Pregnancy and early motherhood among adolescents in five East African countries: A multi-level analysis of risk and protective factors

Abstract

Background: Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes. The aim of this study was to identify the contextual factors that influence adolescent pregnancy and early motherhood in five East African countries. Methods: We use DHS data from five East African countries to examine trends and risk factors associated with adolescent pregnancy. DHS surveys collect detailed information on individual and household characteristics, sexual behavior, contraception, and related reproductive behaviors. Our analysis focuses on a weighted subsample of adolescent's age 15-19 years (Kenya, 5820; Tanzania, 2904; Uganda, 4263; Malawi, 5263; Zambia, 3675). Multilevel logistic regression analysis was used to identify the net effects of individual, household and community level contextual variables on adolescent pregnancy after adjusting for potential confounders. Results: Adolescent pregnancy and early motherhood is common in the five countries, ranging from 18% among adolescents in Kenya (2014) to 29% in Malawi (2016) and Zambia (2014). Although all five countries experienced a decline in adolescent pregnancy since 1990, the declines have been largely inconsistent. More than half of the adolescent's most recent pregnancies and or births in these countries were unintended. The regression analysis found that educational attainment, age at first sex, household wealth, family structure and exposure to media were significantly associated with adolescent pregnancy in at least one of the five countries after adjusting for socio-demographic factors. Conclusion: The study highlights the importance of considering multi-sectoral approaches to addressing adolescent pregnancy. Broader development programs that have positive impacts on girls educational and employment opportunities may potentially influence their agency and decision-making around if and when to have children. Likewise, policies and programs that promote access to and uptake of adolescent sexual and reproductive health services are required to reduce barriers to the use of adolescent Sexual and Reproductive Health (SRH) services.