Prevalence and Factors Associated with an Increase in the Number of Teenage Pregnancies in Chikupili Village-Luano District

Chanda Musonda^*
*Correspondence: Chanda Musonda, Department of Medicine, Copperbelt University, Kitwe, Zambia, Tel: 978839248, Email:

Keywords

Sexually transmitted diseases • Total fertility rate • Relationship

Abbreviations

WHO: World Health Organisation; UNICEF: Unite Nations Children Education Fund; MOH: Ministry of Health; SPPS: Statistical Package for Social Scientists; CSO: Central Statistics Office; ZDHS: Zambia Demographic Health Statistics

Introduction

Background

Adolescent pregnancies are a global problem occurring in high, middle and low-income countries, however, the statistics are higher in marginalized communities, commonly driven by poverty and lack of education and employment opportunities [1-3]. Every year an estimated 21 million girls aged 15-19 years in developing regions become pregnant and approximately 12 million of them give birth [4]. At least 777,000 births occur among adolescent girls below the age of 15 years in developing countries [5]. The prevalence of teenage pregnancy in Africa is 18.8%, of this, 19.3% occurred in Sub Saharan Region and 21.5% in Eastern Africa [6]. In Africa, Zambia has continued to face a high prevalence of adolescent pregnancy over the past 15 years despite measures that have been put in place. Adolescent pregnancy poses a great health and socio-economic risk on the mothers and babies [7]. Pregnancy and childbirth complications are the leading cause of death among girls aged 15-19 years globally, with low and middle income countries accounting for 99% of global maternal deaths of mothers aged 15-49 years [8]. Adolescent pregnancy contributes to the maternal mortality and morbidity as about 3.9 million unsafe abortions are recorded yearly among the girls aged 15-19 [9]. Social and economic consequences associated with teenage pregnancy may include stigma, rejection and violence by partners [10]. Teenage pregnancy also is associated with high school dropout rate [11]. Adolescent pregnancy also has an impact on future earning potential hence leading to long lasting poverty several factors are associated with adolescent pregnancy and these include: early marriages as in many societies girls are pressured to marry and bear children at a tender age [12]. Lack of knowledge, access of Contraception has also been cited by many sources to be a potential reason for the increased rate of teenage pregnancy, the attitude by health care givers towards teenage contraceptive recipients and also government policies are also included [13]. Other factors include early sexual attainment, exposure to media, poverty, religion, family structure [14]. Though there are many studies that have looked at the prevalence and factors contributing to the rise in teenage pregnancy in Zambia, there is limited evidence of studies done in Central province. Therefore this study was aimed at determining the prevalence and factors associated with the rise in teenage pregnancy in Chikupili village, Luano District, Central Province of Zambia. The findings of the study could help policy makers, nongovernmental organisations to come up with programmes that can help curb this problem.

Problem statement

The rise in teenage pregnancy in Zambia has continued to be a public health concern [15]. Unwanted pregnancies and hence early marriages are still at peak and pause a great risks of low birth weight, preterm delivery, and severe neonatal conditions [16]. A lack of pregnancy related knowledge among pregnant adolescent girls can adversely affect their lives as well as those of their unborn children [17]. Ideally, teenagers are expected to be in school throughout their teenage years but due to increase in school drop outs that are caused by early pregnancy, this goal has not been attained [18]. Unplanned teenage pregnancy due to due to low contraception use (10.6%) in Zambia remains a major public health concern [19]. In addition, low knowledge levels and unmet need for contraception are related to young people’s low utilization of reproductive health services and poor sexuality education both in and out of school hence leading to increased teenage pregnancies in Zambia [20]. Statistics show that 17% of women began sexual activity before the age of 15 years, while 69% began before the age of 18. On child bearing, 34 % women gave birth before 18 years, while teenage (15-19 years of age) pregnancy stood at 29% [21]. Currently there are few studies that examine the predictors of teenage pregnancy in the sub-Saharan Region which is the home of Zambia and hence it is with this background that this study is aimed at determining the prevalence and factors associated with teenage pregnancy in Chikupili village of Luano District, Zambia.

