Study title: Kids with kids (extended): translating lived experiences of childhood pregnancy into policy and advocacy

Lead investigators

Nonhlanhla Ndondo, Sarah Bernays, Rashida Ferrand, Katharina Kranzer

Funders

Gates foundation

Implementing partner

The Health Research Unit at the Biomedical Research Training Institute (Project)

Background

Childhood pregnancy (girls under 18) remains a grave public health and social justice issue in Zimbabwe and Southern Africa, despite decades of prevention efforts. UNICEF's 2023 National Assessment reports that 21% of antenatal bookings are among 10–19-year-olds, with a prevalence of 41.2% among 15–19-year-olds. Yet post-conception care for pregnant children continues to be systematically neglected, with disproportionate focus on pregnancy prevention strategies instead.

The formative phase of the ‘Kids with Kids’ study (Phase 1: 2023–2025) highlighted stark realities among 119 pregnant girls aged 12–18 years, namely:

·        88% unwanted pregnancies, often from transactional/exploitative relationships

·        60%+ chronic food insecurity; 50% earning ≤US$50/month

·        20% expelled from school post-pregnancy

·        Punitive family responses (eviction, forced cohabitation) and policy reclassification as "adults," stripping child protection rights.

The formative phase of the Kids with Kids study also found that pregnant children face structural abandonment in the form of obstetric violence, inadequate antenatal care programmes, barriers to antenatal care, mental health crises, familial abuse, exclusion from social protection rights, inappropriate adultification and expectations, and a lack of educational and livelihood pathways, among other vulnerabilities compounded by childhood pregnancy. Additionally, social and moral discourses, embedded in both social and institutional practices, stigmatised girls as "naughty," erasing adult male responsibility and systemic failures. This exacerbates the cycle of punitive responses and the gaps in post-conception care policies and practices that directly address childhood pregnancy.

Study aim(s)

Grounded in the evidence from the first phase of the Kids with Kids study, this second phase aims to translate existing and new evidence on the lived experiences of childhood pregnancy into policies, practices, and advocacy tools that strengthen post-conception care and protection for pregnant children (<18) in Zimbabwe and, potentially, sub-Saharan Africa, improving their health and well-being and ensuring equitable access to services.

Project design

Project design

The project is designed to be operationalised through three interlinked work packages, as outlined below. A doctoral study is embedded in the project and will support this novel work with evidence to be disseminated across relevant platforms.

a.        Work Package A: National Policy Influence

A quarterly Network for Post-Conception Care was established in September 2025. This network adopts a multi-sectoral, holistic approach, convening policy actors from various government ministries (Health, Social Welfare, Education, Youth), implementers, community-based organisations and advocates, researchers, and Youth Advisory Teams (rural- and urban-based adolescent girls aged 18–24 with lived experience of childhood pregnancy).

The Youth Advisory Teams have been established in Harare (urban) and Masvingo (rural), and they will be continuously equipped to participate in policy-shaping dialogues through the Youth Researchers' Academy within BRTI. The academy will equip and mentor the youth advisors to conduct meaningful, empowered research, advocacy, and policy influence. The thematic focus of these dialogues is:

                                                                              i.        Health systems

                                                                           ii.        Social/psychosocial support

                                                                         iii.        Education/socioeconomic pathways.

b.       Work Package B:  Creative Co-Creation TriadThe youth advisory teams will play a pivotal role in supporting and informing evidence gathering and in translating the lived experiences of pregnant and postpartum girls (under the age of 18). Drawing on this experience, the youth advisory teams will collaborate with film experts and researchers to co-create creative visual advocacy outputs (films, digital stories, social media) through a series of workshops delivered by Art of Health[NN1] . The youth advisors will be involved in translating and framing the storyboards, while the film creators will produce the outputs, working closely with the advisors and the research team. The triad will collaboratively determine formats, messages, and audiences to reframe pregnancy as a systemic failure rather than an individual moral lapse.

c.        Work Package C: Regional/International Advocacy

Research findings and creative advocacy outputs will be disseminated through relevant SRHR and child rights platforms to support advocacy for integrating post-conception care into regional frameworks, for instance, by engaging with regional platforms such as the African Union Committee of Experts on the Rights and Welfare of Children (ACERWC) through observer status reports.

Project dates

2025-2028