Nearly four in ten adolescent girls and young women experience unintended pregnancy in southern africa: a multilevel analysis
1
Reproductive Health Program, Pan African University Life and Earth Sciences Institute (including Health and Agriculture), Ibadan, Nigeria
2
Research, Global Empathy Project (GEP), Lusaka, Zambia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
unintended pregnancy (UP) remains a significant public health challenge in sub-saharan africa, with adolescent girls and young women (AGY) in southern africa facing disproportionately higher risks. Despite regional efforts to expand adolescent-friendly programs, classroom-based sexual health initiatives, and condom distribution, teenage pregnancy rates remain persistently high. This study aimed to determine the prevalence and layered determinants of UP among AGW in southern africa to inform targeted sexual and reproductive health (SRH) interventions.
METHODS:
we utilized data from demographic and health surveys conducted across nine southern african nations. The analysis focused on a weighted cohort of 20748 agyw aged 15–24 years who had delivered within five years preceding the survey. Hierarchical logistic regression models were applied to assess personal and community-level determinants associated with unintended pregnancy at p<0.05 significance level.
RESULTS:
the pooled prevalence of UP among AGYW in southern africa was 39.1% (95% confidence interval (CI): 38.8–40.1), ranging from 13.0% in madagascar to 71.9% in south africa. in the final model, higher odds of UP were observed among AGYW with secondary education (adjusted-odds-ration(OR)=1.88, 95% CI 1.65–2.13), media exposure (AOR=1.14, 95% CI: 1.06–1.22), current contraceptive use (AOR=1.24, 95% CI: 1.16–1.33), those reporting distance to a health facility as not problematic (AOR=1.12, 95% ci: 1.04–1.20), and urban residents (AOR=1.19, 95% CI: 1.10–1.30). reduced likelihood was noted among agyw aged 20–24 years (AOR=0.64, 95% CI: 0.60–0.69), those with pregnancy loss history (AOR=0.78, 95% CI: 0.69–0.89), and married AGW (AOR=0.29, 95% CI: 0.27–0.32).
CONCLUSIONS:
the prevalence of UP among AGWY in southern africa remains high at 39.1%. multilevel determinants including age, education, marital status, contraceptive use, media exposure, pregnancy history, health facility access, and residence were identified. governments and SRHprograms should prioritize youth-friendly services, strengthen sexual health education, expand access to care, and tailor interventions to national and local contexts to reduce UP.
unintended pregnancy (UP) remains a significant public health challenge in sub-saharan africa, with adolescent girls and young women (AGY) in southern africa facing disproportionately higher risks. Despite regional efforts to expand adolescent-friendly programs, classroom-based sexual health initiatives, and condom distribution, teenage pregnancy rates remain persistently high. This study aimed to determine the prevalence and layered determinants of UP among AGW in southern africa to inform targeted sexual and reproductive health (SRH) interventions.
METHODS:
we utilized data from demographic and health surveys conducted across nine southern african nations. The analysis focused on a weighted cohort of 20748 agyw aged 15–24 years who had delivered within five years preceding the survey. Hierarchical logistic regression models were applied to assess personal and community-level determinants associated with unintended pregnancy at p<0.05 significance level.
RESULTS:
the pooled prevalence of UP among AGYW in southern africa was 39.1% (95% confidence interval (CI): 38.8–40.1), ranging from 13.0% in madagascar to 71.9% in south africa. in the final model, higher odds of UP were observed among AGYW with secondary education (adjusted-odds-ration(OR)=1.88, 95% CI 1.65–2.13), media exposure (AOR=1.14, 95% CI: 1.06–1.22), current contraceptive use (AOR=1.24, 95% CI: 1.16–1.33), those reporting distance to a health facility as not problematic (AOR=1.12, 95% ci: 1.04–1.20), and urban residents (AOR=1.19, 95% CI: 1.10–1.30). reduced likelihood was noted among agyw aged 20–24 years (AOR=0.64, 95% CI: 0.60–0.69), those with pregnancy loss history (AOR=0.78, 95% CI: 0.69–0.89), and married AGW (AOR=0.29, 95% CI: 0.27–0.32).
CONCLUSIONS:
the prevalence of UP among AGWY in southern africa remains high at 39.1%. multilevel determinants including age, education, marital status, contraceptive use, media exposure, pregnancy history, health facility access, and residence were identified. governments and SRHprograms should prioritize youth-friendly services, strengthen sexual health education, expand access to care, and tailor interventions to national and local contexts to reduce UP.
| eISSN: | 2654-1459 |
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