Determinants of teenage pregnancy in Malawi: a community-based case-control study – BMC Women’s Health

Teenage or adolescent pregnancy occurs in a woman aged 10 to 19 years [1]. They are a global concern [2] and account for 11% of all deliveries worldwide and 23% of the disease burden in Disability Adjusted Life Years (DALYs) from pregnancy and childbirth among women of all ages [3]. Adolescent pregnancies are more likely to occur in marginalized communities [2], with nearly 95% occurring in developing countries [4]. Although there has been a global decline in trends of adolescent pregnancy for the past two decades, adolescent fertility has remained high in sub-Saharan Africa, at 101 births per 1,000 adolescent women [5].

Teenage pregnancy is both a medical and a public health concern due to its detrimental effects on the mother, baby and society. Its significant impact is felt on adolescents’ health and socioeconomic lives, especially girls [6,7,8]. Regarding health consequences, studies have shown a higher risk of adverse pregnancy outcomes among adolescents than among non-adolescents [9]. These negative outcomes include pregnancy and childbirth complications such as eclampsia, haemorrhage, systemic infections and unsafe abortions that contribute to maternal morbidity and mortality and lasting health problems [9, 10]. Babies born to mothers under 20 years of age face higher risks of low birth weight, preterm delivery and severe neonatal conditions [2, 9]. Social consequences for unmarried pregnant adolescents may include stigma, rejection, and violence by partners, parents and peers [7]. Teenage pregnancy and childbearing often lead to early school dropout, jeopardising girls’ future education and employment opportunities [7, 8]. The lower age of first childbearing is a determinant of higher fertility, contributing to high population growth [11, 12]. The growth and development of children born to teenage girls are likely to be affected by the socioeconomic status of their mothers [12].

Despite several detrimental effects to the mother, baby and society that come from teenage pregnancy [6,7,8], Malawi has been known to be among the top countries with a higher proportion of teenage pregnancies regionally and globally [6, 13, 14]. Currently, adolescent childbearing in Malawi is at 29%, a slight increase from a declining trend of 35% in 1992 to 26% in 2010 [15].

Concerted efforts to curb teenage pregnancy in Malawi date back to 1994 with the adoption of the International Conference for Population and Development (ICPD) Program of Action [16] and later on the introduction of the Youth Friendly Health Services (YFHS) program in 2007 [17]. The YFHS program addresses adolescent pregnancy through the ‘minimum package for YFHS’, which includes health promotion and counselling, delivery of health services, referral and follow-up [17]. Despite these efforts, Malawi continues to register an undesirably higher number of teenage pregnancies, as evidenced in the three preceding Malawi Demographic and Health Surveys (MDHS) of 2005, 2010 and 2015 [15].

Globally and regionally, some of the well-known determinants of teenage pregnancy include early sexual activity, marriage, low level of education, low socioeconomic status, lack of knowledge of reproductive health, low contraceptive use, family disruption and lack of power to negotiate for safer sex [12, 18,19,20,21]. In addition, context-specific factors such as quality of health services, place of residence, domestic violence and ethnicity have influenced adolescent pregnancy [19, 21, 22].

In Malawi, studies on determinants of teenage pregnancy are rare. Previous studies mainly focused on socioeconomic factors and they established an association between teenage pregnancy and factors such as low levels of education and low wealth quantile [15] initiation ceremonies [23] high school performance [24] early sexual debut and marriage [18]. Considering the multifactorial nature of determinants of teenage pregnancy, it is implausible to conclude that these are the only determinants of teenage pregnancy in Malawi. To the best of our knowledge, some factors that may influence teenage pregnancy such as use of contraception, domestic violence and the facility type and authority for the source of contraceptives have not been studied. Also notably, a potential source of selection or misclassification bias [25,26,27] exists in all studies conducted in Malawi by studying a population (girls aged 15–19 years) which was partially exposed to variables of interest.

It is against this gap that this study was conducted to identify factors that are associated with teenage pregnancies in Malawi through a community-based case-control study using country-representative secondary data from 2015 to 16 MDHS. The findings from this study will expand the knowledge of factors associated with teenage pregnancy in Malawi. Such knowledge will guide policymakers to develop focused and high-impact interventions to address the problem of teenage pregnancies and their effects in Malawi.