A descriptive qualitative study of pregnancy experiences, care and decision-making amongst South African adolescent girls and young women

Background: Pregnancy among adolescent girls and young women (AGYW) remains a key public health concern, shaped by wider socio-cultural and structural factors. Although global birth rates among adolescent girls are declining, South Africa's rates continue to rise. This study examined AGYW's attitudes, experiences with pregnancy and antenatal care, and views on accessing related services. Methods: The study employed a descriptive qualitative design, using in-depth interviews to explore the experiences of AGYW aged 15-24 years from seven South African provinces, regardless of pregnancy history. Participants were selected from the HERStory 3 survey database and interviewed remotely by telephone, with sixty-eight participants. Interviews were transcribed and translated into English. Data analysis followed an integrated, cyclical thematic approach that identified themes through deductive and inductive methods to identify and define themes, patterns, and relationships. Results: The study identified four main themes: support during pregnancy, mental health, health service experiences, and social or cultural factors affecting pregnancy experiences. Family, particularly parents, played a major role in the pregnancy experiences of AGYW, but limited partner communication and difficulty confiding in families often weakened support networks. Participants reported issues, like premature birth and miscarriage, highlighting a need for postpartum care. Experiences with health services were mixed, with some unaware of available programs. Decisions about abortion involved financial, educational, health, and moral considerations. Conclusions: This study examined AGYW's experiences of pregnancy and pregnancy-related services. Findings suggest that SRH services for AGYW in high-risk communities can be improved by training support professionals to be more sensitive and non-judgmental.