Lived Pregnancy and Motherhood Experience Among Early Adolescent Mothers

Abstract

Introduction

This study explored the experiences of early adolescent mothers (11-15 years) with pregnancy and motherhood.

Methods

We employed a phenomenological qualitative design, with in-depth semi-structured interviews. Snowballing and purposive sampling techniques were used in the selection of 20 early adolescent mothers (11-15 years) for the interview. Data were analyzed using the six-step thematic content analysis espoused by Braun and Clark.

Results

The causes of adolescent pregnancy include peer pressure, engagement in intimate partner relationships, rape, broken home environment, and alcohol use. The community’s reactions to adolescent pregnancy varied, constituting emotional support, social stigma and rejection, and gossip and blame. Challenges during pregnancy included verbal abuse, pregnancy complications, and emotional distress, whereas motherhood challenges involved financial struggles, a lack of time for self-care, breastfeeding issues, and continued verbal abuse. Many of the participants reported excessive bleeding as a complication during childbirth. A few adolescent mothers experienced breech birth and gave birth to preterm babies. Family support, savings, prayers, and medical treatments are strategies that early adolescent mothers adopt to cope with challenges of pregnancy and motherhood.

Conclusion

Integrated programs prioritizing parenting education, infant care, nutrition, and child development are essential for the social inclusion and support of early adolescent mothers.

Introduction

Adolescent pregnancy, often characterized as a pregnancy in a female between the ages of 10 and 19 years, is associated with maternal and child mortality, and intergenerational cycles of ill-health and poverty globally.^1-3 This is a global public health issue, with Africa having the highest burden of nearly 21 million girls giving birth annually.^4-6 Early adolescent pregnancy, defined in the literature as pregnancy at or before the age of 15, has complicated and far-reaching consequences for young girls’ health and general well-being.⁷ Early pregnancy can prevent the teenager from reaching her academic potential, resulting in high economic costs over her life path.⁸ Early sexual debut, early menarche, and delayed marriage increase the risk of unintended pregnancy and early motherhood.⁹ Adolescent pregnancy has a detrimental effect on the emotional, physical, and social well-being of adolescents, contributing significantly to morbidity and mortality.^10-12 Psychologically, adolescent mothers experience a range of emotions during pregnancy and childbirth, including excitement, anxiety over taking on a new role, low self-esteem, regret, stress, and depression.^13-15

Ghana’s 2022 Demographic Health Survey revealed that 15% of women aged 15-19 have given birth, with 11% experiencing live delivery, 4% experienced miscarriage, and 2% currently pregnant.¹⁶ According to the district health information management systems (DHIMS) statistics of Ghana, 542,131 pregnancies among adolescents aged 15-19 years and 13,444 pregnancies among teenage females aged 10-14 years were recorded in Ghana between 2016 and 2020. The Eastern Region has the second-highest frequency of early adolescent pregnancies.¹⁷ Previous studies have reported the role of trust, love, sexual abuse, financial security, and forced marriage in influencing adolescent pregnancy and motherhood.^8,18,19 Anchoring this phenomenon on a theoretical lens, the family’s system theory explains the phenomenon by positing that differentiation of self involves autonomous decision-making and emotional bonding within a meaningful relationship system, while undifferentiated individuals require acceptance and approval for their thoughts and behaviors. A strong sense of self helps early adolescents navigate conflict, rejection, and criticism while valuing family and social groupings. Their ability to bounce back from setbacks might help them emotionally and cognitively separate from their birth family, which lowers the risk of STIs, romantic relationships, and pregnancy.^20,21

Involves significant life changes and is influenced by individual traits, socioeconomic status, preparation, and mental and physical health.²² Experiences are contextual and shaped by cultural and social environments.^5,23 In Ghana, motherhood is viewed as having a crucial role, with families and social life focusing on children with early childbearing and large families.²⁴ Adolescent mothers face negative social and health challenges during early motherhood, affecting their children, families, and communities at large.^24,25 They are typically poor and raise their children in impoverished situations.²⁶ These challenges result from a lack of parental preparation and maturity.²⁷

Several studies have noted some general challenges that adolescent mothers face in their day-to-day endeavors, including economic constraints, stigma, extra responsibility, truncation of education, stress, and suicide.^24,28 Adolescent mothers often adopt coping strategies, such as missing hospital appointments and abandoning babies, because of the challenges associated with adolescent pregnancy.²⁴

A better understanding of early adolescent pregnancy would have important implications for prevention programs.^7,29 Despite the national policy on adolescent sexual and reproductive health, there has been limited progress in addressing challenges related to early pregnancy and motherhood due to insufficient research and inconsistent results in Ghana. Most studies on adolescent pregnancies in Ghana have focused on factors influencing adolescent pregnancy among late adolescents (15-19 years), ^8,30-32 with little attention given to early adolescents. Further research is needed to gather sufficient data to develop policies to address the unique issues confronting early adolescents during pregnancy and motherhood. The present study explored the experiences of early adolescent mothers with pregnancy and motherhood.

