Impact statement
Displaced adolescent mothers experience overlapping mental health risks that are often insufficiently addressed within humanitarian response systems. Their needs cut across adolescent health, maternal and newborn health, protection and mental health and psychosocial support, yet humanitarian programming often responds to these domains separately. This gap is important because adolescence, displacement-related adversity and early motherhood can interact to create a compounded pattern of psychological vulnerability that standard service models may not fully capture. This review introduces the Triple Jeopardy Framework as a conceptual tool for understanding the mental health of displaced adolescent mothers. The framework describes how developmental transitions, exposure to conflict and displacement, gender-based violence (GBV), disrupted social support and caregiving responsibilities may converge to increase risks of depression, anxiety, post-traumatic stress disorder, social isolation and intergenerational harm. At the same time, it recognizes that displaced adolescent mothers are not only vulnerable. Many demonstrate agency, adaptive coping and resilience within highly constrained social and structural environments. The goal of this article is to support more targeted and integrated humanitarian action for adolescent mothers affected by forced displacement. The framework can inform interventions that embed perinatal mental health screening within maternal health services, strengthen community-based mental health and psychosocial support and peer networks, address protection risks such as GBV and child marriage and safeguard access to education, livelihoods and social inclusion. By making this neglected population more visible, the review calls for rights-based, gender-responsive and life-course approaches to mental health care in humanitarian settings.
Introduction
The global displacement crisis has escalated to an unprecedented scale. According to the United Nations High Commissioner for Refugees (UNHCR), 123.2 million people were forcibly displaced worldwide at the end of 2024, including 73.5 million internally displaced persons, 31 million refugees and 8.4 million asylum seekers (UNHCR, 2025). Forced displacement occurs when people are compelled to leave their usual place of residence because of disasters, armed conflict, violence, persecution or other unsafe conditions (Cuadrado et al., Reference Cuadrado, Libuy and Moreno-Serra2023). This movement may occur within countries or across international borders and includes refugees, asylum seekers, internally displaced persons, returnees and other crisis-affected populations. Adolescent girls in displacement face heightened risks of gender-based violence (GBV), child marriage, sexual exploitation and unintended pregnancy (Taylor and Josiah, Reference Taylor and Josiah2023; UNHCR, 2025).
The risks are especially acute for adolescent mothers, defined here as young women who give birth between 10 and 19 years of age (Ganchimeg et al., Reference Ganchimeg, Ota, Morisaki, Laopaiboon, Lumbiganon, Zhang, Yamdamsuren, Temmerman, Say, Vogel, Souza and Mori2014). Research on adolescent pregnancy and motherhood has linked early motherhood with depression, psychological distress, reduced social support, stigma and lower maternal self-efficacy, although findings vary by population, setting, study design and measurement tool (Hudson et al., Reference Hudson, Elek and Campbell-Grossman2000; Kingston et al., Reference Kingston, Heaman, Fell and Chalmers2012; Mutahi et al., Reference Mutahi, Larsen, Cuijpers, Peterson, Unutzer, McKay, John-Stewart, Jewell, Kinuthia, Gohar, Lai, Wamalwa, Gachuno and Kumar2022; Lesinskienė et al., Reference Lesinskienė, Andruškevič and Butvilaitė2025). For example, qualitative work with internally displaced young mothers in Bogotá described victimization, constrained choice and maternal agency within contexts of structural violence (Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019). In Mahama refugee camp in Rwanda, research with pregnant teenagers and teenage mothers similarly described how stigma, disrupted school attendance, solitude and resilience shaped their experiences of pregnancy and motherhood (Ruzibiza, Reference Ruzibiza2021). Evidence from Kule refugee camp in Ethiopia further linked early pregnancy among adolescent girls with displacement-related insecurity, limited reproductive health information and restricted access to adolescent-responsive services (Adhena and Fikre, Reference Adhena and Fikre2023). Among young mothers displaced by conflict in South Sudan and the Kurdistan Region of Iraq, insecurity, caregiving demands, disrupted support systems and restricted service access also affected health and wellbeing (Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024). A wider mixed-methods systematic review of displaced adolescent girls and young women reported related concerns, including adolescent pregnancy, low contraceptive use and access, poor menstrual hygiene management, sexually transmitted infection (STI) and human immunodeficiency virus (HIV) - related stigma and knowledge gaps, child, early and forced marriage or partnership, sexual and GBV and unmet sexual and reproductive health (SRH) needs in humanitarian settings (Soeiro et al., Reference Soeiro, Siqueira Guida, Costa-Santos and Costa2023).
