Understanding pregnancy outcome decision-making among pregnant adolescents in Vietnam: a qualitative study guided by the social ecological model

Abstract

Adolescent pregnancy remains a significant public health concern in Vietnam, yet little is known about how pregnant adolescents make decisions regarding pregnancy continuation or termination. This qualitative descriptive study aimed to explore the decision-making processes of pregnant adolescents and identify the multilevel factors influencing pregnancy outcomes using the social ecological model. Purposive sampling was employed to recruit adolescents aged 15-19 years with unintended pregnancies attending a provincial referral maternal and child health hospital in Central Vietnam. Semi-structured, in-depth interviews were conducted until thematic saturation was achieved. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis. Twelve adolescents participated, including seven who continued their pregnancies and five who chose pregnancy termination. Seven interconnected themes were identified across four ecological levels. At the individual level, pregnancy recognition was commonly accompanied by emotional shock, uncertainty, and evolving pregnancy intentions. Interpersonal influences included both supportive and coercive roles of family members and partner commitment or rejection. At the community level, religious and moral beliefs, financial insecurity, and limited access to reliable reproductive health information and services substantially shaped decision-making. At the societal level, social stigma and cultural expectations regarding marriage, motherhood, and family reputation further influenced pregnancy outcomes. These findings demonstrate that pregnancy outcome decision-making among Vietnamese adolescents is a dynamic process shaped by interacting influences across multiple ecological levels. Interventions should extend beyond individual counseling to include family engagement, adolescent-friendly reproductive health services, improved access to accurate reproductive health information, and community-based strategies to reduce stigma and support informed, person-centered reproductive decision-making.