e7","added_by":"auto","created_at":"2025-12-08 10:27:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20762,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIX.docx","url":"https://assets-eu.researchsquare.com/files/rs-8145461/v1/de6754906c2c1907b3132359.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Teenage Mothers’ Resilience: Motherhood Experiences and Coping Strategies among First-Time Teenage Mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana. A Phenomenological Study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, teenage pregnancy and childbirth remain major concerns for public health and development, given their profound implications on adolescent reproductive health and social well-being [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Teenage is the period between childhood and adulthood, spanning from 13–19 years, when major physical, behavioural, and social changes occur [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These changes are the foundation and crucial to establishing good health in later life and the cornerstones of adult well-being and happiness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, this seems unattainable for more than 50 percent of the world’s teenagers, who live in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Most of these teenagers (90%) have higher fertility rates than those in high-income countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Globally, 16\u0026nbsp;million adolescents give birth annually [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Teenage mothers give birth to one out of every ten babies, with more than 95 percent of these births occurring in LMICs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Ghana, adolescents make up approximately 22.4 percent of the national population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], with teenagers accounting for 30 percent of all recorded births, and 15percent of women aged 15–19 years already having children [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEarly experiences of parenting and motherhood vary by context and are shaped by the cultural norms and social environment surrounding the adolescent [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. One of the key socio-economic challenges faced is dropping out of school, which results in reduced access to education and fewer opportunities for acquiring skills [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Early pregnancy and birth are also risk factors; stillbirth, low birth weight, and child mortality are all health problems for the newborn, whereas with the adolescent mother, fistula, depression, financial distress, malnutrition, and even mortality are serious concerns among teenage mothers in LMICs [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, evidence challenges the assumption that teenage pregnancy has largely adverse consequences for teenage mothers and their infants, highlighting the need to understand teenage mothers' perspectives and experiences [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regardless, after the baby is born, motherhood becomes a reality in societies where conventional gender norms still prevail, and many women’s lives centre around childbearing.\u003c/p\u003e\u003cp\u003eExploring a first-time teenage mother’s experience of motherhood can provide policymakers and healthcare providers with fresh insights, allowing them to respond more effectively to the issues that adolescent mothers face. Teenage mothers are impacted not only by the experiences of early motherhood itself, but also by the attitudes and responses of their parents, families, peers, educational institutions and the broader society [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTransitioning to motherhood requires a combination of physical, emotional, social, and cognitive preparedness; however, most teenage mothers lack the necessary readiness for this transition [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. For those experiencing motherhood for the first time during their teenage years, the simultaneous demands of caregiving responsibilities and personal developmental changes often make the experience particularly challenging and overwhelming [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Thea are required to navigate adult social roles while simultaneously coping with the physical changes of puberty, significant neurological development, and the demands of caring for a newborn [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Because most first-time teenage mothers are of low socio-economic status, adjusting to motherhood is complex and problematic [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study, therefore, explored motherhood experiences and coping strategies among first-time teenage mothers in the Komenda-Edina-Eguafo-Abrem Municipality in the central region of Ghana. The study interrogates the following questions: What are the first-time teenage mothers’ experiences of motherhood? what challenges do first-time teenage mothers face in performing their maternal roles and/or responsibilities? what are the coping strategies first-time teenage mothers adopt in light of their challenges? These questions were guided by the resiliency framework to explore the perspectives of first-time teenage mothers and provide a broader contextual understanding of their experiences of early motherhood.\u003c/p\u003e\n\u003ch3\u003eConceptual framework\u003c/h3\u003e\n\u003cp\u003eThis study was underpinned by Norman Garmezy’s resiliency theory, introduced in 1991. The theory identifies three types of protective factors: individual characteristics, supportive family relationships, and social support systems both within and outside the immediate home environment. These factors help young people cope with challenges and life stressors [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The present study focuses on first-time mothers and their resilience in managing maternal responsibilities, coping strategies, and the social support available to them. According to [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], teenage mothers face significant health risks and caregiving (e.g., being able to meet their baby's financial, physical, and health needs) with their own developmental needs. Some teen mothers show resilience, meeting their children's needs while continuing and engaging in entrepreneurial activities to support themselves financially. However, others struggle and experience significant emotional and psychological distress, including stress, anxiety and diminished self-esteem, as they navigate the challenges of early motherhood [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The influence of individual traits and methods on resilience helps individuals overcome adversity. It is viewed as a dynamic interplay between the individual’s (teenage mother) cognitive and behavioural response to adversity in her environment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCoping strategies, resilience, and motherhood styles (e.g., roles and responsibilities) are all significantly related to one another and create a complex interdependent dynamic as a first-time teenage mother is placed at the centre of the triangle to understand the relationship. Many studies have examined the relationships among resilience, coping strategies, social support, and self-esteem concerning how these factors protect young mothers in their situations and enable them to succeed in the face of adversity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, studies in the growing body of literature have examined the mediating role that first-time teenage mothers' coping strategies play in the relationship between motherhood styles and resilience, particularly in certain Ghanaian contexts. This study employed resilience theory to understand the experiences of motherhood and coping strategies among first-time teenage mothers. The focus of the research and conceptualisation of the theoretical framework explains the complex interplay of motherhood styles, coping strategies, and resilience. These factors (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) revolve around the first-time teenage mother and give her the ability to navigate life adversities or motherhood challenges.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\n\n\n\n\n\n\n\n\n\n\n"},{"header":"Methods and Materials","content":"\u003cp\u003eThis study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. See Appendix A.\u003c/p\u003e\u003ch3\u003eStudy Design\u003c/h3\u003e\u003cp\u003eThis study adopted a phenomenological study design [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This approach was underpinned by Edmund Hussels’s philosophy [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and explains that reality is socially constructed and that the teenage mother’s (individual) interaction with his or her experiences and environment involves the perception, knowledge and reality/life experiences of a phenomenon [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This study design is suitable and provides the understanding needed to explore lived experiences from the perspective of first-time teenage mothers. The study explored maternal responsibility, support systems and coping strategies that mothers adopted in response to the challenges they faced. With this design, the study was able to obtain pertinent information concerning the study’s research questions.