Materials and Methods

Study Setting

This study was conducted in Koforidua, the capital of the Eastern Region, Ghana. The municipality spans 110 square kilometers, accounting for 0.57% of the total land area of the region. The Municipality has a population of 2,917,039, with 30.8% of people under 15.³³ This location was chosen because of an upsurge in sexual activity among the adolescents in the municipality. Child prostitution increased by 40% in the municipality.³⁴

Study Approach and Design

A qualitative research approach was employed to examine the lived experiences and phenomena of motherhood.³⁵ A descriptive phenomenological design was employed to address the research problem. Phenomenological studies investigate human experiences based on the descriptions provided by those involved.³⁶ This design is suitable for exploring how early adolescents understand and perceive their experiences of pregnancy and motherhood.

Study Population and Participant Selection

The study population consisted of early adolescent mothers (11-15 years) in Koforidua. Participants were eligible to participate in the study if they (i) were residents of the three selected communities, namely, Srodae, Betom, and Zongo; (ii) were between the ages of 11 and 15 years; and (iii) had a child.

Individuals who were 16 years old at the time of the study and had given birth after becoming pregnant at 14 or 15 years of age were included. Participants were excluded from the study if they did not reside in one of the three selected communities (Srodae, Betom, or Zongo), were outside the age range of 11 to 16 years at the time of the study (except those who were 16 but had become pregnant at age 14 or 15) and were mentally challenged. Purposive sampling and snowballing techniques were employed to select 20 early adolescent mothers for the interviews. Contact details of early adolescent mothers were obtained from various CHPS compounds in the selected communities, and contacts were established. The researcher identified early adolescent mothers who helped locate other mothers in the neighborhood, and the selection process ended when data saturation was reached.

Characteristics of Early Adolescent Mothers

Table 1 presents the sociodemographic characteristics of the twenty early adolescent mothers who participated in this study. Fourteen participants were from Zongo, four were from Srodae, and two were living in Betom. Zongo had the highest number of participants because early marriage and childbirth are common phenomena in the Muslim community. Eight early adolescent mothers were in Junior High School 3 (JHS 3), three were in Junior High School 2 (JHS 2), five were in Junior High School 1 (JHS 1) and four were in primary school when they became pregnant. Regarding occupational status, 14 were not working, five were students, and one was a makeup artist. Twelve of the 20 participants were dating, and the rest were single. Most of the participants (11) were Muslims, and the remaining participants were Christians.

Table 1.

Demographic Characteristics of Early Adolescent Mothers

Place of residence	Level of education	Occupation	Religion	Relationship status
Zongo	JHS 1	Not working	Muslim	Single
Zongo	JHS 3	Student	Muslim	Single
Zongo	JHS 3	Not working	Muslim	Dating
Betom	JHS 3	Not working	Christian	Dating
Zongo	Primary	Make-up Artist	Muslim	Dating
Srodae	JHS 2	Not working	Christian	Dating
Zongo	JHS 2	Student	Christian	Dating
Zongo	JHS 3	Not working	Christian	Dating
Srodae	JHS 3	Not working	Muslim	Single
Zongo	Primary	Not working	Muslim	Dating
Zongo	JHS 1	Student	Muslim	Dating
Zongo	JHS 1	Not working	Muslim	Single
Zongo	JHS 3	Not working	Muslim	Dating
Srodae	JHS 1	Student	Christian	Single
Betom	JHS 2	Not working	Christian	Dating
Zrodae	JHS 3	Not working	Muslim	Dating
Zongo	Primary	Not working	Christian	Dating
Srodae	Primary	Not working	Christian	Single
Zongo	JHS 1	Not working	Christian	Single
Zongo	JHS 3	Student	Muslim	Single

Note. JHS, or junior high school, is used in the educational system of Ghana. JHS 1, JHS 2, and JHS 3 correspond to grades seven, eight, and nine, respectively.