Although existing literature has documented the risks associated with adolescent pregnancy and forced displacement, there remains a need for a framework that explains how risk and protective environments interact for displaced adolescent mothers. Such a framework is important for identifying where vulnerability is intensified, where protection is weakened and where programs can intervene. This review therefore proposes the Triple Jeopardy Framework to examine how adolescence, forced displacement and early motherhood interact to influence mental health vulnerability and resilience. The review also adopts a risk and protective factors paradigm because this framing supports the identification of vulnerabilities and the design of holistic interventions. Attention to protective factors highlights opportunities to strengthen existing sources of resilience and agency, consistent with a strengths-based approach to supporting displaced adolescent mothers (Fergus and Zimmerman, Reference Fergus and Zimmerman2005; Masten, Reference Masten2014).
Methods
Review approach and literature search
This narrative review synthesizes literature addressing the mental health of forcibly displaced adolescent mothers, a population situated at the intersection of adolescent health, maternal mental health and humanitarian research.
Literature searches were conducted in PubMed, Scopus and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published between January 2000 and December 2025. Searches combined terms related to adolescent motherhood, forced displacement and mental health, including “adolescent mother,” “teenage pregnancy,” “refugee,” “forced displacement,” “humanitarian settings” and “mental health.”
Additional articles were identified through reference-list screening and citation tracking of key publications. Studies were included if they examined mental health outcomes, psychosocial experiences or related determinants among adolescent mothers who were pregnant or parenting in contexts of forced displacement, including refugee, internally displaced, asylum-seeking or conflict-affected populations. Both qualitative and quantitative empirical studies were considered.
Conceptual framework development
The Triple Jeopardy Framework was developed through thematic synthesis and theoretical integration, then refined for alignment with the empirical literature and relevance to intervention design.
Findings
Understanding the mental health of displaced adolescent mothers requires first examining adolescence, forced displacement and motherhood as domains with distinct risk and protective factors, before turning to how these domains intersect among displaced adolescent mothers specifically. The Triple Jeopardy section that follows then examines how these domains compound for displaced adolescent mothers specifically, consistent with an intersectional model of vulnerability, not a simple additive model.
Adolescence-specific mental health risk and protective factors
Adolescence represents a critical developmental period characterized by significant neurobiological, psychological and social transitions (Hughes et al., Reference Hughes, Bellis, Hardcastle, Sethi, Butchart, Mikton, Jones and Dunne2017).
Risk factors
Adverse childhood experiences (ACEs) provide a useful lens for understanding how socioecological conditions influence adolescent mental health vulnerability (Felitti et al., Reference Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss and Marks1998; Hughes et al., Reference Hughes, Bellis, Hardcastle, Sethi, Butchart, Mikton, Jones and Dunne2017; Gu et al., Reference Gu, Zhao, Yuan, Yi, Zhao and Wang2022). ACEs include family conflict, abuse, neglect, parental mental illness or substance misuse, bullying, community violence, educational disruption and exposure to armed conflict or political violence (Rudolph and Flynn, Reference Rudolph and Flynn2007; Betancourt and Khan, Reference Betancourt and Khan2008; Okello et al., Reference Okello, De Schryver, Musisi, Broekaert and Derluyn2014). These experiences can interfere with emotional regulation, cognitive development, social trust, identity formation and future orientation. A systematic review and meta-analysis by Hughes et al. (Reference Hughes, Bellis, Hardcastle, Sethi, Butchart, Mikton, Jones and Dunne2017) found that exposure to multiple ACEs was associated with increased risk of poor mental health outcomes, while cross-diagnostic evidence from Gu et al. (Reference Gu, Zhao, Yuan, Yi, Zhao and Wang2022) linked ACE exposure with greater symptom severity across mental disorders.
Beyond immediate psychological distress, ACE exposure is associated with substance use, living in socioeconomically marginalized or unsafe environments, academic disengagement, interpersonal difficulties and reduced school connectedness. These outcomes show how adversity can disrupt multiple protective systems, including stable caregiving relationships, safe learning environments and structured social participation (Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Evans et al., Reference Evans, Li and Whipple2013; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016).
Protective factors
Despite exposure to adversity, adolescence remains a period of substantial neuroplasticity and adaptive capacity in which protective factors can influence mental health trajectories (Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016). Protective processes include competencies and psychosocial resources that help adolescents manage stress effectively (Masten, Reference Masten2014). Individual assets such as emotional regulation, problem-solving skills, adaptive coping, self-efficacy, agency, future orientation and goal-directed behavior can buffer the psychological effects of adversity (Scales et al., Reference Scales, Benson, Leffert and Blyth2000; Fergus and Zimmerman, Reference Fergus and Zimmerman2005; Hughes et al., Reference Hughes, Bellis, Hardcastle, Sethi, Butchart, Mikton, Jones and Dunne2017).
At interpersonal and contextual levels, supportive relationships and structured developmental opportunities play a central role. Positive peer connections, at least one stable caring adult, family cohesion, warm parenting, school connectedness, extracurricular activities and mental health literacy programs can reduce loneliness, distress and school disengagement while strengthening competence, belonging and help-seeking (Fergus and Zimmerman, Reference Fergus and Zimmerman2005; Weare and Nind, Reference Weare and Nind2011; Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016).
