Adolescent   pregnancy is an international and national dilemma as there are 300 million adolescents  worldwide  and every year  16  million  women  aged 15 to 19   years   give  birth, accounting for approximately 11% of all as   [1] states. In the same light, the population of Cameroon, books adolescent girls contributing to nearly 14% of all childbirths in Cameroon with 2.83% of them being girls under the age of 16 as cited by [2-3]. To this wise, adolescent pregnancy has become a major social, policy, and practice concern. Besides, the Cameroon Medical Council reports that 25% of pregnancies occur in girls of school age, and 20% of pregnant adolescents do not return to school. However, as the number of miscarriages and illegal abortions are not well documented, it is possible that the precise rate of adolescent pregnancy in Cameroon is higher than that overtly reported. Hence, the occurrence of  unwanted pregnancy is usually traumatic among many adolescents as indicated by [4].   Beyond   the  trauma   of   unintended  pregnancy   and   its stigmatisation, there is need for in-depth understanding of adolescent mothers’ coping strategies with   this  reality.   In   our  write-up,   adolescent   pregnancy  is   largely   interpreted  as   personal problems that affect both the individual and the community at large. However, the link between the personal  and   the   public  troubles   with   adolescent  pregnancy   cannot   be  pinned   to   a  single direction. A study carried out in Nigeria by highlighted the fact that to survive with their children, the adolescent mothers in this study engaged in profitable economic activities such as trading, artisan (hair dressing and tailoring) and paid employment inform of shop or restaurant attendants. Meanwhile, studies have also shown that social support is the key factor in adolescent mothers having positive experiences [5] clarify on this. In addition, a study by Stevenson et al. initiate that parents and boyfriends were important to the psychological well-being of pregnant adolescents. Particularly noteworthy, was the finding that the bi-directional exchange of support between parents and adolescents was associated with increased well-being. Contraceptive use is an effective measure used to reduce adolescent pregnancy and prevent an unplanned  repeat   adolescent   pregnancy. Several studies were examined on post     birth contraceptive use by adolescents.  Also, Blank et al. [6] reviewed contraceptive services available to adolescents to prevent pregnancy as well as to prevent a repeat pregnancy. In their systematic review of school based interventions to reduce pregnancy and repeat pregnancy, the authors included interventions   in schools and colleges where peer   education and culturally directed social services were provided, and contraception was readily available at the school. Beyond, some studies have stressed the issue of using religion and religious groups as a means of coping with adolescent pregnancy outcomes. The support was more of a freewill support from the  members and not the policy of  the church in question.   It is   understandable   that  many religious organizations may find it difficult making it a policy since Christianity for instance frowns at premarital sex. Thus, making a policy that adolescent mother should be supported may be translated in some quarters as an implicit support for pre-marital sex. Although in the case of this participant, her commitment and active involvement in church activities might have formed the basis of arriving at the conclusion that she has genuinely repented of her past. Therefore, identifying coping strategies established by adolescent   mothers in   order  to   deal with pregnancy outcomes and motherhood is quite imperative. 

A qualitative methodology was employed to identify coping strategies put up by these young mothers in order to cope with the adolescent pregnancy outcomes. Semi-structured interviews and guided focus group discussions were utilised in collecting data.  More so, a purposive sampling method were used to recruit adolescent mothers; ages 14–19 years old who visited the Hôpital Catholiques des Sœur de Baleng, the biggest antenatal clinic of the community. Adolescents were excluded from the study if they were diagnosed with a learning disability, or were unable to speak, read or write. Individual consents were obtained for adolescents 16 years and above so that life stories were useful to enrich our data analysis beside originality. Assents as well as parental consents were obtained when participants were under the age of 16.  The sample consisted of 43 adolescents (20 pregnant and 23 parenting). The focus group   sample  consisted   of 13 adolescents (6   pregnant   and  7   parenting).  Our  group discussions   and   semi-structured   interviews  were   conducted   in  a   quiet   space  at   the   hospital and   Participants were free to decline an answer, to stop or to leave if there was a feeling of discomfort with the process or questions. Audio recording of interviews and group discussion was optional. We used freelistings so as to understand their point of view on sexuality and source of information at this age. 