Data Collection

Face-to-face in-depth interviews were conducted with early adolescent mothers from different sociocultural backgrounds from May 2023 to July 2023. A semi-structured interview guide was developed, consisting of open-ended questions that enabled participants to share their experiences. The researchers received training in qualitative research methods, ethical data collection, transcription, and coding for accurate interpretation of findings. The interview guide used in this study was developed by the authors, (two males and one female) and has been provided as a supplementary file to ensure transparency and reproducibility. To fine-tune the interview guide, a pilot study was conducted with three mothers of early adolescents from a community with characteristics similar to those of the study setting. The interview guide was reviewed by experts in qualitative research before data collection began. To ensure accuracy, transcripts were back-translated and cross-checked against audio recordings. Discrepancies were discussed and resolved through consensus among the research team. Pseudonyms were assigned to all participants to ensure their anonymity.³⁵ Each interview lasted 30–60 minutes, with an average duration of 45 minutes. The researchers conducted interviews in Twi (the dominant local language), and with the participants’ permission, a voice recorder was used to record the interviews. The researchers ended the data collection process when data saturation was achieved, implying that no fresh, significant insights were found and that sufficient data were gathered to draw meaningful conclusions. After 20 interviews, recurring patterns were observed, and additional interviews did not yield new conceptual insights. Saturation was assessed through ongoing data analysis conducted concurrently with data collection.

Data Analysis

Data analysis was guided by the thematic content analysis proposed by Braun and Clarke to ensure a meticulous and transparent interpretation of participants’ lived experiences.³⁷ This approach ensured that the experiences of early adolescent mothers were central to the analysis and reflected the social construction of the phenomenon. A professional translator in the team, fluent in Twi and academic English, and acquainted with the research context, systematically analyzed the data by listening to the audio, transcribing it verbatim into English notes while reading or listening to the audio, and then systematically coding the results. In the initial phase, the first and second authors transcribed the audio recordings verbatim and read the transcripts repeatedly. Consequently, the transcribed data were compared to ensure internal consistency (Phase 1). Discrepancies were discussed and resolved through consensus among the research team. The first researcher continued coding the data after a discussion with all the authors. Open coding was performed manually using an inductive approach, whereby labels and keywords were derived directly from the raw data rather than a pre-existing framework. These preliminary codes were then iteratively compared and refined, allowing the researchers to group them based on conceptual similarity and shared meaning (Phase 2). During the third and fourth phases, the analysis shifted from individual codes to the development of themes by clustering related materials into broader categories. At this stage, the researcher employed creative and analytical reasoning to determine categories of meaning. This recursive process involved reviewing the developing themes against both the specific coded extracts and the entire dataset to ensure they accurately reflected the nuances of early adolescent motherhood. Finally, the themes were clearly defined and named through collaborative discussions among the research team to verify their internal consistency and relevance to the research objectives (Phase 5). The generated themes were then used for writing (Phase 6). Both manifest and latent content analyses were employed. Manifest content analysis focused on the explicit, surface-level content of the data, such as directly stated words, phrases, and observable descriptions. Latent content analysis, in contrast, examined the underlying meanings, assumptions, and interpretations embedded within the text, allowing for a deeper understanding of participants’ perspectives and the broader contextual significance of the data.

Trustworthiness

Lincoln and Guba’s model of credibility, confirmability, dependability, and transferability was adopted to ensure the study’s trustworthiness. To ensure credibility, the codes and themes developed during the analysis were confirmed and audited by all the authors. The same research instrument was used to interview all early adolescent mothers to achieve dependability. To ensure confirmability, a reflexive process was initiated to identify any personal beliefs that may have affected the study. To achieve transferability, detailed information about the research context, participants, and methods is provided in the methodology section.

Ethical Approval

The study was conducted according to the Declaration of Helsinki and followed the relevant EQUATOR guidelines.³⁸ Written informed consent was obtained from parents or legal guardians before the participation of minors. In addition, verbal assent was obtained from the adolescent mothers. The lead author explained the study objectives, procedures, and interview questions in age-appropriate language to ensure that participants fully understood their involvement and their right to withdraw at any time without consequences. Interviews were conducted in safe and private settings, and care was taken to avoid psychological distress. The participants were assured of confidentiality, anonymity, and their freedom to leave the study without any consequences. The interview recordings were kept on password-protected, encrypted servers with limited access. Only authorized members of the research team had access to the audio recordings of the interviews.

