Background Globally, there were approximately 21 million adolescent pregnancies in 2019, of which half were unplanned. Adolescent pregnancy is an issue of social and health inequity: it hinders young mothers’ chances of continuing with school, and is associated with higher exposure to domestic violence, HIV, and food insecurity. While schooling is a well-known determinant of health, an implementation gap exists in supportive provisions. While protective factors such as school engagement enable improved health outcomes and educational attainment for adolescent mothers, yet limited evidence exists on how school and community stakeholders can can adapt to support these learners. This formative, participatory research engaged young people's expertise to inform implementation priorities for supporting adolescent mothers' educational attainment. Methods This study aimed to co-construct potential support package components, in partnership with young people from a community-academic partnership called a “Teen Advisory Group”. We conducted participatory priority-setting research with a Teen Advisory Group (TAG) of young research advisors (n = 13, ages 21–25) in Eastern Cape, South Africa, over eight weeks in July-August 2022. Using a socio-ecological framework and positive youth development theory, data co-creation occurred across three stages: (1) introductory phone calls; (2) remote engagement through a closed Facebook group (n = 7) with weekly activities; and (3) a 3-day face-to-face participatory design workshop featuring gallery walks, gender-separated group interviews, and arts-based "dreamy care package" activities. Evidence-based comic storylines informed exploratory discussions. Activities were conducted in English and isiXhosa, and analyzed using reflexive thematic analysis combining deductive and inductive approaches, validated through member-checking with advisors (n = 10). Results Adolescent pregnancy exposed young mothers to various forms of stigma, at home, amongst peers, and from the community. Young research advisors described support figures such as social workers and healthcare professionals as important figures who would help them from dropping out of school and prevent further pregnancies. Family-level support mostly helped ease the burden of childcare for the young mother. Staying motivated and focused by setting goals for themselves also kept pregnant and mother learners motivated to continue with school. The young mothers suggested that the government could support adolescent mothers by subsidising formal childcare and some baby essentials during early motherhood. Conclusions Our findings emphasize a multi-faceted approach to supporting pregnant and mother learners. This includes stigma reduction interventions at the household and community level, enhanced teacher training to provide psychosocial and health support, and the provision of accessible and affordable childcare to facilitate a return to school. Furthermore, our results underscore the need for stronger social support systems, multi-sectoral collaboration to integrate healthcare and social work services in schools, and the adoption of youth-led participatory approaches to ensure interventions are relevant and effective.

In resource-constrained settings, structural and material inequalities shape children’s developmental opportunities, yet developmental pathways remain diverse even within shared hardship. This study examined developmental continuity and variation in cognitive trajectories among children born in adversity and assessed whether maternal structural positioning and household material conditions were associated with developmental progression. Data were drawn from 742 children born to adolescent mothers in the large longitudinal cohort in the Eastern Cape, South Africa. Cognitive functioning was assessed using the Mullen Scales of Early Learning (MSEL) at baseline and the Kaufman Assessment Battery for Children (KABC-II) at follow-up. Baseline functioning predicted later cognitive placement, indicating developmental continuity (B = 0.074, SE = 0.030, p = .015). Lower maternal educational attainment was associated with more constrained developmental progression (B = −0.097, SE = 0.023, p < .001), and maternal not in education, employment, or training (NEET) status also predicted constrained trajectories (B = −0.200, SE = 0.049, p < .001). In contrast, consistent access to basic household necessities was associated with more favourable developmental trajectories (B = 0.024, SE = 0.009, p = .012). These findings indicate that variation in children’s developmental trajectories reflects differences in structural positioning and household material conditions. Supporting adolescent mothers’ engagement in education and access to stable resources may represent an important pathway for improving child developmental outcomes.