Motherhood-related mental health risk and protective factors
Maternal and perinatal factors, including hormonal changes, physical recovery from childbirth and the psychosocial demands of infant care, can affect mental health through biological, psychological and social pathways.
Risk factors
Pregnancy and the postpartum period involve physiological and psychosocial changes that can increase vulnerability to depression, anxiety and psychological distress. Hormonal changes during pregnancy and after childbirth are associated with mood regulation, while the physical demands of pregnancy, childbirth, breastfeeding, infant care and postpartum recovery can increase fatigue and emotional strain (Schiller et al., Reference Schiller, Meltzer-Brody and Rubinow2015). Infant care can further intensify sleep disruption and reduce opportunities for rest, which is important because postpartum sleep disturbance has been associated with depressive symptoms and poorer maternal wellbeing (Dennis and Ross, Reference Dennis and Ross2005; Okun, Reference Okun2016).
Birth complications, emergency obstetric interventions, fear during childbirth or traumatic delivery experiences can contribute to postpartum psychological distress and post-traumatic stress disorder(PTSD) symptoms (Ayers et al., Reference Ayers, Bond, Bertullies and Wijma2016; MacKinnon et al., Reference MacKinnon, Houazene, Robins, Feeley and Zelkowitz2018). Social conditions surrounding motherhood also matter: partner absence, intimate partner conflict or violence, isolation from family networks and stigma surrounding the circumstances of pregnancy can reduce help-seeking and weaken access to emotional and practical support (Dennis and Creedy, Reference Dennis and Creedy2004; Ruzibiza, Reference Ruzibiza2021; Wessells and Kostelny, Reference Wessells and Kostelny2022).
Limited access to quality maternal healthcare, including skilled attendance at delivery, emergency obstetric care, postnatal services and maternal mental health screening, can leave psychological distress undetected and untreated (Mutahi et al., Reference Mutahi, Larsen, Cuijpers, Peterson, Unutzer, McKay, John-Stewart, Jewell, Kinuthia, Gohar, Lai, Wamalwa, Gachuno and Kumar2022). Economic strain related to pregnancy, delivery and infant care can also produce chronic stress, especially where housing, employment, financial support or childcare protections are limited.
Protective factors
Protective factors in the transition to motherhood include supportive relationships, respectful maternity care, positive birth experiences, access to maternal health services, psychosocial support and maternal self-efficacy. Evidence from perinatal mental health research suggests that interpersonal support can affect maternal wellbeing during the transition to motherhood (MacKinnon et al., Reference MacKinnon, Houazene, Robins, Feeley and Zelkowitz2018). A Cochrane review of psychosocial and psychological interventions for preventing postpartum depression highlights the importance of social support and psychosocial care in reducing maternal mental health risk (Dennis and Creedy, Reference Dennis and Creedy2004).
Maternal self-efficacy, practical help with infant care, emotional support from partners, family members or peers and access to maternal healthcare services can strengthen caregiving confidence and enable earlier identification of mental health concerns (Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013; Ganchimeg et al., Reference Ganchimeg, Ota, Morisaki, Laopaiboon, Lumbiganon, Zhang, Yamdamsuren, Temmerman, Say, Vogel, Souza and Mori2014; Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019). Motherhood itself may also provide meaning, purpose, identity and motivation, supporting psychological wellbeing in some contexts (Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019).
Displacement-related mental health risk and protective factors
Forced displacement can affect mental health through exposure to traumatic events, prolonged uncertainty and disruption of protective systems, regardless of age or parental status.
Risk factors
Displacement is rarely a linear movement from flight to resettlement. It is often prolonged, sometimes lasting years or decades and may involve repeated movement, changing legal status, secondary displacement and return (Hyndman and Giles, Reference Hyndman and Giles2011; Silove et al., Reference Silove, Ventevogel and Rees2017; El Arab et al., Reference El Arab, Somerville, Abuadas, Rubinat-Arnaldo and Sagbakken2023; Sasie et al., Reference Sasie, Alava, Fekadu, Misganaw, Gebeyehu, Ali, Dema, Afele and Argaw2026).
Across these trajectories, forcibly displaced people may experience violence, physical safety risk, deprivation, exploitation, family separation, detention and uncertainty about safety, legal status and future settlement (Fazel et al., Reference Fazel, Wheeler and Danesh2005; Nickerson et al., Reference Nickerson, Liddell, Maccallum, Steel, Silove and Bryant2014; Silove et al., Reference Silove, Ventevogel and Rees2017). Living conditions in camps, informal settlements, urban areas or host-community settings may involve overcrowding, lack of privacy, inadequate sanitation, restricted mobility, discrimination and limited access to services, contributing to chronic stress and reduced wellbeing (Porter and Haslam, Reference Porter and Haslam2005; Silove et al., Reference Silove, Ventevogel and Rees2017).