Literature Review

Globally, there are 1.2 billion adolescents aged 10-19 years [22]. Teenage pregnancies have remained a global phenomenon with nearly 25% of adolescent women having gotten pregnant worldwide [23]. Africa as a continent has been recorded to have had a teenage pregnancy prevalence of 18.8%, of this 19.3% occurring in Sub- Saharan Africa and 21.5% in Eastern Africa [24]. Adolescent pregnancy poses a great health and socio-economic risk on the mothers and babies [25]. Pregnancy and childbirth complications are the leading cause of death among girls aged 15-19 years globally, with low and middle income countries accounting for 99% of global maternal deaths of mothers aged 15-49 years [26]. Adolescent pregnancy contributes to the maternal mortality and morbidity as about 3.9 million unsafe abortions are recorded yearly among the girls aged 15-19. Social and economic consequences associated with teenage pregnancy may include stigma, rejection and violence by partners. Adolescent pregnancy also has an impact on future earning potential hence leading to long lasting poverty. In association with HIV, teenage pregnancy may impact HIV risk through numerous pathways such as biological changes in pregnancy which might affect immune response or the genital tract may increase HIV acquisition. Another pathway may include the frequent exchange of sexual partners by teenage mothers. Early/Adolescent engagement in sexual intercourse not only gives rise to teenage pregnancies but also sexually transmitted infection. It is noted that adolescent age’s 15-24 account for nearly half of the 20 million new cases of STIs also called Sexually Transmitted Diseases (STD).

A study conducted in Zimbabwe revealed that the risk factors of teenage pregnancies in rural areas included socio-economic background, peer influence, lack of sex education, traditional roles, low level of education, low self-esteem and non use of contraceptives. Other associations included being sexually active at an early age, early marriage, exposure to media, community poverty level.

Contraception

In relation to contraceptives as a risk factor: the inadequate use of contraceptives among youths has led to unintended pregnancies, unsafe abortions, disability such as fistula, infant mortality and high teenage pregnancies which are public health concern and low knowledge levels and unmet need for contraception are related to young people’s low utilization of reproductive health services and poor sexuality both in and out of school.

Education

Studies have found that a lack of education contributes to teen pregnancy in low and middle income, an association has also been found between low education levels and poverty. While a lack of education is sited as a cause of teenage pregnancy, it has also been found that teenage pregnancy itself has an impact on ones capacity to attain an education as it has been found that there is an increased level of school drop outs amidst pregnant teenagers.

Parental relationships

Parents have a very important influence on whether their teenager become pregnant or not, they are powerful and they can use this in directing their children. A correlation was found between the parenting style in the girl’s home and teenage pregnancy.

The findings suggest that adolescent pregnancy will be more common in young women who grow up with authoritarian or permissive parents. In contrast, adolescents with positive, warm, responsive and communicative parents had less cases of teenage pregnancy. Teenagers who fall pregnant blame the lack of sex education, role model and an overarching lack of parental guidance. In addition it has also been noted that when teenagers do attain knowledge on sex, contraception and abortions from relatives or parents, the information tends to be wrong which shows the great need of awareness.

Zambia is one of the countries with a high adolescent fertility with an age specific fertility rate of 141 births per 1000 women compared to the rest of the sub-Saharan African region average of 103 births per 1000 women aged 15-19 years. Use of modern contraceptive in Zambia had improved from 33% in 2007 to 48.5% in 2020. However the Total Fertility Rate (TFR) just dropped by over 1 birth per woman in the last two decades from 6.5 births. Therefore, the findings of this study will provide the Zambian ministry of health with more insight on teenage pregnancy risk factors and help them come up with further policies on how best to eliminate this anomaly. Some of the policy changes that can be put in place include setting up counselling programmes for teenagers, strengthening secondary preventive efforts-education, employment and support_ aimed at helping the mother and child, base programmes on theory- driven approaches with clear behavioural goals and outcomes, using participatory methods. Improving contraceptive use and educating society on its relevance. It will also provide information to the ministry of education on how best they can improve girl child education so as to keep them more in school and hence reduce the rate of teenage pregnancy. Further recommendations and measures will help to aid in the countries realizations of certain goals that have been put in place such as goals to cut out early child marriages by 2023 (UNFPA,UNICEF 2021) and also avail information in some areas of research that haven’t been treaded on.

Objectives

Main objective: To determine the prevalence and factors associated with the increase in teenage pregnancies in Chikupili- Luano district.

Specific objectives: To examine the factors associated with teenage pregnancy in chikupili village

To find out the prevalence of teenage pregnancy in chikupili

To provide recommendations and policies that can be put in place to curb teenage pregnancies n Chikupili Village.