Despite growing recognition of the need for adolescent-responsive HIV and sexual and reproductive (SRH) health services, implementation remains inconsistent, especially in Africa and other low - and middle-income countries where HIV rates are highest. Frontline health and social providers play a critical role in delivering care; however, little is known about their training needs or how to strengthen their capacity in these settings. This study draws on qualitative participatory data from 801 providers across 24 sites in 12 African countries with a high HIV burden, collected during the Paediatric-Adolescent Treatment Africa (PATA) Summit in 2022. Through word association, ranking exercises, and focus group discussions, participants identified training and capacity building as their top priority for service improvement. Thematic analysis revealed three key findings: (1) providers experience training and supervision as empowering - improving their confidence and quality of care; (2) significant gaps exist in training content and capacity building, especially in adolescent-responsive, non-judgemental, and psychosocial care; and (3) training opportunities are often inequitable and lack continuity. Providers emphasized the need for ongoing and equitable access to training opportunities. The findings underscore the urgent need for integrated capacity-building strategies that combine knowledge, mentorship, and systems-level support to strengthen adolescent HIV and SRH services in resource-limited settings.

Adolescent parenthood is a significant issue in Sub-Saharan Africa, which can have adverse effects on mothers, their children and families. South Africa faces challenges in ensuring inclusive education for adolescent girls and young women due to high dropout rates resulting in and contributing to adolescent pregnancy. While a sound policy framework for pregnant and mothering adolescents exists, implementation challenges persist, emphasising the need for effective interventions to support pregnant and mothering adolescents return to and complete their schooling. This commentary brings together quantitative data from surveys with 1046 adolescent mothers in South Africa's Eastern Cape province, coupled with participatory design incubators with young people (N = 13) in the same setting to provide implementation recommendations for policy and practice, with specific reference to the Department of Basic Education's Policy on the Prevention and Management of Learner Pregnancy in Schools. Analysing across the two data sources involved using a socio-ecological lens that acknowledges the multi-level factors and longer-term trajectories that influence adolescent mothers' schooling trajectories. Three inter-related implementation recommendations to support pregnant and mothering adolescents schooling emerge through data triangulation and analyses: (1) supportive school environment, (2) promoting peer-based support, and (3) establishing strong partnerships and referral mechanisms beyond the school setting. These recommendations are grounded in evidence, align with South Africa's existing policy framework, and speak to the expressed needs of adolescents and young people, aiming to address the complex challenges faced by pregnant and mothering adolescents. Evidence-informed interventions to support pregnant and mothering adolescents schooling can ultimately contribute to health, education, and gender equality goals. Stakeholder engagement, especially co-design engagements with pregnant and mothering adolescents, and research, monitoring and evaluation to test intervention feasibility and acceptability are essential for refining and scaling-up interventions to improve the well-being of adolescent mothers and their children.