Displacement can undermine the systems that make daily life stable by interrupting schooling, limiting access to health care and reducing livelihood opportunities, which can increase dependency and chronic stress (Nikuze et al., Reference Nikuze, Sliuzas, Flacke and Van Maarseveen2019; Ahmad et al., Reference Ahmad, Hussain and Shaheen2020; Cuadrado et al., Reference Cuadrado, Libuy and Moreno-Serra2023). Sexual and GBV, including sexual violence, exploitation and intimate partner violence, is associated with psychological distress and adverse mental health outcomes among displaced women and girls (Vu et al., Reference Vu, Adam, Wirtz, Pham, Rubenstein, Glass, Beyrer and Singh2014; Lugova et al., Reference Lugova, Samad and Haque2020). At the same time, mental health and psychosocial support services (MHPSS) services in humanitarian settings are often limited, under-resourced or difficult to access, leaving many displaced people with unmet mental health and psychosocial needs (Almohammadi, Reference Almohammadi2025; Viksveen et al., Reference Viksveen, Doudouh, Jafaer and Salamonsen2026).
Protective factors
Protective factors in displacement contexts can buffer the psychological consequences of traumatic events and chronic displacement-related stressors (Siriwardhana et al., Reference Siriwardhana, Ali, Roberts and Stewart2014). Family unity, social connection, community networks, trusted community figures and culturally meaningful coping practices can support emotional security, practical assistance, identity continuity and collective coping during movement, transit and temporary settlement (Ai et al., Reference Ai, Peterson and Ubelhor2002; Silove et al., Reference Silove, Ventevogel and Rees2017; Butler et al., Reference Butler, Quigg, Bates, Jones, Ashworth, Gowland and Jones2022).
In prolonged displacement, temporary settlement, local integration, return or resettlement contexts, structural and programmatic supports become especially important. MHPSS programs can reduce psychological distress and improve functioning and coping, although effects vary by intervention type, population and setting (Bangpan et al., Reference Bangpan, Felix and Dickson2019). Legal documentation and protection mechanisms can reduce uncertainty related to asylum status, mobility and safety (Eboreime et al., Reference Eboreime, Ezeokoli, Adams and Banke-Thomas2022). Education, skills development, livelihood participation, safe and private housing and inclusive host-community conditions can restore agency, reinforce future orientation, reduce dependency and strengthen belonging (Porter and Haslam, Reference Porter and Haslam2005; Miller and Rasmussen, Reference Miller and Rasmussen2010).
The Triple Jeopardy Framework
Drawing on intersectionality theory, the Triple Jeopardy Framework starts from the premise that social and structural positions do not simply add risks together; they interact to produce distinct experiences of vulnerability and protection (Crenshaw, Reference Crenshaw1991; Bowleg, Reference Bowleg2012). For displaced adolescent mothers, adolescence, forced displacement and early motherhood intersect to produce a distinct psychosocial risk profile, termed here as “triple jeopardy.” The framework maps the multilevel determinants of mental health among displaced adolescent mothers and the pathways through which vulnerabilities may be intensified and buffered (Figure 1).
Triple Jeopardy Framework for displaced adolescent mothers.
Note: Three overlapping domains, adolescence, forced displacement and motherhood, converge to create compounded mental health vulnerability. Bilateral intersections represent two-way risks. The central intersection represents the zone of triple jeopardy, where all three conditions coexist and may increase risk for depression, anxiety, PTSD symptoms and intergenerational mental health risk.
Figure 1. Long description
Three overlapping circles represent adolescence, forced displacement, and motherhood. Adolescence includes neurobiological vulnerability, adverse childhood experiences, and developmental transitions. Forced displacement includes trauma and persecution, disrupted social networks, and forced migration stressors. Motherhood includes hormonal and sleep changes, infant caregiving demands, and perinatal risk factors. The bilateral overlaps are labeled disrupted development, low self-efficacy, and dual provision burden and GBV risk. The central overlap is labeled Triple Jeopardy and leads to mental health outcomes including depression, anxiety, PTSD, and intergenerational trauma transmission.
The framework represents adolescence, forced displacement and motherhood as overlapping domains. The bilateral intersections show how two domains can interact, while the central intersection identifies displaced adolescent motherhood as a distinct position where developmental, structural, reproductive, caregiving and displacement-related conditions converge.
Adolescence and displacement
At the intersection of adolescence and displacement, forced migration can disrupt the social and developmental conditions that support adolescent mental health. Adolescence is a period in which schooling, peer relationships, family stability, community belonging and future orientation are central to wellbeing and social development (Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016). Displacement can weaken these supports through interrupted education, separation from peers or caregivers, exposure to traumatic events, legal uncertainty, restricted mobility and loss of familiar social environments (Silove et al., Reference Silove, Ventevogel and Rees2017; Taylor and Josiah, Reference Taylor and Josiah2023). Protective factors at this intersection include restored school access, stable caregiving relationships, peer connection, safe community spaces, culturally responsive MHPSS services and opportunities for structured participation that rebuild predictability, belonging and agency (Tol et al., Reference Tol, Barbui, Galappatti, Silove, Betancourt, Souza, Golaz and van Ommeren2011; Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Masten, Reference Masten2014).
