UCT-led project supports adolescent mothers through referral process

By 2050, Africa will be home to nearly one billion adolescents. This means that the number of pregnant women and young mothers would likely double. Supporting them by designing services that fit their needs is crucial, said the University of Cape Town’s (UCT) Associate Professor Elona Toska.

Associate Professor Toska, an adolescent health researcher at UCT’s Centre for Social Science Research, was speaking during day one of the 3rd African Workshop on Women and HIV, held in Cape Town from 12 to 13 March. The workshop focuses on improving the quality of life for women living with HIV, reducing transmission rates and strengthening care integration. Two UCT academics – Associate Professor Phumla Sinxadi from the Division of Clinical Pharmacology and Dr Elzette Rousseau from the Desmond Tutu Health Foundation – hold the workshop’s local co-chair title in South Africa.

A multi-pronged referral system

Toska’s presentation was titled: “From research to reality: Outcomes and insights from a multi-pronged referral system for adolescent mothers living with and affected by HIV in South Africa”. Her talk was based on a research study titled: “Help empower youth brought up in adversity with their babies and young children (Hey Baby)”, a joint project between UCT and the University of Oxford, and currently on the go in the Eastern Cape.

“[The research study surveys] how HIV and the experiences of living with and being exposed to HIV, really occur during adolescence [while] at the same time, the young women in our region and in South Africa specifically are also dealing with relationships where they become pregnant and become mothers,” Toska said.

“There’s a lot of considerations here, but one of the areas that a large body of evidence has pulled together is that there’s a lot of shared pathways and factors that drive HIV exposure, risk and acquisition [as well as] becoming pregnant and a mother in adolescence.”

Early pregnancy and motherhood

Toska told the audience that early pregnancy and motherhood in the region is often unplanned and unintended. However, she stressed, that doesn’t mean that adolescent girls and young women don’t love their children and aren’t good mothers. Often, they just need support to get by.

Through Hey Baby in 2018, the team recruited and worked with more than 1 000 adolescents, who were mothers to 1 200 children. The number of children in the cohort has since increased to 1 700.

“We are social scientists, so we try to understand life as it happens with young people. We’re not giving them post-exposure prophylaxis or HIV tests. We’re not taking them to the clinic unless they ask us to,” Toska said. “And in the process of doing this work, we do what we call referrals.”

Toska said roughly a third of adolescents recruited for the mother and baby study are living with HIV. And what they learned during conversations is that these women have a different set of unique experiences that relate mainly to their children, some of whom may have been exposed to HIV in utero, during birth or while breastfeeding.

“They are a group of young women who have additional layers of needs. So, we do subgroup analysis and look at what living with HIV means for these young mothers and their children,” she said.

A detailed Q&A

Toska said their overall research findings are based on 630 participants’ responses, which researchers collected through one-on-one interviews between 2020 and 2025.

The interviews, she said, are a detailed exchange. Participants answer questions about their mental health, violence in the home or elsewhere, whether they attend school or not, and if they have food in their home. For those living with HIV or other chronic conditions, discussions also centre around medication compliance. And their answers spark the referral process, which researchers categorise into emergency and non-emergency groups. Toska said emergency referrals are serious cases and include facilitating urgent support for suicide ideation or attempts, sexual abuse, and the urgent need for emergency contraception, especially after a case of sexual abuse. A woman who is defaulting on her antiretroviral treatment is also considered an emergency case.

During these interviews, Toska said some participants ask for help as soon as their sessions conclude, while others take some time before reaching out via a phone call.

“Sometimes during interviews, participants get upset. But sometimes they’re just relieved to be telling their story to someone [and] that can open the door to have a chat about a referral,” she said.

Supporting young mothers

According to the research findings, a third of the young women required a single referral (counselling, food, medication) over time, while 10% needed more than one referral during two of their three interviews. Further, their research also indicated that adolescent mothers living with HIV were 47% more likely to need referrals. Interestingly, school going adolescent mothers were much less likely to require a referral. This, she said, highlights the importance of keeping young mothers in school and adequately supporting their needs. Over time, she said, researchers noticed that young mothers needed significant support, with some requiring different levels of support to lead fulfilling lives.

“We learned that timing and choice of referral is a big area and not everyone is ready to take the referral up when we are ready to offer it.”

“So, for example, a young mother may need a food referral [and] counselling support or [assistance] with getting to the Department of Home Affairs to get access to the Child Support Grant,” she said. “Referrals are quite complex. We learned that timing and choice of referral is a big area and not everyone is ready to take the referral up when we are ready to offer it.”

What’s important to note, she added, is that participants’ needs also evolve over time.

“What you need when your baby is under six months old is very different to what you need when your baby is three months old or three years old, and where you are as a young mother, depending on how old you are and where you are in your educational or professional trajectory [also count in the referral process],” Toska said.