\u003c/p\u003e\u003ch3\u003eStudy Setting and Population\u003c/h3\u003e\u003cp\u003eThe study was conducted in the KEEA Municipality, one of the densely populated municipalities in the Central Region of Ghana. The KEEA municipality was selected because most of its community members are predominantly low-income earners. The major economic activity is fishing (Fisher Folks), and these factors contribute to a high prevalence of teenage pregnancy and childbirth in the municipality [29; 30]. The study setting was grouped into five zones following the capital towns of traditional communities. A sub-community was selected from each zone: Dutch Komenda in Komenda (zone A), Besease in Kissi (zone B), Abrehyia in Abrem-Agona (zone C), Ntranoa in Ankaful (zone D), and Teterkessim in Elmina (zone E).\u003c/p\u003e\u003cp\u003eThe primary target population for this study comprised first-time teenage mothers aged 13–19 years. The participants were recruited based on specific criteria: the participant must be a first-time teenage mother aged 13–19 years, and she had to have had a child for at least two years (not in care, fostering, or adoption), but biological. This age group was chosen because the literature contains limited data on childbirths among teenage mothers aged 10 to 19 years, and first-time pregnancies are more likely to occur before the age of 15 years [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additionally, pregnancy-related socio-cultural and risk factors among adolescents have been commonly reported in the KEEA Municipality, particularly among females younger than 19 years [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Hence, the study purposively selected first-time-teenage mothers aged 13–19 years to elicit their motherhood experiences and coping strategies\u003c/p\u003e\u003ch3\u003eSampling Procedure\u003c/h3\u003e\u003cp\u003eA purposive sampling approach was employed to recruit participants for the study, specifically targeting first-time teenage mothers. To enhance the selection process, homogeneous sampling was used to ensure that participants shared similar characteristics relevant to the study's objectives [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This sampling strategy facilitated the recruitment of 30 first-time teenage mothers from various sub-communities within the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality in Ghana’s Central Region, including Dutch Komenda (Komenda), Besease (Kissi), Abrehyia (Abrem-Agona), Ntranoa (Ankaful), and Teterkessim (Elmina). In line with community entry protocols, potential participants were engaged. Those who met the inclusion criteria were identified, screened, and interviewed in their place of convenience (homes).\u003c/p\u003e\u003cp\u003eAppointments (date and time) were scheduled for teenage mothers who voluntarily agreed to take part in the study. This approach was necessary due to the absence of a predefined framework for accessing participants from the selected communities. Data saturation was determined based on the guideline by Marshall and colleagues, which suggests that theoretical saturation typically occurs between 10 and 30 interviews. Reflecting the iterative nature of phenomenological inquiry, the sample size was not pre-specified but developed as the richness and depth of experiential data unfolded in response to the saturation point suggested by [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Beyond reaching saturation, the researcher ensured that high-quality data or insights were captured.\u003c/p\u003e\u003cp\u003eThe recruitment of participants was facilitated by three field assistants (all female nursing students) who were final-year undergraduate students at Cape Coast Nursing and Midwifery Training College in the Central Region of Ghana. These field assistants helped organise meetings, screen, and schedule dates and times for the selected interview participants. Even though the field assistants had considerable experience in organising and conducting qualitative interviews, they had five hours of training each day for three days to acquaint them with community entry/gatekeepers, data collection methods, and ethical issues.\u003c/p\u003e\u003ch3\u003eData collection\u003c/h3\u003e\u003cp\u003eData were collected from first-time teenage mothers using a semi-structured in-depth interview (IDI) guide. The guide comprised two main sections. Section A focused on capturing the socio-demographic profiles of the adolescent mothers, including variables such as age, level of education, religious affiliation, marital status, current occupation, and other relevant background information. Section B focused on the main questions concerning motherhood experiences, maternal roles and/or responsibilities, support and coping strategies for first-time teenage mothers. The main questions were based on the objectives of the study. Probes were added to specific questions to obtain the pertinent information needed or in-depth knowledge of the phenomenon.\u003c/p\u003e\u003cp\u003eData collection was conducted over a 20-day period. The initial five days were dedicated to a reconnaissance survey, which involved community entry activities and logistical preparations for fieldwork. During the main phase of data collection, the purpose of the study was clearly explained to each participant prior to the commencement of their interview. Additionally, a clinical psychologist was made available to prepare the minds of the participants to overcome any form of emotional or mental discomfort that may have occurred during the interviews. This approach aims to minimise harm or risk. All participants were assured of their right to anonymity and confidentiality by the investigator, ensuring that their identities were not linked to the data or disclosed in the study’s report. The participants willingly agreed to take part in the study. To support informed participation, the investigator read and explained both the assent and informed consent forms in the local language, Fante, which the participants were more comfortable with, to ensure understanding. The participants were also required to sign or thumbprint a consent form stating their willingness to take part in the study (voluntary participation).\u003c/p\u003e\u003cp\u003e The face-to-face interview approach was employed to collect data in the participants' homes to ensure that they feel comfortable, understood completely and could reply appropriately to the questions. This enabled the participants to reflect on and then discuss their experiences concerning motherhood, support systems, and coping strategies. All the interviews were taped or recorded, and field notes were also taken throughout the data collection process. Each interview lasted between 40 and 75 minutes on average. Handwritten notes and audio recorders helped to ensure that interviews did not decline accidentally, should any of the interview equipment (recorder) break down during the interview process. The investigator did not establish any form of relationship with the participants before or after the fieldwork. However, the participants were informed that the data collection formed part of the author’s MPhil thesis requirements.\u003c/p\u003e\u003ch2\u003eReflexivity\u003c/h2\u003e\u003cp\u003eTo ensure reflexivity, an independent check of the codes was conducted to ensure data coding reliability. The supervisor (EKMD), who is also a qualitative researcher, reviewed all the coded data to check whether the main themes and the subthemes corresponded/reflected the actual meaning depicted in the data, focusing on the selected quotes from the participants to ensure that the analysis of the data was coherent and clear. This approach was adopted to enhance the inter-rater reliability of the data. It was informed by Birks and colleagues’ assertion that reflexivity in qualitative research can be achieved through recognising prior assumptions and experiences, maintaining analytic memos, ensuring coding reliability, and comparing data both within and across the dataset [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Furthermore, the analysis and presentation of findings were guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (see Appendix A), as recommended by [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eTrustworthiness\u003c/h3\u003e\u003cp\u003eIn qualitative research, dealing with questions of credibility and rigour is critical. In contrast to a quantitative study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], generalisability and dependability play a minimal role in qualitative research [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. To prevent researcher and participant biases, potential risks to the trustworthiness of qualitative research, such as credibility, transferability, dependability, and conformability, were addressed and proven in this study. For example, following each interview, the participants were allowed to summarise and validate the important views expressed in line with the questions to ensure that their views/responses were accurately recorded as a way of member checking [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eData Analyses\u003c/h3\u003e\u003cp\u003eFirst, all audio-recorded interviews were transcribed verbatim from one of the Ghanaian languages spoken by the members in the study area (Fante dialect) and translated into the English language together with the field notes that were already written in the English language, which were typed into Microsoft Word and then introduced/uploaded into the software (QSR NVivo 12 Pro qualitative software). To demonstrate the important issues that were identified from the data for analysis, autocoding was first performed to obtain a sense of the data in the software [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Data memos were also used to edit some of the transcripts (proofreads) and ensure that the issues were prepared, described, summarised, and structured for analysis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. To indicate all parts of the textual discourse that comprised one or more categories, a numeric coding technique was used (classification). For example, ‘1’ was used to code 'coping strategies,' 2’ was used to code ‘social support,' 3’ was used to code ‘motherhood responsibility,' and so on. These categories were then whittled down to a manageable size by grouping comparable and related themes to create new ones. This was performed simultaneously with qualitative data analysis experts (supervisor).