Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
BMJ Open. 2023 Mar 17;13(3):e068117. doi: 10.1136/bmjopen-2022-068117.
Understanding the determinants of adolescent pregnancy and how they have changed over time is essential for measuring progress and developing strategies to improve adolescent reproductive health. This study examined changes over time in the prevalence and determinants of adolescent pregnancy in Ghana.
A total of 11 nationally representative surveys from the Ghana Demographic and Health Survey (1988, 1993, 1998, 2003, 2008, 2014), Multiple Indicator Cluster Survey (2006, 2011, 2017-2018) and Malaria Indicator Survey (2016 and 2019) provided data on 14 556 adolescent girls aged 15-19 for this analysis. A random-effect meta-analysis, time trends and multivariable logistic regression models were used to track the prevalence and determinants of adolescent pregnancy.
The pooled prevalence of adolescent pregnancy in Ghana was 15.4% (95% CI=13.49% to 17.30%). Rural areas (19.5%) had a higher prevalence of adolescent pregnancy than urban areas (10.6%). In the overall sample, middle adolescents (15-17 years) (aOR=0.30, 95% CI=0.23 to 0.39), adolescents in urban areas (aOR=0.56, 95% CI=0.43 to 0.74), large households (aOR=0.62, 95% CI=0.49 to 0.78), not working (aOR=0.62, 95% CI=0.43 to 0.90) and those unaware of contraceptive methods (aOR=0.49, 95% CI=0.27 to 0.90) were less likely to become pregnant. Adolescents from middle-income (aOR=0.91, 95% CI=0.67 to 1.24) or high-income (aOR=0.59, 95%CI=0.36 to 0.94) households, those who were semiliterate (aOR=0.56, 95%CI=0.39 to 0.82) or literate (aOR=0.28, 95%CI=0.21 to 0.37) and those with fewer previous sex partners were less likely to become pregnant. Not all determinants in the overall sample were consistently associated with adolescent pregnancy in the last three decades. Between 1988 and 1998, determinants of adolescent pregnancy were age, literacy, employment, household size and whether the mother was alive. Between 2003 and 2008, age, literacy, household size, income, age of last sexual partner, number of previous partners and contraception knowledge determined adolescent pregnancy. From 2011 to 2019, age, residence, literacy and menstrual cycle knowledge were determinants of adolescent pregnancy.
Interventions and policies to prevent adolescent pregnancy should prioritise adolescents from disadvantaged backgrounds.
了解青少年怀孕的决定因素及其随时间的变化，对于衡量进展和制定改善青少年生殖健康的策略至关重要。本研究考察了加纳青少年怀孕率的时间变化及其决定因素。
本研究共纳入了 11 项来自加纳人口与健康调查（1988 年、1993 年、1998 年、2003 年、2008 年、2014 年）、多指标类集调查（2006 年、2011 年、2017-2018 年）和疟疾指标调查（2016 年和 2019 年）的全国代表性调查的数据，这些数据共涉及 14556 名 15-19 岁的青少年女孩。本研究采用随机效应荟萃分析、时间趋势和多变量逻辑回归模型来追踪青少年怀孕率及其决定因素的变化。
加纳青少年怀孕的总患病率为 15.4%（95%CI=13.49%至 17.30%）。农村地区（19.5%）的青少年怀孕率高于城市地区（10.6%）。在总体样本中，中学龄期（15-17 岁）（aOR=0.30，95%CI=0.23 至 0.39）、城市地区的青少年（aOR=0.56，95%CI=0.43 至 0.74）、大家庭（aOR=0.62，95%CI=0.49 至 0.78）、不工作（aOR=0.62，95%CI=0.43 至 0.90）和不知道避孕方法（aOR=0.49，95%CI=0.27 至 0.90）的青少年怀孕的可能性较低。来自中等收入（aOR=0.91，95%CI=0.67 至 1.24）或高收入（aOR=0.59，95%CI=0.36 至 0.94）家庭、半文盲（aOR=0.56，95%CI=0.39 至 0.82）或识字（aOR=0.28，95%CI=0.21 至 0.37）和性伴侣较少的青少年怀孕的可能性较低。并非所有决定因素在过去三十年中都与青少年怀孕一直存在关联。1988 年至 1998 年期间，青少年怀孕的决定因素为年龄、文化程度、就业、家庭规模和母亲是否在世。2003 年至 2008 年期间，年龄、文化程度、家庭规模、收入、上次性伴侣的年龄、性伴侣数量和避孕知识决定了青少年怀孕。2011 年至 2019 年期间，年龄、居住地、文化程度和月经周期知识是青少年怀孕的决定因素。
预防青少年怀孕的干预措施和政策应优先考虑来自弱势群体背景的青少年。
