Introduction

Adolescent motherhood is a significant global issue, with 21 million pregnancies occurring annually worldwide among girls aged 15–19, half of which are unintended [1]. Sub-Saharan Africa (SSA) reports the highest rate of childbirth among adolescent girls (aged 10–14) [1]. The health and social consequences of adolescent motherhood are particularly pronounced, as adolescence is a critical developmental stage marked by ongoing physical, emotional, and cognitive maturation [2]. This developmental vulnerability contributes to elevated maternal mortality and adverse social outcomes among adolescent mothers [3,4].

Prevailing social perceptions further compound the challenges of adolescent mothers, as they are often subjected to stigmatizing narratives that portray them as irresponsible or promiscuous [4]. Such stigma restricts access to education, healthcare, and social support, thereby deepening their exposure to resource insecurity, particularly food insecurity [5,6]. This is especially concerning in SSA, where hunger and food insecurity remain disproportionately high. Recent estimates indicate that more than 20% of the population in SSA experienced hunger in 2024, compared with 8.2% globally, and the region is projected to account for nearly 60% of the world’s chronically undernourished population by 2030 [7].

Food insecurity refers to limited or uncertain access to sufficient, safe, and nutritious food required for an active and healthy life [8]. Food insecurity ranges from low or moderate food insecurity, characterized primarily by compromised dietary quality and variety, to severe or very low food insecurity, in which food intake is reduced, and normal eating patterns are disrupted due to inadequate access to food [9]. It is important to distinguish food insecurity from hunger, which is a potential physiological consequence of more severe forms of food insecurity. Food insecurity is closely linked to a range of adverse psychosocial and physical health outcomes in adolescents, a population particularly vulnerable due to the rapid growth and development that characterizes this life stage [10]. These risks are amplified for adolescent girls who are pregnant or parenting. Compared to older mothers, adolescent mothers are more likely to be malnourished and to give birth to low-birth-weight infants, who themselves face heightened risks of malnutrition, illness, and mortality [11]. In addition to these physiological vulnerabilities, adolescent mothers frequently experience mental health distress driven by stigma, social exclusion, financial hardship, and unmet basic needs [12].

In SSA, where chronic hunger is prevalent, the convergence of adolescent motherhood and food insecurity may perpetuate a cycle of poor health outcomes [12–14]. Further, limited access to nutritious food, healthcare, and social support not only undermines the well-being of young mothers but also compromises the developmental trajectories of their children [11]. Addressing food insecurity is therefore essential to improving maternal and child health and mitigating the broader social consequences of adolescent motherhood. The food security of adolescent mothers and their children living in resource-constrained settings marked by intersecting poverty, hunger, and disease remains an urgent global concern.

Resource Scarcity Theory (RST) offers a multidimensional framework for understanding the drivers, coping mechanisms, and impacts of food insecurity [15]. RST conceptualizes shared social, economic, and ecological vulnerabilities to scarcity, coping strategies, and impacts on well-being [15]. It identifies five core predictors of scarcity: ecological conditions, population pressures, governance structures, market dynamics and entitlement systems that shape individuals’ legal and economic access to food. The coping strategies include modified consumption (e.g., reduced portions or stigmatized foods), migration, reprioritization of resources, and intensification of labour or asset liquidation [16]. RST highlights the physiological and psychological impact of resource insecurity on well-being, including stress, anxiety, and undernutrition. Food insecurity has also been linked to sexual health, including intimate partner violence (IPV) [17,18], transactional sex [19], and increased risk of recent HIV [18]. Applying RST to understand food insecurity not only illuminates the structural and psychosocial drivers of scarcity but also provides a foundation for identifying critical gaps in existing research.

Existing reviews have examined either the experiences of pregnant and parenting adolescents in Africa or the consequences of food insecurity among children and adolescents more broadly, but none has specifically focused on food insecurity among pregnant adolescents and adolescent mothers in SSA [20–22]. For example, Ajayi et al. (2023) synthesized the lived experiences of pregnant and parenting adolescents across Africa, highlighting challenges such as stigma, social exclusion, and barriers to healthcare and education. However, food insecurity was not the primary focus of the review, and its determinants, coping strategies, and health consequences were not comprehensively examined. Similarly, Kasujja et al. (2025) conducted a systematic review of food insecurity and mental health among children and adolescents aged 5–19 years in SSA and found significant associations between food insecurity and adverse mental health outcomes, including depression, mood problems, and other mental disorders. While this review provides important evidence on the impact of food insecurity among young people, it does not specifically address pregnant adolescents and adolescent mothers, a population that experiences unique vulnerabilities related to pregnancy, childcare responsibilities, gendered social expectations, stigma, and socioeconomic disadvantage [16,23].

To our knowledge, no previous review has synthesized evidence on food insecurity among pregnant adolescents and adolescent mothers in SSA. This scoping review addresses this gap by focusing specifically on this underserved population and mapping the existing evidence on the drivers of food insecurity, coping strategies, and associated mental health and sexual and reproductive health outcomes. By consolidating evidence across these interconnected domains, this review advances understanding of how food insecurity shapes the well-being of adolescent mothers and identifies critical research, policy, and programmatic gaps needed to inform interventions aimed at improving health outcomes and disrupting cycles of intergenerational disadvantage in SSA.