Adolescence and motherhood
The intersection of adolescence and motherhood places maternal responsibilities within a developmental period still marked by educational, social, emotional and economic transition. Adolescent mothers may be expected to assume adult caregiving roles while they are still completing education, developing autonomy, forming identity and depending on parents, partners, schools or social systems for housing, income, health care and decision-making support (Kingston et al., Reference Kingston, Heaman, Fell and Chalmers2012; Ganchimeg et al., Reference Ganchimeg, Ota, Morisaki, Laopaiboon, Lumbiganon, Zhang, Yamdamsuren, Temmerman, Say, Vogel, Souza and Mori2014; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016). This can restrict school participation, peer relationships, rest, help-seeking and future planning, while increasing the social and emotional demands attached to pregnancy, childbirth and infant care.
Mental health risks at this intersection include stigma, lower perceived self-efficacy, social isolation, depressive symptoms and unmet perinatal mental health needs. A systematic review of mental health problems and service gaps among pregnant adolescents and young women in sub-Saharan Africa found that limited access to maternal health care, mental health screening, referral pathways and treatment options can leave mental health problems undetected and untreated (Mutahi et al., Reference Mutahi, Larsen, Cuijpers, Peterson, Unutzer, McKay, John-Stewart, Jewell, Kinuthia, Gohar, Lai, Wamalwa, Gachuno and Kumar2022). Similarly, evidence from northwest Ethiopia found higher postpartum depression among adolescent mothers than adult mothers, reinforcing the importance of age-specific maternal mental health support (Kassa et al., Reference Kassa, Batchelder and Gross2024). Protective factors at this intersection include adolescent-responsive maternal care, continued education, family and partner support, peer support from other young mothers, confidential counseling and services that recognize both the young person’s developmental needs and maternal role (Dennis and Creedy, Reference Dennis and Creedy2004; Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013; Ganchimeg et al., Reference Ganchimeg, Ota, Morisaki, Laopaiboon, Lumbiganon, Zhang, Yamdamsuren, Temmerman, Say, Vogel, Souza and Mori2014).
Displacement and motherhood
At the displacement–motherhood intersection, pregnancy, childbirth and caregiving occur within conditions of insecurity, disrupted services and constrained resources. Mothers in displacement may need to secure food, shelter, documentation, health care and infant supplies while also recovering from childbirth, breastfeeding and caring for young children. Displacement can reduce access to antenatal, delivery, postnatal and mental health services, while unsafe living conditions, overcrowding, restricted mobility and poverty can increase caregiving strain (Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013; Adhena and Fikre, Reference Adhena and Fikre2023; Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024).
Exposure to violence and exploitation can also affect maternal mental health in displacement contexts. Sexual violence, intimate partner violence, pregnancy resulting from violence and transactional relationships may occur before, during or after displacement and can contribute to psychological distress, stigma and barriers to care (UNHCR, 2003; Schlecht et al., Reference Schlecht, Rowley and Babirye2013; Wessells and Kostelny, Reference Wessells and Kostelny2022). Also, separation from extended family networks can remove sources of childcare, emotional support, postpartum care and practical assistance. Protective factors at this intersection include safe housing, family unity, access to maternal and newborn health care, confidential mental health screening, prevention and response services for GBV, practical help with infant care and community-based parenting and peer support (Tol et al., Reference Tol, Barbui, Galappatti, Silove, Betancourt, Souza, Golaz and van Ommeren2011; Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013; Bangpan et al., Reference Bangpan, Felix and Dickson2019).
The central triple jeopardy
At the center of the framework, displaced adolescent mothers are required to manage caregiving, development and survival at the same time. They may be expected to perform adult maternal work while still navigating adolescent developmental transitions and living in environments where safety, schooling, family support, health services and legal protection are unstable or disrupted (Ruzibiza, Reference Ruzibiza2021; Adhena and Fikre, Reference Adhena and Fikre2023; Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024). The central risk is that each condition can weaken the protective factors that might otherwise buffer the others.
Adolescent pregnancy may be stigmatized, and this stigma can intensify in displacement when households and communities are under economic strain or when pregnancy is associated with sexual violence, early marriage, transactional relationships or pregnancy outside socially accepted norms (Schlecht et al., Reference Schlecht, Rowley and Babirye2013; Ruzibiza, Reference Ruzibiza2021; Adhena and Fikre, Reference Adhena and Fikre2023). Young mothers may experience social judgment while depending on family members, partners, humanitarian systems or host communities for food, shelter, childcare, documentation and health care (Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019; Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024; Wallis et al., Reference Wallis, Cadena Camargo and Krumeich2024). This produces a psychosocial profile marked by constrained agency, social isolation, heightened caregiving pressure, psychological distress related to traumatic experiences and reduced access to developmentally appropriate maternal and mental health support.