Thematic Analysis 

Thematic analysis using grounded theory methods was used for the 43 individual interviews and two   focus   group  interviews.   Preliminary   themes  were   reviewed   and  compared   within   the research team using Atlas-ti and re-categorisation and recoding followed with in-depth   analysis of  language and concept mapping [7-8].

RESULTS

From the extracts of the 43 pregnant/parenting adolescents surveyed, 4 main themes (coping approaches) were identified; family and community support, individual strategies, socio-economic approaches and structural approaches. 

Family and community support

Most of the participants mentioned relying on family and community for support due to their new   statuses. As a result, we came up with a number of subthemes from the family and community strategies used to assist these young mothers manage the situation such as; support from mother, arranged marriages, family directed adoptions, community and church assistance. When asked how supportive their families were to them, most respondents said that their families were very supportive.

Presentation of Research Area

The Baleng village in Cameroon is a Bamiléké community living in the mountainous upper plateaus of the West Region of Cameroon with a surface area of 218Km². From the results of the population census conducted in 2005, the population in the district town of Bafoussam II (Baleng) was 121 282 inhabitants. However, extrapolating figures from the census using the growth rate of 2.6 over the period, the current population of the municipality is 149 662 inhabitants according to [9]. Given the multi-ethnic nature of the area, we find majority of the ethnic groups in Cameroon there even though there is a relative majority of so-called indigenous peoples in the rural area. These indigenous majorities are essentially Bamilékés. The coexistence of these populations is harmonious. Moreover, there are almost all religious denominations present in Cameroon, although there is a predominance of Catholics.

Ethnographic views on early pregnancy and motherhood among the Baleng

Motherhood is extremely gendered and equally charge by women who endure the magnitudes of looking after the children. As for young mothers, particularly those impending from lowly families, they are unable to employ help and rather depend on on help from their mothers or other womanly kinfolks demonstrates that it becomes very challenging if they do not co-reside with an adult female.  In addition, when a woman is unmarried the young mother and her family shoulder the financial burden of taking care of the child as [10] indicate. Meanwhile, the additional member puts a strain to the budget of the family, especially when the young mother comes from a low socio-economic background. As well, early motherhood does not only pose challenges of transition to motherhood, it also brings social and economic challenges to the young woman and her families [11] further explain.  In the Baleng community like other communities in Cameroon and beyond, this presents a serious threat to gender parity in education. Being so, sometimes leads to absenteeism, which in turn could lead to dropping out of school. However, in cases where most learners who have returned to school after childbirth, they find it difficult to balance mothering and schooling [12-14] added. Also, South African society remains highly gendered with respect to normative roles for mothers and fathers, where the work of care giving, including cooking, cleaning, taking care of children and other domestic roles as expressed by [15]. In many Cameroonian societies and particular in Baleng, it has been identified to be the domain of women and girls. Expressively, Tronto [16] argued “The young mothers‟ school work suffers as they tend to focus more on childcare. In the same light, providing care sometimes demands the caring person to be attentive to the needs of the cared, and in the process the one providing care forgets her needs. Thus, schooling young mothers have a divided attitude of heart as they focus more on taking care of the child and pay less attention to school work. In another face, stated that owing to migration, most young mothers from informal settlement have left their grandmothers or relatives who might have stepped in to help in taking care of the child in the rural areas. Here, many of the young mothers cannot nature their own mothers so they go for assistance as they are working in order to afford for the family. So, young mothers tussle to have someone to look after their children as they seek to further their education.  Below are some of the stories of adolescent mothers who requested to receive much support from their families:

When my mother warned me to keep the pregnancy because it was sinful and risky to do abortion being her only daughter though sad and shameful of the situation, I continued to live with her in her room in spite of the frequent quarrel with my father who was not in support of my staying with the family any more for the fear of influencing his children with the first wife. My mother helped me a lot during my pregnancy and even after I delivered a baby girl. She taught me about baby’s needs and how to care the baby. I’m really proud of her when I always look at my kicking baby despite being sometimes sad about the shame I brought to my family and the seemingly endless bad blood I created between her and my father. (Adolescent mother, 19 years) 

When I got discharged from the hospital and came back home my parents bought me most of things a baby would need. My uncle also bought some clothes for the baby. My brother a mobile phone dealer brought me a simple mobile phone so that I could communicate with the wife any time I needed their help since our parents may not be able to support me and my baby all the time and my boyfriend is still a student. Truly my family was very supportive. However, it is very shameful to have such a baby in my community. (Adolescent mother, 17 years).

