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The COVID-19 pandemic created unprecedented challenges for global health and development, exacerbating inequalities and intensifying vulnerable populations’ difficulties. Women, adolescents, and children were disproportionately affected, with disruptions in education, healthcare, and social support systems threatening decades of progress. Although COVID-19 is no longer classified as a Public Health Emergency of International Concern (PHEIC), its impacts continue to be felt, especially in low- and middle-income countries (LMICs). Yet, amidst these challenges, hope emerge through innovative, evidence-informed interventions that can potentially transform lives on a large scale and regain the derailed progress toward achieving Sustainable Development Goals particularly SDG 3 on “Good Health and Well-being”.
This article highlights proven strategies that address two critical public health challenges: unintended adolescent pregnancies and maternal mortality. Drawing on evidence from two systematic reviews published in the BMC Public Health Journal under the “Putting Countries Back on the Path to Achieving SDGs” project led by the African Institute for Development Policy (AFIDEP), the author explores interventions that have successfully enhanced adolescent and maternal health outcomes. From school-based education programmes that empower young people to make informed choices to community-driven maternal health initiatives that improve service uptake, these research-backed solutions provide a roadmap for policymakers, healthcare professionals, and advocates striving to create more equitable health systems.
Tackling Unintended Adolescent Pregnancies
Each year, an estimated 21 million pregnancies occur among adolescents aged 15–19 in LMICs, with approximately 50% of these being unintended. Many of these pregnancies result in unsafe abortions, while those who carry their pregnancies to term face increased risks of complications, poor maternal and child health outcomes, and economic hardship. Adolescent mothers are more likely to drop out of school, limiting their future opportunities and reinforcing cycles of poverty. Despite the urgent need for sexual and reproductive health (SRH) services, many adolescents struggle to access contraception and counselling due to stigma, discrimination, and restrictive policies.
The COVID-19 pandemic further intensified these challenges by disrupting healthcare systems, restricting movement, and closing schools—one of the strongest protective factors against early pregnancies. The inability to access SRH services and the loss of structured education left many adolescent girls more vulnerable, contributing to increased rates of unintended pregnancies, child marriages, and school dropouts. Without effective interventions, adolescent girls remain at risk of poor health, economic insecurity, and social exclusion. However, research has identified strategies to mitigate these risks and support adolescent reproductive health.
Comprehensive sex education (CSE) is a widely used approach for preventing adolescent pregnancies, providing young people with factual, age-appropriate information on SRH including contraception, sexually transmitted infections (STI) prevention, and healthy relationships. While school-based CSE programmes play an important role in improving SRH knowledge, research highlights that curriculum-based education alone has limited effectiveness in reducing unintended pregnancies unless paired with contraceptive provision and accessible SRH services. To maximise its impact, national governments should integrate comprehensive sexuality education (CSE) into school curricula and ensure that adolescents have access to youth-friendly SRH services alongside education efforts.
Beyond education, skill-building initiatives have proven effective in reinforcing SRH programmes. These interventions, which include teacher-led SRH sessions, interactive learning approaches, and confidence-building exercises, have been associated with improved contraceptive use, delayed sexual initiation, and a stronger understanding of reproductive health. By integrating skill development into adolescent-focused programmes, interventions can become more impactful in reducing unintended pregnancies.
Peer-led interventions are another promising approach. Adolescents often respond more positively to their peers’ messages than authority figures, making youth-led SRH education an effective tool. Trained peer educators provide SRH information in schools and communities, facilitating open discussions about contraception, safe sexual practices, and healthy relationships. Some programmes even incorporate peer referrals to youth-friendly health services, bridging knowledge and action gaps. To strengthen and expand these initiatives, community-based organisations (CBOs) and civil society organisations (CSOs) should scale up peer-led programmes, ensuring that adolescents are both the recipients and drivers of SRH knowledge within their communities.
While school-based interventions are essential, they must be complemented by community-based programmes to reach adolescents outside the education system. These initiatives involve parents, community leaders, and local organisations in promoting reproductive health, addressing cultural barriers to contraception, and creating a supportive environment for young people. When SRH education is paired with accessible contraceptive services, adolescents are more likely to make informed choices about their reproductive health.
However, information alone is not enough. Many adolescents face barriers to accessing contraceptives due to stigma, lack of confidentiality, or financial constraints. Programmes that integrate contraceptive access with SRH education are more effective in reducing unintended pregnancies. Ensuring these services are youth-friendly, non-judgmental, and easily accessible—whether through schools, community health centres, or mobile clinics—removes significant barriers to contraceptive uptake. Health ministries and education sectors must prioritise training teachers to deliver sexual and reproductive health education in ways that are accurate, engaging, and responsive to adolescents’ needs.