\u003c/p\u003e\u003cp\u003eTo obtain an intuitive sense of the data and to define our method of organising and categorising the data rather than having it controlled purely by the software, we employed systematic qualitative-oriented text analysis to develop a framework for analysis. As a result, we used the software's \"query\" tool to look for certain words and phrases that were important to the identified themes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Approximately 30 quotes/codes and 18 categories/subthemes were obtained during the analytical process. Identifier numbers, for instance, PD1, PD2,...to PD30, were created and assigned to each participant's quotations or views. Even though RFT performed the coding and generated themes, to ensure intercoder(ing) reliability, a supervisor also performed confirmatory coding of the data independently. Themes were compared, and where needed, the main and subthemes were refined and defined properly to capture the essence of each theme. The descriptive narratives of the themes were used to contextualise the analysis.\u003c/p\u003e\u003cp\u003e Finally, statements from the participants (verbatim) were used to represent the participants' points of view to illustrate the findings. This, on the other hand, did not affect the meaning of the participants' subjective viewpoints or actual expressions. All the participants' conceptual expressions were categorised in a way that represented the important and subtle meanings they connected to their views. Frequencies (N) and percentages (%) were used to represent the socio-demographic characteristics of the participants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The results of the study were presented in a thematic framework (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) using systematic qualitative-oriented text analysis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the background characteristics of the participants. The ages of those interviewed ranged from 17 to 19 years, with half (50%) being 19 years old. None of the participants younger than 17 years had experienced childbirth. In terms of education and marital status, only three participants (10%) had completed high school and were married, while the majority of participants (63%) were single. Regarding religious affiliation, most participants (90%) identified as Christians. Employment data showed that half of the participants (50%) were unemployed. Among those engaged in income-generating activities, six (20%) were involved in petty trading, while others worked in vocational fields such as sewing (13%) and hairdressing (10%), with a few (7%) participating in mobile banking services.\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\u003eSocio-demographic characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(100%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (in completed years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior High School (JHS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior High School (SHS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePetty trading\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeamstress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHairdresser\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile banking/Transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eSource\u003c/b\u003e: Fieldwork/data\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eThematic Results\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the themes and subthemes derived from the analyses conducted. Three main themes were realised: teenage motherhood coping strategies; accepting motherhood responsibility as a mother; support activities; and sources of support for teenage mothers, with subthemes including social, physical emotional, and spiritual coping support; a sense of being a teenage mother; caring for new-borns; a sense of feeling regret; a sense of feeling happy; combining maternal roles with others; partner\u0026rsquo;s neglect; teenage mother's plan; and planning for the child's future or aspirations. Sources of support were categorised as self-motivation, family support; friend/peer support; and baby father support. In addition, physical, social, and emotional support were categorised as support activities for first-time teenage mothers.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCoping strategies\u003c/h2\u003e\u003cp\u003eMost pregnancies and births in this study were unplanned, regardless of whether the births were desired. According to the findings, teenage mothers lacked the necessary preparation to handle the responsibilities of motherhood/parenting. Owing to their lower capacity to cope with stress as first-time teenage mothers, and their limited knowledge of acceptable childcare practices and skills, mothers have potentially adverse health outcomes for their children [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. First-time teenage mothers had many responsibilities and roles, such as caring for their children and meeting their needs. In addition, caring for a child at that teenage was a difficult task, especially for new/first-time teenage mothers who were unprepared or unplanned to have a child at that age; nonetheless, the majority of them met the challenge with tenacity and fortitude. Teenage mothers were likely to adjust to their new role as mothers and cope with it. Issues such as social coping, physical coping, and emotional and religious coping emerged as subthemes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSocial coping\u003c/h2\u003e\u003cp\u003eOne of the coping strategies that first-time teenage mothers adopted was social networking and interaction among peers/friends, family members, and neighbours. A few of them had friends with whom they shared their experiences (stress, worries, problems) to help them cope well after childbirth. Some of the teen mothers also engaged in conversation with others to help them overcome their challenges. The following quote summarises their responses:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;At first, it was difficult for me to go out and engage my friends in conversation, but I realised that the more I talk to some of my friends and neighbours, the more I feel that I am becoming an adult. Talking to my friends helped me to free my mind and let me go of my past\u0026hellip; Besides, I am not the only teenager who has given birth, so I feel sound and cope well with my social life. I am okay now\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003cb\u003e-\u003c/b\u003ePD 21, 19 years with 9- month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePeer support served not only as an outlet for emotional expression but also as a mechanism for normalising their experiences. Through social interaction, these young mothers found reassurance and a renewed sense of identity. Another participant affirmed this sentiment, saying:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I speak with other girls like me, I do not feel judged. They understand what I go through. Sometimes, we laugh, cry, and share advice\u0026mdash;it helps me not to feel lonely. It gives me strength to go on.\u0026rdquo;\u003c/em\u003e \u0026mdash; PD 10, 18 years with 7-month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePhysical coping\u003c/h2\u003e\u003cp\u003eProper childcare or motherhood helps to strengthen the bond between mothers and children. The majority of teenage mothers talked about how they had adjusted to life after having a child as a physical coping strategy. Some of the participants shared their views on how they dealt with motherhood for the sake of their children. One of the participants expressed herself as follows:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;After I gave birth, I did my best to find something to do so I could provide for myself and my child, I don\u0026rsquo;t get anything from anybody not even from my baby\u0026rsquo;s father since he neglected the child after he got me pregnant but I am managing physically as if there is no problem[\u0026hellip;] I am trying to do my best as a mother\u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD4; 19 years with 19- month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Some of the first-time teenage mothers often had to rely on their own strength and adaptability to ensure their children were cared for. This physical resilience was characterised by taking on household duties, finding ways to earn a living, and maintaining routines for their babies despite limited external support. Another young mother reinforced this narrative:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I wake up early every day to wash, cook, and feed my baby. It is not easy, but I know my baby depends on me, and I have to be strong. No one else will do it for me\u0026hellip;\u0026rdquo; \u0026mdash;\u003c/em\u003e PD16, 18 years with 11-month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eEmotional coping\u003c/h2\u003e\u003cp\u003eTeenage mothers relate their emotional support to advice and talking to help them feel sound and build strong resilience to stress, pain, and other complications after childbirth. Some of them also expressed that they were depressed and cried almost every night because their boyfriends or partners had issues with them. Some even ended up rejecting or ignoring them, which affected them emotionally. This is what one participant had to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I cried almost every night [\u0026hellip;] I was in pain and worried when I determined that I was pregnant; my boyfriend told me he was not responsible for the pregnancy, hmm. [She sighed]\u0026hellip; At first, I didn\u0026rsquo;t know how to tell my parent about it\u0026hellip; until finally, my friend advised me to inform my mother and apologise to her. Surprisingly, my mother comforted me emotionally and advised me positively, so I felt loved again after childbirth\u0026rdquo; -\u003c/em\u003ePD 29;19 years with a 5-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother teen mother shared a similar experience of emotional struggle and the critical role of support in her recovery:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I became so quiet and didn\u0026rsquo;t talk to anyone after giving birth. I felt like I had failed myself. But my aunt spoke to me almost every day. She told me that I still have a future and that the baby is a blessing, not a mistake. That really helped me to stop blaming myself and start thinking positively.