Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women

Abstract

BackgroundAlthough teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort.ObjectiveTeenage girls, aged 15–18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status.ResultsOverall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21–0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05–2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07–0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58–0.83 and OR 0.78; 95% CI 0.64–0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07–6.25, and OR 2.21 95% CI 1.13–4.29).ConclusionAlthough some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.

Risk Factors for Pregnancies Among Females Age 15 to 19 in Rwanda: A Secondary Data Analysis of the 2014/2015 Rwanda Demographic and Health Survey (RDHS)

“…Upon further analysis, however, we found that the 51 individuals with teenage pregnancy who reported using contraceptive methods all started using them after delivering their first child, meaning that 100% of the teenage pregnancies occurred when contraceptives were not used. This finding also suggests that having a previous pregnancy prompted teenagers to start using contraceptives to prevent unwanted pregnancy, similar to a study conducted in South Africa (Christofides et al, 2014). While pregnancy cannot be used as a protective factor to future pregnancy, the evidence suggested that providing information of contraceptives to teenagers at early age is important.…”

“…Numerous studies, including our bivariate analysis, have found an association between economic status and teenage pregnancy (Christofides et al, 2014;Neal et al, 2015). Economic status should always be considered when designing programs as it influences access to education and health services, and so should the power of decision-making (Briggs & Brownell, 2007;UNFPA, 2015).…”

“…Existing evidence suggests a long list of possible risk factors contributing to teenage pregnancies, including low education level, lack of negotiation skills, insufficient parental supervision, not using contraceptive methods, age at marriage, religion, residing in rural versus urban areas, peer pressure, and lower economic status (Ajala, 2014;Christofides et al, 2014;Kanku & Marsh, 2014;Moni, Nair, & Devi, 2013;Neal, Chandra-Mouli, & Chou, 2015;Okigbo & Speizer, 2015;Rutaremwa, 2013). In addition, teenagers living in households headed by single females or in families with poor family relationships are at higher risk of getting pregnant (Odimegwu & Mkwananzi, 2016).…”

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

“…Across the region, 35-40 percent of women have a first child by age 19, and over 70 percent by age 25, signifying increased HIV risk through high levels of unprotected sex [46,48]. Indeed, the rapid increase in HIV infection among young women corresponds with a dramatic increase in fertility: in South Africa, 19 percent of 18 year old women have ever been pregnant, versus 38 percent at age 19, 43 percent at age 21, and 72 percent at age 23 [47].…”

‘Behaving well’: the transition to respectable womanhood in rural South Africa

“…Recent studies aimed at understanding these experiences, for example, have focused on sexual risk because of HIV, a disease disproportionately affecting young South African women (e.g., Idele et al 2014; Ruark et al 2016; Shisana et al 2014). The risk of unintended pregnancy and the lack of contraception are also common subjects of concern (e.g., Christofides et al 2014; Harrison et al 2016; Mchunu et al 2012), as is the culture of sexual- and gender-based violence in South Africa (e.g., Jewkes et al 2010; Russell et al 2014; Waxman et al 2016). Although collectively these areas of research provide a wealth of important information about the challenging environments in which girls become women, the focus on risk sometimes obscures girls’ everyday ‘non-risky’ lived experiences.…”