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.

OBJECTIVES:
To explore the barriers to implementing adolescent pregnancy prevention interventions in LMICs using a social-ecological framework.

METHODS:
This qualitative exploratory study involved 19 participants who had implemented adolescent pregnancy prevention programs across 24 LMICs. Data were collected through virtual in-depth individual interviews, organized using Dedoose software, and analyzed thematically.

RESULTS:
The findings revealed barriers at multiple levels. Intrapersonal (adolescents) barriers included low perceived relevance and motivation to engage, generational expectations and social modeling leading to disengagement, limited autonomy, stigma, and reliance on unverified online information over professional guidance. Interpersonal barriers involved family endorsement of child marriage, normalization of early pregnancy and intergenerational patterns, male-dominated decision-making, and restrictive family influences. At the community level, barriers included the influence of cultural norms and traditions, religious constraints, acceptance of gender-based violence, social stigma against adolescent pregnancy prevention programs, and language barriers. Institutional and organizational barriers encompassed bureaucratic and corrupt processes to obtain project implementation permissions, lack of institutional support for sexual and reproductive health (SRH) programs, and resistance from schools. Policy-level barriers included vague or conflicting policies related to cultural practices, lack of coordination among government ministries, parental consent requirements for SRH services, absence of disaggregated national data, and limited scale-up and integration of effective interventions at the national level.

CONCLUSIONS:
Future efforts must account for these complex challenges to enhance the impact and sustainability of such interventions.

KEY MESSAGE:
Adolescent pregnancy prevention interventions in LMICs face complex, multi-level barriers that hinder their effectiveness and sustainability. Addressing these challenges requires a comprehensive, context-sensitive approach informed by the socio-ecological framework. Poster session 4 (Group B)