Experts Map Barriers to Teenage Pregnancy Prevention in Low- and Middle-Income Countries

Adolescent pregnancy prevention programmes in low- and middle-income countries (LMICs) are being undermined by seven interrelated challenges, according to a qualitative exploratory study of the people who implement such interventions on the ground. The research, conducted by Aimable Nkurunziza and colleagues, involved in-depth virtual individual interviews with 19 adolescent pregnancy prevention programme implementers working across 24 LMICs. The responses were organized using Dedoose software and analysed thematically, with the aim of identifying why so many interventions fail to achieve positive outcomes despite years of investment in the field.

The first cluster of barriers concerned how adolescents themselves engage with prevention programmes. Implementers reported that young people’s participation depended heavily on whether a programme felt useful to them, and, at times, on the material or social benefits of attending. Stigma made attendance socially risky, pushing adolescents toward private information-seeking rather than open participation. Prevention efforts were further constrained by gendered dynamics: the unequal allocation of resources and decision-making power between girls and boys limited boys’ involvement in programmes while simultaneously restricting girls’ agency over their own reproductive choices.

A second set of challenges operated at the household and community level. Poverty and material insecurity within families, together with transactional marriage practices such as bride price, were reported to contribute to early unions and subsequent childbearing. Programme legitimacy was also contested in many settings. Implementers described how taboos surrounding adolescent sexuality, religious opposition, persistent myths about contraception, and the normalization of violence all made it harder for prevention initiatives to gain acceptance among the communities they serve.

The third cluster of barriers was administrative and structural. Respondents cited bureaucratic delays, weak institutional backing, resistance at school level, and unstable or poorly enforced policy environments as factors that limited the continuity and scale-up of interventions. These implementation conditions, the study suggests, determine whether even well-designed programmes can survive beyond their initial pilot phase or donor funding cycles.

The authors conclude that effective teenage pregnancy prevention in LMICs requires more than delivering sexual and reproductive health information. Programmes must be designed to feel relevant to adolescents while reducing stigma and protecting confidentiality to support genuine engagement. Interventions also need to address gendered power dynamics and gatekeeper control, alongside the community-level legitimacy barriers of taboo, religious opposition, contraception myths, and normalized violence. Sustainable impact, the study argues, will depend on enabling implementation conditions, including reduced bureaucratic delays, stronger institutional and school support, coherent policies, reliable financing beyond donor cycles, and better data to guide targeted action.

Subject of Research: Barriers to implementing adolescent pregnancy prevention interventions in low- and middle-income countries

Article Title: Exploring barriers to implementing adolescent pregnancy prevention interventions in low- and middle-income countries: Perspectives from international experts

Article References: Nkurunziza, A., Nkurikiyintwali, J. M. V., Ndayisenga, J. P., Kasine, Y., Twagirayezu, I., & Uwera, Y. D. N. (2026). Exploring barriers to implementing adolescent pregnancy prevention interventions in low- and middle-income countries: Perspectives from international experts. PLOS One, 21(10), e0360943. https://doi.org/10.1371/journal.pone.0360943

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360943

Keywords: adolescent pregnancy, low- and middle-income countries, sexual and reproductive health, qualitative research, programme implementation, public health, gender inequality, stigma, Exploring, barriers, implementing, adolescent