FACTORS ASSOCIATED WITH EDUCATIONAL CONTINUATION AMONG PREGNANT ADOLESCENTS IN THAILAND’S EDUCATIONAL DISTRICT 12: A MIXED-METHODS STUDY
Abstract
Individual, family, and institutional factors affect educational continuation among pregnant adolescents. This study examined factors associated with educational continuation and explored how local systems support pregnant adolescents to remain in education. An explanatory sequential mixed-methods design was conducted in Educational District 12, Thailand. The quantitative phase included 216 pregnant adolescents recruited through antenatal care clinics in three provinces: Chonburi, Chanthaburi, and Nakhon Nayok. Binary and multivariable logistic regression were used to identify factors associated with educational continuation. The qualitative phase included 34 participants selected from the three provinces, representing pregnant adolescents, partners, parents or caregivers, teachers, school administrators, health personnel, and local government representatives. In-depth interviews were analyzed thematically using the Context–Input–Process–Product (CIPP) framework, and quantitative and qualitative findings were integrated using a joint display. Educational continuation was associated with living with parents or relatives (AOR = 3.18), early antenatal care (AOR = 2.12), assistance during pregnancy (AOR = 2.68), and higher mental health support (AOR = 3.58). Among adolescents with partners, higher partner income (AOR = 4.45) and absence of partner drug use (AOR = 5.12) were additionally associated with continuation. Qualitative findings showed that these factors operated through flexible educational arrangements, school–health service coordination, family and partner support, privacy protection, and stigma reduction. Multisectoral coordination emerged as a cross-cutting mechanism supporting continued school participation. Educational continuation depends on coordinated support across schools, health services, families, and local authorities. Translating national policy into flexible, supportive, and non-stigmatizing local practices may help pregnant adolescents remain in education and pursue future opportunities.
How to Cite
References
- 1. Adarayan–Morallos, P. L. (2018). Evaluation of school-based feeding program in Cangcahipos Elementary School using CIPP model: Basis for enhanced program implementation. Journal of Education and Practice, 9(29), 63–74.
- 2. Babadi, F., Esfandiari, M., Cheraghi, M., & et al. (2024). Evaluating the dentistry program in Iran using the context, input, process, and product (CIPP) model: A comprehensive analysis. Frontiers in Medicine, 11, Article 1394395. https://doi.org/10.3389/fmed.2024.1394395
- 3. Babatunde, A. O., Abdulkareem, A. A., Akinwande, F. O., & et al. (2021). Leveraging mobile health technology towards achieving universal health coverage in Nigeria. Public Health Practice, 2, Article 100120. https://doi.org/10.1016/j.puhip.2021.100120
- 4. Bakwa-Kanyinga, F., Valério, E. G., Bosa, V. L., Alfama, C. O., Sperb, M., Capp, E., & Vettorazzi,
- J. (2017). Adolescent pregnancy: Maternal and fetal outcomes in patients with and Without preeclampsia. Pregnancy hypertension, 10, 96–100. https://doi.org/10.1016/j.preghy.2017.06.009
- 5. Barnet, B., Arroyo, C., Devoe, M., & et al. (2004). Reduced school dropout rates among adolescent mothers receiving school-based prenatal care. Archives of Pediatrics & Adolescent Medicine, 158(3), 262–268. https://doi.org/10.1001/archpedi.158.3.262
- 6. Best, J. W. (1977). Research in education. Prentice Hall.
- 7. Cheng, E. R., Rifas-Shiman, S. L., Perkins, M. E., & et al. (2016). The influence of antenatal partner support on pregnancy outcomes. Journal of Women's Health, 25(7), 672– 679. https://doi.org/10.1089/jwh.2015.5468
- 8. Cruz, E., Cozman, F. G., Souza, W., & Takiuti, A. (2021). The impact of teenage pregnancy on school dropout in Brazil: A Bayesian network approach. BMC Public Health, 21(1), Article 1850. https://doi.org/10.1186/s12889-021-11878-3
- 9. Department of Health, Bureau of Reproductive Health, Ministry of Public Health. (2024). Teenage pregnancy surveillance report, 2024. Ministry of Public Health.
- 10. Gilson, L. (2012). Health policy and systems research: A methodology reader. World Health Organization.