Method

Our scoping review followed the framework of Arksey and O’Malley, which was further enhanced by the Joanna Briggs Institute [24]. The steps include (i) identifying the research question, (ii) identifying relevant studies, (iii) study selection, (iv) charting the data, and (v) collating, summarizing, and reporting the results [24]. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines (S1 Table) [25]. A systematic review was not considered suitable for our broad search scope, as it is primarily designed to address narrowly defined questions and test specific hypotheses [26,27]. A scoping review was deemed appropriate for identifying relevant literature, mapping available evidence, and identifying knowledge gaps [24]. In contrast to systematic reviews, formal methodological quality appraisal is not a required component of scoping review methodology [23]. Therefore, a methodological quality or risk of bias assessment was not conducted, as the primary objective of this review was to map the breadth and characteristics of the available evidence rather than evaluate the effectiveness of interventions or synthesize findings for causal inference.

Result

The search results are presented in a PRISMA-ScR flow diagram [25], shown in Fig 1. A total of 311 results were identified using the search criteria, and then 48 duplicates were eliminated. Thereafter, two reviewers screened 263 articles for eligibility, and 240 articles were excluded (Fig 1). A full text review was conducted for 23 studies, and an additional four studies were identified from citation searching. A total of 16 articles were eligible and included for data extraction (Table 2).

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Fig 1. PRISMA flowchart of the number of unique records at each stage.

Source: Page MJ, et al. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1371/journal.pone.0346835.g001

General characteristics of included studies

The studies included in the review examined the food insecurity experiences of adolescent mothers in SSA countries (Table 1), using both qualitative and quantitative approaches. Most of the studies employed quantitative methods (n = 10). Ghana accounted for most studies (n = 7) [29–35], followed by South Africa [4,25,36–39], and Ethiopia [40,41]. Only single studies were identified from Nigeria [42], Malawi [43], and Uganda [44] (Fig 2). The articles are discussed below: categorized into an overview of drivers of food insecurity, coping strategies, and mental, sexual, and reproductive health (SRH) impacts. Five studies focused on pregnant adolescent mothers [29,30,40,42,43], and six studies examined parenting adolescent mothers [25–27,36,42,44] (Table 2). Three additional studies focused on both pregnant and parenting adolescent mothers [31–33]. While two studies by Carbone et al. (2019) and Toska et al. (2022) addressed adolescent mothers living with HIV.

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Table 1. Summary of included study characteristics.

https://doi.org/10.1371/journal.pone.0346835.t001

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Fig 2. Geographical distribution of the 16 studies reviewed in this article.

https://doi.org/10.1371/journal.pone.0346835.g002

Food insecurity was assessed using a range of measurement approaches across the included studies. Quantitative studies commonly employed validated instruments, including the Household Food Insecurity Access Scale (HFIAS) [29,40], the Child Food Insecurity Experience Scale (CFIES) [31], and measures derived from the South African National Food Consumption Survey [36]. One study used a locally validated household food insecurity questionnaire [45], while others used indicators such as food sufficiency [31], household hunger [30,42], or single-item measures of food insecurity [29,30]. Qualitative studies explored experiences of food insecurity through participant narratives. The heterogeneity in measurement approaches should be considered when comparing findings across studies.

Discussion

Findings from this scoping review provide a comprehensive overview of the economic, social, and ecological drivers, coping strategies, mental health, and SRH impacts of food insecurity among adolescent mothers in SSA. The studies were sparsely distributed across the region, with most studies concentrated in Ghana, South Africa, and Ethiopia, reflecting geographic research gaps (Fig 2). These findings can inform future research, interventions, and policy addressing food insecurity among adolescent mothers in SSA.

Applying Resource Scarcity Theory (RST) provided a useful lens for understanding how social, economic, and ecological vulnerabilities intersect to shape food insecurity among adolescent mothers in SSA [15]. Across the included studies, structural drivers such as poverty, educational disruption, stigma, caregiving responsibilities, limited livelihood opportunities, and environmental constraints contributed to conditions of resource scarcity that constrained adolescent mothers’ ability to meet their basic needs. In response, adolescent mothers adopted a range of economic, social, and survival-oriented strategies to navigate food insecurity. These experiences were further associated with adverse mental, sexual, and reproductive health outcomes, including depression, suicidal ideation, HIV-related risk behaviours, and poor treatment adherence. Drawing on these interconnected findings, we developed a conceptual framework (Fig 3) that illustrates the pathways linking structural drivers, food insecurity, coping and survival responses, and health outcomes among adolescent mothers in SSA.