\u0026rdquo;\u003c/em\u003e \u0026mdash; PD12, 18 years with a 6-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eReligious coping\u003c/h2\u003e\u003cp\u003eFirst-time teenage mothers were primarily given spiritual support by offering gratitude or praise to God for their success childbirth. They believe that a supreme being gifted them with a child because of hope and faith; they have to withstand any adversity as a coping approach to caring for their babies. Some of the participants believed that bearing a child is a gift/blessing from God. This belief helps most teenage mothers to give birth instead of abortion. Even some of them were ignored by their boyfriend after impregnating them. Some of them indicated that their boyfriend introduced them to abortion, but did not abort the child, even though some attempted. This is what one participant said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026lsquo;\u0026lsquo;\u003cem\u003eI believe that the child is a gift from God, so I don\u0026rsquo;t have to say it is a bad thing to give birth at this age and abort it [...] I listen to gospel music and the word of God to overcome my emotions as a coping mechanism[\u0026hellip;] I didn\u0026rsquo;t plan the pregnancy, but it happened, and I cannot abort it[\u0026hellip;], but I will tell other teenagers to avoid having sex at this age and avoid intimate relationships...\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD 14; 19 years with 9- month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eAccepting responsibility as a mother\u003c/h2\u003e\u003cp\u003eCompared with other crucial roles as an unborn adolescent, a first-time mother's new maternal role/responsibility is extremely challenging [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Some teen mothers described the difficulties they had in reconciling motherhood (as a responsibility) with being a mother (a new maternal role). As a result, some teenage mothers were forced to manage their multiple roles. Other important duties associated with raising children were mentioned by the young mothers: they had to make difficult decisions about whether to stay at home or take care of their children when they wanted to do something else, such as going to church, school, or work/trade. Some of the participants had the following conclusions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip; Every day I am with my baby [\u0026hellip;] as a young mother, I manage to take full responsibility for my baby as adult mothers do [\u0026hellip;] just that, there were lots of places I used to go, but when I gave birth, I stopped because I know I have a baby. Therefore, I stay home 24/7 [every day of the week] to take care of my baby \u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD1; 17 years with a 6-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome of the participants believed it was their obligation to care for their children, and the sense of accepting motherhood was crucial to them. Some of them recalled that from the initial stage of pregnancy to childbirth was a nightmare; they had sleepless nights, overthinking how to accept and perform the motherhood roles and responsibilities of adult mothers. Consequently, they were too young to do it. Most of the time, however, they had to accept it in good faith and build a motherhood mindset; to be good, caring and responsible mothers. One participant said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip;I knew I had to cater for my baby by myself, I have a motherhood mindset now. Even though I am young, I can still take full responsibility like an adult mother\u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD4; 19 years with 19-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePartner\u0026rsquo;s neglect\u003c/h2\u003e\u003cp\u003eFirst-time teenage mothers emphasised that \u0026lsquo;partner\u0026rsquo;s neglect\u0026rsquo; affects them emotionally, physically, and financially. In most cases, partners fail to meet their needs and withhold their affection, time, and attention toward them and their babies. The majority of the participants reported that baby fathers/partners neglected them because they were not ready to take responsibility. They denied responsibility for the pregnancy and the obligations ahead. These are excerpts from some of the participants;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Issues started coming up the moment I got pregnant. I knew that because he could not take responsibility for the pregnancy, that is why he quits the relationship and neglected us\u0026rdquo;\u003c/em\u003e \u0026not;PD30; 19 years with a 9-month-old child\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[\u0026hellip;] in our community, it seems the guys are almost the same, the moment they impregnate you, they neglect you to carry your pregnancy/baby alone\u0026hellip;\u0026rdquo;\u003c/em\u003e \u0026not;PD4; 19 years with 19- month child.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Hmm! [\u0026hellip;] because He denied the pregnancy, He doesn\u0026rsquo;t know how to talk to me or visit the baby, so he had to neglect us\u0026hellip;\u0026rdquo;\u003c/em\u003e \u0026not;PD8; 19 years with an 11-month-old child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eCombining maternal roles/responsibilities\u003c/h2\u003e\u003cp\u003eEvidence indicates that bearing a child while still a teenager has significant adverse health effects [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Combining maternal roles as a first-time teen mother comes with numerous challenges, especially when trying to balance the unmet needs of a child as the primary caregiver while ensuring optimal caregiving practices often becomes a difficult task. Doubling up with the roles and responsibilities of motherhood, such as being able to meet newborns\u0026rsquo; and infants\u0026rsquo; needs and that of the mother\u0026rsquo;s physical, mental and social well-being while going through the motherhood transition as a teenager. Most teenage mothers reported interest in integrating motherhood roles with other responsibilities, such as continuing their education, finding work/ trading, and/or balancing motherhood obligations. Some of the participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;... It\u0026rsquo;s going to be hard because I have not cut [stopped] breastfeeding my child, I wish I could wait for maybe some years before I can continue with my education, but I have to combine school with my maternal role \u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD13; 19 years with a 5-month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe participants were asked, \u0026lsquo;What do you do to support yourself and your baby?\u0026rsquo;. A considerable number of views were expressed; engaging in petty trading (selling) was one of the things that most first-time teenage mothers suggested and planned to earn a living/income. Taking items such as secondhand clothing, vegetables, and fish from owners and shops to sell was perceived to be easy. One of the participants, whose partner was less supportive and struggled to sell something (petty trade) to support herself, had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;Life is difficult for me because if I don\u0026rsquo;t sell, I will not get money to cater for myself and my baby. My baby is growing and eats a lot [\u0026hellip;] my boyfriend is stingy about giving me money unless I tell him that my baby is sick, before he will bring small money\u0026hellip;.