Yet it should be noted that in Baleng and  generally amongst, Cameroonian  families’ extended families,  especially   in   rural  areas do help.   Some daughters often live with their parents or grandparents even after they are married. Though it is not unusual for three to four generations to live in the same house, with the older ones helping to look  after   the   younger  ones.   Some   participants   reported  that   they   were  raised   by   their grandparents because their parents were separated or had to work in other cities. In this case, their grandparents became the main support for them instead of their parents. However, when the baby   was   born, it is the   whole  family’s   responsibility   to  raise   the child   and  support   these adolescent mothers.

My grandmother   asked me to bring the child when she was 2 years old. As I wanted to start a training. I wanted to learn sewing and I could not be going to learn it with my child. (Adolescent mother, 19 years)

Our first son lives with my grandmother. We sent him to school there because we wanted to have another   baby.  We   needed   to  reduce   the   weight  and   charge   on  us.   (Cohabiting   pregnant adolescent, 19 years)

Most teachers in school were disappointed and sad, according one pregnant adolescent. They still supported her and pushed her to continue with her schooling, which is not always the case for some adolescent mothers.

You see that year naaa, my teachers were very angry and disappointed because they believed in me so much, they used to help me at times, and it was hard for them when they found out. I was so depressed because it was so painful that I had disappointed them. But they encouraged me to stay in school, they encouraged me not to drop out and become nothing. I am grateful if it was not for them, I don’t know where I would be. (Pregnant adolescent, 18years).

Additionally, participants received mixed levels of support from friends, and the level of support largely depended on the type of friendship before the pregnancy. Loyal friends were said to support the mothers during the pregnancy and after the baby’s birth. During an interview with a participant, her friend was present and helped out with the baby. They seemed very close and, according to her, becoming pregnant strengthened the relationship between the two friends.

Some [friends] are very close, like this one who is here now, she now visits me every day. Even before I had the baby she used encourage me. The others are now very distant from me. I think because I was pregnant. (Cohabiting pregnant adolescent, 17 years).

Contrariwise, this supportive scenario between friends was not the same for others who felt isolated, sometimes because their friends were young mothers themselves:

I have one best friend and she has a baby as well, how can she support me? She has to look after her baby so she does not have time to visit me and to support me. So I decided to just be here. (Cohabiting pregnant adolescent, 18 years).

It also emerged that the females among the teaching staff of the community schools were also a resource for adolescent girls who got pregnant and those who became mothers. Most of the participating adolescents described them as being good in monitoring how the male teachers related to some of the girls in the schools, as it happened occasionally that some male teachers took advantage of the girls and sometimes impregnated them. For the few girls who had been lucky to go back to school after having their babies, it appeared that the female teachers played key roles in apologising to their parents and encouraging   them not  to give   up on   their daughters: 

Oh I know one girl who is back in school now after having her baby…but she was lucky that when one female teacher went to apologize to her father, the man accepted and listened to their advicsome teachers do that some times, but some parents listen to them and others don’t. (Pregnant adolescent, 19 years).

One pregnant adolescent actually had the motivation from the back-to-school girl’s case that she would go talk to her teachers to encourage to her parents as they did for that girl.

I haven’t lost hope…I know that if I go and see the female teachers, they will help me…they did it for one of my friends and she is now back to school I only pray that my parents will listen to them…but I am sure that if I go to see them, they will go and talk to my parents for me (Pregnant adolescent, 17 years).

Certainly, despite the general community attitude being described as negative towards pregnant adolescents and mothers, some community midwives, nurses and health workers stood out as a huge resource with some pregnant adolescents describing them as their main source of support.

For most participating pregnant adolescents, midwives were the most friendly health personnel in the community and the only reason they even think of attending clinics and hospitals. They were described as the only ones who say nothing about being a “bad girl”, but everything about being a bad mother if they found out that you do not attend the clinic regularly. It arose from the FGDs   and  interviews   that   most  of   the   pregnant  adolescents   who   braved  the   stigma   and community   sneering  to   patronise   RHS,  found   the   strength  to   do   this  partly   through   the encouragement of the midwives.

This midwife is so nice but some of the other nurses do not give me quick attention (Pregnant adolescent, 17years).

