Significant heterogeneity was observed in the prevalence of IPV and non-partner sexual violence among adolescent women in economically distressed urban settings, with upwards of 25% of ever-partnered women experiencing past-year IPV in Baltimore, Ibadan, and Johannesburg, and more than 10% of adolescent women in Baltimore and Johannesburg reporting non-partner sexual violence. Findings affirm the negative health influence of GBV even in disadvantaged urban settings that present a range of competing health threats. A multisectoral response is needed to prevent GBV against young women, mitigate its health impact, and hold perpetrators accountable.

Background The impact of pregnancy on the health and livelihood of adolescents aged 15–19 is substantial. This study explored sociodemographic, behavioral and environmental-level factors associated with adolescent pregnancy across 5 urban disadvantaged settings. Methods The Well Being of Adolescents in Vulnerable Environments study used Respondent Driven Sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), Delhi (500) and Shanghai(438). RDS-II and post-stratification age weights were used to explore the odds associated with “ever had sex” and “ever pregnant”; adjusted odds of pregnancy and 95% CI were developed by site and gender. Results Among the sexually experienced, pregnancy was most common in Baltimore (females 53%, males 25%) and Johannesburg (females 29%, males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, Delhi and Shanghai. Current schooling and condom use at first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were: early sexual debut (Johannesburg participants, Baltimore females) being raised by someone other than 2 parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males, Johannesburg participants). Conclusions The reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, as well as differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside, with particular attention to neighborhood-level factors.

Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.