Mental health of adolescent mothers.

Our review findings reveal that adolescents face an elevated risk of experiencing poor mental health [64,65]. There was substantial variability in the prevalence of antenatal depression across LMICs ranging from 16.7% in Bangladesh [38] to 70% in Cameroon [39] compared to an average of 12% in high-income countries [66,67]. Similarly, postpartum depression ranged from 18.8% in Burkina Faso [31] to 43.6% in Malawi [44], surpassing the global estimate of 17.2% [68].

Mental health issues in this population extend beyond depression. Substance use frequently co-occurs with depressive symptoms, as shown in a Nairobi study where 24.5% of depressed pregnant adolescents engaged in substance use [34]. Suicidal ideation affected 14.3% of pregnant adolescents in Ethiopia [32], with suicide attempts reported by 6.5% in Bangladesh [36]. These outcomes are linked to factors such as poverty, intimate partner violence, family rejection, stigma, and chronic illness [17,36,39,44,69].

Posttraumatic stress symptoms were reported in 18.3% of adolescent mothers in Iran [46], consistent with the literature that suggests higher levels of perceived stress among pregnant adolescents compared to their never-pregnant peers [63]. Studies found that adolescent mothers view childbirth as traumatic, shaped by experiences such as fear of death, loss of control, marital status, and sexual partner violence [17,44,70]. Fear of childbirth was also documented, involving concerns about the labor process, the hospital environment, the child’s health, and postpartum recovery [60]. These concerns reflect broader patterns observed in prior research, where adolescent mothers often felt unprepared for childbirth due to lack of experience and psychological readiness [71,72].

In addition, adolescent mothers frequently reported emotional distress, including worry, isolation, helplessness, guilt, shame, and regret [49,53,56,58,59]. These symptoms often reflect underlying anxiety, depression, and possible post-traumatic stress disorder [48,73].

Although most studies emphasize negative mental health outcomes, one study reported a positive experience, noting that some adolescent mothers felt happiness in fulfilling family roles and pleasing their husbands and extended families [49]. These positive emotions were attributed to strong social support, cultural validation of motherhood, and the perceived achievement of adult status. Such findings indicate that when adolescents receive affirmation and support from their immediate social environment, emotional resilience may be enhanced. These insights point to the value of strength-based approaches that not only mitigate risk but also foster protective factors rooted in local cultural contexts [18].

The disparities in mental health outcomes among LMICs reflect broader structural issues, including limited mental health infrastructure, shortages of trained professionals, and restricted access to services in rural areas [50]. Cultural stigma around adolescent pregnancy and mental illness further restricts help-seeking and recognition of psychological distress [59,74]. Additionally, the heterogeneity in prevalence rates may be attributed to methodological differences across studies, such as variations in sampling methods, study design, assessment tools, and screening tool cut-off points [66,75,76]. These inconsistencies highlight the need for more rigorous, harmonized approaches in future research to enhance comparability and inform policy development.

Influences on mental health.

Our review highlighted a broad range of factors influencing the mental health of adolescent mothers. Key determinants identified across the included studies include limited education [31,40,53,55], poverty [40,51,55,58,59], marital status [59], food insecurity [37], number of children [40], child weight [40], rigid social norms [59], and absence of social support [31,33,51,53,55,58,59]. These findings align with existing literature, suggesting that adolescent mothers are more likely to reside in low-income communities, be born to parents with limited educational and employment achievements, have a history of child abuse, live in turbulent home environments marked by strained interpersonal relationships, and have restricted social support networks [18,77]. Collectively, these conditions are associated with increased vulnerability to adverse mental health outcomes.

