{
  "abstract": "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 (<20 years) compared with adult women (20 + years) 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 = 0.003), fewer follow-up ANC visits (mean 3.1 vs. 3.8, p < 0.001), and lower adherence to iron-folic acid supplementation (59.0% vs. 69.4%, p < 0.001). Continuity of care was also lower (53% vs. 59%, p < 0.001). Adolescents experienced more mistreatment during delivery (26.9% vs. 18.6%, p = 0.003). 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: 1.11–6.13, p = 0.028), public facility use (aOR: 4.33, 95% CI: 1.44–13.1, p = 0.009) and intimate partner violence (IPV) (aOR: 3.31, 95% CI: 1.16–9.39, p = 0.025). Protective factors included being in Kenya (aOR: 0.19, 95% CI: 0.05–0.75, p = 0.018), privacy during delivery (aOR: 0.44, 95% CI: 0.21–0.92, p = 0.030) and high perceptions of quality of care (aOR: 0.37, 95% CI: 0.18–0.76, p = 0.007). Obstetric complications were associated with rural residence (OR: 2.25, 95% CI: 1.09–4.63; p = 0.028) and antenatal depression (OR: 2.43, 95% CI: 1.19–5.00, p = 0.015). 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’ maternal healthcare experiences and outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya",
    "Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom",
    "Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya",
    "Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya",
    "Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America",
    "Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America",
    "Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America",
    "Ethiopian Public Health Institute, Addis Ababa, Ethiopia",
    "Department of Family Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa",
    "School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa",
    "School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America",
    "Liverpool School of Tropical Medicine, Liverpool, United Kingdom"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Beatrice Amboko"
    },
    {
      "affs": [
        1
      ],
      "name": "Irene Mugenya"
    },
    {
      "affs": [
        2
      ],
      "name": "Emily Odipo"
    },
    {
      "affs": [
        3
      ],
      "name": "Rose Jepchumba Kosgei"
    },
    {
      "affs": [
        4
      ],
      "name": "Wen-Chien Yang"
    },
    {
      "affs": [
        5
      ],
      "name": "Shalom Sabwa"
    },
    {
      "affs": [
        6
      ],
      "name": "Gebeyaw Molla Wondim"
    },
    {
      "affs": [
        7
      ],
      "name": "Nompumelelo Gloria Mfeka-Nkabinde"
    },
    {
      "affs": [
        8
      ],
      "name": "Londiwe Mthethwa"
    },
    {
      "affs": [
        9
      ],
      "name": "Nokuzola Cynthia Mzolo"
    },
    {
      "affs": [
        10
      ],
      "name": "Margaret E. Kruk"
    },
    {
      "affs": [
        11
      ],
      "name": "Catherine Arsenault"
    },
    {
      "name": "Jacinta Nzinga"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0a98hqev32n7y.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0004729",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004729",
  "id": "0a98hqev32n7y",
  "issns": [
    "2767-3375"
  ],
  "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004729",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2735|Global Maternal and Child Health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health care facilities"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Maternal health/Antenatal care"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Maternal health/Birth/Labor and delivery"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Maternal health/Pregnancy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Obstetrics and gynecology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Birth/Labor and delivery"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Africa/Kenya"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups/Adults"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups/Children/Adolescents"
    ],
    [
      "plos",
      "/People and places/Population groupings/Families/Children/Adolescents"
    ]
  ],
  "openalex": "W7220367032",
  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0004729&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/0a98hqev32n7y.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pgph.0004729",
      "source": "plos",
      "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004729"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:women's health",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Maternal healthcare quality, continuity, and experiences among pregnant adolescents and adult women in Ethiopia, Kenya, and South Africa: A cohort study",
  "title_text": "Maternal healthcare quality, continuity, and experiences among pregnant adolescents and adult women in Ethiopia, Kenya, and South Africa: A cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/0a98hqev32n7y",
  "venue": "PLOS Global Public Health",
  "versions": []
}