Findings

Circumstances Leading to Early Adolescent Pregnancy

The participants were asked to describe the events leading to their pregnancies. The findings revealed five sub-themes: peer pressure, engaging in intimate partner relationships, rape, broken home, and the influence of alcohol.

Peer Pressure

Many of the participants explained that their peers played a role in the circumstances that led to their pregnancy. Peer influence, including sharing experiences at outings, parties, and with boyfriends, contributed to adolescent pregnancy by attracting others to explore similar experiences. One participant said:

“I wasn’t ready to do that stuff, but peer pressure led me. I was influenced by my friends in school. “When my friends came, they would talk about their experiences, but I wasn’t ready to do these activities” (Participant L).

Similarly, a participant claimed to have become pregnant because of the influence of friends in several ways, including attending parties and outings and introducing her to a boyfriend.

“I followed my friends to a party, and I met a guy through them who became my boyfriend, and I had sex with him. We have dated for more than one year.” (Participant T)

Intimate Partner Relationship

Intimate partner relationships were key contributors to early adolescent pregnancy. According to some participants, dating and engaging in unprotected sex with boyfriends led to pregnancy. Some participants who became pregnant with their boyfriends said:

“Please, I got pregnant by the guy I’m dating. I went to a birthday party sometime, and I met him there. I did not return home after the party; I slept at his place for the night. We had sex, and this resulted in the pregnancy” (Participant E).

“Oh, I met the guy while I was walking on the street, he proposed to me and I accepted. We started dating and had sex, which resulted in this pregnancy. For me, I did not know I got pregnant. I did not get my period when it was supposed to come.’’ (Participant N)

Influence of Alcohol

Alcohol use contributed to risky behavior among participants. A few participants talked about how they were affected by the influence of alcohol. Some participants who were at a party, intoxicated, explained:

“When I was in school, Form 3s were asked to sleep in school because of the BECE. One day, my friends asked me to go with them to a party. A friend celebrated her birthday.”We had some drinks, but I didn’t know they had put something in my drink that made me sleep. It was when I slept that it happened.” (Participant C)

“Please, I went to a birthday party, and I got intoxicated from drinking. I don’t know how I got pregnant. All I knew was I woke up in someone’s house, which was nowhere near where I had gone for the party. I met the guy at the party; that was my first time meeting him.” (Participant O)

Rape

Some participants reported experiences of rape, despite its illegality and social disapproval in Ghana. Two participants were raped consciously or unconsciously. The participants who were raped shared their experiences:

“My mum was working for this man that I used to visit. One day, I visited him when my mum wasn’t around. He sent me to purchase something for him, and when I returned, he made me bring the stuff to his room, and he slept with me.” (Participant J)

“A friend was celebrating her birthday. We had some drinks, but I didn’t know they had put something in my drink that makes you sleep. It was when I slept that it happened” (Participant S).

Community Reactions to News of Early Adolescent Pregnancy

The results revealed various reactions from the community, particularly toward pregnant adolescent girls, highlighting sub-themes such as gossip and blame, emotional support, stigma, and social rejection.

Emotional Support

Participants reported receiving emotional support from family and friends during pregnancy. Some community members, especially the friends of pregnant adolescent girls, supported them, providing comfort to maintain emotional stability. They provided comfort for pregnant early adolescents to maintain emotional stability. The quotes explain the following:

“My friends from the community remained friends with me when I got pregnant because they didn’t want me to feel bad” (Participant R)

“Some said it was okay to be pregnant because I would give birth and take care of the baby”. (Participant D)

Stigma and Social Rejection

Community members are prejudiced against girls who become pregnant during adolescence. They tend to stigmatize and mock pregnant girls. Five participants indicated that they had experienced some form of stigma from their community. This is manifested through mockery and the loss of friends. The quotes below affirm the following.

“Most of the community folks made fun of me when I got pregnant. Some did not know I was living that kind of life, so most of them stopped talking to me. They couldn’t believe I was the one to have brought such shame to my family.” (Participant B)

“Most of the community folks who knew me were disappointed, and some of my relatives refused to talk to me. Others made fun of me by passing derogatory comments and this made me very sad. My siblings told me not to mind them when they say all the negative stuff.” (Participant C)

Gossip and Blame

The parents of pregnant adolescent girls were blamed for their children’s pregnancies. Some communities have attributed adolescent pregnancies to irresponsible parenting. Some participants stated this affirmatively.

