{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:57:56Z","timestamp":1791223076357,"version":"4.1.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Swiss Federal Department of Foreign Affairs","award":["81067262"],"award-info":[{"award-number":["81067262"]}],"id":[{"id":"https:\/\/ror.org\/03fxa4766","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-005254"],"award-info":[{"award-number":["INV-005254"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The capacity of health systems to provide quality care for pregnant adolescents remains underexplored. This study examined the quality, continuity, and experiences of maternal healthcare among pregnant adolescents (&lt;20 years) compared with adult women (20\u2009+\u2009years) in Ethiopia, Kenya, and South Africa. It also explored factors associated with mistreatment and obstetric complications among adolescents using data from the Maternal and Newborn Health eCohort study. We followed 3,051 pregnant women from their first antenatal care (ANC) visit until six weeks postpartum. We used descriptive analyses to compare care quality and outcomes and logistic regression to identify factors among adolescents. The study included 380 adolescents and 2,671 adults. Adolescents had lower first-trimester ANC attendance (22% vs. 30%, p\u2009=\u20090.003), fewer follow-up ANC visits (mean 3.1 vs. 3.8, p\u2009&lt;\u20090.001), and lower adherence to iron-folic acid supplementation (59.0% vs. 69.4%, p\u2009&lt;\u20090.001). Continuity of care was also lower (53% vs. 59%, p\u2009&lt;\u20090.001). Adolescents experienced more mistreatment during delivery (26.9% vs. 18.6%, p\u2009=\u20090.003). Obstetric complications occurred in 31% of adolescents compared with 25.9% of adults. Mistreatment was associated with rural residence (adjusted odds ratio (aOR): 2.61, 95% CI: 1.11\u20136.13, p\u2009=\u20090.028), public facility use (aOR: 4.33, 95% CI: 1.44\u201313.1, p\u2009=\u20090.009) and intimate partner violence (IPV) (aOR: 3.31, 95% CI: 1.16\u20139.39, p\u2009=\u20090.025). Protective factors included being in Kenya (aOR: 0.19, 95% CI: 0.05\u20130.75, p\u2009=\u20090.018), privacy during delivery (aOR: 0.44, 95% CI: 0.21\u20130.92, p\u2009=\u20090.030) and high perceptions of quality of care (aOR: 0.37, 95% CI: 0.18\u20130.76, p\u2009=\u20090.007). Obstetric complications were associated with rural residence (OR: 2.25, 95% CI: 1.09\u20134.63; p\u2009=\u20090.028) and antenatal depression (OR: 2.43, 95% CI: 1.19\u20135.00, p\u2009=\u20090.015). These findings highlight gaps in adolescent maternal healthcare. Strengthening adolescent-responsive and respectful care within primary healthcare, alongside integrated mental health and IPV support, may improve adolescents\u2019 maternal healthcare experiences and outcomes.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004729","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:33:49Z","timestamp":1791221629000},"page":"e0004729","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal healthcare quality, continuity, and experiences among pregnant adolescents and adult women in Ethiopia, Kenya, and South Africa: A cohort study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5754-3853","authenticated-orcid":true,"given":"Beatrice","family":"Amboko","sequence":"first","affiliation":[{"name":"KEMRI-Wellcome Trust Research Programme","place":["Nairobi, Kenya"],"department":["Health Economics Research Unit"]},{"name":"University of Oxford","place":["Oxford, United Kingdom"],"department":["Nuffield Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4827-5241","authenticated-orcid":true,"given":"Irene","family":"Mugenya","sequence":"additional","affiliation":[{"name":"KEMRI-Wellcome Trust Research Programme","place":["Nairobi, Kenya"],"department":["Health Economics Research Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Odipo","sequence":"additional","affiliation":[{"name":"Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose Jepchumba","family":"Kosgei","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Obstetrics and Gynaecology, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8206-1496","authenticated-orcid":true,"given":"Wen-Chien","family":"Yang","sequence":"additional","affiliation":[{"name":"Milken Institute School of Public Health, The George Washington University","place":["Washington, United States of America"],"department":["Department of Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalom","family":"Sabwa","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health","place":["Boston, Massachusetts, United States of America"],"department":["Department of Global Health and Population"]},{"name":"Emory University","place":["Atlanta, Georgia, United States of