\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD10; 19 years with a 20-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eA sense of being a first-time teenage mother\u003c/h2\u003e\u003cp\u003eThe desire to become a first-time teenage mother or to have a baby was also brought up as a genuine way for teen mothers to regard themselves as adults. Some of the teenage mothers were overjoyed to have a baby at such a young age, whereas others were disappointed. Although some of the pregnancies were unintentional or unplanned, more than half of the teen mothers who chose to have babies did so because they wanted to be mothers. Therefore, some had no problems giving birth or feeling like mothers when asked about how they felt as first-time teenage mothers. These were the views of some participants:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;Ooh! Hm [she sighed] I was disappointed in myself when I conceived. I was not happy initially; I told my friend, and she also told me that those giving birth are not better than I, so since then, I also made up my mind that I can take care of the baby. Therefore, I didn\u0026rsquo;t see anything wrong with becoming a mother because I am only my mother\u0026rsquo;s child, so becoming a mother was a good thing, my mother has a grandson now, and she\u0026rsquo;s happy too\u0026rsquo;\u0026rsquo;\u0026not;\u003c/em\u003ePD1; 18 years with a 6-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn contrast, a teenage mother aged 18 years noted that being a mother means a lot to her because most of her age mates in her community have babies. The participant realised that having a baby is a blessing, even though she did not expect pregnancy at that age, she still never regretted having a baby. She said,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;It was unplanned, but I have not regretted having a baby. The reason is that my boyfriend was working, so he gave me hope and told me he would take care of me so I could take good care of myself and my baby, so from day one, I have been blessed as a mother\u0026hellip;\u0026rsquo;\u0026rsquo;\u0026not;\u003c/em\u003ePD6; 18 years with a 4- month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eCaring for new-borns/babies\u003c/h2\u003e\u003cp\u003eRecognising and understanding the maternal function, as well as being a healthy mother, gave the participants a sense of caring for their newborns as mothers. When they became mothers, the majority of teen mothers said they received care and love from their newborns and relatives. Some people expressed their contentment by expressing concern about their newborns. Some teenage mothers reported the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip;Being a mother?... I will say I am happy and feel good because I am blessed with a child, but I have to do the best for my baby to be happy as well. Although I was too young to have a baby, I wanted to be a good mother. I had to get up early to prepare everything for my baby before she woke up...\u003c/em\u003e \u0026not;PD23; 18 years with a 13-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis was further corroborated by a teenage mother aged 18 years:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip; I do not feel like I am young, I feel like I am getting old. I feel like I\u0026rsquo;m a mother, a woman, and I like it\u0026hellip;\u003c/em\u003e [Her hardest struggles included the baby\u0026rsquo;s crying and not getting sleep]. \u003cem\u003eIn the morning and at night, I don\u0026rsquo;t get much sleep when the baby cries. When I wake up, I don\u0026rsquo;t feel fine[well] because I get so tired...\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD7; 18 years with a 3- month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eA sense of feeling regret\u003c/h2\u003e\u003cp\u003eMaternal responsibilities gave some of the participants a sense of regret in caring for their newborns as mothers. Some of the teenage mothers expressed some concern about their regret for newborns because some of them had to stay home all day to care for their babies and disassociate themselves from friends and parties. One of the participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip;I have regretted hmm [she sighed\u0026hellip;], because there are many responsibilities on me that I can\u0026rsquo;t accept anymore, I don\u0026rsquo;t party [go out with friends] as much as I used to [\u0026hellip;], I can\u0026rsquo;t leave my baby, and that is what I don\u0026rsquo;t like about having a baby now. I have gotten to stay at home and can\u0026rsquo;t go anywhere, meanwhile, at first, if I go out, I get money from my friends\u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD11; 19 years with a 4-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother participant who had mixed-sense feelings about childbirth had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;I will not say I have regretted having a baby at this time, nor will I say I am happy. This is because since I had my baby\u003c/em\u003e, \u003cem\u003eI tried not to associate myself with too many people [\u0026hellip;], I think once you have a baby, your mindset should change. I have to focus and think about the responsibility ahead of me\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD2; 19 years with a 3-week child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eA sense of feeling adulthood\u003c/h2\u003e\u003cp\u003eOther teen mothers shared their feelings about transition to adulthood and were unhappy and unhealthy as first time teen mothers. Despite their weird feelings and numerous difficulties, they believed that having a child is more important than anything else. This is what one participant had to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip;Ooh yeah, I was unhappy when I gave birth to my baby, my life changed, because I found myself not doing things that I know that I should not be doing. I think and act like an adult\u0026hellip; It makes me a lot more careful as a mother now...\u0026rsquo;\u0026rsquo; \u0026not;\u003c/em\u003ePD9; 19 years with a 7-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eTeen mothers\u0026rsquo; plans for their children\u003c/h2\u003e\u003cp\u003eTeenage mothers who had completed senior high school (SHS) expressed a desire to continue their education. Some of them had plans to visit a nursing school or university in the next five years. Higher education, they believe, will give them more options to help them take excellent care of themselves and their baby. Nearly all teenage mothers had beautiful plans for their children\u0026rsquo;s future. They were very optimistic about plans/aspirations for their children. Some of the participants mentioned that being a first-time teenage mother has prepared them for motherhood. They also expressed their desire and plans for their babies/children to grow up free of the unpleasant experiences they [teenage mothers] had from childhood through to motherhood.\u003c/p\u003e\u003cp\u003eMany teenage mothers expressed high hopes for their children\u0026rsquo;s future, viewing their success as a reward for the sacrifices they were making in the present. One participant shared her aspiration for her child\u0026rsquo;s education and future status:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; I want my baby to grow up very well and become somebody better than I do, I will help my baby to go to school and become a great person like a lawyer, teacher, doctor, etc., in the future to take care of me when I am also old\u0026hellip;\u0026rdquo; \u0026mdash;\u003c/em\u003e PD21, 19 years with a 9-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn a similar vein, another young mother linked her hopes for financial security and care in later life to the future success of her child:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;my child should be a great person, he should be rich to take care of me when I\u0026rsquo;m old because I struggle to cater for him\u0026hellip;\u0026rdquo; \u0026mdash;\u003c/em\u003e PD23, 18 years with a 13-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some, their dreams extended beyond personal benefits, envisioning their children as influential figures capable of transforming their families and communities. As one participant put it:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;my sweat will not be in vain, I wish my child becomes a leader like a president or member of parliament [MP] in future to take good care of me in my old age, help my family and other needy people\u0026hellip;\u0026rdquo;\u003c/em\u003e \u0026mdash; PD14, 19 years with a 9-month-old child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eActivities and Support\u003c/h2\u003e\u003cp\u003eSocial, physical, and emotional support can be used to define support activities. Emotional and instrumental (social, physical) factors were two of the categories. In the literature, emotional support is defined as acts that provide care, love, trust, and concern. In contrast, instrumental support refers to direct assistance such as money, in-kind assistance, labour, and time when a person is in need [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The need for social support in assisting teenage mothers in coping with and adapting to the predicament of becoming mothers was stressed. A teenage mother aged 19 years mentioned this:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;My mother gave me a lot of support [physical and social], especially when I gave birth, she taught me how to take care of my stomach so that it doesn\u0026rsquo;t become big. She also taught me how to take care of my body and keep my baby neat as well. She most of the time holds my baby and sings for my baby to sleep whenever my baby cries so hard.\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD8; 19 years with an 11-month-old child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA teenage mother aged 19 years who received massive support (emotionally and physically) from her father had this view to share:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;I get both emotional and physical support from my father [\u0026hellip;] when I gave birth, my mother got angry with me, so I went and stayed with my father [separated from his wife]. He was the one giving me money to buy food, clothes, and medicine for my baby. He makes sure I breastfeed and bathe my baby well. At night, when the baby cries, my father takes the baby and walks inside the room until the baby sleeps\u0026rdquo;\u003c/em\u003e \u0026not;PD13; 19 years with a 5-month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e The participants stated that their primary source of social support was their family/relatives/parents, peers/friends, and self-motivation. A few of them also mentioned the father of the child/partner. More than half of the participants said that their families were extremely supportive, whereas others said that their friends/peers were somewhat supportive.