BACKGROUND:
Teenage pregnancy remains a critical public health and development concern in Ethiopia. Although the national rate declined slightly from 16% in 2000 to 13% in 2016, progress is slow, and Ethiopia’s adolescent fertility rate remains above the sub-Saharan average (10.1%) and far from the SDG target of 3% by 2030. This study aimed to assess the trends, determinants, and systemic responses to teenage pregnancy in Ethiopia.

METHODS:
A mixed-methods approach was employed, guided by the socio-ecological model, focusing on behavioral, interpersonal, institutional, and socio-cultural factors. The analysis integrated a comprehensive literature review, 58 key informant interviews, and a desk review of national and regional quantitative data.

RESULTS:
The findings reveled high teenage pregnancy rate in Ethiopia, 13%. Major drivers of teenage pregnancy included inadequate access to age-appropriate sexual and reproductive health education, limited availability of adolescent-friendly health services, peer influence, weak life skills, and deep-rooted socio-cultural norms such as early marriage. Emerging risks were also noted, including the impact of digital social-media and the vulnerabilities faced by adolescents in conflict-affected areas. The analysis also revealed that Ethiopia has gaps in inclusive, adolescent-centered approaches and effective multi-sectoral coordination.

CONCLUSIONS:
There is a need for a transformative and context-sensitive roadmap to reduce teenage pregnancy in Ethiopia. Priorities should include reproductive health education, expanding adolescent-friendly services, school retention and empowerment programs, targeted support for vulnerable groups, and stronger enforcement of protective legal frameworks to accelerate progress towards the national goal of teenage pregnancy reduction to less than 3% by 2030.