“People in my community used to gossip about me. They used to say that my mum watched me get pregnant. It’s a whole lot. They talked a lot, but I turned a deaf ear to it” (Participant P)

“They used to say that I was a bad girl, that's why I got pregnant. They even said my mum didn’t train me properly, which is why I got pregnant. They said a whole lot”. (Participant J)

Challenges Early Adolescent Girls Face During Pregnancy

Challenges include insults, pregnancy complications, and emotional distress. The findings provide useful insights into the unique challenges that adolescents face during pregnancy.

Insults

During pregnancy, early adolescents are insulted and rebuked by their parents and caregivers. This destabilizes them emotionally. A verbally abused participant stated:

“I didn’t face challenges; I was able to carry out the pregnancy without any difficulty. It was my aunt who used to insult me a lot” (Participant N)

Pregnancy complications

Almost all of the interviewed participants reported having had one or more pregnancy complications, including waist pain, nausea, vomiting, and loss of appetite. The quotes illustrate the following.

“I had constant waist pains during the pregnancy and even when I was in labor. When it happened, I would tell my mum and my grandmother to give me something for the pain, and we would even visit the clinic for drugs. I had the pain throughout until I gave birth. I used to work a lot when I was pregnant.” (Participant D)

“I’m an asthmatic patient, and so I used to get asthmatic attacks. I was taking painkillers to numb the pain. However, even then, I would throw up after taking the painkiller before I became okay.” (Participant M)

Emotional Distress

Some participants reported emotional distress during pregnancy, including anxiety and sadness. Two participants indicated that they experienced some form of emotional distress due to fear of stigmatization during pregnancy. The quotes below affirm the following.

“I couldn’t go to school because I did not feel comfortable walking around in public, so I was always indoors. I missed a whole year in school as a result. I would have been in SHS by now” (Participant G)

“I struggled to sleep when I was pregnant. In addition, the thought of me being pregnant still baffled me, and I used to throw up a lot in my third trimester” (Participant R)

Complications With Childbearing Among Early Adolescents

The participants discussed complications during and after childbearing based on their responses to an interview guide. The major sub-themes that emerged included excessive bleeding, preterm delivery, and breech birth.

Excessive Bleeding

Participants reported losing significant blood during childbirth. Many participants described how they lost excessive blood during the period of giving birth. Some participants recounted the following.

“No, but I lost a lot of blood. I thought I was going to die as a result of that” (Participant Q)

“I bled profusely. I lost a lot of blood during the delivery process” (Participant K)

Preterm Baby

Preterm delivery occurs when babies are born alive before 37 weeks of age. Two participants had babies born before the usual nine months. The two participants recounted the following:

“My baby was premature. I gave birth to him at 8 months, 4 days after I became pregnant. The doctors told me if I was not lucky, I would lose the baby” (Participant I)

“My baby was premature; I gave birth at 8 months, so we were hospitalized for about three days. The baby was diagnosed with jaundice.” (Participant T)

Breech Birth

There are times when a baby fails to present its head first during pregnancy. A participant who experienced a breech birth said the following:

“The midwives told me the baby was not coming out head first” (Participant H)

Challenges Early Adolescent Mothers Face in Raising a Child

This theme highlights some challenges that adolescent mothers face in raising their children. The study revealed five distinct sub-themes for early adolescents: lack of time for self-care, health challenges, financial challenges, verbal abuse, and breastfeeding issues.

Financial Challenges

Some early adolescent mothers find it difficult to meet their children’s needs. This difficulty stems from a lack of financial resources to meet the child’s physical needs. Twelve participants admitted that they struggled financially as they raised their children.

“During that time, his dad wasn’t giving us money, so we were struggling to eat. It was my mum who was taking care of me” (Participant J)

“Bathing him isn’t a problem. I struggle with feeding the baby sometimes, especially when the father is facing financial challenges. When he eats and I have not even eaten, I am okay, as he is important to me.” (Participant H)

Lack of Time for Self-Care

Early adolescent mothers faced role conflict while nurturing their children. A few participants revealed that they lacked time for self-care. The following quotes illustrate this:

“Oh, the problems are a lot. Now I have to constantly watch the baby because he crawls everywhere as he’s growing. Sometimes, it gets annoying, but because it’s my child, I can’t do anything. Sometimes, I have to take care of the baby and put him to sleep before I can do what I want to do for myself, maybe washing or cooking. He started eating solids at 4 months of age, so I was preparing the food myself at home. He would eat anything I give him, so he doesn’t disturb me a lot.” (Participant F)

“Taking care of the baby is difficult. He only sleeps better when I breastfeed him well. The baby is usually up at dawn, so I have to also wake up and breastfeed him then, and he goes back to sleep. He hasn’t yet started eating other foods.” (Participant O)

Health Challenges

Some participants admitted that they face one health challenge or the other, being themselves or their babies. One participant, who was an asthmatic patient, indicated the following.