Furthermore, some participants provided deep insights into their perceptions of the institutional responses to the issues of adolescent pregnancy.

I like it because when you start coming to the hospital as a young girl, they encourage you to go back to school... and they always make sure they talk to you and tell you what to eat to keep your baby all of that stuff, to take care of the baby, don’t be stress about it.  (Pregnant adolescent, 16years)

Individual Approaches

Some   participants   mentioned  they   used   individual  strategies   such   as  religious   orientation, avoidance, changing   friendship   choices, relocation, cohabitation, becoming   antisocial, attempting abortions, enhanced contraception, etc. Churches in the communities, despite being against premarital sex and especially sexual activity among youths also seem to be a good source of support upon which pregnant adolescents and mothers   can  count.   The   majority  of   participating   pregnant  adolescents   and   mothers  agreed especially to the resourcefulness of their churches in their situations

I thank God that we have this church in the village. When I got pregnant, I was an active member in the youth ministry, so I was really ashamed but after the pastor reproached me for bringing shame to the church, he encouraged the ministry to be supportive of me. They have been my friends through it all… (Pregnant adolescent, 18 years) and I also started reading the bible a lot, because if you commit a sin, you should not commit another sin like abortion because you can make the situation worse. (FGD)

Its God who helped me, I started praying. My mother also encourages me to go to the clinic all the times. (FGD)

Additionally, a pregnant adolescent said: 

I have been ignoring the negative things that my friends have been saying. I just avoid those friends who say negative things especially at school (FGD). 

For some, it was the case of cohabitation and relocation.We are already living together but we will get married in one to two years. He has not yet paid my dowry and has not yet seen my father normally. He is the one taking care of my needs and taking care of everything financially (Cohabiting adolescent mother, 18 years).

More so, some of these girls decided to occupy themselves or return to school as emphasised below.

I have started my own small business now. I don’t want to go back to school and I did not want to wait for the child to walk then I will start selling this at the market. I am keeping some of the money preparing for my child’s things. (Pregnant adolescent, 17 years)

A number of respondents reported that they will return to school with most of the reasons centred on the desire to have a better job later in life. However, the main reason cited, was geared towards the wellbeing of the child.

I have decided to go start school again. I want to have my baccalaureat so that I can go to university like me friends. My mother has accepted to help me with the baby as I go for classes. I always wanted to become a journalist and I cannot leave it like that now. I want my child to have a better future.  (Adolescent mother, 18 years) If I don’t go back to school, then I will have no job later in life and will not be able to take good of my child. (Pregnant Adolescent, 16 years)

Socio-economic approaches 

Socio-economic approaches were more linked to the material needs of the adolescent mothers and subthemes mentioned reflected how they managed to cope in their context, as narrated in the following transcripts.

During this period, I had many guys…many many many guys. They were close to six and I was dating more than one at a time. These guys use to help me in all dimensions. They helped financially, morally. I was 18 years old by then. Most of these guys were older than me; some for about 5 years and others 10 years older than me. (Adolescent mother, 19 years)

Some tried to look for jobs or learn a trade. I had one of my sisters that used to come and take me and we will go and carryout tasks and that is how at the end of the day I will have my 1000, 1500 or even 2000FRS and it is with the money that I could do my prenatal consultations and   buy some things   too  for  myself  (Adolescent               mother,                19                years).

Structural Approaches

The following transcript was obtained from structural approach.

He refused the pregnancy and my mother reported him in the brigade and they came and took him. He was there for one day and they left him after. They said he should be giving money for the child’s things. Now he is giving something small every week because they have warned him. (Pregnant adolescent 17 years)

Although pregnancy as a stressful event affects both adolescents and adults, the stigmatisation of the   phenomenon   of  pregnancy   makes   it  more   stressful   for  the   adolescents   than  their   adult counterparts   according  to.   As   indicated  earlier, our   investigation revealed   that   most  of   the   participants   had  negative   experiences, including   rejection   and abandonments, immediate loss of support and burden of pregnancy or parenting. Consequent to these experiences, the pregnant and parenting teenagers had to find some coping strategies. Our study suggests 4 prominent coping strategies put up by these participants to cope with pregnancy outcomes, namely:   family and community support, individual approaches, socio- economic approaches and structural approaches.

