Individual and contextual factors associated with mistimed and unwanted pregnancies among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis

Abstract

Introduction Unintended pregnancies are associated with a number of risk factors such as malnutrition, mental illness, unsafe abortion, maternal mortality and horizontal transmission of HIV to children. These risks are predominant among adolescent girls and young women compared to older women. This study examined the individual and contextual factors associated with unintended pregnancy among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa. Materials and methods Data for this study was obtained from recent Demographic and Health Surveys carried out between 2010 and 2018 in 10 countries in sub-Sahara Africa. The sample size for this study was made up of 6,791 adolescent girls and young women (aged 15–24), who were pregnant during the surveys and had complete responses on all the variables considered in the study. Unintended pregnancy was the outcome variable in this study. Descriptive and multilevel logistic regression analyses were performed and the fixed effect results of the multilevel logistic regression analysis were reported as adjusted odds ratios at 95% confidence interval. Results Unintended pregnancy in the selected countries was 22.4%, with Angola, recording the highest prevalence of 46.6% while Gambia had the lowest prevalence of 10.2%. The likelihood of unintended pregnancy was high among adolescent girls and young women aged 15–19 [aOR = 1.48; 95% CI = 1.26–1.73], those with primary [aOR = 1.99; 95% CI = 1.69–2.33] and secondary/higher [aOR = 2.30; 95% CI = 1.90–2.78] levels of education, single (never married/separated/divorced/widowed) adolescent girls and young women [aOR = 9.23; 95% CI = 7.55–11.28] and those who were cohabiting [aOR = 2.53; 95% CI = 2.16–2.96]. The odds of unintended pregnancy also increased with increasing birth order, with adolescent girls and young women having three or more births more likely to have unintended pregnancies compared to those with one birth [aOR = 1.99; 95% CI = 1.59–2.48]. Adolescent girls and young women who had ever used contraceptives (modern or traditional), had higher odds of unintended pregnancies compared to those who had never used contraceptives [aOR = 1.32; 95% CI = 1.12–1.54]. Finally, adolescent girls and young women who belonged to the rich wealth quintile were more likely to have unintended pregnancy compared to those in the poor wealth quintile [1.28; 95% CI = 1.08–1.51]. Conclusion The study found that age, marital status, level of education, parity, use of contraceptives and wealth quintile are associated with unintended pregnancy among adolescent girls and young women in high fertility sub-Saharan African countries. These findings call for the need for government and non-governmental organisations in high fertility sub-Saharan African countries to restructure sexual and reproductive health services, taking into consideration these individual and contextual level characteristics of adolescent gir...

Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: Evidence from demographic and health surveys

“…First, the surveys used in this study were based on cross-sectional data, and hence, causal interpretations of the findings cannot be established. Second, both IPV and pregnancy termination were self -reported, and as a result, there is the possibility of under-and over-reporting of data ( Ahinkorah, 2020a , 2020b , 2020c ).…”

Predictors of Pregnancy Termination among Young Women in Ghana: Empirical Evidence from the 2014 Demographic and Health Survey Data

“…Young women who had their first sex at the age of 20-24 and those whose first sex occurred at first union had lower odds of having a pregnancy terminated compared to those whose first sex happened when they were less than 15 years old. The higher probability of an unintended pregnancy among young women who have sex at earlier ages could be the plausible reason for this finding [66,67]. These unintended pregnancies have been attributed to a lack of or inadequate access to sexual and reproductive health services, including family planning [68,69], as well as the socio-cultural norms surrounding access to contraceptive services among young women having their first sex at an age of less than 15 years [70,71].…”

Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa

“…The various categories used to describe each of these variables are in Tables 2 and 3 . This study also adopted the categorization of the variables from previous studies [ 6 , 17 ].…”

“…Detailed information on the two-stage sampling procedure exist in previous studies [12,13]. A total of 62, 747 AGYW (aged [15][16][17][18][19][20][21][22][23][24] were included in this study. Table 1 has comprehensive information on the sample.…”