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eFamily support\u003c/h2\u003e\u003cp\u003eFamily support was seen as the immediate support given to teenage mothers. Some of the teenage mothers moved out of their parents\u0026rsquo; homes when they realised that they were pregnant. This was one of the approaches teen mothers used to show regret, disappointment and seek forgiveness to attract some support from their families and relatives. This is what one of the participants had to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;I moved to stay with my friend when I got pregnant because I knew I had disappointed my parent and had to move out to avoid insults [\u0026hellip;] but Immediately I came back from the hospital my mother bought me some of the items I would need, my big sister also bought clothes for my child when she heard that I had given birth. My Uncle has been giving me money because they know my baby\u0026rsquo;s father is a student and not working. Thus far, my family supports me very well.\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD14;19 years with a 9- month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eSupport from the father of the child\u003c/h2\u003e\u003cp\u003e In a few instances, some of the participants mentioned that their baby's fathers provided some support for them after both families had settled their relationship/pregnancy-related issues. It was further revealed that this support was not even enough to take care of themselves and their babies. One of the participants had this to say:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[\u0026hellip;] He [the baby's father] ignored me for some time during pregnancy until childbirth. Later, my parent went to see the family. His family advised him to accept the baby and take care of the child, so he started visiting us. He brings a little money, but that\u0026rsquo;s not enough to take care of the child.\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD3; 18 years with a 9-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003ePeers/Friends support\u003c/h2\u003e\u003cp\u003eAlmost all the teenage mothers interviewed had friends who were familiar with their pregnancies. Teenage mothers reported that they had significant support from friends/peers during and after childbirth. Most participants had emotional and physical (financial) support from their friends/peers. This was mentioned by one of the participants:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My friend never disappointed me; she stood by my side and provided me with some form of emotional and financial support. She motivates me and gives me little money for food and sometimes buys me a gift, which makes me feel that she has my back [she is there for me] ...\u0026rsquo;\u0026rdquo;\u003c/em\u003e \u0026not;PD23, 18 years with a 13-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother participant also emphasised the critical role her close friend played during her time of need, highlighting the value of peer solidarity:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even when my parents were angry at me, my best friend never left me. She would come to check on me, help with the baby, and remind me that I am not alone. She was like a sister to me when I needed one most.\u0026rdquo;\u003c/em\u003e \u0026mdash; PD17, 19 years with a 10-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSelf-motivation\u003c/h3\u003e\n\u003cp\u003eThe well-known saying, \u0026ldquo;experience is the best teacher,\u0026rdquo; was reflected in the narratives of teenage mothers who, drawing from their own journey, offered advice to their peers\u0026mdash;particularly those who had not yet become mothers. They used their experiences as a platform to motivate other adolescents to pursue their life goals and reject the notion that teenage pregnancy marks the end of one\u0026rsquo;s potential. Their reflections also served as a form of personal empowerment, demonstrating a determination and redefine their futures. Some participants shared the following:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;\u0026hellip;I will say that it is not easy to give birth so they [other teenage girls] should concentrate on their education and not have babies at this time like me and they should also assess their boyfriends well before giving themselves to them [engaging in sexual intercourse] because some of the boys are very bad and may ignore you when you get pregnant\u0026hellip;\u0026rsquo;\u0026rsquo; \u0026not;\u003c/em\u003ePD1; 17 years with a 6-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome participants also indicated that they preferred to give birth early so that their children could grow up to become close companions later in life their friends:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;[My little advice] \u0026hellip; is that we should not give up [as teenage mothers] because we have given birth, it is even good to have a child at this time so that my child can grow up so quickly and become my friend\u0026hellip;at least when I get to my old age my child can also take care of me. I will make sure I take good care of my child\u0026hellip;\u0026rsquo;\u0026rsquo;\u003c/em\u003e \u0026not;PD 8; 19 years with a 10-month child.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother participant corroborated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"...Sometimes I feel it's better that I had my baby early. By the time I am in my thirties, my child will be grown, and we can talk like sisters. I don\u0026rsquo;t want to be too old when my child is still young. At least, she can support me when I\u0026rsquo;m older...\"\u003c/em\u003e \u0026mdash; PD 12; 18 years old with an 11-month child\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnderpinned by resilience theory [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], this study explored motherhood experiences and coping strategies among first-time teenage mothers in the KEEA municipality in the Central Region of Ghana. The study participants were between the ages of 13 and 19 years, with a mean age of 18 years. This is because none of the first-time teenage mothers interviewed was younger than 16 years, even though young/early adolescents were more likely to have experienced sexual intercourse or pregnancy due to their limited knowledge of sexual education, adolescent sexual and reproductive health, and the socio-cultural and risk factors for teenage pregnancy in the study areas [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additionally, the level of education reported by teenage mothers was low, with the majority in primary and junior high schools. The results revealed that most first-time teenage mothers cater to themselves and provide optimal care for their babies, with aspirations and motives to attain a high level of education (e.g., tertiary). Few of them also indicated that they must engage in businesses, vocational skills, and petty trading to earn income to provide for their children and themselves. The results also revealed that the majority of the teenage mothers were Christians. The study also revealed that the majority were never married with a few of them cohabiting. These findings may be related to the fact that in typical Ghanaian communities, teenagers are more likely to reproduce more children while single because of the borrowed Western cultures such as weddings which prevent most of them from using traditional approaches to get married to reduce premarital sex and unplanned pregnancies and childbirth [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of the study revealed that first-time teenage mothers often struggled to meet their babies\u0026rsquo; needs while managing their own, with some engaging in petty trading to support their roles and making critical decisions to meet their financial demands and overcome their challenging childcare and motherhood responsibilities and needs. This finding aligns with that of [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], who reported that adolescent mothers face significant challenges affecting their development and ability to accept motherhood responsibilities. Focusing on support from fathers in alleviating financial hardships is consistent with [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] assertion that fathers involved in childcare reduce the emotional and psychological stress on teen mothers, aiding their transition to parenthood.\u003c/p\u003e\u003cp\u003eThe results of the study revealed that accepting maternal roles and responsibilities was challenging at the initial stage of life, and most first-time teenage mothers were unhappy and regretted having babies, but eventually built capacity and resilience as mothers. This aligns with the findings of [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], who reported the mother\u0026rsquo;s initial unhappiness and fear during childbirth. Despite these challenges, the teen mothers in our study claimed to have good plans and aspirations, striving for success for themselves and their children. The findings from the study corroborate those of the studies conducted by [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], highlighting the significant demands on adolescent mothers\u0026rsquo; development and adaptation to motherhood.