BACKGROUND:Fathers are intricately bound to the experience of adolescent mothers and their children. Yet, fathers of children born to adolescent mothers, particularly within the context of HIV, remain neglected in the literature. These exploratory analyses provide insight into the characteristics of fathers of children born to adolescent mothers affected by HIV in South Africa. SETTING:Eastern Cape Province, South Africa. DESIGN:Cross-sectional data from a prospective cohort study. PARTICIPANTS:Young mothers (10-24 years of age) and their children (0-68 months). All mothers completed detailed study questionnaires, including standardised and study-specific measures, relating to their self, their children and the fathers of their children. Summary statistics are presented based on maternal self-report of father characteristics. χ2 tests and t-tests (Fisher's exact/Kruskal-Wallis tests, where appropriate) were additionally used to explore sample characteristics (including father characteristics, maternal experience and child characteristics) according to paternal age and father involvement in childcare (defined by responses to four maternal self-report questions). Father characteristics were also explored according to maternal HIV status and maternal mental health status. RESULTS:40% of fathers were adolescents (10-19 years) at the birth of their children. Overall, father involvement was low (19.5%). Compared with noninvolved fathers, involved fathers were more likely to be older when their child was born (21 years vs 20 years, t=4.30, p=0.04), to be in a relationship with the mothers of their children (74.8% vs 47.2%, χ2=40.8, p≤0.0001), to reside with their children and their mothers (14.7% vs 3.7%, χ2=49.3, p≤0.0001) and to attend the first antenatal appointment (4.3% vs 1.5%, χ2=5.21, p=0.02). A quarter (25.4%; 227/894) of the adolescent mothers in the sample were living with HIV. The prevalence of maternal HIV was found to be higher among adolescent mothers of children born to older fathers compared with adolescent fathers (31.7% vs 15.9%, χ2=28.3, p≤0.001). Likewise, depressive symptoms were more prevalent among adolescent mothers of children born to older fathers compared with adolescent fathers (9.9% vs 5.3%, χ2=6.08, p=0.01). Adolescent mothers reporting poor mental health were less likely to be in a relationship with the fathers of their children (41.8% vs 54.1%, χ2=7.32, p=0.03) and more likely to experience domestic violence perpetrated by the fathers of their children (8.2% vs 3.3%, χ2=6.07, p=0.01) and to engage in arguments about finances with the fathers of their children (30.0% vs 17.0%, χ2=10.8, p=0.001). While some differences in individual subscales were identified, overall composite scores of child cognitive development did not differ according to father age or father involvement. CONCLUSIONS:Analyses provide the first preliminary description of the fathers of children born to adolescent mothers affected by HIV in South Africa. Fathers are inherently tied to the experiences of adolescent mothers and their children. Father involvement with their children was low. Further research is required to explore the potential barriers to father involvement and pathways to overcome these. Efforts to bolster father engagement, such as the inclusion of fathers within maternal and child service provision, may have benefits for fathers, adolescent mothers and their children. There was a high prevalence of adolescent fatherhood in the study. Adolescent fathers may have specific needs requiring tailored intervention for adolescent parent families. The need for the inclusion of fathers within policy, programming and research remains.

Background: Nurses have a critical role to play in the delivery of sexual and reproductive health (SRH) services to adolescents and young people. Nurses’ interactions with adolescents and young people can shape sexual and reproductive behaviours and outcomes, including willingness to access and engage with healthcare services. However, little research from low- and middle-income contexts has explored nurses’ firsthand perspectives regarding their relationships with adolescents and young people in the context of SRH service provision, especially since the COVID-19 pandemic. Aim: This study explored nurses’ perceptions of working with adolescents and young people as well as how these impressions manifest in one-on-one exchanges between nurses and young patients. Method: Semi-structured interviews were conducted with 20 nurses providing SRH services to adolescents and young people and based at public health facilities in urban, peri-urban and rural areas within a health sub-district of the Eastern Cape province of South Africa. Data were analysed using an inductive thematic approach. Results: While many nurses described the challenges facing adolescents and young people in an empathic way and expressed a desire and willingness to engage with and educate them, some found it ‘difficult to break through’. Nurses linked this difficulty to the shame adolescents and young people feel when discussing SRH concerns, but also to them having ‘attitude’ and ‘not listening’. Findings highlight how while nurses may genuinely care about providing services to their young patients, internal and social biases may impact their motivation and willingness to effectively support adolescents and young people within the context of SRH service provision. To improve patient–provider relations, we suggest a focus on practical and participatory interventions to improve interpersonal dynamics.

Globally, education of children with disabilities increasingly occurs in inclusive school settings, requiring specialised teacher education. Scholars emphasise relational and instrumental skills, to overcome prejudice and exclusion. Visual impairment (VI) is emotionally evocative, presenting particular challenges to inclusion. Using data from in-service teacher education for VI inclusion in South Africa, this theoretical paper explores the personal and emotional barriers which teachers must negotiate surrounding the 'new reality' of VI in their classrooms if successful inclusion is to be achieved, and how teacher education may support this. We set qualitative data from an in-service short course for teachers of VI learners against ideas from disability studies, critical psychoanalysis and anthropology, conceptualising relational issues arising from VI in the classroom. Due to VI's evocation of unconscious anxieties in the observer, we argue that the experiences and needs of children with VI may be felt as 'matter out of place' in the classroom, confounding inclusion. Teacher anxiety threatens the capacity for containment and creativity, undermining the secure relationship which is elemental to successful learning. To manage the experiences, feelings and needs of VI learners, teachers require education which facilitates processing of their own emotions surrounding this evocative form of disability.