- 11. Gorry D. (2019). Heterogeneous Consequences of Teenage Childbearing. Demography, 56(6), 2147–2168. https://doi.org/10.1007/s13524-019-00830-1
- 12. Gorry, D. (2023), Consequences of Teenage Childbearing on Child Outcomes in the United States. Journal of Policy Analysis and Management, 42(1), 225- 254. https://doi.org/10.1002/pam.22454
- 13. Groves, A. K., Gebrekristos, L. T., McNaughton Reyes, L., & et al. (2022). A mixed-methods study of resilience and return to school among adolescent mothers in South Africa. Global Public Health, 17(9), 2111–2124. https://doi.org/10.1080/17441692.2021.1953560
- 14. Health Data Center, Ministry of Public Health. (2021). Data on repeat adolescent pregnancies and educational continuity. https://hdc.moph.go.th/center
- 15. Humberstone, E. (2018). Social Networks and Educational Attainment among Adolescents Experiencing Pregnancy. Socius, 4, 2378023118803803. https://doi.org/10.1177/2378023118803803
- 16. Ibrahim, R. (2026). Promises and realities: a qualitative assessment of Ghana's school re-entry policy for adolescent mothers in the Tamale metropolis. International Journal of Adolescence and Youth, 31(1), 2666633. https://doi.org/10.1080/02673843.2026.2666633
- 17. Jochim, J., Meinck, F., Toska, E., & et al. (2023). Who goes back to school after birth? Factors associated with postpartum school return among adolescent mothers in the Eastern Cape, South Africa. Global Public Health, 18(1), Article 2049846. https://doi.org/10.1080/17441692.2022.2049846
- 18. Kang, H. (2021). Sample size determination and power analysis using the G*Power software. Journal of Educational Evaluation for Health Professions, 18, Article 17. https://doi.org/ 10.3352/jeehp.2021.18.17
- 19. Kuruvilla, S., Hinton, R., Boerma, T., Bunney, R., Casamitjana, N., Cortez, R., Fracassi, P., Franz-Vasdeki, J., Helldén, D., McManus, J., Papp, S., Rasanathan, K., Requejo, J., Silver, K. L., Tenhoope-Bender, P., Velleman, Y., Wegner, M. N., Armstrong, C. E., Barnett, S., Blauvelt, C., … PMNCH Multisectoral Collaboration Study Group (2018). Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development. BMJ (Clinical research ed.), 363, k4771. https://doi.org/10.1136/bmj.k4771
- 20. Machoka, B. N., Kabiru, C. W., & Ajayi, A. I. (2024). "My father insisted that I have the baby but not in his house": Adolescent pregnancy, social exclusion and (dis)empowerment of girls in an urban informal settlement in Kenya. PLOS Global Public Health, 4(2), Article e0003742. https://doi.org/10.1371/journal.pgph.0003742
- 21. Maemeko, E. L., Nkengbeza, D., & Chokomosi, T. M. (2018). The Impact of Teenage Pregnancy on Academic Performance of Grade 7 Learners at a School in the Zambezi Region. Open Journal of Social Sciences, 06, 88–100.
- 22. Marmot, M., Friel, S., Bell, R., & et al. (2008). Closing the gap in a generation: Health equity
- a. through action on the social determinants of health. The Lancet, 372(9650), 1661– 1669. https://doi.org/10.1016/S0140-6736(08)61690-6
- 23. Maslowsky, J., Stritzel, H., & Gershoff, E. T. (2022). Post-Pregnancy Factors Predicting Teen
- a. Mothers' Educational Attainment by Age 30 in Two National Cohorts. Youth Soc, 54(8), 1377–1401. https://doi.org/10.1177/0044118x211026941
- 24. Moghadas-Dastjerdi, T., Omid, A., & Yamani, N. (2020). Evaluation of health experts'
- education program for becoming multiprofessionals (family health caregiver) regarding health system transformation plan: An application of CIPP model. Journal of Education and Health Promotion, 9, 227. https://doi.org/10.4103/jehp.jehp_75_20
- 25. Morgan, A. K., Anima, P. A., Wadei, B., & Katey, D. (2025). Addressing stigma and discrimination towards school re-entry of teenage mothers in Ghana. International Journal of Adolescence and Youth, 30(1), 2441322. https://doi.org/10.1080/02673843.2024.2441322
- 26. Morgan, A. K., Ibrahim, R., Owusu, A. F. S., Awafo, B. A., Quartey, T., Aziire, M. A., Katsekpor, J. T., Owusu, A. S., & Katey, D. (2023). Prevalence and associated factors of school re-entry among teenage mothers in Ghana’s Volta Region: a cross-sectional survey. International Journal of Adolescence and Youth, 28(1), 2242476. https://doi.org/10.1080/02673843.2023.2242476
- 27. Mtoi, E. H. (2024). Implementation of education re-entry policy for adolescent mothers in
- Urambo District, Tanzania. International Journal of Multidisciplinary Research and Analysis, 7(10), 4898–4907.