\u003c/p\u003e\u003cp\u003eThe results of the study revealed that most of the first-time teenage mothers had interrupted life plans due to pregnancy and its accompanying financial burdens. Some of them had plans and aspirations after childbirth, which were related mainly to education and vocational careers. They also showed tenacity and optimism for themselves and aspired to great professions such as teachers, lawyers, and doctors for their children's future, echoing [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], who discovered that people can remain strong and achieve positive outcomes despite adversity. Teen mothers\u0026rsquo; confidence in their plans supports [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], who reported that teenage mothers are resilient and capable of overcoming pregnancy and birth challenges. This finding also supports [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], affirming that teenage mothers can meet their own and their children's developmental needs through resilience.\u003c/p\u003e\u003cp\u003eThe findings of the study indicated that teenage mothers view motherhood as a significant part of their lives and strive to meet their children's needs as adult mothers. Even combining maternal roles as first-time teen mothers accompanied by pregnancy-related challenges, including maternal stress, financial strains, and neglect by their partners, particularly when they balance their unmet needs as primary caregivers and provide optimal caregiving practices for their infants, sometimes becomes extremely cumbersome [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Doubling up with the roles and responsibilities of motherhood and meeting their physical, mental, and social well-being while going through the motherhood transitions as teenagers [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. However, some of the first-time teenage mothers developed motherhood skills, knowledge, purpose identification, and positive life improvements through self-motivation. The findings of the study affirm [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] that young mothers often become more autonomous and feel elevated to adult status. While partners reacted negatively, parents were shocked, unhappy, and sad upon learning about their daughter's pregnancy. Fathers particularly refused to accept the news, although mothers were unconcerned with the pregnancy's result, echoing findings by [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] affirms the findings of this study, where many teenage mothers make deliberate decisions to keep their infants, accept motherhood, and continue to thrive in life regardless of the pain and stress they go through when the fathers of their babies neglect them. The findings of the study also corroborate the findings of the previous study by [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] on the relationship dynamics between adolescent mothers and their children\u0026rsquo;s biological fathers where many adolescent mothers desired more resilience to take responsibility for their children, recognise and understand the maternal function, as well as being a healthy mother, gave them a sense of caring for their new-borns as mothers without their baby fathers [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The study also revealed that most teenage mothers are competent, caring, and responsible. One must still consider whether motherhood as a young adolescent/teenager under the age of 20 years is preferable, or it constrains adolescent opportunities, and the potential negative influence on children [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings also highlight various types of support (social, physical and emotional support) from the support systems such as parents/family, relatives, friends/peers and the fathers through conversation, problem-sharing, and material and financial support for first-time teenage mothers. This affirms the evidence of [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], who emphasises the need for community involvement in supporting young mothers. Lander also underscores the essential role of support from parents, friends, and teachers of teenage mothers who need unique social, emotional and psychological support to negotiate many changes and transitions early [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings from the study showed that in addition to social and emotional support activities, which were intangible, physical support activities were tangible to teenage mothers and also helped them access some financial, medical, business opportunities and material resources to overcome some of their challenges after childbirth. This affirms the findings of a study by [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], where physical support is a way of overcoming adversity and necessitates the assistance of young mothers. The study further revealed that although teenage mothers from diverse social backgrounds share aspirations aligned with societal expectations regarding education and vocational success, only those who possess the necessary knowledge, abilities, and resources can effectively pursue these goals and secure a better future for themselves and their children [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. The findings of this study indicated that the primary sources of support for first-time teenage mothers included family members, friends or peers, and personal motivation. These results align with those of [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], who identified friends as a significant source of support for pregnant or parenting adolescents. Friends not only offer emotional reassurance but also serve as companions for sharing everyday experiences. Furthermore, the same study highlighted that peer social support is closely linked to a reduction in parenting-related stress, especially when emotional support is consistently available [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The theoretical framework underpinning the study postulates that the coping strategies (social, emotional, physical and religious) of first-time teenage mothers are crucial in understanding how teenage mothers manage and overcome maternal stresses and challenges they face in childbirth and childcare practices (motherhood responsibilities) [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Similarly, [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], explained coping as \"a person's continually changing cognitive and behavioural effort utilised to manage specific external and internal demands that are assessed as taxing or beyond the person's resources.\" Teenage mothers observe a variety of coping strategies to thrive after childbirth. This finding corroborates that of [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], who also reported that in terms of stress during pregnancy and parenthood, teenagers typically choose an emotion-focused coping method. Acceptance of adolescent pregnancy, along with social, material, and financial support, is recognised as a key coping strategy employed by adolescent mothers [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Kaye further suggests that acknowledgement of paternity plays a significant role in how teenage mothers cope with early motherhood. This finding is supported by several studies indicating that many young women express a strong desire and willingness to embrace motherhood despite their age and circumstances [\u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUnderstanding the experiences of first-time teenage mothers in the Ghanaian context may offer insights for improving targeted interventions such as adolescent sexual and reproductive health information and family planning services aimed at assisting teenagers in preventing unplanned pregnancies and childbirth. The study highlights the complexities surrounding motherhood, responsibilities and coping strategies among first-time teenage mothers, emphasising the critical roles of resilience and social support systems in their ability to navigate the challenges they face. The results revealed first-time teenage mothers\u0026rsquo; resilience as a key factor enabling them to manage the emotional, social and financial demands of raising their children. While some first-time teen mothers demonstrated significant inner strength in performing their motherhood responsibilities, the role of social support\u0026mdash;particularly from family, peers, and partner networks\u0026mdash;emerged as a crucial element in enhancing their coping strategies. There is a need for interventions that strengthen both personal resilience and the social fabric of support systems that are crucial for helping these teen mothers achieve positive health outcomes for themselves and their babies. Additionally, a holistic approach not only targets improving access to girl‒child education and family planning services but also fosters a supportive environment that values and nurtures young mothers by addressing their needs and provide adequate social, physical and emotional support with strong intrapersonal resilience; where teenage mothers can cope well and build the capacity to navigate the multifaceted nature of motherhood challenges and support them in fulfilling their adulthood or maternal responsibilities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eCOREQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eConsolidated Criteria for Reporting Qualitative