America"],"department":["Department of Epidemiology, Rollins School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gebeyaw Molla","family":"Wondim","sequence":"additional","affiliation":[{"name":"Ethiopian Public Health Institute","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-7626","authenticated-orcid":true,"given":"Nompumelelo Gloria","family":"Mfeka-Nkabinde","sequence":"additional","affiliation":[{"name":"University of KwaZulu-Natal","place":["Durban, South Africa"],"department":["Department of Family Medicine, Howard College Campus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Londiwe","family":"Mthethwa","sequence":"additional","affiliation":[{"name":"University of KwaZulu-Natal","place":["Durban, South Africa"],"department":["School of Nursing and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nokuzola Cynthia","family":"Mzolo","sequence":"additional","affiliation":[{"name":"University of KwaZulu-Natal","place":["Durban, South Africa"],"department":["School of Nursing and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret E.","family":"Kruk","sequence":"additional","affiliation":[{"name":"Milken Institute School of Public Health, The George Washington University","place":["Washington, United States of America"],"department":["Department of Global Health"]},{"name":"Harvard T. 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Chan School of Public Health","place":["Boston, Massachusetts, United States of America"],"department":["Department of Global Health and Population"]},{"name":"Washington University in St. Louis","place":["St. Louis, Missouri, United States of America"],"department":["School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Arsenault","sequence":"additional","affiliation":[{"name":"Milken Institute School of Public Health, The George Washington University","place":["Washington, United States of America"],"department":["Department of Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinta","family":"Nzinga","sequence":"additional","affiliation":[{"name":"KEMRI-Wellcome Trust Research Programme","place":["Nairobi, Kenya"],"department":["Health Economics Research Unit"]},{"name":"Liverpool School of Tropical Medicine","place":["Liverpool, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"6","key":"pgph.0004729.ref001","first-page":"47","article-title":"Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis","volume":"16","author":"A Eyeberu","year":"2022","journal-title":"Int J Health Sci (Qassim)"},{"key":"pgph.0004729.ref002","unstructured":"World Health Organization. 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Available from: https:\/\/www.who.int\/health-topics\/adolescent-health#tab=tab_1"},{"issue":"01","key":"pgph.0004729.ref004","first-page":"170","article-title":"Physical and psychological vulnerability of adolescents during pregnancy period as well as post traumatic stress and depression after child birth","volume":"07","author":"M Akter","year":"2019","journal-title":"Open J Soc Sci"},{"key":"pgph.0004729.ref005","author":"EA Sully","year":"2020","journal-title":"Adding it up: investing in sexual and reproductive health 2019"},{"issue":"1","key":"pgph.0004729.ref006","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/s12978-018-0640-2","article-title":"Prevalence and determinants of adolescent pregnancy in Africa: A systematic review and Meta-analysis","volume":"15","author":"GM Kassa","year":"2018","journal-title":"Reprod 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A systematic scoping review","volume":"19","author":"T Mekonnen","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"pgph.0004729.ref019","first-page":"45","article-title":"Timing and quality of antenatal care among adolescent mothers in a rural community, Uganda","volume":"14","author":"V Kayemba","year":"2023","journal-title":"Adolesc Health Med Ther"},{"issue":"11","key":"pgph.0004729.ref020","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-013268","article-title":"Adolescents\u2019 experience of mistreatment and abuse during childbirth: A cross-sectional community survey in a low-income informal settlement in Nairobi, Kenya","volume":"8","author":"AI Ajayi","year":"2023","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pgph.0004729.ref021","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1186\/s12884-022-04821-w","article-title":"Adverse obstetric and neonatal outcomes of adolescent pregnancies in Africa: A scoping 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development","volume":"17","author":"C Arsenault","year":"2024","journal-title":"Glob Health Action"},{"issue":"8","key":"pgph.0004729.