“My asthmatic attacks used to come at dawn, and when they happen, I’m unable to breastfeed because when the baby sucks my breast, it would be painful.” (Participant B)

Another participant indicated that her child complained of stomach pain.

“Sometimes he’d get a stomachache, and we would give him drugs. He would also get rashes, and the grandmother would treat them for him” (Participant C)

Breastfeeding Issues

The issue relating to breastfeeding is multifaceted, as one participant revealed that she lacked knowledge on how to breastfeed a child. This is how she put it.

“I didn’t know how to breastfeed and bathe the baby, but my mum has been teaching me how to do it. My uncle and my father’s family also support me” (Participant G)

It is also difficult to produce enough breast milk to breastfeed a child due to poor eating habits. Another participant who struggled to feed her baby said:

“Sometimes, it gets difficult to eat the right kinds of food for me to be able to breastfeed my baby, because I need to eat right to get enough breast milk to feed the baby”. (Participant H)

Verbal Abuse

Caregivers sometimes use assault and abuse and exert dominance over early adolescent mothers. One participant explained that she had received insults from a family. She said:

“problem I’m facing is that my grandmother usually uses the fact that I’m a teenage mother to insult me when there is an issue between us” (Participant I)

Coping With the Roles of a Mother

Early adolescent mothers face new roles that can be challenging. To function effectively, they adopt coping strategies, such as family support, financial management, religious practices, and medical treatment, which align with the specific challenges they face.

Family Support

Participants receive support from their families, which helped them cope with challenges as they have taken up new roles as young mothers. The quotes are explained as follows:

Participant D reported that the woman she was living with at Adawso when she was pregnant mum helped her throughout her journey. She fed her and took good care of her. But her mum also supports her now

“My grandmother has been supporting me, especially with feeding the baby, so I can say we are managing, although it is not all that green. The baby is my priority now” (Participant F)

Savings

Early adolescent mothers manage their finances by assuming new roles. This enables them to cater to the needs of their children. One participant explained this as follows:

“I am trying my best. I have been saving money sometimes, so when I need something, I rely on the savings because I’m not working at the moment. It hasn’t been easy” (Participant E)

Praying

One early adolescent mother undertook spiritual exercises such as praying and sought supernatural strength and help during these challenging times.

“I am praying God will take me through schooling so I can get a job and take care of the baby and my mother. My mother has suffered.” (Participant B)

Medical Treatment

Some early adolescent mothers rely on medicine when facing health challenges. One participant stated that she buys drugs when their baby becomes ill. She explained:

One participant (G) reported that they had a drug which was gotten from the pharmacy (Aunty Mary), and when given to the baby, it became quite okay

Discussion

The specific problems of early adolescent parenthood have important social, emotional, and health ramifications. This study examines the lived experiences of early adolescent mothers, emphasizing the reasons, responses of the community, challenges associated with childbirth, and coping strategies. While previous studies have explored adolescent pregnancy, limited attention has been given to early adolescent pregnancy. Understanding factors contributing to early adolescent pregnancy is essential for developing effective interventions, enhancing support networks, and addressing the underlying causes of this issue. This study contributes to the literature by providing in-depth qualitative insights into pregnancy and motherhood among a rarely studied population, thereby addressing an important evidence gap in Ghana. The findings extend existing knowledge by highlighting precursors to sexual debut, pregnancy challenges and complications, and coping mechanisms.

