Isano Sandra, Khatib Ziad El, Blanchet Karl
University of Global Health Equity, Kigali, Rwanda.
Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Reprod Health. 2025 Jul 19;22(1):131. doi: 10.1186/s12978-025-02077-z.
Adolescent pregnancy remains a pressing global public health concern, with 21 million births annually among 15–19-year-old girls, 12 million of which occur in low- and middle-income countries. Sub-Saharan Africa (SSA) experiences disproportionately high adolescent birth rates, driven by poverty, cultural norms, gender inequality, and limited access to sexual and reproductive health and rights (SRHR) services. In Rwanda, despite significant progress in reproductive health, adolescent pregnancy remains prevalent, affecting 5% of girls aged 15–19, with regional disparities. Existing studies highlight contributing factors, including socioeconomic status, limited SRHR services, and cultural stigmas, but gaps persist in understanding comprehensive determinants and adolescent experiences.
A cross-sectional survey was conducted in Burera (rural) and Nyarugenge (urban) districts in Rwanda to understand factors influencing adolescent pregnancy. A total of 441 adolescent girls aged 12–19 years (253 from Burera and 188 from Nyarugenge) were recruited using systematic random sampling. Data collection occurred between June and August 2024, with questionnaires administered in Kinyarwanda by trained research assistants. Descriptive statistics and logistic regression analyses were used to identify associations between adolescent pregnancy and socio-demographic and SRHR factors.
The study revealed a 12.7% prevalence of adolescent pregnancy, with significant regional disparities: 80.4% of cases occurred in rural Burera, compared to 19.6% in urban Nyarugenge. Adolescents aged 15–19 years had reduced odds of pregnancy compared to their younger peers aged 12–14 years, though this difference was not statistically significant. Secondary education emerged as a protective factor, significantly lowering the odds of pregnancy (OR = 0.13, = 0.017). Delaying sexual debut to ages 15–17 was also strongly protective (OR = 0.04, < 0.001). Formal sexual and reproductive health education was associated with reduced pregnancy risk, reported by 67.8% of non-pregnant adolescents compared to 33.9% of pregnant adolescents (OR = 0.29, = 0.012). Socio-economic stability, reflected by maternal employment and parental education, further reduced pregnancy risk. Rural adolescents faced greater barriers to accessing SRHR services, including confidentiality concerns (55.4% vs. 35.6%, = 0.004) and limited service availability (12.5% vs. 1.8%, = 0.017), highlighting the challenges in addressing adolescent pregnancy in rural settings.
Addressing adolescent pregnancy in Rwanda requires targeted interventions focusing on rural areas like Burera, where pregnancy rates are highest. Expanding access to SRHR education, improving service delivery, and addressing socio-economic barriers are critical steps in reducing pregnancy rates and promoting adolescent health. Collaborative efforts should prioritize enhancing educational opportunities, empowering parents, and improving adolescents’ awareness and confidence in accessing reproductive health services.
青少年怀孕仍然是一个紧迫的全球公共卫生问题，每年15至19岁女孩中有2100万例分娩，其中1200万例发生在低收入和中等收入国家。撒哈拉以南非洲（SSA）的青少年出生率高得不成比例，其原因包括贫困、文化规范、性别不平等以及获得性健康和生殖健康及权利（SRHR）服务的机会有限。在卢旺达，尽管在生殖健康方面取得了重大进展，但青少年怀孕仍然很普遍，影响了15至19岁女孩的5%，且存在地区差异。现有研究强调了促成因素，包括社会经济地位、有限的SRHR服务和文化耻辱感，但在理解综合决定因素和青少年经历方面仍存在差距。
在卢旺达的布勒拉（农村）和尼亚鲁根盖（城市）地区进行了一项横断面调查，以了解影响青少年怀孕的因素。使用系统随机抽样方法共招募了441名12至19岁的青少年女孩（253名来自布勒拉，188名来自尼亚鲁根盖）。数据收集于2024年6月至8月期间进行，由经过培训的研究助理用基尼亚卢旺达语发放问卷。使用描述性统计和逻辑回归分析来确定青少年怀孕与社会人口学因素和SRHR因素之间的关联。
该研究显示青少年怀孕患病率为12.7%，存在显著的地区差异：80.4%的病例发生在农村的布勒拉，而城市的尼亚鲁根盖为19.6%。与12至14岁的年轻同龄人相比，15至19岁的青少年怀孕几率降低，不过这种差异无统计学意义。中等教育成为一个保护因素，显著降低了怀孕几率（OR = 0.13， = 0.017）。将首次性行为推迟到15至17岁也具有很强的保护作用（OR = 0.04， < 0.001）。接受过正规性健康和生殖健康教育与降低怀孕风险相关，67.8%的未怀孕青少年报告接受过此类教育，而怀孕青少年的这一比例为33.9%（OR = 0.29， = 0.012）。母亲就业和父母教育所反映的社会经济稳定性进一步降低了怀孕风险。农村青少年在获得SRHR服务方面面临更大障碍，包括对保密性的担忧（55.4%对35.6%， = 0.004）和服务可及性有限（12.5%对1.8%， = 0.017），这凸显了在农村地区解决青少年怀孕问题的挑战。
在卢旺达解决青少年怀孕问题需要有针对性的干预措施，重点关注像布勒拉这样怀孕率最高的农村地区。扩大获得SRHR教育的机会、改善服务提供以及消除社会经济障碍是降低怀孕率和促进青少年健康的关键步骤。合作努力应优先加强教育机会、增强父母能力以及提高青少年在获得生殖健康服务方面的意识和信心。