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Fig 3. Conceptual framework of social, economic, and ecological drivers, coping responses, and health impacts of food insecurity among adolescent mothers in SSA.

https://doi.org/10.1371/journal.pone.0346835.g003

Ecological drivers were particularly critical for adolescent mothers living in rural communities who depended on agriculture for their livelihoods. This factor is under-researched. Just one study in Cape Coast, Ghana, reported how anthropogenic environmental degradation rendered the soil infertile, highlighting systemic issues [33]. Although evidence from this review was limited, these findings should be understood within the broader context of environmental vulnerability in SSA, where declining agricultural productivity, land degradation, and climate-related shocks may reduce food availability and access among households dependent on agriculture [47]. Adolescent mothers may be especially vulnerable to these disruptions because of their limited economic resources and dependence on household and community food systems. Further research is needed to better understand how environmental and climate-related factors intersect with social and economic vulnerabilities to shape food insecurity among adolescent mothers in SSA.

Our review also noted how food insecurity was consistently linked to poor mental health outcomes. This pattern mirrors evidence from other low-resource settings in SSA and high-income countries where food insecurity amplifies the psychological burden [48,49]. For example, research among low-income single mothers, older than 18 years in Virginia, USA, showed that those experiencing food security reported poor mental health [48]. Similarly, findings among displaced and refugee youths in Kampala reported a similar association between chronic food insecurity and depression [49]. These findings align with evidence on the mental health consequences of uncertainty in obtaining food, feelings of shame, and awareness of social inequities [50]. Future studies should consider examining the pathways from food insecurity to poor mental health among adolescent mothers [50].

Food insecurity had significant implications for sexual and reproductive health among adolescent mothers. Limited access to food and economic resources due to broader structural inequalities increased vulnerability to transactional and coercive sexual relationships among some adolescent mothers [33]. These experiences should be understood within the context of constrained economic opportunities, social disadvantage, and gendered power relations, rather than as individual risk-taking behaviours. Evidence from South Africa further demonstrated that food security was associated with lower odds of transactional sex, age-disparate sex, and other HIV-related risk behaviours [36], suggesting that addressing food insecurity may reduce exposure to adverse sexual and reproductive health outcomes.

While the study by Toska et al. (2022) reported that food insecurity did not differ by HIV status, the rates of food security among children born to adolescent mothers living with HIV were lower compared to adolescent mothers who are HIV negative. This suggests that the effects of food insecurity may extend intergenerationally and intersect with maternal HIV status.

These findings highlight several areas for intervention and program development. For governments and social protection agencies, the evidence suggests a potential role for food assistance, cash transfer programs, and livelihood support initiatives targeted at pregnant and parenting adolescents [29,34]. Within the education sector, school re-entry initiatives, literacy programs, and vocational skills training may help address educational disruption and improve future economic opportunities [51]. Healthcare providers may benefit from integrating food insecurity screening and referral pathways into adolescent-friendly sexual and reproductive health, antenatal, postnatal, and mental health services [52]. Collectively, these approaches may help address the interconnected social, economic, and health challenges associated with food insecurity among adolescent mothers, although further intervention research is needed to determine their effectiveness.

Existing research has largely focused on links between food insecurity and HIV/STI vulnerability, with limited evidence on its effects on other critical dimensions of sexual health, such as sexual and gender-based violence (GBV), sexual function, and psychosexual counselling, and reproductive health, including antenatal, intrapartum, and postnatal care; contraception, fertility care, and safe abortion care [53]. Further research on other marginalized adolescent mothers, including those living with disabilities, was not available. Addressing these gaps is essential for developing holistic interventions that integrate food security into broader SRH service delivery for adolescent mothers.

Some research gaps were evident from this review. Existing studies are also geographically concentrated in a small number of SSA countries, with large regions remaining unrepresented, and rarely consider ecological drivers of food insecurity. While food insecurity is known to heighten SRH risks through pathways such as transactional or coerced sex and increased vulnerability to HIV and other STIs, its relationship to other sexual health domains, including sexual and gender-based violence, sexual function, psychosexual counselling, and comprehensive sexuality education, remains largely unexamined. Similar gaps exist for reproductive health areas such as antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care. Addressing these evidence gaps through geographically diverse longitudinal research that provides insight into causal pathways between food insecurity and poor health outcomes (mental health and SRH) in SSA will be critical for developing effective, context-specific interventions that address the intertwined challenges. Lastly, further investigation is needed to understand the role of stakeholders in supporting livelihood opportunities for adolescent mothers.

Conclusion

Our scoping review highlights that food insecurity is a critical yet underexamined determinant of adolescent mothers’ health and well-being in Sub-Saharan Africa. Applying the Resource Scarcity Theory highlighted how resource scarcity shapes the health and well-being of adolescent mothers in SSA. Future research should move beyond predominantly cross-sectional, quantitative designs to include longitudinal, qualitative, and mixed methods approaches that capture lived experiences, relational dynamics, and causal pathways. Expanding the scope of inquiry to underexplored SRH domains will be vital to advancing holistic understandings of adolescent mothers’ needs. By centring adolescent mothers in future research and policy, stakeholders can ensure that solutions are not only evidence-informed but also sustainable, equitable, and transformative.

Supporting information

Acknowledgments

The authors wish to acknowledge the assistance of the University of Toronto librarians.