In assessing the family and community approaches accessible for these young mothers, some key concepts were highlighted namely; family support, community support, family directed adoption, and family arranged marriages as well as church assistance. Majority of the subjects asserted that the greatest form of support was from their mothers either financially, emotionally or morally which is in conjunction with the findings of a previous study which asserts that primary support usually comes from family, particularly the teenager’s own birth mother. Besides, some of the   subjects mentioned relying on assistance from siblings   and well-wishers in the community. Our study also found some positive effects of early motherhood such as adolescent mother feeling comfortable with motherhood responsibilities if reactions from both parents and partners are positive, concurring with Benson [17], who states that increased self-esteem and life satisfaction are linked to supportive relationships between parents and pregnant/mothering adolescent. Despite the negative implications of the adolescent mothers, the findings point out that some of the adolescent mothers are stable and with the required support, they can adapt, survive, prosper, and create those opportunities for achievements both for themselves and their young ones. It is recognised that family interactions contribute a lot in helping teen mothers in coping   and   adapting  to   the   situation  of   motherhood   as  parents   can   provide  emotional, instrumental,  informational,   or   appraisal  support   in   helping  adolescent   mothers   with  their motherhood responsibilities as confirmed by Benson [17], that family support leads to positive outcomes for adolescent mothers and positive maternal well-being; and less depression as well as less   risk  of   child   abuse.    Community   support   motivates  adolescent   mothers   in  coping   and adapting to the situation of becoming mothers in their early ages as it provides social capital. Others highlighted the fact that they turned to their churches and were more frequent in the programs of the church and found aid and hope through its members. Contrariwise, this was different from a number of studies carried out in Thailand area where adolescents with unwanted pregnancy outcomes tend to flee from the churches due to the feeling of disgrace and shame of moral decadence [18]. 

Secondly, individual approaches to coping with pregnancy outcomes, highlighted the following concepts;     religious   attachments,   resolved  cohabitations,   varying   location,  varying   friends, occupying   oneself, returning   to  school,   attempting   abortions,  antisocial/avoidance,   enhanced contraception as well as   attributing wrong paternity. Avoidance was mainly used as a buffer from the teasing, scorning, rebuke or reproach from friends or as a means for averting hash treatment from parents. Avoidance was characterised by keeping away from negative people or situations, while others were able to stand the negative experiences through the support they received from parents, siblings, in laws, and at times friends who encouraged them to keep the pregnancy and go back to school after delivery. It should be noted that assurance or possibility of going back to school for those who were schooling at the time of getting pregnancy was the strongest motivation to keep going. While others were coping through the support they received, others managed to cope by realising that they had committed a sin through getting pregnant before marriage, and that they could commit another sin by aborting the pregnancy, instead they repented   and  started   depending   on  God, his   word,   and  prayer.   Another   interesting  coping strategy   from our   study was  that   of   focussing on   the child  and its   future.   To support  this, focusing on the future was reported by Wilson-Mitchell et al., [19] as an attribute responsible for resilience and a coping strategy utilised by pregnant teenagers in a study of psychological health and life experiences of pregnant adolescent mothers in Jamaica. From our study, focusing on   the  future   was   a  strong motivation   in   keeping  the   pregnancy   amidst  the many   negative experiences,  even   in  instances   where   the  person   responsible   for  the   pregnancy   denied responsibility. Participants narrated how they understood that children were a gift from God and that they may just grow to hold positions of influence in future and keep their mothers in old age. In addition, some adolescents saw it as a privilege to have a child because some adults never had children in their life time. Similar findings were reported by Wilson-Mitchell, Bennett, and Stennett, [19], where some of their subjects indicated that they were motivated to keep the pregnancy, because no one knew what the children may become in future and the fact that there was no   guarantee  that   they   will  have   another   child if  they   terminated   the pregnancy.  Such thoughts motivated the pregnant or parenting adolescents to keep their pregnancies or children respectively   amidst  the   harsh   experiences.   While  four   out   of  the   five   coping  strategies; avoidance, support from parents, partners and friends, repentance and dependence on God, and focussing   on  own   and   the  child’s   future   can  be   described   as  adaptive   coping   strategies, there   was   one  particular   adolescent   who  developed   a maladaptive coping strategy, that is denial of pregnancy and parenthood.

