A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

Abstract

Background Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors. Methods A total pooled weighted sample of 10,010 teenagers (in the age group 15–19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment. Results Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02–1.42), married (aOR = 7.71, 95% CI: 6.31–9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34–1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy. Conclusion The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001–2018)

“…Palamuleni and Adebowale (2014) reported that nearly 43% of the pregnancies were unintended in Malawi [ 17 ], Ameyaw et al, (2019) found that 54.5% of pregnancies in Namibia were unplanned [ 16 ] and 46.6% of pregnancies in the Gambia were unintended or mistimed in 2020 [ 18 ]. The declining trend in the prevalence of unintended pregnancies in Zambia could be attributed to the increase in the proportion of women using modern contraceptive methods which has resulted in a reduction in the prevalence of unmet need for family planning [ 19 , 36 – 38 ].…”

Magnitude and Factors Associated with Teenage Pregnancy in Somaliland: Evidence from Somaliland Health and Demographic Survey, 2020

“…Illiterate women are susceptible to teenage pregnancy. Women with better educational status are expected to have access to sexual education and to be economically empowered [6][7][8][9] which in turn increases women's autonomous decision for pregnancy. Sociocultural factors, particularly in rural communities, where parents prefer their daughters to get married at an early age and consider it as a blessing, 10,11 contributes to teenage pregnancy.…”

A generalised structural equation model of the individual and contextual correlates of teenage pregnancy and modern contraceptive use among adolescent girls in Malawi

“…Adolescent Birth Rates in SSA has shown to be predicted by sexual health knowledge, age at rst sex, age at rst marriage, marital status, levels of education, wealth index, service provision, service quality and cultural factors (7)(8)(9)(10)(11)(12)(13)(14)(15). In Malawi, factors that predict teenage childbearing are not different from those identi ed at SSA level.…”