Research\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eIDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eIn-Depth Interview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eKEEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eKomenda-Edina-Eguafo-Abrem\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eGSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eGhana Statistical Service\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eGHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eGhana Health Service\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eSenior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eSDGs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eSustainable Development Goals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eSQOTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eSystematic Qualitative-Oriented Text Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eLAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eLegally Authorised Representation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eUNFPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eUnited Nations Population Fund\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4681%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75.5319%;\"\u003e\n \u003cp\u003eWorld Health Organisation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study was conducted following the ethical principles outlined in the Declaration of Helsinki [53]. The priniciple of non-maleficence, anonymity and confidentiality were given prominence in this study. Ethical clearance was obtained before data collection, informed consent was obtained from all participants. As none of the participants were minors (under 16 years of age), written consent from parents, guardians, or legally authorised representatives (LARs) was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Cape Coast Institutional Review Board granted ethical approval/clearance (UCCIRB/CHLRB/2019/09). Permission was sought from the municipal health directorate. All of the community entry protocols were critically followed with the approval letter. The parents and guardians of teen mothers were also informed about the purpose of the study to obtain their consent. This did not have any influence on the data. Finally, the participants\u0026rsquo; informed consent was obtained from teenage mothers before the interview. A clinical psychologist was made available to be consulted to help overcome any form of emotional or mental discomfort that may have occurred during the interviews. This was a measure or approach to minimise harm or risk during and after the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All relevant data supporting the findings of this study are included within the article. Full interview transcripts can be made available upon reasonable request from the first author through the Department of Population and Health, University of Cape Coast, via email at [email protected], or by contacting the first author directly.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper is based on MPhil research conducted by R.F.T., who conceptualised the study, developed the methodology, collected and analysed the data, and prepared the initial draft of the manuscript. E.K.M.D. supervised the research. R.F.T., F.D., and E.K.M.D. collaboratively reviewed and revised the manuscript to enhance its scientific rigour and approved the final version for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere gratitude to the teenage mothers who participated in the study for their consent and willingness to share their lived experiences. The first author also acknowledges the data collection support received from the Samuel and Emelia Brew-Butler SGS/GRASAG at the University of Cape Coast, which made it possible for the MPhil research to be completed on time. The first author also acknowledges Abdul-Aziz Seidu (PhD) and Nancy Esi Plange for their constructive reviews and feedback. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. The adolescent health indicators recommended by the Global Action for Measurement of Adolescent health: guidance for monitoring adolescent health at country, regional and global levels. World Health Organization; 2024 May. p. 22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma MS, Joglekar AR. Adolescence period and its ethical, moral and spiritual values. Int J Futuristic Innov Arts Humanit Manage (IJFIAHM). 2024;3(1):37\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMekonnen Y, Telake DS, Wolde E. Adolescent childbearing trends and sub-national variations in Ethiopia: a pooled analysis of data from six surveys. BMC Pregnancy Childbirth. 2018;18:1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R. Our future: a Lancet commission on adolescent health and wellbeing. 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Midwifery. 2011;27(1):53\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJewkes R, Morrell R, Christofides N. Empowering teenagers to prevent pregnancy: lessons from South Africa. Cult Health Sex. 2009;11(7):675\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanday S, Makiwane M, Ranchod C, Letsoala T. Teenage pregnancy in South Africa: with a specific focus on school-going learners.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGee CB, Rhodes JE. Adolescent mothers' relationship with their children's biological fathers: Social support, social strain and relationship continuity. J Fam Psychol. 2003;17(3):370.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u0026ndash;4.\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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Resilience, Teenage motherhood, Coping strategies, Psychological support, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-8145461/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8145461/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFirst-time teenage mothers often face distinct psychosocial and emotional challenges compared to adult mothers. Unlike adult mothers who are mature enough to accept responsibility for their actions and are resilient to function independently, the same cannot be said of first-time teenage mothers. Lacking adequate support and resilience, they become more vulnerable to the demands of early motherhood. The study explored the motherhood experiences and coping strategies of first-time teenage mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis qualitative phenomenological study employed purposive sampling technique to select 30 first-time teenage mothers. A face-to-face in-depth interviews were conducted using a semi-structured interview guide. The interview data were managed using NVivo and thematically analysed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe findings revealed that teenage mothers\u0026rsquo; sense of responsibility was influenced by the multifaceted challenges and complex realities of early motherhood. They reported experiencing emotional and maternal distress as well as feeling regret and neglected by baby fathers. These challenges often stemmed from limited psychological support, social stigma, and a lack of preparedness for parenting roles. Despite these challenges, they adopted various coping strategies (social, physical and religious), and sought support from family and peers as well as self-motivation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eUnderstanding the lived experiences of first-time teenage mothers in Ghana offers valuable insights for developing targeted interventions. These should include comprehensive adolescent sexual and reproductive health education, accessible family planning services, and the establishment of robust social support systems to ensure the well-being and long-term development of teenage mothers and their children.\u003c/p\u003e","manuscriptTitle":"Teenage Mothers’ Resilience: Motherhood Experiences and Coping Strategies among First-Time Teenage Mothers in the Komenda-Edina-Eguafo-Abrem (KEEA) Municipality of Ghana. A Phenomenological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 10:27:50","doi":"10.21203/rs.3.rs-8145461/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-14T10:40:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T11:22:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-12T15:04:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"216971556457981614392846539665419062641","date":"2025-12-10T05:01:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T06:47:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251048444299808289117893110666493274927","date":"2025-12-08T07:17:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-06T14:30:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162541383961841877465420931016375096454","date":"2025-12-05T08:13:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87657392451350259750489433370919447734","date":"2025-12-03T19:44:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338185159050199928908280048327056989616","date":"2025-12-03T17:26:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-03T14:56:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-01T14:18:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-19T09:37:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-19T09:33:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-11-18T12:27:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"adb08e41-b6d5-4a9d-92b2-bc12803c607a","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T17:55:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 10:27:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8145461","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8145461","identity":"rs-8145461","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}