Despite a sound policy framework, the right of learners with disabilities in South Africa to inclusive and equitable quality education is not being met. A key reason hindering the realisation of this right is that there are very few teacher education programs focused on supporting learners with disabilities. Acknowledging the urgency of teacher education, in this paper we draw on qualitative data from 109 teacher participants and 39 course facilitators of a series of disability inclusion-focused teacher education short courses in the Western Cape province of South Africa. Based on their experience of the courses, we consider how teachers can be empowered to meet the diverse needs of their learners within an inclusive framework. Findings highlight that professional and personal growth facilitated a more empathic understanding of learners and the opportunity to collaborate with others, enabling teachers to find creative ways of solving problems faced in their workplaces. To support teachers in meeting the needs of their learners, teacher training should facilitate active reflection on the role they play in shaping the lives of their learners, and prepare teachers to respond to challenges strategically, taking advantage of the resources available to them within and beyond their school environment.

This paper considers teacher education for teachers of learners with severe to profound disabilities (SPD) in South Africa, in both formal and non-formal learning programmes within a disability studies in education framework. Qualitative data were collected from a range of education stakeholders including non-governmental (NGOs) and disabled people organisations (DPOs). Based on a thematic analysis, findings show limited pre-service teacher education programmes focused on teaching learners with SPD. In-service teacher training through education departments and NGOs and DPOs, is usually through basic short courses or workshops and are not complemented by on-going support. We argue for a reconceptualization of teacher education in South Africa to prepare teachers to meet the diverse needs of learners, including those with SPDs within an inclusive education context. Skills in addressing barriers to learning should be infused throughout initial teacher education, in line with the principles of universal design for learning while impairment-specific knowledge can be offered in related modules that focus on reasonable accommodation for children with disabilities. In-service education can occur in formal and informal programmes and should empowers teachers to become lifelong learners.

Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12-24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017-2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers.

Recent data protection regulatory frameworks, such as the Protection of Personal Information Act (POPI Act) in South Africa and the General Data Protection Regulation (GDPR) in the European Union, impose governance requirements for research involving high-risk and vulnerable groups such as children and adolescents. Our paper's objective is to unpack what constitutes adequate safeguards to protect the personal information of vulnerable populations such as children and adolescents. We suggest strategies to adhere meaningfully to the principal aims of data protection regulations. Navigating this within established research projects raises questions about how to interpret regulatory frameworks to build on existing mechanisms already used by researchers. Therefore, we will explore a series of best practices in safeguarding the personal information of children, adolescents and young people (0-24 years old), who represent more than half of sub-Saharan Africa's population. We discuss the actions taken by the research group to ensure regulations such as GDPR and POPIA effectively build on existing data protection mechanisms for research projects at all stages, focusing on promoting regulatory alignment throughout the data lifecycle. Our goal is to stimulate a broader conversation on improving the protection of sensitive personal information of children, adolescents and young people in sub-Saharan Africa. We join this discussion as a research group generating evidence influencing social and health policy and programming for young people in sub-Saharan Africa. Our contribution draws on our work adhering to multiple transnational governance frameworks imposed by national legislation, such as data protection regulations, funders, and academic institutions.

Background: While growing evidence has documented risks and resilience to HIV and poor sexual and reproductive health (SRH) among young women, young mothers' abilities to respond to and overcome challenges have been understudied. Developing appropriate methodologies to measure resilience in the context of HIV, especially among young mothers, is a critical first step to filling this gap. We aimed to improve the relevance, and comprehensibility of an open-access resilience measure for use among young mothers living in HIV-endemic communities in South Africa. This paper summarizes a two-stage study that was carried out in the Eastern Cape, South Africa.Methods: First, n = 9 cognitive interviews were conducted to inform the adaptation of the Child and Youth Resilience Measure Revised (CYRM-R) for use among young mothers (n = 7 living with HIV). The adapted measure was applied in remote interviews with 892 adolescent mothers during the COVID-19 pandemic (December 2021-April 2023). We investigated the basic psychometric properties of the adapted measure using STATA16.Results: Cognitive interviews offered unique perspectives on how to modify items in English and isiXhosa, including items that had similar understandings and responses, with new probes and additional key words added to seven items. Participants' understanding of item wording and the translation of items resulted in word changes or substitution to maximise participants' understanding of eight out of 17 items. The utilization of vignettes proved to be useful in engaging participants to reflect on their experiences. The revised scale had moderate psychometric properties. The EFA confirmed a two-factor structure, and the internal consistency of the CYRM-R was moderate (alpha = 0.75; omega = 0.75).Conclusion: Cognitive interviews supported the adaptation of a resilience measure for adolescent mothers affected by HIV in South Africa. Initial psychometric properties highlight possible further adaptations needed, potentially due to the unique population of adolescent mothers.

