Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda

Abstract

BackgroundIn sub-Saharan Africa, one in every five young women becomes pregnant, and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes and a high abortion rate, yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who were frequently engaged in transactional sex in Kampala, Uganda.MethodsWe analyzed data from a study that investigated the uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on sociodemographics, sexual behavior, reproductive health outcomes, and substance use. Pregnancy was determined by testing for beta-human chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan–Meier technique, and logistic regression was used to determine the correlates of pregnancy.ResultsWe included 285 volunteers with a mean age of 19.9 [standard deviation (SD), ± 2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to the interview, of whom 12.8% consumed alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhoeae. The mean age at first sexual intercourse was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow-up, an incidence of 23.5 per 100 person-years [95% confidence interval (CI), 17.5–31.6]. Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months [adjusted risk ratio (aRR) 1.97; 95% CI, 1.05–3.70] and those who reported not using contraception (aRR 5.89; 95% CI, 2.74–12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI, 0.30–0.90).ConclusionThe incidence of unintended pregnancy was high despite the availability of free contraceptive services. We recommend sociobehavioral studies to explore this further. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.

Factors Associated with Delayed Utilization of Antenatal Care Services among Pregnant Women: A Case Study at Jinja Regional Referral Hospital, Uganda

“…Furthermore, antenatal care services may not be youth-friendly, and the approach taken by health professionals toward adults aged 18-24 may be discouraging, which reduces their utilization of the services. Related to the results, Namukisa et al [25] indicated that maternal young age is associated with lower rates of ANC usage due to many young women having unwanted pregnancies. Contrary to the above results, [26] found that young women (below 25 years) were more likely to receive antenatal care than older women (above 31 years).…”

Factors influencing unintended pregnancy and abortion among unmarried young people in Nigeria: a scoping review

“…Similarly, in Ethiopia, sexual debut before the age of 18 was positively associated with unintended pregnancies [ 63 ]. Adolescents during this period of rapid physical development may be particularly vulnerable to exploitation by older individuals due to ignorance about their own physical and sexual development [ 17 , 32 , 33 ]. Encouraging adolescents to abstain from sexual activity during this critical period can help delay the onset of sexual activity and reduce the likelihood of unintended pregnancies.…”

“I want one nurse who is friendly to talk to me properly like a friend”: Learner preferences for HIV and contraceptive service provision in Gauteng, South Africa

“…This includes being further stigmatised by healthcare staff who openly question youth about whether their sexual activities are age appropriate. Stigma is also noted by numerous studies to be a universal issue affecting individuals in all areas of their lives and is shown to affect healthcare-seeking behaviour [ 23 ], [ 24 ]. Context-specific innovative programs, example mastery experiences through sport which will also include vicarious experiences whereby youth observe peers succeeding at certain sports, are needed to build up self-efficacy and resilience within youth themselves which could then empower them to deal with experiences of stigma more effectively.…”