African Population and Health Research Centre, APHRC Campus, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya.
Guttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA.
BMC Pregnancy Childbirth. 2019 Feb 6;19(1):59. doi: 10.1186/s12884-019-2204-z.
Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes. The aim of this study was to identify the contextual factors that influence adolescent pregnancy and early motherhood in five East African countries.
We use DHS data from five East African countries to examine trends and risk factors associated with adolescent pregnancy. DHS surveys collect detailed information on individual and household characteristics, sexual behavior, contraception, and related reproductive behaviors. Our analysis focuses on a weighted subsample of adolescent's age 15-19 years (Kenya, 5820; Tanzania, 2904; Uganda, 4263; Malawi, 5263; Zambia, 3675). Multilevel logistic regression analysis was used to identify the net effects of individual, household and community level contextual variables on adolescent pregnancy after adjusting for potential confounders.
Adolescent pregnancy and early motherhood is common in the five countries, ranging from 18% among adolescents in Kenya (2014) to 29% in Malawi (2016) and Zambia (2014). Although all five countries experienced a decline in adolescent pregnancy since 1990, the declines have been largely inconsistent. More than half of the adolescent's most recent pregnancies and or births in these countries were unintended. The regression analysis found that educational attainment, age at first sex, household wealth, family structure and exposure to media were significantly associated with adolescent pregnancy in at least one of the five countries after adjusting for socio-demographic factors.
The study highlights the importance of considering multi-sectoral approaches to addressing adolescent pregnancy. Broader development programs that have positive impacts on girls educational and employment opportunities may potentially influence their agency and decision-making around if and when to have children. Likewise, policies and programs that promote access to and uptake of adolescent sexual and reproductive health services are required to reduce barriers to the use of adolescent Sexual and Reproductive Health (SRH) services.
青少年怀孕仍然是发达国家和发展中国家面临的主要挑战。青少年时期的早婚和意外怀孕与许多不良的健康、教育、社会和经济后果有关。本研究的目的是确定影响五个东非国家青少年怀孕和早育的背景因素。
我们利用五个东非国家的 DHS 数据，研究与青少年怀孕相关的趋势和风险因素。DHS 调查收集了关于个人和家庭特征、性行为、避孕以及相关生殖行为的详细信息。我们的分析重点是年龄在 15-19 岁的青少年的加权样本（肯尼亚，5820；坦桑尼亚，2904；乌干达，4263；马拉维，5263；赞比亚，3675）。多水平逻辑回归分析用于确定个体、家庭和社区层面的背景变量对青少年怀孕的净效应，同时调整了潜在的混杂因素。
五个国家的青少年怀孕和早育现象都很普遍，肯尼亚的青少年怀孕率（2014 年）为 18%，马拉维和赞比亚（2014 年）为 29%。尽管自 1990 年以来，所有五个国家的青少年怀孕率都有所下降，但下降幅度并不一致。这些国家中，超过一半的青少年最近怀孕或生育是意外的。回归分析发现，在调整了社会人口因素后，教育程度、首次性行为年龄、家庭财富、家庭结构和媒体接触在至少一个国家与青少年怀孕显著相关。
本研究强调了考虑多部门方法解决青少年怀孕问题的重要性。更广泛的发展计划，对女孩的教育和就业机会产生积极影响，可能会影响她们在何时生育孩子的自主权和决策。同样，需要制定和实施政策和方案，促进获得和利用青少年性健康和生殖健康服务，以减少青少年性健康和生殖健康服务利用的障碍。