Additional stressors included unintended pregnancy, pregnancy complications, and the gender of the child [33,39,43,46,51]. Unplanned pregnancies were commonly linked to increased depression, anxiety, and emotional distress among adolescent mothers [39,47]. These challenges were worsened by limited readiness for parenthood, strained family ties, and fears of disrupted life plans [39]. Some also struggled to bond with their infants, as adolescent mothers faced difficulty forming emotional attachments and lacked fulfillment in the caregiving role [47]. This burden intensified in gender-biased contexts. A study from India reported that young women who delivered female infants faced 2.43 times higher odds of distress compared to those with male infants [33]. This finding aligns with earlier research conducted in South Asia, indicating that women undergo psychological distress following the birth of a female child due to entrenched gender norms that favor sons [78–82]. Such norms and discriminatory practices represent violations of adolescent mothers’ rights to health, dignity, and protection, as outlined in international human rights frameworks [16,79].

Inadequate support also emerged as significant stressor for adolescent mother’s mental health [31,51,52,59]. The lack of support from spouse, family, and healthcare providers contributes to elevated stress levels. Support plays a crucial role in mitigating depression and mental health problems. Struggle to balance maternal responsibilities and the pursuit of competencies essential for effective motherhood further compounds their stress and contribute to identity conflict [63].

Insufficient knowledge and skills, particularly in areas such as pregnancy and delivery care, breastfeeding, childcare, health behaviors, and accessing supportive resources, contribute to their stress [55,56]. These stressors are further intensified by stigma originating from immediate and extended family members, particularly in cases of unmarried or repeatedly pregnant adolescents, who are often perceived as having brought dishonor to their families [58].

HIV-positive status emerged as an additional risk factor [53]. Depression and stigma associated with HIV during pregnancy can hinder the HIV care and adherence to antiretroviral therapy (ART). This is consistent with broader literature suggesting that internalized HIV-related stigma can compound depression during pregnancy [83]. Recognizing these multifaceted stressors is crucial for developing comprehensive interventions and support systems for adolescent mothers facing mental health challenges. However, while these associations were consistently reported, the depth of analysis varied across studies. Few studies identified correlations without exploring causal mechanisms or adequately controlling for confounding variables, which limits the generalizability and robustness of the findings.

Coping mechanism used by adolescent mothers.

The review highlighted coping strategies employed by adolescent mothers in LMICs. Some of the adolescents demonstrated resilience, fueled by a desire to succeed and a positive outlook on the future [48]. Such coping strategies included pursuing education and vocational skills. Faith and religion also emerged as significant coping mechanism, helping them avoid overthinking about their situations [60]. Notably, comparable coping strategies have been identified in previous studies, suggesting commonalities in resilience strategies across different contexts [74,84]. However, in some contexts, religious framing of suffering as a test of faith or morality may suppress open discussion of abuse or deter help-seeking, particularly in cases of sexual violation [52,59]. Some mothers relied on the support of family, friends, and spouse, while others exhibited adaptability after childbirth, attributing their focus to lessons learned and an enhanced understanding of the world [60]. Comparable findings highlighted the complexity of managing stress during this pivotal life transition [85]. However, it is important to consider that not all adolescents cope equally; some face stigma, express regret, and engage in negative behaviors like isolation, risky relationships, and drug use [58].

Access and utilization of mental health service.

The scoping review revealed obstacles and support for adolescent mothers accessing mental health services. Perceived benefits of seeking care, such as motivation to address depressive symptoms, positive interactions with providers, and access to informational support were cited as facilitators [50]. However, social and cultural norms, as discussed in previous studies, create hesitancy and fear of judgment, hindering service utilization [50,52,58,59]. Stigmatization, particularly by health providers surrounding both mental health issues, early pregnancy, single motherhood and unwed pregnancies often discourages individuals from seeking help, especially in communities where discussions about mental health are restricted. The social and cultural norms may also lead to blaming young mothers for their situation, which makes them less likely to use mental health services. Additionally, traditional and religious beliefs add to this stigma, with some cultural contexts viewing mental health struggles as a sign of personal weakness or divine punishment [52,59]. These deeply rooted attitudes cause adolescent mothers to be hesitant about seeking help, fearing judgment or isolation [74]. These barriers are not just cultural, they represent systemic violations of adolescent girls’ right to access timely, appropriate, and non-discriminatory mental health care.

