Pregnant adolescents' dynamic engagement with participatory women's groups for maternal and newborn health in rural India: a qualitative study.

Introduction: Around 21 million girls globally become pregnant each year, many in the context of early marriage, yet we know very little about supporting them during the perinatal period. This study explores how pregnant adolescents engage with women's groups practising participatory learning and action (PLA) to improve maternal and newborn health in rural eastern India.

Methods: The study was carried out with Ekjut, a non-governmental organisation responsible for training government-incentivised volunteers who facilitate groups in several Indian states. A team of three qualitative researchers carried out 29 semistructured interviews, nine focus group discussions and five video-recorded observations of groups in 12 villages of Jharkhand, eastern India, from December 2018 to December 2019. We interviewed girls and women with different levels of engagement with PLA groups, as well as health workers and analysed data using thematic analysis.

Results: Pregnant adolescents wished to attend PLA groups and learn from them but faced many barriers to doing so. These included restrictive marital norms that were stronger with younger age and enforced by pervasive gossip. Marital family support and access to a skilled government health worker, however, could moderate these restrictive norms to enhance engagement with PLA groups. Pregnant adolescents expressed wanting elders present in PLA groups and valued marital family support to help them navigate the challenges of pregnancy and motherhood. Pregnant girls from more restrictive families were particularly vulnerable and socially isolated, requiring more intense engagement from health workers to connect them to PLA groups and health services.

Conclusion: Research and programmes to support pregnant girls would benefit from acknowledging the restrictions of early marriage and pregnancy while also engaging constructively with these restrictions. This might involve recognising the potential of PLA groups to foster adolescents' developmental capacities but also constructively engaging with marital families and providing broader developmental support.