Peer pressure was identified as a contributing factor to adolescent pregnancy. Adolescent development and reproductive health are significantly influenced by the family system theory. Emotional dynamics in nuclear families involve marital conflict, spousal dysfunction, child impairment, and emotional distance. Early teenagers may seek validation from friends and financial security through romantic partnerships due to unmet needs, and this can lead to pregnancy. This affirms the weakening of the family system, as parents have minimal influence on the lives of children. The Findings of this study regarding the challenges of early motherhood resonate with international literature from other low- and middle-income settings, highlighting the pervasive nature of certain adolescent parenting struggles. For instance, peer pressure identified among mothers mirrors findings from Ethiopia, Mexico and Malaysia, where adolescent girls who indulged in sexual activity as a result of peer pressure and those from poor economic backgrounds experienced higher pregnancy prevalence compared to their counterparts who were not influenced by their peers.^39-42 Our findings also align with earlier narrative critical review where peer pressure, poverty, substance abuse, among other have been established as major determinants of adolescent pregnancy.⁴³ This present study contradicts previous studies in Ghana, where a lack of money was identified as a major driver of adolescents’ sexual activity^8,44,45 as the study participants did not indicate financial challenge as a precursor to their involvement in sexual activity leading to pregnancy. In addition, our findings do not express similar patterns and support a systematic review in Africa, where the most obvious predictors were sexual coercion and pressure from male partners, low or incorrect use of contraceptives, and poor parenting.⁴⁶ The disparity in the study findings can be attributed to difference in socio-cultural factors, family dynamics and variation in community expectations.

The predominant community reactions to early adolescent pregnancy found were stigma and social rejection. The theory of family systems emphasizes the crucial role of family support in adolescent health outcomes. Parental support, both emotional and material, significantly influences health outcomes. The expression of stigma and social rejection may lead to poorer maternal and neonatal outcomes. Similarly, in some cultures, such as Australia ¹³ Brazil ⁴⁷ and South Africa ⁴⁸ early adolescent mothers are usually stereotyped as a disgrace to society and are more often regarded as failures despite the personal perceived benefits of achieving motherhood. Confirming these findings,⁴⁹ reported social stigma and discrimination as social challenges faced by pregnant adolescents. Emotional support is another community reaction to adolescent pregnancy. This finding has been identified by previous studies, in which a lack of emotional support from community members was seen as a barrier to holistic wellbeing as a challenge faced by pregnant adolescent mothers.^47,50 National adolescent health frameworks should include anti-stigma social campaigns targeting early pregnancy and motherhood at the local level.

Pregnancy complications are a common challenge faced by early adolescents. These include waist pain, nausea, vomiting, and loss of appetite. There is a need to integrate an age-appropriate and culturally sensitive education programs into antenatal health care services to empower early adolescents to identify clinical issues related to pregnancy and seek medical attention early. This is likely to reduce poor pregnancy outcomes. This finding is affirmed in similar studies, which highlighted that many adolescents lack physical and psychological readiness for pregnancy or childbirth, increasing their vulnerability to complications and severe health consequences.^51,52 In a qualitative study in southern Ghana, adolescent pregnancy was typically accompanied by primary health issues, including headaches and anemia ³¹ a finding that was not observed in our present study. Earlier studies contradict our findings, as pregnancy complications were previously reported to include anemia, stillbirth, preeclampsia/eclampsia, preterm birth, and low birthweight, which were found to be significant complications of adolescent pregnancy in a global context.^53,54

Excessive blood loss is a major complication encountered by early adolescents during childbirth. This can be attributed to the biological immaturity of the body structure in early adolescents, such as a poorly developed uterus, pelvic structure and birth tissues. This finding is consistent with previous studies ^55-57 as adolescents were identified to have an increased risk of poor obstetric outcomes, including postpartum hemorrhage, anemia, and maternal morbidity. However, differing from earlier population-based studies in the U.S., where adolescents less than 15 years of age were more likely to experience intrauterine growth restriction, preterm delivery, stillbirth, and infant death and may have an increased risk of cesarean and operative vaginal delivery due to underdeveloped bone structure.⁵⁸ Differential pregnancy outcomes were reported for adolescents in the different study settings.

Financial difficulties are a significant issue faced by early adolescent mothers when raising their children. This is because early adolescents lack the requisite skills and technical knowledge to secure and attain financial security. The financial vulnerability of early adolescent mothers underscores the need for integrated policy responses that promote education re-entry, vocational skill development, and targeted social protection. This finding is consistent with previous studies^24,57,58 where financial constraints were recorded as the main challenge faced by adolescents in raising their children. In a study in Mexico, economically disadvantaged adolescent mothers with low education, wealth, and depressive symptoms struggled to care for their children.²⁸