Another significant barrier was the limited access to health facilities for adolescent mothers in remote areas [59]. Geographic constraints and transportation difficulties often prevent individuals from reaching mental health facilities, especially when these facilities are concentrated in urban areas. A shortage of mental health care workers and facilities primarily located in urban areas also exacerbates the challenges of accessing services for adolescent mothers [59]. These access issues are particularly acute in LMICs, where mental health funding is low and resources are disproportionately distributed [10]. Adolescent mothers are particularly burdened, as they often face encounter additional barriers, including limited mobility due to economic or familial dependency, social stigma surrounding early motherhood, and reduced autonomy in decision-making [1,2]. These disparities further restrict access to mental health services, making it challenging for adolescent mothers in underserved areas to receive timely and appropriate mental health support.

Mental health interventions for adolescent mothers.

Our review identified only one interventional study incorporating Community-Based Peer Support. In the identified intervention, participants attended bi-monthly face-to-face sessions (12 total, 75 minutes each), with WhatsApp used for coordination, Q&A, and continued engagement. This approach led to a reduction in depressive symptoms and common mental disorders [61]. A comparable study conducted in South Africa echoed these findings, highlighting the benefits of peer group support in fostering emotional connection and meaningful social networks among adolescent mothers [86]. Sanders et al. (2022) further advocate for the integration of school- and community-based parenting programs to improve outcomes for young parents [87].

In light of findings from the review, we propose strategies for improving the mental health of adolescent mothers in LMICs.

• Establish structured community-based peer support groups where adolescent mothers meet regularly for guided discussions led by trained peers [61].
• Design mobile-based mental health tools (e.g., SMS or app-based counseling) that are low-cost and accessible, allowing adolescent mothers to receive emotional support and reduce stigma-related isolation, particularly in low-resource settings where mental health services are limited [61].
• Educate frontline healthcare workers to identify signs of emotional distress, suicidal ideation, and trauma among adolescent mothers using trauma-informed care principles, while fostering nonjudgmental attitudes [18,50].
• Implement targeted family and partner involvement programs that aim to reduce interpersonal violence, increase male engagement in postnatal care, and address underlying gender norms affecting adolescent motherhood and mental health [14].
• Integrate mandatory mental health screening and referral services into routine antenatal and postnatal care, using simple, validated screening tools adapted for adolescents [32].
• Design educational and vocational programs targeting adolescent mothers that not only improve skills and employability but also build self-esteem and resilience [8].
• Secure policy-level support and cross-sector collaboration, ensuring that ministries of health, education, and social welfare co-design and implement adolescent-responsive mental health programming [14].

Methodological.

The predominant emphasis on quantitative studies in this review highlights gaps in existing literature. Motherhood’s impact is highly individualized and challenging to quantify [88]. While quantitative methods are valuable for measuring mental health outcomes, their limitations in providing contextual understanding emphasize the importance of qualitative studies. The review findings highlight the need for context-specific qualitative studies to capture the diverse, culturally grounded experiences of adolescent motherhood.

Geographical.

The review analyzed 35 studies from 17 countries, which accounted for 13.1% of the total 137 LMICs. Specifically, only four studies were from South Asia, constituting 10% of the total 30 countries in that region, and no studies were identified from Latin America and the Caribbean, East Asia and Pacific, or Europe and Central Asia. These results indicate a constrained research landscape regarding this topic in LMICs. Possible contributing factors include structural inequities in global research funding, language barriers in publication, and institutional research capacities [89,90]. For instance, mental health research in Latin America and the Middle East is often marginalized due to linguistic exclusion and limited integration into international research agendas [6,72]. Additionally, contextual factors may influence the shaping of research priorities in these regions. For example, within the South Asian context, adolescent motherhood is often disguised by prevalent societal norms and cultural expectations, making it a silent struggle for young mothers who face limited access to healthcare and support systems [89]. The deeply rooted cultural taboos surrounding premarital pregnancies and early marriages [91] further exacerbate the challenges faced by adolescent mothers, hindering open discussions and comprehensive research on their mental health needs. Future funding should support research, potentially in all regions and countries, to understand the impact of adolescent motherhood on mental health.