Research questions

• What are the correlates of teenage pregnancy in chikupili?

• What is the prevalence of teenage pregnancy in chikupili?

• What recommendations and policies can be put in place to curb teenage pregnancies in chikupili?

Conceptual framework and measurement of variables

The variables identified in this study are socio demographic and socio-economic. The scale used is nominal. sociodemographic variables included; use of contraceptives, parent to child relation, religion. The socio-economic variables include; region, type of residence, level of education. The intervening variables include: government policies, parent child relations and sex education. Teenage pregnancy is the dependent variable that is influenced by other factors which are considered as independent factors. The inadequate use of contraceptives among youths has led to unintended pregnancies, unsafe abortions, disability such as fistula, infant mortality and high teenage pregnancies which are public health concern. and low knowledge levels and unmet need for contraception are related to young peoples low utilization of reproductive health services and poor sexuality both in and out of school (Table 1 and Figure 1). Education also has a large bearing as most teenagers that tend to fall pregnant are of low education background. Furthermore the risk of teenage pregnancy is greater among teenagers whose parents have no formal education.

Definition of terms

A teenager is a person transitioning from childhood to adulthood in that they are biologically mature but not emotionally. In this study, a teenager is a female person aged between 15-19 years.

Pregnancy is the state in which a fetus develops in the uterus of a woman of childbearing age, from conception to birth.in this study, teenage pregnancy is referred to as pregnancy of a woman aged 15-19 years.

Socio-demographic factors were defined as age, marital status and use of contraceptives in this study.

Socioeconomic factors were defined as region, residence, education, wealth index, ethnicity and religion.

Methodology

Study site and population

Proposed study was done in chikupili village of Luano district due to the rapid increase in teenage pregnancies in the area. Study population were the teenage girls of the area as they are the ones falling pregnant in this case.

Study design

For our study, a cross-sectional analytical study design was used. Data was collected from a group of people at only one point and an association was made between certain factors and teenage pregnancy. Participants were administered with individual questionnaires that were answered after consent was given (Table 2).

Sample size and sampling

Sample size determination

Formula that was used for sample size determination was

Sampling

Clusters were made and participants in the study were picked using simple random sampling in order to avoid biasness.

Eligibility criteria

• Fem ale aged 15 and above were eligible to participate. This was because the area of focus was on the female gender, despite the fact that adolescence ranges from 11-19, the older women who might have experienced teenage pregnancy were able to give their deep knowledge about this, secondly these women also could have been mothers to the pregnant girls hence they could have given a review on the parent to child relations.

• All males above 16.

Exclusion criteria

• Any females below 16.

• Any males below 16.

Plan for data collection: Collection of primary data was through questionnaire and personal interviews for individuals who were unable to complete the questionnaires. The questionnaires used were semi-structured in that it had both open ended and close ended questions. Also, secondary data was used and it was from health centre and school in order to access the number of teenagers that had fallen pregnant from 2010-2018. The questionnaire was a guide to measure the factors leading to teenage pregnancies.

Plan for data processing and analysis: In compiling and analyzing data collected, SPSS version 26 was used together with descriptive and differential statistics.

Data management

Data was entered weekly upon collection. It was comprised mostly of hard copy data.

Data storage

Data was stored safely with a good security system only accessed by researcher.

Ethical consideration

Before the study was carried out, permission from Tropical Disease Research Centre (TDRC), was sought. There after, permission from central province health office and Chikupili health center director in charge was obtained. Before any enrollment, the study was explained clearly to the participants and they were informed about the benefits and the disadvantages of their participation in the study. The nature of the study was made known to them in that it was voluntary and withdrawal was allowed at will. In addition, they were assured of the confidentiality with which their information was handled, hence, information gathered in this study was made available to relevant authorities with no link to participant’s identity. Once all this had been understood, informed concert was obtained.

Work plan

This project was meant to be carried out in 2021-2022. Data was collected by use of questionnaires and interviews, between 8 hours and 17 hours on each day of the data collection period (Table 3).

Budget

Results

Sample characteristics

For this study, a total of three hundred and eighty-four (384) participants from Chikupili village of Luano district were recruited upon obtaining informed consent from them and having met the criteria for selection. Out of the calculated sample size 384 a total of 384 individuals were interviewed making the response rate to be 100%. The socio-demographic characteristics of participants of the respondent were obtained and further questions were asked in order to assess the prevalence of teenage pregnancies and associated risk factors.