A lack of time for self-care, verbal abuse, and difficulty breastfeeding a child are challenges faced by adolescent mothers. Similarly, the role conflict and lack of time for self-care reported in this study align with experiences in Kenya, where young mothers face significant stress while adjusting to the demanding new roles of parenthood.^50,59 Corroborating the study finding, it is reported that adolescent mothers are faced with the problem of role conflict and attribute this challenge to insufficient maternal role and insufficient support from significant others, a notable finding in our study.⁶⁰ Similarly, the lack of knowledge about infant care and contradictory information from various sources are obstacles to caring for babies.⁵⁸ Concerning breastfeeding issues, an integrative review revealed that half of adolescent mothers stopped breastfeeding after a month, which was influenced by social and cultural norms and personal beliefs about motherhood.⁶⁰

Our findings demonstrate the importance of family support as a common adaptation strategy in the face of challenges during motherhood. As affirmed in other studies ^13,60 young mothers receive good support from their mothers, siblings, and close friends but rarely from the father of their baby or the wider community. In contrast to a reported studies finding in Ghana, missing hospital appointments and abandoning babies are coping strategies adopted by adolescent mothers in the face of challenges.²⁴

Conclusion

The weakening of the traditional family structure affects the general well-being of adolescents. Early adolescent mothers face numerous challenges, including financial difficulties, which affect their ability to adjust to motherhood and their stage of development during pregnancy. A key finding of this study is that early adolescent mothers receive emotional support from community members, even though adolescent pregnancy is frowned upon in society. It plays a crucial role in enabling early adolescent mothers to cope with motherhood. The difficulties faced by adolescent mothers necessitate the urgent need for multidisciplinary interventions that address their social and biological vulnerabilities. Granted the paucity of information on newborn care and breastfeeding revealed among early adolescent mothers, healthcare providers should integrate age-specific, practical parental education into current maternal and neonatal care. The Ghana Education Service could strengthen existing curricula by integrating age-appropriate and context-specific sexual and reproductive health topics, particularly at the junior/senior high level, where these knowledge gaps were most evident. Social programs should transcend beyond adolescent support to provide comprehensive support that bolsters family systems to support adolescent mothers’ return to the classroom and their long-term well-being.

Strengths and Limitations of the Research

This study has several strengths by providing evidence on stigma, childbirth complication and motherhood challenges. The use of the Braun and Clarks six step thematic content analysis strengthens the methodological rigor of the study by ensuring replicability and transparency. Additionally, the study provides evidence on highly vulnerable and under-researched subgroups, making the findings socially and academically acceptable. This study is not without limitations. Firstly, the results of phenomenological research are context-specific and might not apply to all early adolescent mothers in Ghana or outside of Koforidua Municipality since they concentrate on a thorough examination of participants’ actual experiences. Future research could use a mixed-methods design to measure the prevalence of key issues, such as mental health outcomes, social support, identified in this qualitative study. The study explored only the experience of adolescent mothers with pregnancy and motherhood. Future research should assess the experience of adolescent fathers in the advent of pregnancy and fatherhood. Lastly, research on the impact of sexual and reproductive health education in avoiding early teenage pregnancies and supporting young mothers may inform public health interventions.

Supplemental Material

Supplemental Material - Lived Pregnancy and Motherhood Experience Among Early Adolescent Mothers

Supplemental Material for Lived Pregnancy and Motherhood Experience Among Early Adolescent Mothers by Mary Sefa Boampong, Richard Ofori and Seth Christopher Yaw Appiah in INQUIRY: The Journal of Health Care Organization, Provision, and Financing.

Footnotes

Acknowledgement

We are grateful to all of our participants for providing substantial information for this study. God bless them all.

ORCID iD

Richard Ofori

Ethical Consideration

This study was conducted in accordance to the Declaration of Helsinki. Ethical clearance was obtained from the Ethics Committee of the Kwame Nkrumah University of Science and Technology (HuSSREC/AP/102/VOL.1, 6^th April 2023).

Consent to Participate

We obtained signed informed consent from the parents and guidance from early adolescent mothers. Additionally, verbal assent was obtained from early adolescent mothers involved in this study.

Authors Contribution

All authors contributed to the conceptualization and design of the study. Mary Sefa Boampong, Richard Ofori, and Seth Christopher Yaw Appiah carried out material preparation, data collection, and analysis. Richard Ofori and Mary Sefa Boampong wrote the initial draft of the manuscript, while Seth Christopher Yaw Appiah provided feedback on the manuscript. The final manuscript was reviewed and approved by all Authors.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets analyzed during the current work are accessible from the corresponding author upon reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

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