Likewise, our   study   highlighted socio-economic   approaches with   respect  to   coping   with adolescent pregnancy in this group. The key concepts identified herein were; getting profitable jobs, transactional sex, learning a trade. In this same vein, our study is complementary to a study carried   out   in  Nigeria   which   indicated  that   adolescents   in  the   community   practiced  small businesses and trades to survive and fend for both their babies and themselves. Moreover, some of them undertook housemaid jobs as is the case of some of the subjects in our study. Similarly, studies carried   out  by [19], indicated that adolescent mothers generally tend to look for small occupations which could keep them away from over depending on others for assistance.

More   so, we   indicated structural   approaches to management and coping   with  pregnancy outcomes underscoring some key concepts like; legal interventions, government/social policy. Many studies have underlined the use of similar approaches to manage adolescent pregnancy but a few have indicated the use of legal pursuit to gain assistance from partners or bring partners who reject the responsibility of pregnancy/paternity to book. Furthermore, government policy tends to favour adolescent girls over their partners since some who had been raped had to break the  silence.   Remarkably, this   finding  coincides   with   a  recent   study   which  emphasised   the inability of adolescent girls to break the silence of a rape followed by pregnancy an inability to disclose rape identity due to fear and sigma associated [20]. Conclusively, our study largely revealed a reluctance of these adolescent girls to use structural approaches, and consequently they were the least used due to fear and stigma.

Coping with emotional demands of adolescence coupled with the demands of pregnancy and in most   cases   rejection  and   disapproval   by  family   and   society  makes teenage   pregnancy   very stressful and thus, requiring coping strategies to manage these outcomes. From our study, most of the respondents had negative feelings upon realising their pregnancy, as essentially all those interviewed including the few who were married had unintended pregnancies. Consequently, they   felt   distressed, embarrassment, disappointed, frightened   and  ashamed   that   they  were pregnant.   In   addition, parents, siblings, some   friends   and  partners   reacted   negatively  by expressing   disappointment, distress, and   denial   of   pregnancy  to   an extent   of  some   parents rejecting   their  pregnant   teenagers.   Amidst  the   negative   experiences, both   the  pregnant   and parenting adolescents had diverse unmet needs ranging from health care and health information especially HIV status, socioeconomic and emotional concerns including the desire to go back to school. As a means to withstand the negative experiences and live within the circumstances of unmet adolescent and motherhood needs, the pregnant and parenting adolescents used a number of adaptive coping strategies. 

The inference of this study's conclusions is that, platforms need to be designed to assist adolescents who   do experience unintended pregnancies, including approaches to support pregnant and parenting adolescents to finish their studies. Community systems should be built to support these adolescents to avoid instances of young women being kicked out of their homes. In the cases where this cannot be avoided, temporary transitional homes should be implemented to house  pregnant   and/or   parenting  adolescents   while   preparing  them   to re-enter   the  society successfully.

One of the most significant findings of our research concerns the lost opportunity of participants to further their education. In addition to the conservative attitudes of school officials, the main obstacles to participants continuing their study are the lack of money, time and childcare. Without income support and child care, there is little prospect of them returning to full time study. There should be adolescent mothers’ support groups in schools and in communities where volunteer adolescent mothers can all get together to discuss and share experiences promoting openness, identification with one another and also, creating a sense of belonging. As a result, these support groups   can   alternatively   be  used   to   empower  these   mothers   through  psycho-education   on preventative measures, health related topics and ongoing motivation as well as encouragement. More so, the availability and accessibility to   psychotherapy   as  well   as   counselling  services (especially in remote areas) is recommended to assist adolescent mothers address and manage their emotional needs and setbacks.

1. World Health Organization. "Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries." 2011. Retrieved from http://www.who.int/immunization/hpv/target/preventing_early_pregnancy_and_poor_reproductive_outcomes_who_2006.pdf.

2. Kongnyuy EJ, Nana PN, Fomulu N, Wiysonge SC, Kouam L, Doh AS. "Adverse perinatal outcomes of adolescent pregnancies in Cameroon." Maternal and Child Health Journal, vol. 12, no. 2, 2008, pp. 149–154. doi:10.1007 /s10995-007-0235-y.

3. Tebeu PM et al. "Geographic distribution of childbirth among adolescents in Cameroon from 2003 to 2005." Obstetrics and Gynecology International.