While substantial research has emerged from the frontlines of the COVID-19 pandemic, as well as from studies with adolescent populations, there has been a dearth of research focused in South Africa on the context-specific experiences of healthcare workers (HCWs) and the adolescents and young people (AYP) to whom they provide services. This article documents the experiences of provision and receipt of HIV and sexual and reproductive health (SRH) services during the COVID-19 pandemic from the perspective of South African HCWs (n = 13) and AYP (n = 41, ages 17-29). Findings highlight several barriers to accessing comprehensive HIV and SRH services during the pandemic including lockdown-related mobility restrictions (reported by HCWs), prioritisation of COVID-19 above other healthcare needs, longer health facility waiting times, poor treatment by HCWs (reported by AYP), discomfort and perceived stigma from having to queue outside health facilities, and fear of contracting COVID-19 (reported by both groups). While HCWs reported that HIV and SRH services continued to be available during the pandemic, AYP described seeking these services - such as long-acting reversible contraception, check-ups for their babies and medical refills - and being told that because they were not considered emergency cases, they should return on a different date. By capturing diverse experiences and perspectives from both groups, our findings reiterate the growing call for health system investments to strengthen the delivery of adolescent services, including investing in appropriate channels of communication between young people and their healthcare providers (for example, through adolescent peer supporters or community healthcare workers) and differentiated models of service delivery (for example, multi-month ART refills and community pick-ups). Closing the gap between the experiences and needs of adolescents and the healthcare workers who serve them may support young people and HCWs in buffering against changes brought about by the COVID-19 pandemic.

Despite the need for inclusive education in South Africa, many teachers have not been appropriately trained for the inclusion process for learners with disabilities in classrooms. A consideration of teacher education for inclusive education involves examining both the structural and professional barriers to training that prevent effective implementation. We review the outcomes of a teacher education project in South Africa through three studies that emanate from Teacher Empowerment for Disability Inclusion (TEDI) at the University of Cape Town. These studies are a situation analysis; a survey of teacher education availability for working with learners with severe disabilities; and an evaluation of short courses. We draw on these studies to develop a holistic picture of the kind of training needed to develop the knowledge, attitudes and skills of teachers to address barriers to learning that arise from disability. This entails a conceptual analysis of how the different elements of training work together to address learner needs.

Deaf learners are among the most disadvantaged when it comes to educational outcomes in South Africa. The aim of this paper, therefore, is to explore the educational needs of learners who are deaf and use the findings as a basis from which to strengthen their education. This research employed a qualitative research design, drawing on interviews with deaf learners, teachers, school management team members (SMTs) and parents. Data were analysed using thematic analysis. Findings reveal that deaf learners have significant difficulty in communicating with their teachers, and that teachers of the deaf in South Africa are not sufficiently trained to understand the educational needs of their learners. Recommendations regarding the strengthening of training for teachers of the deaf are made.

