Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub- Saharan Africa: A systematic review

Joan Mutahi, Department of Psychiatry, College of Health Sciences, University of Nairobi,
Anna Larsen, Department of Global Health, University of Washington, Seattle, WA, United States
Pim Cuijpers, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherland
Stefan Swartling Peterson, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
Jurgen Unutzer, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
Mary McKay, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
Grace John Stewart, Department of Global Health, University of Washington, Seattle, WA, United States
Teresa Jewell, University of Washington Libraries, Seattle, WA, United State
John Kinuthia, Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
Manasi Kumar, Aga Khan University

This work was published before the author joined Aga Khan University.


Background: Pregnant adolescent girls and young women (AGYW, aged 12–24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region.

Methods We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies.

Findings Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs.

Interpretation Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA.

Funding Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.