Demographics

The demographic characteristics of the respondents focused on the sex, age, grade of the participant, marital status and whether they had a boyfriend or girlfriend. The results are summarized in Table 4 below.

Out of the 384 participants, the majority were female (n=278,72.4) while only 106 (27.6%) males took part in the study. The findings in Table 2 revealed that most of the respondents were residents of Chikupili. Their ages ranged, with the highest frequency being among the those 20 and below (210,54.7%), 35.4% were aged between 21-30 years, 8.6% were between 31-40 years and only 1.3% were above 40 years (Figures 2 and 3).

Knowledge

In order to assess the knowledge of the pupils, different questions were asked and their frequency distribution is summarized in the tables below. When asked if they had sexual knowledge on sexual education before pregnancy. 248 (72.1%) of the participants agreed while 96 (27.9%) said no. 138(35.9%) had no knowledge on the forms of contraception neither did they use any, but the rest had and the distribution was 105 (27.3%) condoms, 78 (20.3%) pills, 52 (13.5%) injections, and 11 (2.9%) had heard and used other forms of contraception. In addition, most of the participants (235,64.4%) affirmed that these forms were very accessible, 102 (28.2%) said they were fairly accessible, and 27 (7.4%) found them to be scarce. Health worker had a very good attitude towards issuing the contraceptives according to 316 (84.5%) of the participants while 58 (15.5%) reported that health workers had a very bad attitude (Table 5).

In order to assess knowledge about contraception, 2 questions were answered with total score of 2. For which each question was scored one point for a correct response and zero for incorrect response. An overall knowledge score was calculated by adding up the scores for each respondent across all questions (Table 6). There were (n=265, 69.0%) of respondents with good knowledge regarding contraception, while (n=119, 31.0%) had bad (poor) knowledge about contraceptive use as seen in the Figure 4 below.

Relationship with parents

The relationship between parents and the participants was assessed by asking the questions shown in the Table 7 below. A huge number of the participants 293 (78.3%) confirmed that there was frequent monitoring by parents before the pregnancy, while 81 (21.7%) reported no such activity. To elucidate more, 268 (69.8%) of the respondents had sexual education at home and 116 (30.2%) did not have sexual education. Furthermore, the education level of the respondent’s parents varied as follow; 104 (30.2%) had no education, 162 (47.1%) had been to primary school, and 68 (19.8%) had reached secondary school.

Assessment of the relationship between the participants and their parent by scoring the the questions asked above, 3 questions were answered with total score of 3. Each of which was scored one point for the desired response, and zero for an incorrect response. An overall score was calculated by adding up the scores for each respondent across all questions (Table 8). There were (n=268,70.7%) of respondents with a good relationship with their parents, while (n=111, 28.9%%) had bad or poor relationship with their parents as seen in the Figure 5 below.

Activities of area

The participants were asked about social activities for youths influencing them both in positive and negative ways. When asked about the available activities that kept the youths busy, 273 (75%) said soccer, 66 (18.1%) swimming, 10 (2.7%) peer education, and 15 (4.1%) said other activities. Despite these activities, there were other places that were regarded as being of bad influence to teenagers which 339 (88.9%) admitted were present. Among these, the place that stood out was bars/clubs with 335 (96%) of the responses, followed by shrines with 14 (4%) of the responses and 35 participants being unable to identify such places. In addition, 324 (87.8%) participants reported that teenagers frequently visit such places, 45 (12.2%) said sometimes and 15 did not respond (Table 9).

The participants were asked how strict the regulations against teenagers in these clubs were, overwhelmingly, 271 (70.6%) participants said they were not strict at all, 85 (21.9%) said they were slightly strict and 29 (7.6%) said very strict. Most of the participants (350, 93.6%) thought teenage marriages were also factor leading to teenage pregnancies and 24 (6.4%) did not (Table 10).

Correlations

The Table 11 below shows the correlation between prevalence of teenage pregnancies and other factors. There’s a correlation between age when first pregnant and marital status during first pregnancy (p-value=0.036) meaning most participants were 19 years and below during first pregnancy. However, there is no correlation between age when first pregnant and level of education (p-value=0.128), relationship with parents (p-value= 0.606), contraception knowledge (p-value=0.103).

