Factors associated with adolescent pregnancy in Zambia: a secondary data analysis of the 2018 Zambia demographic and health survey.

BACKGROUND: Globally, complications from pregnancy and childbirth are the leading causes of death among adolescent girls aged 15-19 years. In Zambia, nearly three in ten adolescent girls have begun childbearing, with rates as high as 35% in rural areas. These high rates contribute to adverse maternal and newborn outcomes, perpetuating intergenerational cycles of poverty and limiting opportunities for education and economic empowerment among young mothers. This study explored factors associated with adolescent pregnancy in Zambia. METHODS: This cross-sectional study utilized data from the 2018 Zambia Demographic and Health Survey. A total of 2,996 adolescents aged 15-19 years were included in the analysis. This study utilized the socioecological model to select potential influencing factors for adolescent pregnancy. Descriptive and multivariable analyses were conducted using SPSS version 22 software. RESULTS: The prevalence of adolescent pregnancy was 29.9%. Most adolescents had no sexual partners (59.0%), and 49.7% had initiated sexual intercourse. Factors independently associated with adolescent pregnancy included increasing age, marital status (AOR = 5.4; 95% CI: 3.7, 7.9), knowledge about contraception (AOR = 3.4; 95% CI: 1.2, 9.8), use of contraception (AOR = 3.4; 95% CI: 1.2, 9.8), literacy level (AOR = 1.7; 95% CI: 1.1, 2.6), and exposure to family planning messages in newspapers or magazines (AOR = 2.6; 95% CI: 1.1, 6.4). Other factors included wealth status (AOR = 2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR = 3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR = 3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR = 4.2; 95% CI: 2.0, 8.9 for poorer versus richest) and age at first sexual intercourse (AOR = 2.1; 95% CI: 1.3, 3.4 for 15-17 versus 18-19, AOR = 3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18-19). CONCLUSION: Key factors associated with adolescent pregnancy in Zambia include older age, early marriage, low literacy, low socioeconomic status, early sexual initiation, and limited exposure to family planning messages via newspapers. Interventions to address this problem should include behavioral change communication strategies that discourage early sexual debut, especially among older adolescents. Furthermore, leveraging media platforms, particularly newspapers, in disseminating accurate messages on contraception and enforcing statutory laws on the legal age of marriage are crucial efforts in addressing this problem.