Adolescent motherhood can alter the future opportunities available to girls and the challenges they face. This article considers how adolescents’ capabilities are influenced by pregnancy and motherhood, using a mixed-methods case study of Rwanda. Adolescent motherhood impacts girls’ lives across multiple capabilities including education, psychosocial well-being, voice and agency, and economic empowerment. Rarely were adolescent mothers in our sample supported to return to school, for instance. Their pregnancy and motherhood were stigmatised by their families, peers, wider community and service providers. The psychosocial consequences of adolescent motherhood are significant, linked to social isolation and multifaceted stressors, including poverty. Despite recent policy and service improvements, adolescent mothers continue to be left behind.