Sociodemographic characteristics of the adolescents
Our study involved 600 girls whose mean age was 16.9 years (SD ± 3.84). To note, 9.7% were married or separated at the time of the study and 75% were school-going. Other baseline characteristics of the adolescents are summarized in table 1 and 2.
Family and Household Characteristics
Table 3 describes the baseline household and family characteristics of the 600 girls that participated in the study. The mean household size was 7.6 (± SD 5.06) and the mean number of adolescents aged 10-19 years in the households was 3.2 (±3.01). Of the 600 adolescents, only 81 (9.3%) had fathers with highest education level of Advanced- level and above, 72 (14%) had fathers who had completed Ordinary -level education and 110 (24%) had fathers with no education at all. Also, 142 (31% had mothers with no education at all while only 52 (3.3% had mothers who had A-level education and above and only 96 (13.7%) of mothers had completed O -level education. Most of the adolescents; N=288 (59%) belonged to large family sizes of 7 and above. The social economic status was nationally representative. We had 240 (42%) categorized as poor, 239 (37%) as moderate and 119 (22%) as rich according to a scoring system which was different for rural and urban dwelling adolescents.
Only 282 (42%) reported ever having discussed sex with their parents. Of the 600 adolescents, 240 (43%) reported their parents’ parenting styles as being Disciplinarian/Authoritative, 249 (37%) reported their parents as being permissive or liberal.
Behaviour and experiences of adolescents
We also described the behaviours and experiences of adolescents which affect adolescent pregnancy and table 4 has a summary of the findings. From the 200 girls who had ever been pregnant, the mean number of pregnancies was 1.1 (SD 0.64) and mean age of first pregnancy was 16.6 years.
Over 60% (N=337) had ever had sex and the mean age of first sex was 15.2 years while the average age of the sexual partner was 18.2 years. Most of them N=300 (89%) reported that they consented to having sex the first time, but less than half; 47% (N=139) used condoms. From the N=132 in Wakiso district who were sexually active, the average number of sexual partners was 1.8 people. (This data was not collected in Kamuli district).
Bivariate analysis of Risk Factors of Adolescent Pregnancy
Table 5 describes bivariate analysis of the socio-demographic risk factors for adolescent pregnancy. The mean age (SD, Range) was 18 (1.1, 14-19) years for those who had a pregnancy and 16.4 (1.9, 13-19) among those who had never had a pregnancy.
The findings of the bivariate analysis of behaviour and family-related risk factors of adolescent pregnancy are summarized in table 6 below. Knowledge of pregnancy prevention and contraceptive use were statistically significant risk factors of pregnancy.
Multivariate analysis of Risk Factors of Adolescent Pregnancy
All the variables with p values below 0.2 were put in the model to determine independent predictors of adolescent pregnancy. Factors that are independent predictors of adolescent pregnancy included are summarized in Table 5 below.
Sub-analysis of risk factors of adolescent pregnancy by district
We conducted a sub analysis by district to find the risk factors of adolescent pregnancy by district. We found some differences as noted in table 6. In both districts, age and not going to school were risk factors for pregnancy. In Kamuli district, sexual abuse, working for money, “ever-taken alcohol” and accurate knowledge of contraceptives increased the risk. In Wakiso district, “ever wanted to take her life”, no education and poverty were risk factors.
Protective and Risk factors for adolescent pregnancy
Qualitative findings revealed factors that protect or increase risk of adolescent pregnancy and these are summarized in matrix 1.
Matrix 1: Protective and risk factors for teenage pregnancy
Protective factors against pregnancy
Factors increasing pregnancy
• Being in school
• Having personal goals or aspirations
• Access to SRH information
• Use of family planning
• Religion/fear of God
• Inadequate information on SRH
• Early sexual debut
• Alcohol and drug abuse
• Being out of school
• Older adolescents
• Good relationship with parents
• Parent-adolescent communication
• Parental guidance and supervision
• Meeting basic needs
• Exemplary parents
• Positive peer influence
• Small families
• Absence of parental supervision
• Disobedient adolescents
• Negative peer influence
• Abuse at home/Domestic violence
• Negative parental influence
• Community and radio SRH programs
• Role models
• Child protection services
• Unregulated information in the media (radio, TV, social media)
• Desire for material/monetary gains
• Poverty- inability to meet needs
• Negative community influence and norms
• slums, acceptance of child marriage
• Weak legal system
• Widespread alcohol and drug abuse
Protective factors against adolescent pregnancy
As shown in matrix 1, the study revealed protective factors at individual, relationship and broader community levels. At individual level, being in school, having personal goals/aspirations, use of contraceptives, access to SRH information and religion/fear of God were mentioned as key protective factors against adolescent pregnancy. Study participants viewed schools as keeping adolescents busy, offering guidance and counseling and promoting self-esteem and respect that keep adolescent away from engaging in premarital sexual activity thus avoiding becoming pregnant.
