Exploring barriers to implementing adolescent pregnancy prevention interventions in low- and middle-income countries: Perspectives from international experts

BACKGROUND: Adolescent pregnancy remains a significant public health concern, particularly in low- and middle-income countries (LMICs). Although various interventions have been implemented to address this issue, many have failed to achieve positive outcomes due to numerous barriers. OBJECTIVE: To explore the barriers to implementing adolescent pregnancy prevention interventions in LMICs. METHODS: This qualitative exploratory study involved 19 adolescent pregnancy prevention program implementers across 24 LMICs. Data were collected through virtual in-depth individual interviews, organized using Dedoose software, and analyzed thematically. RESULTS: Findings highlighted seven interrelated challenges shaping programme reach, acceptability, and sustainability. Experts reported that adolescents' engagement depended on perceived usefulness and, at times, material or social benefits of attendance, while stigma made participation social risky and encouraged private information-seeking. Prevention efforts were further constrained by gendered allocation and unequal decision-making power, which limited boys' participation and girls' agency. Separately, poverty, household material insecurity, and transactional marriage practices such as bride price contributed to early unions and subsequent childbearing, while programme legitimacy is challenged by taboo, religious opposition, contraception myths, and the normalization of violence. Finally, implementation was hindered by administrative delays, weak institutional backing, school-level resistance, and unstable or poorly enforced policy environments, limiting continuity and scale-up of interventions. CONCLUSION: Effective teenage pregnancy prevention in LMICs requires more than delivering sexual and reproductive health (SRH) information; programmes must be designed to feel relevant to adolescents while reducing stigma and protecting confidentiality to support genuine engagement. Interventions also need to address gendered power dynamics and gatekeeper control, alongside community-level legitimacy barriers such as taboo, religious opposition, contraception myths, and normalized violence. Sustainable impact will depend on enabling implementation conditions, including reduced bureaucratic delays, stronger institutional and school support, coherent policies, reliable financing beyond donor cycles, and better data to guide targeted action.