4. Schmidt RM et al. "Moderate to severe depressive symptoms among adolescent mothers followed four years postpartum." Journal of Adolescent Health, vol. 38, no. 6, 2006, pp. 712–718. doi:10.1016/j.jadohea lth.2005.05.023.

5. Ballard JL et al. "New Ballard score expanded to include premature infants." Journal of Pediatrics, vol. 119, no. 4, 1991, pp. 417–423.

6. Blank L. et al "Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings." Journal of Pediatric and Adolescent Gynecology, vol. 23, no. 2, 2010, pp. 231–351.

7. Strauss AL. and Corbin J. Basics of qualitative research techniques and procedures for developing grounded theory. Sage Publications, Thousand Oaks, CA, USA, 1998.

8. Cluett ER. Principles and practice of research in midwifery, 2nd ed., Churchill Livingstone Elsevier Limited, Philadelphia, PA, USA, 2006.

9. BUCREP. "Répartition de la population du Cameroun (par département, arrondissement, district) en 2010 par sexe." 2011.

10. Jewkes R. and Christofides N. "Teenage pregnancy: rethinking prevention." Youth Policy Initiative Roundtable 5: Teenage Pregnancy. Paper prepared for the HRSC, Pretoria: Reserve Bank, 2008.

11. Jewkes R et al. "Empowering teenagers to prevent pregnancy: lessons from South Africa." Culture, Health and Sexuality, vol. 11, no. 4, 2009, pp. 389–403.

12. Chigona A. and Chetty R. "Girls' education in South Africa: special consideration to teen mothers as learners." Journal of Education for International Development, vol. 3, no. 1, 2007, pp. 1–17.

13. Chigona A. and Chetty R. "Teen mothers and schooling: lacunae and challenges." South African Journal of Education, vol. 28, no. 3, 2008, pp. 261–281.

14. Bhana D et al. "South African responses to pregnant girls and young parents: a study of some Durban and Cape Town secondary schools." Agenda, vol. 76, no. 2, 2008, pp. 78–87.

15. Bozalek V. "Contextualizing caring in Black South African families." Social Politics. International Studies in Gender, State and Society, vol. 6, no. 1, 1999, pp. 85–99.

16. Tronto C. "Women and caring: what can feminists learn about morality from caring?" In: V. Held (Ed.), Justice and Care: Essential Readings in Feminist Ethics, Westview Press, New York, 1989, pp. 101–115.

17. Benson MJ. "Child and adolescent social work." International Journal of Environmental Research and Public Health, vol. 11, no. 5, 2014, pp. 4729–4744. doi:10.3390/ijerph110504729.

18. Nitirat P. "Thai adolescents' sexual behaviors and school-based sex education: perspectives of stakeholders in Chanthaburi Province, Thailand." Ph.D. dissertation, The University of North Carolina at Chapel Hill, Ann Arbor, 2007.

19. Karline Wilson-Mitchell et al. "Psychological health and life experiences of pregnant adolescent mothers in Jamaica." International Journal of Environmental Research and Public Health, vol. 11, no. 5, 2014, pp. 4729–4744. doi:10.3390/ijerph110504729.

20. Ilika A. and Anthony I. "Unintended pregnancy among unmarried adolescents and young women in Anambra State, south east Nigeria." African Journal of Reproductive Health, vol. 8, no. 3, 2004, pp. 92–102.

21. Morgan D. The focus group guidebook. Sage Publications, Thousand Oaks, CA, USA, 1998.

22. Morgan DL. "Focus groups." Annual Review of Sociology, vol. 22, 1996, pp. 127–158.

23. Kruger R. Moderating focus groups. Sage Publications, London, UK, 1997.

24. Berenson AB. et al. "Adverse perinatal outcomes in young adolescents." Journal of Reproductive Medicine, vol. 42, no. 7, 1997, pp. 559–564.

25. Raneri LG. and Wiemann CM. "Social ecological predictors of repeat adolescent pregnancy." Perspectives on Sexual and Reproductive Health, vol. 39, no. 1, 2007, pp. 39–47. doi:10.1363/3903907.

26. Gale R et al. "Is teenage pregnancy a neonatal risk factor?" Adolescents in Health Care, vol. 10, no. 4, 1989, pp. 404–408.