Preventing unintended adolescent pregnancies requires a holistic approach that combines education, skill-building, peer-led programmes, and community support. Schools and health systems must work together to create an environment where adolescents can make informed choices about their reproductive health. Scaling up these proven interventions is key to reducing pregnancy rates and ensuring better health, education, and economic outcomes for young people.
Improving Maternal Health Through Enhanced Healthcare Service Uptake
Maternal mortality remains a major global health challenge, with over 295,000 women dying annually from preventable pregnancy-related complications. Most of these deaths occur in LMICs, where limited healthcare access, socio-economic barriers, and inadequate health infrastructure hinder maternal service utilisation. The COVID-19 pandemic further exacerbated these challenges, straining already fragile health systems and diverting resources away from maternal care. Lockdowns, economic hardship, and healthcare disruptions limited access to antenatal care (ANC), skilled birth attendance, and emergency obstetric services, reversing gains made in reducing maternal deaths. Evidence-informed interventions aimed at increasing healthcare engagement among pregnant women are essential for reducing maternal mortality and improving birth outcomes.
Mobile health interventions have emerged as a game-changer in improving maternal healthcare access, particularly in LMICs, where physical barriers often prevent pregnant women from attending regular ANC visits. Evidence from systematic reviews demonstrates that mobile-based interventions, such as SMS reminders and phone call follow-ups, have significantly improved service utilisation among pregnant women. For instance, evidence from a cluster-randomised controlled trial (cRCT) in Tanzania and Zanzibar found that pregnant women who received mobile health interventions were 2.39 times more likely to complete at least four ANC visits compared to those who did not receive reminders.
Another meta-analysis of three RCTs showed that pregnant women who received SMS reminders were 1.82 times more likely to have skilled birth attendance compared to those in control groups. Additionally, evidence shows that HIV-positive pregnant women who received text message reminders were 66% more likely to attend postnatal care after delivery than those who did not receive reminders. Recognising their success, governments and health ministries should expand mobile health (mHealth) platforms, ensuring that pregnant women receive timely reminders, remote consultations, and continuous support throughout pregnancy and postpartum periods.
Active engagement of male partners has also proven effective in improving maternal health outcomes. Programmes that involve men through targeted counselling and education increase their understanding of pregnancy-related risks and encourage them to provide financial and emotional support to their partners. Such involvement has been shown to boost skilled birth attendance (SBA) and retention in antiretroviral therapy (ART) programmes, highlighting the importance of inclusive healthcare approaches. However, passive involvement strategies, such as invitation letters for antenatal care visits, have been less effective, underscoring the need for active engagement of male partners. To fully harness this potential, policymakers should prioritise strategies that actively engage male partners, providing them with education and support to positively influence maternal health outcomes.
Facility-based interventions have played a pivotal role in addressing maternal health challenges, particularly among HIV-positive pregnant women. Integrating antenatal care and ART services within the same facility has removed access barriers, improving maternal ART uptake and retention. National governments and development partners must continue to strengthen integrated healthcare platforms, ensuring that ANC, ART, and maternal services are provided in cohesive, accessible ways to meet the diverse needs of pregnant women.
Similarly, community-based programmes have demonstrated success, with trained community health workers delivering essential antenatal and postnatal care, counselling for postpartum depression, and promoting good infant care practices such as exclusive breastfeeding and hygiene. To enhance the effectiveness of these initiatives, community health workers must be empowered and supported with the training, resources, and systems they need to deliver consistent maternal healthcare outreach, particularly in underserved rural settings.
The evidence underscores the importance of combining these interventions to achieve maximum impact. Mobile health initiatives, male partner engagement, service integration, and community-based efforts create a more supportive and accessible healthcare system for pregnant women throughout their maternal journey.
The findings from these systematic reviews reinforce the urgent need to scale up evidence-informed interventions that address adolescent pregnancies and improve maternal healthcare. As part of efforts to achieve SDG 3— ensuring healthy lives and promoting well-being for all— stakeholders must take decisive action to implement these proven strategies.
Read more in the published systematic reviews:
Mzembe, T., Chikwapulo, V., Kamninga, T. M., et al. (2023). Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: A review of systematic reviews. BMC Public Health, 23(1), 1734. https://doi.org/10.1186/s12889-023-16558-y
Mohamed, S., Chipeta, M. G., Kamninga, T., et al. (2023). Interventions to prevent unintended pregnancies among adolescents: A rapid overview of systematic reviews. Systematic Reviews, 12(1), 198. https://doi. org/10.1186/s13643-023-02361-8