Adolescent girls and young women (AGYW) in South Africa experience early pregnancy and motherhood, sexual- and gender-based violence (SGBV) and disproportionate exposure to HIV. High rates of early adolescent pregnancy, in most cases unintended, also increase the risk of HIV infection. These factors make AGYW a highly vulnerable population and put them at an increased risk of economic hardship, as well as substantial mental health challenges, often with a lack of social support.

Pregnant and mothering AGYW need multisectoral support programmes, yet current interventions often stop when AGYW become mothers or acquire HIV, when sensitive support services are most needed. In general, Southern African programming has also failed AGYW in numerous ways: it does not adequately address the complex social, behavioural and structural obstacles faced by young women in South Africa, nor has it meaningfully involved AGYW beyond early-stage or user-testing in intervention research.

Pregnant and mothering AGYW would benefit from non-clinical options that better support their distinct health journey and recognise the temporality of their rapidly changing needs. Technology has become a critical tool in crafting youth-centred and responsive approaches.

Through systematic equity action-analysis (SEA), we will apply novel, southern, qualitative and action-oriented participatory methods. We will invite meaningful participation in research, and implementation in advocacy through intersectional, relational approaches.

The aim is to centre the leadership and capabilities of adolescent girls and young women to generate and translate knowledge that can shape research partner Shout-it-Now’s digital and face-to-face wellbeing services. The study will engage AGYW, including pregnant and mothering AGYW, and Shout-it-Now peer ambassadors to collaboratively:

1. Gather transdisciplinary, multimethod evidence on pregnant and mothering AGYW’s digital and face-to-face service trajectories
2. Describe and engage with their understanding and experience of digital and relational wellbeing (RWB)
3. Respond by re-imagining digital and face-to-face services for pregnant and mothering AGYW through differentiated service-delivery options, expanding options and choices that enable them to flourish, on their terms.

The expected impact of this partnership will be strengthened quality and responsiveness of Shout’s digital and face-to-face health and wellbeing services, as well as the formation and sustainment of meaningful connections between pregnant and mothering AGYW, peer ambassadors and supportive community networks.

The research will explore the health service trajectories and experiences of pregnant and mothering AGYW in Shout’s cohort and peer ambassadors supporting service delivery, and the factors that shape these experiences.

The research will also explore how pregnant and mothering AGYW and peer ambassadors understand, experience and express RWB in their digital and non-digital lives. Collaboratively, the research will identify actions that co-researchers and community stakeholders can undertake to reimagine safe and contextualised RWB-centred digital and face-to-face spaces for AGYW to explore and flourish.

The lead research institution, the University of Cape Town’s Adolescent Accelerators Research Hub (UCT AARHub), and its research partner Shout will regularly review progress on co-researcher recruitment and undertake reflexive dialogue to understand situational and contextual ethical considerations, and review progress. The researchers will review and adjust the recruitment strategies as needed, with a focus on the best interests and safety of pregnant and mothering AGYW and peer ambassadors. Any changes made to the recruitment strategies will go through UCT’s ethical review and be documented in the research process notes.

Debriefs will take place after each workshop to reflect on the co-researchers’ experiences and the direction they wish to take their involvement in the project. This will be done iteratively and through open-ended, supportive probes and art-based activities (mindmapping, freewriting, drawing). Co-researchers and the research team will be invited to keep a research journal to document their reflections on the process of relational thinking, gathering and working, which will also highlight learnings on the best ways to approach biases. This will provide a basis for iteratively discussing and responding to expressed experiences of power dynamics, as well as using the information to identify additional training and mentorship needs.