When a child is at school, she gets counseling from home and school. She comes back from school late and leaves home early to go to school. All the time she is busy that can help her to protect herself (FGD older out-of-school adolescents, Wakiso)
The chances of a girl out-of-school getting pregnant are high. This is because she has nothing to do. But the one in school is kept busy. (FGD older out-of-school-Wakiso)
Most study participants expressed worry of the likely increase in adolescent pregnancies following closure of schools due to COVID-19.
I think you have also heard that during this COVID-19 period when these girls are not in school, we have got more pregnancies. Children don’t have anything to do, so nothing else keeps them busy except being sexually active. (KII Peer educator Wakiso)
Having targets or future career aspirations was also mentioned as a protective factor for adolescent pregnancy.
I ask my children every time from the youngest, “What are you going to become when you grow up?”. You see, you have to keep talking these things to the children. If she is studying to become a health worker you ask her, “Do you know what can stop you from continuing with school? (KII Leader Wakiso)
Access to information on SRH including on pregnancy prevention and having faith in God were other key individual level protective factors.
Relationship level protective factors against adolescent pregnancy
Study findings revealed that adolescents who had good relationship with parents, received guidance and supervision and had their basic needs met were protected from pregnancy. Parent-adolescent communication including sexual and reproductive health was another protective factor against pregnancy.
Communication has helped put in me a mentality that when I get pregnant, I'm not returning home. This is because whenever my father is counseling me, he tells me, “If you get pregnant you won't see me again….” I love him so much, so this message is ever on my mind. I'm not going to get pregnant (FGD older adolescents out-of-school, Wakiso)
Parents who provided good examples to their children like not engaging in multiple sexual relationships and not abusing alcohol as well as those who provided for basic needs including sanitary pads were also mentioned as protective factors for adolescents against pregnancy.
If you are at school and you tell your parents that you need knickers, pens and all other stuff and they buy them for you, you will not fall in love just because you know that they are providing you each and everything you need. (IDI pregnant Adolescent Wakiso)
I think that when this adolescent girl has all the necessities she requires, she will not get pregnant because it is lack of money that always puts them in these problems (KII Religious leader, Kamuli)
Small families which enable parents to have adequate time to guide and support children was another protective factor.
In families with few children, they (parents) give time to their adolescents but for those with many children some are sent to the village to their grandparents who might not manage them. The rich usually have three or four children who they are able to cater for and also stay with them and they easily monitor them (IDI pregnant adolescent Kamuli)
Having peers with positive influence like encouraging each other to remain in school and to avoid risky behaviours such as use of alcohol and engaging in premarital sex was another protective factor mentioned.
Some adolescents, their friends tell them and keep them safe from getting unwanted pregnancies (IDI pregnant Adolescent, Wakiso)
Community Level Protective factors
At community level, availability of community support and education programs on SRH, counseling services, having good community role models who educate adolescents about remaining in school and child protection services such as police and probation and welfare officers also help to prevent adolescent pregnancies.
Radio talk shows. The various shows talking about SRH and play skits on radio have helped some adolescents from getting pregnant (KII, CDO Kamuli)
Having good role models like the Queen mother of Buganda, the Speaker of Parliament encouraged adolescent girls to remain in school and avoid becoming pregnant.
Factors increasing the risk of adolescent pregnancy
At individual level, inadequate information on SRH, early sexual debut, alcohol and drug abuse being out of school especially for older adolescents increased risks of becoming pregnant.
