Date of Award


Document Type

Open Access Dissertation


Health Promotion, Education and Behavior


Norman J. Arnold School of Public Health

First Advisor

Lucy Annang Ingram


Zimbabwe has a high maternal mortality with adolescent girls and young women facing disproportionately high risk of maternal morbidity and mortality. Current approaches to reducing maternal mortality in Zimbabwe focus on the pregnancy period with antenatal care, obstetric care, and micronutrient supplementation during pregnancy. Although important, these approaches are not reaching a large number of women and may benefit from integration with pre-pregnancy approaches. The importance of pre-pregnancy interventions to promote young women’s health has been emphasized, yet many young women in developing countries like Zimbabwe do not have access to pre-pregnancy care because little is understood about the concept of pre-pregnancy planning. Furthermore, it is unknown which interventions will have the greatest impact on maternal outcomes of women in these countries. The purpose of this research was to work collaboratively with adolescent girls, young women, and key stakeholders in Harare, Zimbabwe to bridge the knowledge gap around pre-pregnancy planning and to inform the development of a pre-pregnancy planning intervention. Interview data were collected from June-August 2015 from adolescent girls and young women (14-24 years) (n=48) and key community stakeholders (n=24) from two low-income high-density communities in Harare. Sixteen focus groups were also conducted in November 2015 with females aged 14-24 years, healthcare workers, and partners of females aged 14-24 years (n=134). Qualitative analysis with Nvivo 10 software indicated that adolescent girls and young women conceptualized pregnancy across 8 themes: carrying a child, motherhood, the best time for pregnancy, pregnancy decision makers, who is responsible for the pregnancy, pregnancy burden, pregnancy dangers, and increase in social status with pregnancy. Participants expressed mixed views concerning the possibility of planning a pregnancy and described pregnancy planning across the pre-pregnancy, pregnancy and post-pregnancy phases. Key community stakeholders described a physical environment related to pregnancy and planning for pregnancy that was limited in programming targeting adolescent girls and young women and a social environment that was deeply rooted in culture and cultural practices. Focus group participants described potential pre-pregnancy efforts that included clinic programs, community outreach, edutainment, empowerment of young women, parent and partner involved or targeted programs, peer education, school programs, technology programs, and youth friendly environments. Findings suggest that considering the socio-sociocultural influences on pregnancy will be beneficial in developing pre-pregnancy efforts to improve maternal and child health in Zimbabwe.