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

Abstract

BackgroundAdolescent 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.MethodsWe 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.ResultsAdolescent 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.ConclusionThe 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.

Structure and content of the maternal representations of Mexican teenagers during their first pregnancy

“…5,[11][12][13][14] The emotions during the adolescent pregnancy resulted have a complex spectrum to same that referred by other authors, 16,17 that depend of social support received, your preoccupation by the newborn care, and the acceptation of your role as a mother, that is positive when the teenagers make actions as buy utensils for care your son or depending of your interpretation of fetal movements. The paternal figure in this group of adolescents was almost inexistent, the paternity seemed to follow a however, in the cases studied, the adolescents referred have that postpone your studies and works, what contrast with the situation of Brazilian teenagers in whom the lack of education and work opportunities they push to the adolescent toward pregnancy, 5 or of African teenagers whom lack of communication means through which to receive sexual orientation, 2 or of Spanish teenagers which quest social recognition, 6 while Mexican teenagers pointed out belief that the pregnancy is a consequence of rebellion toward your parents, argument why possibility that many teenagers classified your pregnancy as desired in spite of be unplanned (maybe to ease his guilt), except when your couples were not present in your life. This information endorses the idea that the causes and motivations of pregnancy, they keep relation with the mother-son link, for example, between worst couple relationship with fetus's father, the adolescents desired less that your son was similar to him, as an unlink shape of the father, also between more conflictive was the Content and structure of the maternal representation "Pregnant but paired, a bad decision legitimized", identified in the speech of pregnant adolescents that they attended to prenatal control.…”

“…According to national registers from Mexico, the percentage of newborns with mother minor than 19 years during 2010 and 2017 was 16,4 and 17,5 respectively 1 ; like adolescent pregnant prevalence from Kenia during 2014 that was 18%. 2 The adolescent pregnancy is an international public health problem because during this life stage, the pregnancy affects negatively the adolescent and newborn health. 3 With the objective of influence in this problem, diverse studies show the social and individual variables which are related to the pregnancies increase during the adolescence.…”

“…To social level, in occidental countries is identify pronatalism as cultural discourses which promote the mortality as a process that is part of woman´s life, and the foment of practices and beliefs which idealize the maternity, 4 in Brazil as social causes is recognized the contexts restricted of labor and educative opportunities, 5 in Spain the intra-family violence and violent couple relationships, 6 and in Colombia the perpetuation of conventional family (heterosexual couple with sons) as a social basic unit. 7 As individual elements, in African countries is recognized the lack contact with communication means, low socioeconomic level, and couple relationships since early age, 2 while that in Spain mentions the necessity of adolescents for reach personal realization and feel-self socially important and loved. 6 The causes and motivations of adolescent pregnancy are related to the shape as the adolescent interprets your pregnancy, aspect that guide yours, practices and beliefs towards maternity and model part of your identity as a woman.…”

Interventions for preventing unintended pregnancies among adolescents

“…[1] Pregnancy during adolescence has implications that may result in detrimental health, educational, social and economic outcomes. [2] Many SA adolescents find themselves in an environment with a growing burden of HIV, where sexual and reproductive health needs are influenced by the numerous social determinants of health, such as poverty. The SA National Adolescent Sexual and Reproductive Health and Rights Framework Strategy [3] recommends the strengthening of interventions for adolescents, thus aiming to reduce the incidence of sexually transmitted infections and HIV, as well as unplanned and unintended pregnancies.…”

Secondary school students’ awareness of contraceptive methods, understanding of HIV/AIDS prevention and perception of HIV/AIDS risk in Dar es Salaam, Tanzania

“…Adolescents and young adults (AYA) in Tanzania engage in high-risk sexual behaviors, including sexual activities with multiple sexual partners and inconsistent use of condoms, and they have adverse experiences, such as unwanted pregnancy [2]. More than half of the most recent pregnancies and/or births among East African adolescent girls aged 15-19 years were unintended, and educational attainment, age at first sexual experience, household wealth, family structure and exposure to media were significantly associated with adolescent pregnancy [3]. Among unmarried sexually active women aged 15-19 years in Tanzania, educational status, opportunities to learn about modern contraception, perceived partner and/or friend support for contraceptive use, higher knowledge and self-efficacy for contraceptives were associated with modern contraceptive use [4].…”