INTRODUCTION:
Unplanned pregnancies among adolescent girls and young women (AGYW) in Sub-Saharan Africa constitute a major public health challenge, leading to discrimination, school dropout, unsafe abortions, and maternal mortality. Addressing this challenge requires an accurate understanding of its prevalence and contributing factors. This systematic review and meta-analysis assessed the prevalence and predictors of unplanned pregnancies in this population.

METHODS:
Following PRISMA guidelines, we searched PubMed/Medline, Cochrane CENTRAL, and Google Scholar using keywords such as “unplanned pregnancies”, “adolescent girls”, “young women,” and “Sub-Saharan Africa.” Eligible studies were observational studies reporting the prevalence and predictors of unplanned pregnancies among AGYW in Sub-Saharan African countries. A random effects meta-analysis was conducted using R (v4.4.3). Risk of bias was assessed using Joanna Briggs Institute checklists.

RESULTS:
From 1139 citations, 42 studies from 33 countries were included, totaling 109909 participants. We included 36 cross-sectional studies, 1 cohort study, 3 qualitative studies, and 2 mixed-methods studies. The overall prevalence of unplanned pregnancies was 15% (95% CI: 11%-20%), with the highest prevalence in Central Africa (22%), and lowest in Southern Africa (11%). Risk factors included sexual debut before age 18 (OR: 3.11), history of contraceptive use (OR: 1.21), being employed (OR: 1.36), and history of sexual violence (OR: 1.48). Protective factors included secondary or higher education (OR: 0.74), rural residence (OR: 0.79), high religiosity (OR: 0.64), living in female-headed households (OR: 0.79), and media exposure (OR: 0.6879).

CONCLUSIONS:
There is a high prevalence of unplanned pregnancies among AGYW in Africa, owing to factors such as early sexual debut and sexual violence. These results highlight the need for targeted interventions addressing these factors to improve outcomes.