Agency and resilience are also present within this overlap. Studies of internally displaced young mothers in Bogotá and conflict-displaced young mothers in South Sudan and the Kurdistan Region of Iraq show that motherhood can provide meaning, identity, joy and motivation, even amid structural violence, loss, separation, insecurity and constrained choice (Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019; Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024). These findings support a strengths-based approach in which interventions reduce distress and risk while also strengthening protective processes that young mothers already draw on, including maternal identity, peer connection, practical caregiving support, adolescent-responsive maternal care, prevention and response services for GBV, education pathways and community-based MHPSS.
The framework therefore identifies displaced adolescent motherhood as a distinct psychosocial position and highlights intervention points where protective factors can be strengthened across domains, including education, peer connection, confidential maternal and mental health services, caregiving support, stigma reduction, prevention and response services for GBV and community-based MHPSS.
Intergenerational mental health risk
Children of displaced adolescent mothers may experience heightened developmental and mental health risk because their early caregiving environment is shaped by three overlapping conditions: maternal adolescence, forced displacement and early motherhood. This pathway differs from general maternal mental health risk because the mother is still in adolescence while also managing caregiving under conditions of disrupted education, limited autonomy, stigma, poverty, insecurity and reduced access to adolescent-responsive maternal and mental health care (Kingston et al., Reference Kingston, Heaman, Fell and Chalmers2012; Ganchimeg et al., Reference Ganchimeg, Ota, Morisaki, Laopaiboon, Lumbiganon, Zhang, Yamdamsuren, Temmerman, Say, Vogel, Souza and Mori2014; Stein et al., Reference Stein, Pearson, Goodman, Rapa, Rahman, McCallum, Howard and Pariante2014).
Intergenerational risk may operate through biological, attachment-mediated and environmental pathways. Chronic psychological distress during pregnancy may affect fetal development through stress-related biological processes, while maternal depression and PTSD symptoms can reduce sensitive caregiving and affect early attachment (Stein et al., Reference Stein, Pearson, Goodman, Rapa, Rahman, McCallum, Howard and Pariante2014; Zeanah and Gleason, Reference Zeanah and Gleason2015; Dadi et al., Reference Dadi, Miller, Bisetegn and Mwanri2020). For displaced adolescent mothers, these pathways may be intensified because the mother and child often share the same adverse conditions, including food insecurity, unsafe housing, poverty, violence, legal uncertainty, disrupted services and limited access to health and social support.
Intergenerational mental health risk is therefore a downstream consequence of the Triple Jeopardy Framework: supporting displaced adolescent mothers’ mental health, education, safety, caregiving capacity and access to care also supports early child development.
Discussion
This review examined how risk and protective factors affecting displaced adolescent mothers intersect across adolescent development, forced displacement and early motherhood. The Triple Jeopardy Framework argues that these domains do not operate as separate layers of vulnerability. Their overlap can produce synergistic risk, where age, gender, pregnancy, caregiving responsibility, displacement, poverty, disrupted education and exposure to violence interact to intensify psychological distress and reduce access to protection.
Intersectionality provides the conceptual basis for understanding why these risks should not be examined in isolation. It draws attention to how social positions and structural conditions combine to produce distinct forms of exclusion, vulnerability and unequal access to support (Crenshaw, Reference Crenshaw1991; Bowleg, Reference Bowleg2012). Displaced adolescent mothers occupy multiple positions at once, and these positions affect their access to protection, care, education and social support. A Canadian case study of migrant and refugee women found that single-axis legal and policy frameworks failed to capture how migration status, gender and economic precarity combined to produce distinct vulnerabilities (Tastsoglou and Freedman, Reference Tastsoglou and Freedman2025).
Synergistic risk strengthens this argument by explaining why intersecting risks may have effects beyond simple addition. Evidence from broader literature on adversity, polyvictimization, environmental risk and interaction effects shows that risk factors can interact to produce harm beyond their individual effects (Clougherty et al., Reference Clougherty, Levy, Kubzansky, Ryan, Suglia, Canner and Wright2007; Adams et al., Reference Adams, Moreland, Cohen, Lee, Hanson, Danielson and Briggs2016; Lederer et al., Reference Lederer, Dijkstra and Heskes2019; Putnam et al., Reference Putnam, Amaya-Jackson, Putnam and Briggs2020). Applied to this review, the point is not that displaced adolescent mothers simply have many risks. Pregnancy, adolescent developmental stage, displacement, disrupted education, poverty, violence and service exclusion may interact in ways that create a more severe mental health risk environment than any single factor would produce independently. Evidence from refugee and migrant communities on the Thailand–Myanmar border illustrates this interaction: adolescent pregnancy was linked with forced marriage, lack of contraception, fear of childbirth, financial insecurity, domestic violence, stigma around premarital sex, limited support and suicidal distress (Asnong et al., Reference Asnong, Fellmeth, Plugge, Wai, Pimanpanarak, Paw, Charunwatthana, Nosten and McGready2018).
