Understanding adolescent perinatal wellbeing in rural parts of Kenya: A qualitative study

Introduction: Despite global efforts to reduce adolescent birth rates, the problem persists in low- and middle-income countries. Sub-Saharan Africa has the highest rates (97.9 births per 1000 women). In Kenya, more than 15 % of adolescent girls become pregnant. Forty-three percent of these develop depression. This study investigated adolescent pregnancy in rural Kenya to understand the challenges and context-specific factors that can help adolescents maintain good mental health during pregnancy and the motherhood. Methods: An exploratory qualitative study was conducted in Kilifi County between October and November 2021. A total of 73 participants consented to participate in the study. Twenty adolescents took part in in-depth interviews (IDIs). Young women (12) with experience of adolescent pregnancies, partners (5), family members (24), and community influencers (12) participated in separate focus group discussions (FGDs). IDIs and FGDs were conducted in Swahili to understand experiences, challenges and opportunities for supporting mental health during the perinatal period. Data were translated and transcribed then analyzed thematically. Results: Five themes emerged from the study: pregnancy as an isolating event, challenges accessing antenatal care, limited future potential, mental health impact of adolescent pregnancy, and protective factors for sustaining good mental health. Adolescents expressed mixed feelings about their pregnancies but shared common worries, including difficulties accessing skilled antenatal care, strained family relationships, and uncertainty about their future, particularly regarding education and employment. These challenges were exacerbated by a lack of support, cultural norms, and a desire to avoid shame. Protective factors for maintaining good mental health included self-encouragement, acceptance, and supportive relationships. Conclusion: Pregnant adolescents face significant challenges that affect their ability to cope with pregnancy and parenthood. To promote their mental health, they need strong social support from partners, family, teachers, and healthcare workers, as well as access to life skills, education, social welfare, and employment systems.