This study sought to analyse the trends and factors associated with teenage pregnancy and early motherhood using multilevel modelling of ZDHS data between 2001 and 2018. The study focused on the influence of both individual and community level factors on teenage pregnancy as well as how these factors vary between clusters. Our review of literature reveals that no known comprehensive study of this nature has been conducted in Zambia and thus bolstering the importance of our findings. The significant findings indicate that overall, there is an increase in teenage pregnancies in Zambia. However, there are apparent disparities in the trends of early pregnancies among different groups of teenagers. Teenagers who are 15 years old, live in rural areas and are from poorest households reported an increase in early pregnancy over the four surveys analysed for this study. The increase in the trends of early pregnancy was also observed among those illiterate and married/formerly married teenage women. An apparent decline in teenage pregnancy was observed among young women who are exposed to family planning messages and for those who know their fertile periods.
At the individual level, we found that marital status was strongly associated with teenage pregnancy. Teenagers that reported being currently married or those living with partners were more likely to be pregnant compared to their never-married counterparts. These findings are consistent with evidence from other previous studies in Zambia (4, 20) and Africa (3). The relationship between marital status and early pregnancy has long been held in literature (6). Once married, the pressure to have a baby is often high on young couples because of the economic and social value that is attached to childbearing in most African societies (21). In the same vein, marriage is a protection from societal stigma for due to the social expectation of childbearing among married women.
Poverty equally plays a crucial role in motivating both early marriages and early pregnancy. In their qualitative study looking at parallel discourses on early pregnancy in rural Zambia, (6) found poverty to be a prominent factor in early marriages, both from the parents and young women’s perspective. Parents want to marry off their young girls for cash from bride-wealth while young girls are motivated to leave their parents’ homes because of the failure by parents to meet basic needs such as school fees and other daily necessities. Our study also confirms the role of poverty in early pregnancy and early marriages as we find that teenagers from wealthier households are less likely to have early pregnancies compared to those from poorer backgrounds. Similar findings were reported by a previous study on the same population in Zambia (4).
As expected, older teenagers have higher odds of early pregnancy than younger ones because they are likely to be more sexually active and exposed and thus being predisposed to early pregnancy. The fact that the higher odds of pregnancy among older teenagers remained significant even after controlling for age at sexual debut means that it is an important predictor of teenage pregnancy. It is still possible however, that younger teenagers are less likely to report sexual activities due to social and institutional barriers (22). A complex interchange of factors is likely to be at play to explain old teenage and pregnancy. Family and peer pressure to have boyfriends and get married as elucidated by (23) is more likely to be felt the most by older teenagers. Furthermore, older teenagers are more likely to experience peer and parental pressure to be married. Another dynamic, which is likely to make older teenagers be more exposed to early pregnancy, is the veil of secrecy that is attached to sexual and contraceptive topics in traditional family setup in Zambia. This brings challenges of access to authentic information on sexual reproductive health.
Unlike many similar previous studies (3–5) our research does not find a significant relationship between educational qualification and teenage pregnancy. However, this result is consistent with a study from Bangladesh (24) which also did not find educational qualification to be significantly affect early marital pregnancy. This study instead, finds literacy to be an important predictor of early pregnancy. Illiterate young women have higher odds of getting pregnant compared to literate ones. We suspect that correlation between literacy levels and educational qualification must have accounted for the non-significance of the latter in this study. It is plausible that literate women would be more empowered with the skills to prevent pregnancy than their illiterate counterparts would. Since literacy is directly associated with educational status, it is reasonable that in Africa, teenage who are out of school are more likely to get pregnant and have an early start to childbearing than those who are in school (3). This could also be the reason for high prevalent rates of teenage pregnancy and early marriages in sub-Saharan Africa where almost one third of teenagers are out of school (25). Literate women are expected to have better access to sexual education and be better informed about sexual, health and reproductive rights that help them to avoid early and risky behaviours.
The results from this study indicate that early sexual debut increases the odds of early pregnancy. Sexual debut is a proxy measure of a woman’s onset exposure to pregnancy due to the widespread nature of premarital sex in most societies (26). The link between early sexual debut and early pregnancy is obvious. Early sexual debut exposes young girls to risks of pregnancy at their most fertile ages, keeps them at risk of pregnancy longer due to their younger ages at sexual debut and elongates their reproductive lifespan compared to their counterparts that initiate sex late especially in relation to inadequate sexual education and contraceptive use. A study in East Africa also had similar findings (26). In Zambia, some studies have pointed to the role played by social norms and the pressure for material gains as influencing factors for young girls to engage in early sexual debut and subsequently early pregnancy (6, 23). Zambia’s social norms on sexual behaviour are anchored in secrecy and religion. Svanemyr’s study reported that no parents indicated lack of adequate knowledge on risks of unprotected sex as the reason for early pregnancy.
Inadequate contraceptive use is also another critical factor that was not mentioned by parents and yet crucial in early pregnancy prevention (5). The secrecy around sex topics between parents and children illuminated by social and cultural norms is a major contributing factor for early sexual debut (3). Pressure for material benefits has previously been constructed as a parallel and non-dominant narrative of sexual behaviour and early pregnancy and yet very common especially in rural Zambia (6, 23).
Media exposure is significantly associated with early pregnancy among teenagers in this study. Teenagers who are exposed to family planning messages are less likely to have early pregnancy. Other studies conducted in sub-Saharan Africa found this relationship to be statistically significant (27, 28) Family planning messages reinforces the knowledge base of young people on safer sex and contraceptive use which prevents early pregnancy. It is unconceivable that only radio and television messages on family planning would contribute to a reduction in teenage pregnancy. Disseminating of such information has become relatively easier in this era of improved technology where mobile communication gadgets are carried everywhere, coupled with enhanced ways of sharing information through social media and other related platforms.
Surprisingly, knowledge of fertile period, employment status and recent visits to a health facility were associated with higher odds of teenage pregnancy. These results seem to validate claims of rational choice in early pregnancy as made by some scholars (4). They posit that early pregnancy in developing countries may be more intended than in developed countries in view of social and cultural norms that seem to encourage the practice. Our results, which show that young women with knowledge of the fertile period had higher odds of falling pregnant which pregnancies, could be intentional. Similarly, results, which indicate those employed as being more likely to have early pregnancy, may suggest that they rationally decided to get pregnant because of the financial security their employment brings to taking care of children.
The influence of contextual factors on early pregnancy have been thought provoking. This study found that variations in early pregnancies are mostly attributable to individual level factors. However, some significant variations were also observed between communities. Apart from community family planning messages, none of the contextual factors have been found to predict teenage pregnancy. Even more startling is the finding that place of residence, which has always been found to be associated with teenage pregnancy was not the case in our study. A Zambian study focusing on a similar population group reported that rural young women are more likely to have early pregnancy compared to their urban counterparts (4, 29). However, our study is significantly different as it pools data from four surveys compared to just one analysed by Munakampe and colleagues. Findings demonstrate the presence of other factors, which may be more important than residence are influencing sexual activities among young people and subsequently early pregnancy.