Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis

Gunawardena, Nathali; Fantaye, Arone Wondwossen; Yaya, Sanni

doi:10.1136/bmjgh-2019-001499

Cited by 62 publications

(67 citation statements)

References 66 publications

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“…The teenage pregnancy and childbearing situation in Malawi provide a compelling case to study. First, although teenage pregnancy has declined over the decade globally, Malawi has one of the highest rates [9–11] currently at 29% of the population. Secondly, although various programmes have been implemented to ensure that girls prevent early pregnancy, especially among the poor, over the decade[12,13], the impact of such programmes provides weak evidence of the determinants of teenage pregnancy, which undermines effectiveness, and thus leads to mixed outcomes in terms of teenage pregnancies and childbearing.…”

Section: Introductionmentioning

confidence: 99%

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

et al. 2019

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BackgroundTeenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.MethodsThe study used the 2004, 2010 and 2015–16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.ResultsThe teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015–16. Trends showed a “u-shape” in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015–16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%).ConclusionThe findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

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Section: Introductionmentioning

confidence: 99%

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

et al. 2019

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“…This nding is re ective of studies conducted in sub-Saharan Africa and other parts of the world which investigated the predictors of pregnancy among young people: lack of SRH knowledge, parenting and family related attitudes as well as low parental communication and support were key predictors of unmet needs for contraception (21,25,26,27). A study from Uganda investigating healthcare perceptions of family planning among adolescents established that lack of community SRH knowledge, myths and misconceptions among adolescent girls and health care providers' attitudes were associated with non-use of contraceptives among adolescent girls (25).…”

Section: Discussionmentioning

confidence: 64%

“Those are things for married people ”: Exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Kenya

Mwaisaka

Wado²,

Ouedraogo

et al. 2020

Preprint

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BackgroundContraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. One factor likely to limit contraceptive use among adolescent girls is the attitude of parents and other community members including adolescent girls themselves. Understanding parents’, other adults’ in the community and adolescent girls’ perspectives and attitudes towards contraceptive use might help to unravel the cause of low use of contraception among adolescent girls. This study therefore sought to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. MethodsQualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15-19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents.Results Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; i) Perceptions about adolescents’ sexuality and risk prevention, ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, iii) Post-pregnancy contraceptive considerations and iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion.ConclusionsOur findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.

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“…This nding is re ective of studies conducted in sub-Saharan Africa and other parts of the world which investigated the predictors of pregnancy among young people: lack of sexual and reproductive health knowledge, parenting and family related attitudes as well as low parental communication and support were key predictors of unmet needs for contraception (21,25,26,27). A study from Uganda investigating healthcare perceptions of family planning among adolescents established that lack of community SRH knowledge, myths and misconceptions among adolescent girls and health care providers' attitudes were associated with non-use of contraceptives among adolescent girls (25).…”

Section: Discussionmentioning

confidence: 65%

“…The urgent need to encourage family and community discussions that dispel myths about contraceptive use cannot be overemphasized. Understanding parental and adolescents' contraceptive concerns and involving parents in adolescent pregnancy prevention programmes is vital as studies have shown that low parental communication and support is a key predictor of teenage pregnancies in sub-Saharan Africa (21). Whilst some parents have claimed that they have been engaged in sexuality education of their adolescents, in reality, such discussions are often barely communicated tacitly through intimation.…”

Section: Introductionmentioning

confidence: 99%

“Those Are Things for Married People”: Exploring Parents’/adults’ and Adolescents’ Perspectives on Contraceptives in Kenya

Mwaisaka

Dibaba²,

Ouedraogo

et al. 2020

Preprint

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BackgroundContraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. One factor likely to limit contraceptive use among adolescent girls is the attitude of parents and other community members including adolescent girls themselves. Understanding parents’, other adults’ in the community and adolescent girls’ perspectives and attitudes towards contraceptive use might help to unravel the cause of low use of contraception among adolescent girls. This study therefore sought to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. MethodsQualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15-19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents.Results Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; i) Perceptions about adolescents’ sexuality and risk prevention, ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, iii) Post-pregnancy contraceptive considerations and iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion.ConclusionsOur findings suggest that there is a need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic efforts should therefore be directed towards the provision of sexual and reproductive health knowledge and services through a well-informed approach that will provide accurate information on how contraceptive methods work, the side effects of each method and the benefits associated with them at the family and community levels. Programmatic efforts should further seek to enhance the capacity of parents to discuss sexuality with adolescents.

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Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis

Cited by 62 publications

References 66 publications

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

“Those are things for married people ”: Exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Kenya

“Those Are Things for Married People”: Exploring Parents’/adults’ and Adolescents’ Perspectives on Contraceptives in Kenya

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