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004446","article-title":"Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa","volume":"21","author":"C Arsenault","year":"2024","journal-title":"PLoS Med"},{"issue":"4","key":"pgph.0004729.ref026","doi-asserted-by":"crossref","DOI":"10.9745\/GHSP-D-23-00506","article-title":"Implementation of maternal and newborn health mobile phone E-cohorts to track longitudinal care quality in low- and middle-income countries","volume":"12","author":"K Wright","year":"2024","journal-title":"Glob Health Sci Pract"},{"key":"pgph.0004729.ref027","unstructured":"Ministry of Health Ethiopia. Integrated Antenatal, Labor, Delivery, Newborn and Postnatal Care Card."},{"key":"pgph.0004729.ref028","unstructured":"Ministry of Health Ethiopia. National Antenatal Care Guidelines. 2022."},{"key":"pgph.0004729.ref029","unstructured":"Ministry of Health Kenya. National Guidelines on Quality Obstetrics and Perinatal Care. 2022."},{"key":"pgph.0004729.ref030","unstructured":"Ministry of Health Kenya. Mother and Child Handbook. 2020."},{"key":"pgph.0004729.ref031","unstructured":"Department of Health. National guidelines for maternity care in South Africa. 4th ed. 2016."},{"key":"pgph.0004729.ref032","unstructured":"World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016."},{"key":"pgph.0004729.ref033","article-title":"Women\u2019s report of mistreatment during facility-based childbirth: Validity and reliability of community survey measures","volume":"5","author":"HH Leslie","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pgph.0004729.ref034","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12978-022-01546-z","article-title":"Associations between self-reported obstetric complications and experience of care: A secondary analysis of survey data from Ghana, Kenya, and India","volume":"20","author":"N Kapula","year":"2023","journal-title":"Reprod Health"},{"key":"pgph.0004729.ref035","volume-title":"India Human Development Survey-II (IHDS-II), 2011-12","author":"S Desai","year":"2018"},{"key":"pgph.0004729.ref036","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.genhosppsych.2020.12.007","article-title":"Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis","volume":"68","author":"L Wang","year":"2021","journal-title":"Gen Hosp Psychiatry"},{"issue":"9","key":"pgph.0004729.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0184934","article-title":"Timing and adequate attendance of antenatal care visits among women in Ethiopia","volume":"12","author":"S Yaya","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004729.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0053747","article-title":"Factors affecting antenatal care attendance: Results from qualitative studies in Ghana, Kenya and Malawi","volume":"8","author":"C Pell","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004729.ref039","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s12978-021-01183-y","article-title":"Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: A systematic review","volume":"18","author":"LR Ninsiima","year":"2021","journal-title":"Reprod Health"},{"key":"pgph.0004729.ref040","doi-asserted-by":"crossref","first-page":"684081","DOI":"10.3389\/frph.2021.684081","article-title":"Implementation strategies to enhance youth-friendly sexual and reproductive health services in Sub-Saharan Africa: A systematic review","volume":"3","author":"C Obiezu-Umeh","year":"2021","journal-title":"Front Reprod Health"},{"issue":"1","key":"pgph.0004729.ref041","doi-asserted-by":"crossref","first-page":"42","DOI":"10.12968\/jcyn.2007.1.1.23307","article-title":"Adolescent communication: perceptions and beliefs","volume":"1","author":"J Kelsey","year":"2007","journal-title":"J Children\u2019s Young People\u2019s Nursing"},{"issue":"12","key":"pgph.0004729.ref042","article-title":"Prevalence and determinants of the place of delivery among reproductive age women in sub-Saharan Africa","volume":"15","author":"KS Adde","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004729.ref043","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1186\/s12913-026-14611-1","article-title":"Maternal and neonatal health service access and utilisation in sub-Saharan Africa (2015\u20132023): A systematic review and meta-analysis","volume":"26","author":"BA Ayele","year":"2026","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0004729.ref044","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1186\/s12913-018-3370-9","article-title":"The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: A systematic review and meta-analysis","volume":"18","author":"GA Fekadu","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"pgph.0004729.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-13-5","article-title":"Why do women prefer home births in 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