- 28. Narita, R., & Diaz, M. D. M. (2016). Teenage motherhood, education, and labor market
- outcomes of the mother: Evidence from Brazilian data. EconomiA, 17(2), 238–252. Office of the Council of State. (2016). Act for prevention and solution of the adolescent pregnancy problem, B.E. 2559 (2016). Government Gazette.
- 29. Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K., & Valenzuela, C. P. (2024). Births: Final Data for 2022. National Vital Statistics Reports, 73(2), 1–56.
- 30. Patton, G. C., Sawyer, S. M., Santelli, J. S., & et al. (2016). Our future: A Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423–2478. https://doi.org/10.1016/S0140-6736(16)00579-1
- 31. Peters, D. H., Adam, T., Alonge, O., & et al. (2013). Implementation research: What it is and how to do it. BMJ, 347, Article f6753. https://doi.org/10.1136/bmj.f6753
- 32. Rasanathan, K., Bennett, S., Atkins, V., & et al. (2017). Governing multisectoral action for health in low- and middle-income countries. PLoS Medicine, 14(4), Article e1002285. https://doi.org/10.1371/journal.pmed.1002285
- 33. Ruzibiza, Y. (2021). 'They are a shame to the community … ' stigma, school attendance, solitude and resilience among pregnant teenagers and teenage mothers in Mahama refugee camp, Rwanda. Glob Public Health, 16(5), 763–774. https://doi.org/10.1080/17441692.2020.1751230
- 34. Sheikh, K., George, A., & Gilson, L. (2014). People-centred science: Strengthening the practice of health policy and systems research. Health Research Policy and Systems, 12, Article 19. https://doi.org/10.1186/1478-4505-12-19
- 35. Sobngwi-Tambekou, J. L., Tsague-Agnoux, M., Fezeu, L. K., & Ndonko, F. (2022). Teenage childbearing and school dropout in a sample of 18,791 single mothers in Cameroon. Reproductive Health, 19(1), 10. https://doi.org/10.1186/s12978-021-01323-4
- 36. Stufflebeam, D. L. (2007). CIPP evaluation model checklist. Western Michigan University.
- 37. Thanintranon, S., C., T., A., T., A., D., N., M., Chinthakanan, O., & O., C. (2022). Teenage Pregnancy and Dropout Rate From School After Delivery in Northern Thailand. Evidence Based Women's Health Journal, 12(1), 17–21. https://doi.org/10.21608/ebwhj.2019.6533.1011
- 38. Toosi, M., Modarres, M., Amini, M., & Geranmayeh, M. (2021). Context, Input, Process, and Product Evaluation Model in medical education: A systematic review. Journal of Education and Health Promotion, 10(1), 199. https://doi.org/10.4103/jehp.jehp_1115_20
- 39. World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. World Health Organization.
- 40. World Health Organization. (2017). Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation. World Health Organization.
- 41. World Health Organization. (2021). Adolescent birth rate (2021 indicator dataset). World Health Organization. Retrieved January 27, 2026, from https://data.who.int
- 42. World Health Organization. (2024). Adolescent birth rate (2024 indicator dataset). World Health Organization. Retrieved January 27, 2026, from https://data.who.int
- 43. Yousefi, S., Montazeri, S., Javadifar, N., & Saki, Malehi A. (2025). Psychosocial support during pregnancy: Perceptions and expectations among pregnant teenagers in Ahvaz, Iran— A qualitative content analysis. Reproductive Health, 22, Article 134. https://doi.org/10.1186/s12978-025-02081-3