In Eastern and Southern Africa (ESA), 20 per cent of girls become pregnant before the age of 20, representing one of the world’s highest rates of adolescent pregnancy. This region also faces a pronounced challenge of adolescent parenthood. The demands of parenthood, often coupled with low partner support, compound adolescent mothers’ vulnerability to school dropout, poverty, isolation, and HIV acquisition. These challenges often extend to the children of adolescent mothers, resulting in lower educational achievement, higher vertical HIV acquisition, increased poverty, and a higher likelihood of early parenthood in the next generation. There is limited evidence available on how best to improve the health, economic, and social outcomes for adolescent mothers and their children. This brief focuses on the experiences of adolescents during pregnancy and early motherhood, particularly those living with HIV. It emphasizes important considerations for programming that can promote positive pregnancy and parenting experiences, ultimately leading to favorable outcomes for both adolescent mothers and their children. This brief is part of a broader series that aims to support the translation of research into improved adolescent SRH and HIV programming.