This synergistic risk is also evident in the disruption of protective factors. Family support, school connection, safety, peer relationships, social belonging and access to services are central protective factors for refugee, displaced and adolescent populations (Fazel et al., Reference Fazel, Reed, Panter-Brick and Stein2012; Reed et al., Reference Reed, Fazel, Jones, Panter-Brick and Stein2012; Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016). For displaced adolescent mothers, these protective systems are placed under additional strain by pregnancy, childbirth, breastfeeding, infant care, stigma, restricted mobility and dependence on partners, relatives or humanitarian systems. A study of Syrian refugee mothers in Türkiye found that post-migration stress predicted postpartum depression indirectly through reduced resilience and social support, not as a direct risk factor alone (Salameh et al., Reference Salameh, Acarturk, Sha, Hall and Guney2026). This finding suggests that displacement-related stress may harm mental health by weakening the supports that usually buffer distress.
The framework also clarifies why adolescent motherhood in displacement has implications for both maternal and child wellbeing. Perinatal mental health evidence shows that maternal depression, PTSD symptoms and chronic psychological distress can affect child development through biological, attachment-mediated and environmental pathways (Stein et al., Reference Stein, Pearson, Goodman, Rapa, Rahman, McCallum, Howard and Pariante2014; Dadi et al., Reference Dadi, Miller, Bisetegn and Mwanri2020). Research on ACEs also shows that adversity can carry across generations through caregiving environments, parental mental health and social conditions (Burke et al., Reference Burke, Fitzhenry, Houghton and Fortune2021; Racine et al., Reference Racine, Deneault, Thiemann, Turgeon, Zhu, Cooke and Madigan2025). The Triple Jeopardy Framework adds that, for displaced adolescent mothers, intergenerational risk begins while the mother herself is still in adolescence.
Despite these risks, the protective factors identified in this review are equally important. The evidence reviewed here shows that displaced young mothers may experience stigma, constrained choice and psychological distress while also drawing on social support, resilience, maternal identity, caregiving commitment and responsive services as protective resources (Fergus and Zimmerman, Reference Fergus and Zimmerman2005; Fazel et al., Reference Fazel, Reed, Panter-Brick and Stein2012; Reed et al., Reference Reed, Fazel, Jones, Panter-Brick and Stein2012; Masten, Reference Masten2014; Cadena-Camargo et al., Reference Cadena-Camargo, Krumeich, Duque-Páramo and Horstman2019; Howe et al., Reference Howe, Stites, Bassett, Ewart, Hammada, Sulaiman, Lony and Maguek2024; Salameh et al., Reference Salameh, Acarturk, Sha, Hall and Guney2026). A Triple Jeopardy lens therefore helps identify both sides of the intervention problem: where risks interact to intensify distress, and where protective systems are disrupted or can be strengthened.
Implications for policy and practice
The synergistic risks and protective factors identified in this review point to the need for integrated support that recognizes displaced adolescent mothers as adolescents, mothers and displaced people at the same time.
Maternal and infant health services can serve as entry points for mental health support. Antenatal, delivery, postnatal and infant health visits provide opportunities to identify depression, anxiety, PTSD symptoms, suicidal ideation, psychological distress related to traumatic experiences and safety concerns. Humanitarian evidence supports integrating mental health into general health services where specialist care is limited, and perinatal mental health evidence supports screening and referral as part of maternal care (IASC, 2007; Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013). For displaced adolescent mothers, these services need to be confidential and adolescent-responsive because stigma, low autonomy, restricted mobility and dependence on partners, relatives or humanitarian systems may prevent help-seeking (Mutahi et al., Reference Mutahi, Larsen, Cuijpers, Peterson, Unutzer, McKay, John-Stewart, Jewell, Kinuthia, Gohar, Lai, Wamalwa, Gachuno and Kumar2022). MHPSS interventions also need to reflect the realities of adolescent caregiving by offering childcare, flexible scheduling, mobile or community-based delivery, peer groups and safe spaces where young mothers can receive support while caring for infants (Rahman et al., Reference Rahman, Fisher, Bower, Luchters, Tran, Yasamy, Saxena and Waheed2013; Cohen and Yaeger, Reference Cohen and Yaeger2021).
SRH and GBV services need to incorporate the specific needs of adolescents. Pregnancies may occur under multiple circumstances, including within marriage, after sexual violence, in coercive or transactional relationships or outside socially accepted norms. These circumstances may carry different implications for stigma, safety, autonomy and distress. Coordinated pathways between survivor-centered GBV response, confidential disclosure systems, reproductive health care, child protection and social services are therefore essential (IASC, 2007; Schlecht et al., Reference Schlecht, Rowley and Babirye2013; Wessells and Kostelny, Reference Wessells and Kostelny2022; Stark et al., Reference Stark, Roa, Rodriguez, Pena, Deitch and Seff2025).