Theoretical framework.

A lack of theoretical frameworks in the included studies emerged as a gap, which limits the ability to contextualize results, compare outcomes across contexts, and design culturally grounded mental health interventions for adolescent mothers in LMICs. Given the intricate nature of adolescent motherhood and its impact on mental health, incorporating theoretical foundations becomes essential to develop comprehensive and responsive strategies [92]. While the challenges of motherhood in isolation may contribute to negative mental health conditions, the intersection of this role with other socio-cultural identities (such as race, ethnicity, gender identity, sexual orientation, socioeconomic status) elicits distinctive circumstances that need to be considered. One promising theoretical framework for delving into the mental health experiences of adolescent mothers is the intersectionality perspective, which can be applied in future research to examine how overlapping identities such as age, gender, socioeconomic status, and cultural background collectively influence mental health outcomes. Researchers could use intersectional analysis to disaggregate data by multiple identity markers and explore how structural inequalities affect access to mental health services across different subgroups [93]. This lens can help uncover unique psychosocial stressors or barriers to care that arise from compounded forms of marginalization, thereby informing targeted interventions and culturally responsive policies [92]. Longitudinal or comparative studies using intersectional frameworks across varied LMIC settings could further illuminate context-specific disparities and resilience factors.

Another theoretical framework to consider is transition theory, which elucidates transition as periods of instability and vulnerability. Applying this framework in future studies could help researchers systematically examine the psychological and social shifts that adolescent mothers experience, from pregnancy through postpartum [94]. Future research might use this theoretical framework to map out stages of transition and identify both risk and protective factors influencing mental health at each phase. In LMIC contexts especially, the theoretical framework can guide culturally sensitive, stage-specific mental health strategies that address transitional stressors unique to adolescent populations [94].

In addition, the socioecological framework (which emphasizes multi-level influences from individual to policy level) and life course theory (which considers long-term effects of early exposures) can enable more holistic and equity-oriented approaches [23,78,79]. These theoretical frameworks can structure future studies to explore how community, familial, and institutional factors shape adolescent mothers’ mental health over time and help align research with appropriate mental health programs in LMIC settings.

Motherhood and mental health.

The review found that studies predominantly addressed individual transitional phases—antenatal, birth, and postnatal without extensively exploring the interactions and interdependencies between these phases. Only a limited number of studies (20%) consider both antenatal and postnatal periods, while just one study incorporates all three phases. This lack of integration between phases overlooks the continuum of motherhood experiences and the potential cumulative impact of multiple transitions on a woman’s journey into motherhood. Previous research suggests that an integrated approach to studying motherhood transitions, encompassing antenatal, birth, and postnatal phases, can provide a more nuanced understanding of the dynamic processes involved [4]. The interconnectedness of these phases highlights the need for a comprehensive perspective to capture the evolving nature of motherhood experiences. Addressing this gap in literature would contribute significantly to the existing knowledge base and facilitate a more holistic understanding of the complexities inherent in the transition to motherhood.

Further, the predominant focus of the studies was on mental health issues, particularly emphasizing mental health disorders and their symptoms among adolescents. Nevertheless, a notable gap exists in the research landscape, as there is a scarcity of studies exploring the predictors of mental health issues, barriers to the utilization of mental healthcare, mental health interventions, and coping strategies in this population. This gap suggests a need for a more comprehensive understanding of the factors influencing mental health and the resources available to address it among adolescent mothers. Furthermore, it was observed that certain studies did not explicitly designate mental health as a primary focus but rather included it as a subsection within the broader context of adolescents’ experiences related to motherhood. This observation highlights the importance of integrating mental health considerations more explicitly into research on adolescent motherhood, as mental well-being plays a critical role in their overall health and resilience. Recommendations include fostering more research efforts to investigate stressors and coping strategies for mental health outcomes, and urging a more integrated approach to studying mental health within the specific context of adolescents’ motherhood-related experiences [95].