The Relationship Between School Dropout and Pregnancy Among Adolescent Girls and Young Women in South Africa: A HPTN 068 Analysis

Abstract

Background. Prevention of both school dropout and teen pregnancy represent clear public health priorities for South Africa, yet their complex and potentially cyclical relationship has not been fully explored. Objective. To further understand how this relationship operates, we analyzed data from a randomized trial of young women aged 13 to 20 years enrolled in school in rural South Africa to estimate the association between pregnancy and subsequent dropout and between dropout and subsequent pregnancy. Method. We examined inverse probability (IP) of exposure-weighted survival curves for school dropout by pregnancy and for pregnancy by school dropout. We used weighted curves to calculate 1-, 2-, and 3-year risk differences and risk ratios. Additionally, we used an IP-weighted marginal structural cox model to estimate a hazard ratio (HR) for each relationship. Results. Dropout from school was associated with subsequent pregnancy (HR 3.58; 95% confidence interval [CI] [2.04, 6.28]) and pregnancy was associated with subsequent school dropout (HR 2.36; 95% CI [1.29, 4.31]). Young women who attended school but attended fewer days had a higher hazard of pregnancy than those who attended more school (HR 3.64; 95% CI [2.27, 5.84]). Conclusion. Pregnancy is both a cause and a consequence of school dropout. Consideration of school attendance and academic performance could ultimately enhance pregnancy prevention efforts in this population. Programs should be tailored differently for (1) girls who have dropped out of school, (2) those who are in school and at risk for pregnancy, and (3) those who are in school and become pregnant.

Addressing the unique needs of adolescent mothers in the fight against HIV

“…In another study, adolescents who had ever been pregnant were more likely to report unprotected sex in the last 3 months when compared to nulliparous adolescents (39.8% vs. 30.5%). Furthermore, adolescents who had ever been pregnant were also more likely to report physical partner violence (47.2% vs. 16.8%) and transactional sex (21.9% vs. 16.9%) , known relational and structural risk factors for HIV infection . Research is needed to understand how the psychological, relational and structural changes that accompany the transition to adolescent motherhood influence unprotected sex.…”

Lived Experiences of Adolescent Mothers Attending Mbale Regional Referral Hospital: A Phenomenological Study

“…The negative view is further amplified by the adolescents' expression of repercussions of adolescent pregnancy on school attendance as expressed in other studies. Moreover, related research has shown that keeping girl child in school is a way of averting adolescent pregnancy and motherhood [ 20 , 33 , 34 ]. The stigma starts form the girl herself to the school community.…”

“…It has further been urged that, once supported, these adolescent mothers can attain potential as much as their peers that postponed child bearing. Moreover debate has raged on that the undesirable lifestyles are not a consequence of adolescent pregnancies and motherhood but rather an extension of the predisposing factors [ 18 – 20 ].…”

Interventions for preventing unintended pregnancies among adolescents

“…Pregnancy during adolescence is considered both an antecedent and consequence of school dropout in South Africa (SA). [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.…”