Pathways to empowerment of adolescent mothers: a policy-oriented approach for improving postpartum self-efficacy and health service access within Iran's health system.

backgroundAdolescent motherhood is a complex public health and social challenge, particularly in low- and middle-income countries where cultural norms and policy frameworks intersect. Teen mothers often enter parenthood without adequate emotional readiness, social support, or access to youth-friendly healthcare. Self-efficacy, defined as an individual's belief in their ability to manage and succeed in specific tasks, is crucial for empowering adolescent mothers to navigate postpartum challenges, improve parenting outcomes, and maintain mental well-being. In Iran, existing adolescent and maternal health policies are limited and often fail to adequately address the unique needs of this population. These gaps increase their vulnerability to mental health challenges, poor parenting outcomes, and long-term socioeconomic and psychosocial disadvantages. The aim of this study is to analyze the multi-level challenges faced by adolescent mothers in the postpartum period, drawing on the perspectives of key stakeholders, including adolescent mothers, their families, policymakers, and health service providers, and to co-create policy recommendations that integrate self-efficacy-oriented strategies into Iran's maternal health system. MATERIALS AND

methodsThis study employed a multi-phase, mixed-methods approach, with the primary focus on qualitative interviews and Delphi assessment. Semi-structured interviews were conducted with 21 policymakers and health service providers, as well as in-depth interviews with 23 adolescent mothers, to explore their perspectives on postpartum challenges and empowerment strategies. The study also drew on a previously conducted literature review as part of the broader research project to identify evidence-based strategies for supporting adolescent mothers. A Delphi panel, comprising national experts from the health, education, psychology, and social sectors, was subsequently convened to assess, validate, and refine policy recommendations. Thematic analysis of the qualitative interview data, in combination with insights from the literature review, guided the development of a culturally sensitive and context-specific policy framework, ensuring that the recommendations were evidence-informed and practically relevant to Iran's maternal health system.

resultsThe findings revealed that adolescent mothers face complex, multi-dimensional challenges across individual, familial, structural, and policy levels. Improving adolescent maternal health in Iran requires a comprehensive, multi-level approach that integrates adolescent-friendly care into national policies. Empowerment-focused interventions and family-community engagement are vital to enhance postpartum self-efficacy and reduce stigma. Strengthening healthcare provider training and creating youth-friendly services will improve care quality and accessibility. Effective intersectoral collaboration and robust monitoring systems are essential for sustained impact. Continued research will support evidence-based policy refinement and better outcomes for adolescent mothers.

conclusionThis study calls for culturally tailored, evidence-based interventions, improved provider skills, and strong community support. Policies must address both psychosocial and clinical needs of adolescent mothers simultaneously, with continuous monitoring and support for applied research to ensure effectiveness and ongoing improvements in the health outcomes of this at-risk group.