Education and structural support should be treated as part of the mental health response. Schooling, peer belonging and future orientation are protective for adolescent mental health, yet pregnancy and caregiving can exclude young mothers from these supports (Fazel et al., Reference Fazel, Reed, Panter-Brick and Stein2012; Reed et al., Reference Reed, Fazel, Jones, Panter-Brick and Stein2012; Viner et al., Reference Viner, Ozer, Denny, Marmot, Resnick, Fatusi and Currie2012; Patton et al., Reference Patton, Sawyer, Santelli, Ross, Afifi, Allen, Arora, Azzopardi, Baldwin, Bonell, Kakuma, Kennedy, Mahon, McGovern, Mokdad, Patel, Petroni, Reavley, Taiwo, Waldfogel, Wickremarathne, Barroso, Bhutta, Fatusi, Mattoo, Diers, Fang, Ferguson, Ssewamala and Viner2016). Humanitarian programs can support school re-entry, alternative learning, vocational training, childcare and safe youth spaces that include pregnant and parenting adolescents (Meherali et al., Reference Meherali, Nisa, Aynalem, Ishola and Lassi2025).
Safe housing, documentation, transport, food security, livelihood support, childcare and access to maternal and child health services also address the daily conditions that maintain distress. This is consistent with evidence that daily and post-displacement stressors can worsen mental health after traumatic events have occurred, and that post-migration stress may affect postpartum depression through reduced resilience and social support (Porter and Haslam, Reference Porter and Haslam2005; Miller and Rasmussen, Reference Miller and Rasmussen2010; Silove et al., Reference Silove, Ventevogel and Rees2017; Hou et al., Reference Hou, Liu, Liang, Ho, Kim, Seong, Bonanno, Hobfoll and Hall2020; Salameh et al., Reference Salameh, Acarturk, Sha, Hall and Guney2026).
Finally, research and program design need to incorporate the lived experiences of displaced adolescent mothers. Their perspectives are necessary for identifying how pregnancy, stigma, safety, caregiving, service access and social support interact in specific settings. Longitudinal and mixed-methods designs are especially useful for examining how maternal mental health, caregiving conditions, displacement-related adversity and child development influence one another over time (Stein et al., Reference Stein, Pearson, Goodman, Rapa, Rahman, McCallum, Howard and Pariante2014; Eboreime et al., Reference Eboreime, Ezeokoli, Adams and Banke-Thomas2022).
Limitations
This review has several limitations. As a narrative review, it did not employ comprehensive database searches, dual screening or formal quality assessment and may not capture the full scope of relevant literature. The evidence base is also heterogeneous, with studies varying by setting, population, design and measurement approach. Findings should therefore be interpreted as a conceptual synthesis, not pooled evidence of prevalence or effect size.
Conclusion
Adolescent mothers in forced displacement remain insufficiently recognized in adolescent health, maternal health, protection and MHPSS programming. Their mental health needs arise from the interaction of adolescence, forced displacement and motherhood, not from any one domain alone. The Triple Jeopardy Framework offers a conceptual structure for understanding these intersecting risks and protective factors.
Effective responses should integrate mental health into maternal and adolescent health services, strengthen peer and family support, link care to SRH and GBV services, support school re-entry and future planning, address structural barriers and recognize the agency and resilience that young mothers demonstrate within constrained settings.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2026.10298.
Data availability statement
No original data were collected for this narrative review. All materials analyzed are from published sources cited in the reference list.
Acknowledgments
The authors thank the researchers and practitioners whose work informed this narrative review.
Author contributions
D.O. and E.E. conceptualized the study. D.O. and O.A. conducted the literature search, screening and data extraction. D.O. wrote the first draft of the manuscript. E.E. supervised the project, guided the review methodology and led the development of the Triple Jeopardy Framework. O.A., C.S. and B.A. contributed to interpretation and synthesis of the literature. All authors critically revised the manuscript and approved the final version for submission.
Funding statement
This work was supported by the Canadian Institutes of Health Research – Centre for Research on Pandemic Preparedness and Health Emergencies (GL1-198205). The funder had no role in the study design, literature search, analysis, interpretation, writing of the manuscript or decision to submit the article for publication.
Competing interest
The authors declare no conflicts of interest.
AI statement
Claude (Anthropic) was used in a limited capacity for language editing and editorial refinement. ChatGPT (OpenAI) was used to assist with the design and generation of the graphical abstract. All AI-assisted outputs were critically reviewed, verified for accuracy and substantially revised by the authors. The authors take full responsibility for the final content of the manuscript and graphical abstract.
Ethics and approvals
Ethics approval was not required because this narrative review synthesized evidence from previously published literature and did not involve primary data collection with human participants.
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