Pregnant and parenting teens in Nairobi’s informal settlements: the hidden mental toll of stigma

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Pregnancy is demanding at any age. But for adolescents, it comes on top of everything else they are dealing with: school, relationships, and the passage into adulthood. Add the hormonal shifts and shock of an unplanned pregnancy, and the weight of societal disapproval, and it is little wonder that pregnant adolescents are at heightened risk of mental disorders.

Existing studies have largely focused on quantifying the burden of mental health problems and their risk factors among pregnant and parenting adolescents. Less attention has been paid to understanding how pregnant and parenting adolescents themselves experience, interpret and navigate these mental health challenges in their everyday lives.

We have spent a combined 40 years researching adolescent sexual and reproductive health across Africa, and what policymakers can do to alleviate their pressures. In our most recent paper we looked at the social consequences of adolescent pregnancy. In particular we examined experiences of stigma, rejection, social isolation and lost opportunities that affected adolescents' mental health and how the girls coped with the pressures.

Our study drew from interviews with 22 pregnant and parenting girls and 10 parents or caregivers in an urban informal settlement in Nairobi, Kenya, where adolescent childbearing is common. The burden of adolescent childbearing in Kenya's informal settlements is disproportionately high, with birth rates reaching roughly 116 per 1,000 girls aged 15-19 (compared to a national average of 73 per 1,000).

We found that much of the mental distress they experienced was socially produced, through paternity denial, financial precarity, humiliation and exclusion by family, school, church and community.

Girls carry the blame; male partners remain socially invisible. We argue that stakeholders should move beyond moralising adolescent pregnancy and instead provide comprehensive, evidence-informed support that enables adolescent girls and their children to thrive.

Three layers of distress

Our study explored the social pressures that contributed to psychological distress among pregnant and parenting adolescent girls, and what factors helped them cope.

We identified three layers of distress:

• costs

• stigma

• shame.

The first was the kind of hardship any struggling household faces: the cost of food, rent, school fees and sanitary products. Many of the girls we spoke to already lived with single mothers scraping by on unstable, low-paid work. Pregnancy stretched that thin income further. Several girls described turning to high-interest mobile loans which only deepened their financial stress.

Most of the girls reported that the fathers denied paternity or refused support after initially promising to help. They were left to shoulder childcare and household costs alone. Also, participants reported that employers were unwilling to hire them or accommodate their children, pushing some of them into longer working hours for little pay.

An 18-year-old parenting girl recalled:

They tell you that they will employ you but without the child or that you take your child to daycare, yet you do not even have money. It takes me two hours to wash clothes, I get paid 250 shillings [US$2] because of the child. She only sits on her own for five minutes then you must pick her up and that is why it takes longer to wash the clothes.

The second layer was distinctive to their new, stigmatised status as pregnant or parenting adolescents. This form of distress is based on family, friends and community reactions to adolescent pregnancy. It stems from the perception of adolescent pregnancy as an individual's moral failing.

The girls we interviewed weren't just struggling quietly. They were publicly shamed, mocked, whispered about and shunned by neighbours, teachers, classmates and even close friends. Fathers reportedly blamed the girls' mothers for “failing” to protect and control their daughters, and this triggered conflicts. One adolescent girl told us her father called her “a burden and embarrassment”. Several girls dropped out of school even when they wanted to continue their education. Yet the boys and men who got them pregnant were invisible.

The third layer was internal. Having absorbed months of judgement and rejection, many adolescent girls described overwhelming shame, guilt and a sense of worthlessness. Some withdrew from friends and family entirely. In the most severe cases, this internalised distress escalated into suicidal thoughts or attempts. And, in a context where abortion is heavily restricted, some girls turned to unsafe methods to try to end unwanted pregnancies out of desperation rather than choice.

A 16-year-old parenting adolescent girl shared:

I wanted to hang myself. I thought maybe my parents would chase me away or beat me, I used to come back (from school) and cry, cry, and cry. I tried taking tea with a lot of tea leaves (to abort) but it never worked out. I wanted to buy poison and take it … Something used to tell me to get out of the house get hit by a vehicle and die because I have wronged my parents.

What helped?

Not all experiences followed the same trajectory.

Supportive family relationships were consistently described as critical turning points. Adolescents whose parents responded with acceptance rather than punishment frequently reported feeling better able to cope with their circumstances. In several cases, adolescent girls highlighted that reassurance from a parent was particularly important in helping them regain a sense of stability and mental safety. A 19-year-old parenting young woman shared:

My mother found out about the pregnancy when it was three months. She encouraged me by telling me that it was not the end of everything, and she was still going to be my mother no matter the situation I found myself in.

Grandmothers commonly provided practical assistance, especially childcare and emotional support. Community-based groups also played an important role by offering counselling, material support and opportunities for social connection.

Interactions with other pregnant or parenting adolescents were highly valued. They provided a sense of solidarity, reduced isolation, and reassured girls that others faced similar challenges and had found ways through them.

What needs to change?

Our findings suggest that reducing the mental health toll of adolescent pregnancy requires more than just economic support, though that matters too.

Interventions also need to directly address stigma in schools, religious institutions, health facilities and neighbourhoods and expand access to psychosocial support.

Policymakers and other key stakeholders addressing this issue need to move beyond pregnancy prevention to comprehensive support systems that enable young mothers to thrive.

Anthony Idowu Ajayi works for the African Population and Health Research Center. He receives funding from the African Regional Office of the Swedish International Development Cooperation Agency (Sida) under grant contribution number 16302, awarded to the African Population and Health Research Center for the Challenging the Politics of Social Exclusion project.

Caroline Kabiru receives funding from the Swedish International Development Cooperation Agency (Sida) through a grant to the African Population and Health Research Center for the Challenging the Politics of Social Exclusion project (Sida Contribution No. 16302). The views expressed herein do not necessarily represent those of Sida.

Vallery Auma Obure works for the Africa Population and health Research.

By Anthony Idowu Ajayi, Research Scientist, African Population and Health Research Center And

Caroline W. Kabiru, Senior Research Scientist, African Population and Health Research Center And

Vallery Obure, social scientist, African Population and Health Research Center