“… I tried to commit suicide…”: Understanding the intersections between mental health, HIV and teenage pregnancy

Background Mental health is an essential component of well-being, yet marginalized groups, particularly adolescents, face systemic inequities and barriers to accessing care. This paper describes the experiences of adolescent girls in their access to healthcare services and how these experiences might have contributed to their mental health and well-being in the Western Cape province, South Africa. Methods This qualitative study employed narrative and semi-structured interviews to explore the sexual and reproductive health and mental health well-being of adolescent girls aged 15–19. Participants included adolescent girls in various categories; pregnant, postpartum, HIV positive, and HIV negative, recruited from three youth-friendly primary healthcare facilities using purposive and snowball sampling methods. A total of 17 adolescents, 4 healthcare providers, and 4 parents were interviewed and a focus group was held, involving 6 sub-district frontline healthcare program managers. Results The factors contributing to mental health among the adolescents were broadly categorised under five themes, 1) Navigating the impact of unintended pregnancy, 2) Negotiating the home environment and other relationships, 3) Barriers to access to services at facility level, 4) Social challenges, and 5) Improving mental health services. Conclusion This study explored factors that contribute to or hinder the mental well-being of adolescent girls and the barriers to accessing mental health services. Designing tailored approaches to the identified factors and systemic challenges that counter mental distress for this age group can significantly mitigate the impact on their mental health.