Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women

• Type of Material: Article
• Authors: Nicola J. Christofides, University of the Witwatersrand; Rachel K. Jewkes, University of the Witwatersrand; Kristin Dunkle, Emory University; Frances McCarty, University of the Witwatersrand; Nwabisa Jama Shai, University of the Witwatersrand; Mzikazi Nduna, University of the Witwatersrand; Claire Sterk, Emory University
• Language: English
• Date: 2014-12
• Publisher: Taylor & Francis
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Nicola J. Christofides et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3402/gha.v7.23719
• Title of Journal or Parent Work: Global Health Action
• ISSN: 1654-9716
• Volume: 7
• Issue: 1
• Start Page: 23719
• End Page: 23719
• Grant/Funding Information: This study was funded by the National Institute of Mental Health (grant numbers MH 64882-01, MH 64882-04S1A1, and 1R03MH085599) and the South African Medical Research Council.
• Keywords: unplanned pregnancy; adolescent pregnancy; unwanted pregnancy; South Africa; gender-based violence
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology

Abstract

Background Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Objective Teenage girls, aged 15–18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Results Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21–0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05–2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07–0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58–0.83 and OR 0.78; 95% CI 0.64–0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07–6.25, and OR 2.21 95% CI 1.13–4.29). Conclusion Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.