Limited information about SRH. This is making the boy and the girl miss out the basic information about sexual health. They will have it in mind to test and discover what exactly happens when we do what we see and hear (KII Teacher, Kamuli)
Early sexual debut was another driver of adolescent pregnancy mentioned:
Adolescents engage into sexual intercourse early. Here they are very sharp. They start at fourteen to fifteen years …. and remember that if a girl starts menstrual periods and indulges in sex, the end result is being pregnant (IDI Adolescent, Kamuli)
Drug and alcohol abuse and limited judgment were also mentioned as factors leading to adolescent pregnancy.
Our children here take drugs and alcohol. Such children cannot control themselves and end up in sexual activity and become pregnant, (FGD fathers, Wakiso)
At relationship level, absence of parental supervision, disobedient adolescents, negative influence from peers, child abuse and domestic violence as well as negative parental influence were key factors mentioned to increase adolescent pregnancy.
Lack of parental supervision and guidance was mentioned as a factor leading to teenage pregnancy. Study participants mentioned that children who are not well guided or have poor relationships with their parents are easily lured into sexual activity.
Negative parental influence such as bringing sexual partners at home and having sex when children are listening can also lead girls into pregnancy.
In most cases, we the mothers are the ones who spoil our children … By bringing in many men, one goes out (a man) and the next one (another man) comes in then you are spoiling the children. (FGD Mothers, Wakiso)
In small houses at night, a child will listen to what you are doing and she will also go and discuss it with her friends. In the end, they will also end up going to demonstrate what father and mother does. (IDI Adolescent, Kamuli)
Other parents stay with their children, so they play sex when children are hearing. So, the next day the children may want to do it (KII District Official, Kamuli)
It was noted that some girls engage in sexual relationships to escape mistreatment at home.
Mistreatment at home is obvious case. You'll definitely decide one day and run away from home to go and find a way to survive and that's where you'll get problems, boys or maybe your friends may connect you to boyfriends. (FGD older adolescents out-of-school Kamuli)
At home they might mistreat me but if I have boy who loves me and says that he wants to marry me, why should I stay at home when I’m being mistreated? (FGD younger adolescents in-school, Wakiso)
Child abuse especially sexual abuse was also linked to increased cases of adolescent pregnancy.
Sometimes she’s raped or parents force her against her will when they want finances (FGD younger adolescent in school, Wakiso)
Some study participants blamed girls for dressing inappropriately as reason for sexual abuse.
Negative influence of peers and parents were also mentioned as factors leading to adolescent pregnancy. It was noted that some girls are encouraged by their peers or parents to get into sexual relationships in anticipation of material or monetary gifts. Others become pregnant owing to negative influence from their peers.
You can find your friend having a nice skirt but when you have no way you can have it. When you go to her and consult where she bought her nice skirt, she says she fell in love and then got it. You also end up doing the same and then get pregnant. (IDI Pregnant Adolescent, Kamuli)
I could be with my friends and they share what they do with their boyfriends. One can tell you that they had fun and drunk (alcohol). This gives you ideas and you tell your boyfriend to do the same and the end result is pregnancy (FGD Adolescents in school Wakiso)
At broader community level, unregulated information in the media (radio, TV, social media), desire for material/monetary gains among adolescents, poverty and inability to meet basic needs, negative community influence and norms such as acceptance of child marriage, widespread use of alcohol and drugs especially in slums and the weak legal and child protection systems were key drivers of adolescent pregnancy in the study setting.
Most study participants attributed the high rates of adolescent pregnancy to unregulated print and electronic media content that makes sexual activity attractive for young people and some try it out and become pregnant.
You see even those films are vulgar (pornographic)… A child may see a film that has sexual intercourse scenes in it and says that let me also try it out and she gets pregnant (FGD older adolescents out of school Wakiso)
Then in the urban set-up the radios, televisions and phones cause a lot of destruction… (KII Wakiso District leader)
Desire for quick monetary and material gains among adolescent girls led to sexual relationships with older men who can provide such and girls ended becoming pregnant. For some of hem it is due to poverty.
Just buying some food will entice a girl into sex. They admire some small things like “kicomando”(cheap food sold on the roadside). Because the parents can’t afford giving the required necessities to their children (IDI Adolescent, Wakiso)