A África do Sul estabeleceu um sistema de Educação Inclusiva que mantém escolas especiais para atender estudantes que demandam grandes necessidades de apoio e centros de apoio vizinhos às escolas comuns. Embora haja discussão sobre o que agregam ou não as escolas especiais, existem relativamente poucos estudos que se propõem a compartilhar as perspectivas de estudantes dessas escolas. Este estudo baseia-se em entrevistas com 39 estudantes de seis escolas especiais e dois de centros educacionais de apoio. As entrevistas foram transcritas e submetidas à análise temática de conteúdo, o que revelou que os estudantes se sentem desapontados, pois suas deficiências não são compreendidas pelos professores. Eles expressam a necessidade de maior apoio social e psicológico relativo às suas experiências escolares, à deficiência e aos problemas sociais. Eles também apontam a necessidade de os professores serem mais pacientes e comprometidos. Os estudantes que vivem em instituições de acolhimento destacam as condições precárias de vida e a ausência de apoio dos cuidadores dessas instituições, o que impacta sua possibilidade de aprendizagem. As necessidades que foram identificadas pelos estudantes podem subsidiar professores que se interessam em melhorar a qualidade da educação ofertada.

Growing evidence documents the effects of the COVID-19 pandemic on adolescents in East and Southern Africa. We present and explore the longitudinal health and development-related priorities and challenges of adolescent advisors in South Africa and Kenya, including prior to, and during the COVID-19 pandemic. Findings were co-generated with adolescent advisors in the Eastern Cape Province of South Africa (n=15, ages 18-22 in 2019) and Kisumu, Kenya (n=16, ages 10-14 in 2020). Prior to COVID-19, adolescent advisors engaged in a participatory exercise to share and explore their health and development-related priorities and challenges in 2019 and 2020. During the COVID-19 pandemic in 2020 and 2021, members of the same groups shared their experiences, challenges and coping strategies in semi-structured telephone interviews (Eastern Cape: n=14, aged 19-23; Kisumu n=12, aged 11-16) and group-based remote participatory social media activities (n=27 activities with n=12 advisors, Eastern Cape). We thematically analysed COVID-19 activities, considering them alongside pre-pandemic priorities and challenges. Many of the health and development-related priorities and challenges identified prior to COVID-19 remained issues of concern during COVID-19. These included education; victimization and violence; teenage pregnancy; substance use; household tension, conflict and inadequate family and caregiver support; health and medication concerns (South Africa) and water and food shortages (Kenya). Other issues such as financial insecurity, mental health, and crime were strong themes that emerged during COVID-19, which were not directly reported as priorities prior. Although almost all of adolescent advisors' most pressing pandemic-related challenges were also priorities for them prior to COVID-19, these issues were often discussed as new, and caused by the onset of COVID-19. While demonstrating how COVID-19 has exacerbated pre-existing vulnerabilities, we also suggest that the pandemic may have brought about a new way for adolescents to make sense of, and articulate pre-existing challenges.

Vaccines are an essential public health intervention in response to global emerging infectious diseases such as COVID-19. South Africa aims to vaccinate 67% of its population in 2021 to contain the transmission and effects of COVID-19. While evidence suggests that younger South African adults may be less likely to accept vaccines than older adults, little is known about vaccine hesitancy among South African adolescents and young people. This chapter discusses findings on vaccine-related beliefs, intentions and acceptability from participatory work with South African adolescents and young people ages 17 to 29 years, conducted through online closed-group activities. Findings highlight vaccine hesitancy among adolescents and young people that, if not addressed, may undermine the effectiveness of the vaccine-based COVID-19 response. Reasons provided for reluctance to use vaccines include: mistrust of government and scientists; low illness vulnerability perceptions; conspiracy-related beliefs; fear of injections and potential side-effects, and a preference for non-biomedical (traditional and/or natural) remedies. Potential enablers of vaccine acceptability and uptake include: receiving information from trusted sources; the desire for safety; perceived vaccine effectiveness, and observing the safe uptake among trusted people such as peers and family members. Access to accurate information is important, but may in itself be insufficient. We suggest a multi-dimensional approach aimed at addressing perceptions of low vulnerability to disease, mistrust and the perceived effectiveness and safety of vaccines. Ensuring accurate information from trustworthy sources, meaningfully engaging traditional and alternative health practitioners, developing family- and peer-based initiatives, and building trust in government and international health infrastructure may support vaccine uptake, thus strengthening social and health outcomes for South Africa’s next generation.