Factors associated with changes in teenage pregnancy in rural areas in Malawi between 2010 and 2016

Abstract

Teenage pregnancy is a global challenge but developing countries are more affected than developed countries. Malawi experienced increase in teenage pregnancy in rural areas between 2010 and 2016 at a time when other countries in the sub-Sahara region such as Kenya, Rwanda and Zimbabwe experienced a decline. Teenage pregnancy is associated with adverse maternal and neonatal outcomes including obstructed labor and pregnancy induced hypertension and in Malawi contributes 20% to 30% of maternal deaths. The study examined predictors of teenage pregnancy in 2010 and 2016 and contribution of various predictors towards changes in teenage pregnancy in rural areas between 2010 and 2016. A binary logistic regression was used to examine predictors of teenage pregnancy in 2010 and 2016 while nonlinear multivariate decomposition regression model was used to examine predictors which contributed to changes in teenage pregnancy between 2010 and 2016. A weighted sample of 4,058 teenagers aged 15-19 in 2010 and 4,345 teenagers aged 15-19 in 2016 from Malawi demographic health survey was used. Factors which predicted teenage pregnancy in 2010 and 2016 were modern contraceptive use, knowledge on modern family planning, education attainment, household wealth, region and ethnicity among others (p<0.05). The study further revealed that changes in teenage pregnancy were attributed to variations in characteristics of teenagers. The overall changes contributed 131.3% of changes in teenage pregnancy between 2010 and 2016 (p<0.05). This means teenage pregnancy between 2010 and 2016 would have reduced by 131.3% in the absence of changes in teenager’s characteristics. Several Characteristics contributed to the changes but the key ones include modern contraceptive use (80%), age (77%), knowledge of modern contraception (23%), household wealth (-5.2%) and education attainment (-31.5%) (p<0.05). The study recommend an evaluation of sexual and reproductive health programs targeting teenagers in rural areas to understand why teenage pregnancy is high among modern contraceptive users and those with knowledge of modern contraceptives. Additionally, there is need to promote girl child education up to completion of secondary school and wealth creation activities as these protected teenagers from experiencing pregnancy.