Factors Associated With Teenage Pregnancy Among Sexually Active Girls in Malindi Subcounty: a Mixed-method Study

Abstract

Background: Adolescence is a period characterized by experimentation. Teenagers get involved in high risk behavior such as unprotected sex which leads to unintended pregnancies, unsafe abortions and STIs/HIV. It is estimated that 16 million teenage girls aged 15 - 19 years and 2 million under 15 years of age become pregnant annually, with 95% being from low and middle income countries. In Africa, this poses a major public health problem. Despite advancement in sexual and reproductive health service provision, the rate of teenage pregnancy in Kilifi County was as high as 28.9% as of 2020 since the understanding of the factors that place these adolescents at increased risk of teenage pregnancy is limited. Emergence of Covid 19 pandemic has resulted in increasing incidence of teenage pregnancy as reported by local authorities. Little is known about the factors leading to the high incidence of teenage pregnancies since there are no local studies that have explored into the causative factors. There is therefore need to look into the factors associated with teenage pregnancy in the county, particularly Malindi Subcounty, which is the largest region in the county to be able to develop interventions that would mitigate the situation. Objective: To determine the factors associated with teenage pregnancy among sexually active girls in Malindi Subcounty Methodology: This was a mixed methods study that used qualitative and quantitative approaches to investigate factors associated with teenage pregnancy in Malindi Subcounty. The quantitative arm through a case-control approach used a semi-structured questionnaire. All eligible participants assented and whose parents’ consented were included in the study and were given the questionnaires until the desired sample size was reached. The qualitative arm used a focus group discussion with sexually active teenage girls, key informants’ interviews from parents/guardians, chief and religious leaders. An in-depth interview was also conducted with a pregnant teenage girl. The tape recorded data was transcribed fully, cleaned and thematic analysis was done. Analysis: Quantitative data was analyzed using the Statistical Package for Social Sciences version 21.0. Data that was categorical was analyzed and presented as frequencies and percentages. Summary of the continuous data was done and presented as means and standard deviations. Pearson Chi square test was utilized to compare the groups on the socio-demographic, economic, and reproductive health factors. Factors found to be of statistically significant were further subjected to a multivariate analysis with the use of logistic regression. Odds ratio as well as 95% confidence intervals were calculated and reported where it seemed fit. All statistical tests were considered significant where the p value < 0.05. Thematic analysis of qualitative data that resulted from the transcribed audio recordings of the focus group discussion and interviews was done. Relevance of the study: The information obtained from this study informed on the factors contributing to teenage pregnancy. This information will be relevant to promote reproductive health education and behavior towards safe sex practices among adolescents with an aim to reducing the incidence of teenage pregnancy, HIV, STIs and unsafe teenage abortions. Overall it would reduce morbidity and possibly mortality from complications of teenage sexual activity. Findings would also inform local policies and guidelines geared to addressing issues of teenage pregnancy.