ABSTRACT:
Teenage pregnancy in the sub-Saharan region remains a major public health issue, with Malawi’s teenage pregnancy rate being among the highest globally, with nearly one in three adolescent girls aged 15–19 years having begun childbearing. However, national averages mask significant regional differences. This study aimed to identify and describe spatial patterns and hotspots of teenage pregnancy in Malawi and to examine key sociodemographic factors associated with adolescent pregnancy. We used data from the Malawi Multiple Indicator Cluster Survey 2019–2020. Our analysis sample included 5,770 girls aged 15–19 years. Survey-weighted descriptive statistics, chi-square tests, and logistic regression models were used to examine associations between teenage pregnancy and sociodemographic characteristics. Using QGIS, geospatial analyses were conducted to map the district and areas of high prevalence per cluster and to identify geographic hotspots. The national teenage pregnancy rate was 27.2% (95% CI: 25.5%–28.9%), with substantial regional variation. Rates were highest in southern and border districts, whereas urban areas had lower rates than rural areas. Teenagers from lower-income households and those who were married or in union had a higher likelihood of pregnancy. Contraceptive use increased following pregnancy. After adjusting for other variables, neither place of residence nor education level demonstrated a significant association with teenage pregnancy. This study’s findings highlight the need to enforce child marriage laws, support poverty reduction and girls’ empowerment programs, promote early contraceptive use, and direct resources to the most affected areas to address teenage pregnancy.