The Table 12 below shows both a crosstabuation and correlation between Knoweledge levels and demographic characteristics. There is correlation between knowledge and age of participant (p-value= 0.000), age when first pregnant (p-value=0.000), and level of education (p-value=0.000). However, there’s no correlation between knowledge and sex of the participant (p-value=0.97).

The Table 13 below shows both crosstabulation and correlation between relationship level with parents and demographic characteristics. There’s a correlation between relationship with parents and age of partcipant (p-value=0.000), level of education (p-value= 0.02), marital status during the first pregnancy (pvalue= 0.000). In contrast, there is no correlation between relationship with parents and sex of the participant (p-value=0.76), age when first pregnant (p-value=0.063).

The Table 14 below shows correlation between knowledge levels and relationship with parents for which the p-value was 0.03.

Discussion

Prevalence of teenage pregnancies

This study aimed to determine the prevalence and factors associated with teenage pregnancy in chikupili village or Luano district in Zambia. The prevalence of teenage pregnancy in this study was found to be 48.8% (95% CL) which is higher than the report of previous studies, 37% [27]. This disparity may be due to the differences in the time range between the two studies.A study on on a total of 24 countries from East, West, Central, North and Southern Africa sub-regions was conducted. The pooled results showed that the prevalence of adolescent pregnancy was 18.8% with East Africa having a prevalence of 21.5% and Northern Africa having the lowest 9.2%. Teenage child bearing increased dramatically from 2% of girls at age 15 to 36% at age 19 and teenagers from poorer households were more likely to have begun child bearing before the age of 20 (29%) compared to those from weSalthier families (21%) [28]. In this study no correlation was found between age when first pregnant and knowledge levels (p-value=0.103) or relationship with parents (p-value=0.606). However there was a corelation between age when first pregnant and marital status when first pregnant (p-value=0.036). Furthermore, most of the participants who got pregnant in the age range of 19 years and below were single compared to those above 20 years which showed the were married.

Education

Low education levels when first pregnant were noted among the respondents with 42.8% having no education and a further 30% having attended only primary school. low academic achievement and poor sex education are a leading cause of high pregnancy rate in zambia among women aged 15 to 19 [29]. The study further shows that women with a higher education level tend to delay marriage and childbearing. The author concludes that teenage pregnancy was as a result of poor social, economic and health outcomes for mother and child Despite these reports showing an association, no correlation was found in this study between education level and prevalence of teenage pregnancies (p-value=0.128). a simlar study showed that the highest rates of adolescent pregnancy are among those who have no education or only a primary education, especially for those who are under the age of 16 in Kenya, Tanzania, and Uganda [30].

Knowledge on contraception

This study determined that 69% of the partcipants had good knowledge regarding contraception. Only 35.9% reported not to have known or used any form of contraception, the had. Despite knowing and using these contraceptives, the prevalence of teenage pregnancies is still high. The role of contraception use in preventing teenage pregnancies is a matter to be studied further.

Limitations

The present study had some restrictions that need not be overlooked when interpreting the study results. One factor limiting was the inability of some participants to read and write, this caused collection of data to be slower as interpretation had to be done and participants could not fully express themselves. The findings of the study cannot be generalized to the entire central province as the study population only consisted of Chikupili residents.

Conclusion

This study found that adolescent pregnancy remains a common health care problem in Chikupili village. Age, marital status, community-level contraceptive utilization, age at initiation of sex, educational level were found to have a statistically significant association with teenage pregnancy Therefore, designing public health interventions targeting higher risk adolescent girls such as those from the poorest household through enhancing maternal education and empowerment is vital toreduce adolescent pregnancy and its complications. Ensuring teenage age girls partcipation in school and other social activities that would be beneficial to them and and deter them from engaging in activities that would lead to them being pregnant.

Recommendation

Establishing more activities like peer education, school clubs is one sure way of reducing the number of teenage pregnancies as the teens will be more engaged in profitable activities. Banning and also putting strict rules on early marriage offenders is needed. Free education will go a long way in keeping both the male and female teenagers in school hence reducing chances of the getting pregnant. Measures preventing teens from frequenting the bars can also be put in place lastly parent sensitization on the need to offer sexual education to their children is a measure that can be undertaken.

Acknowledgement

I would to pass my sincere gratitude and appreciation to my supervisor Mr. Bright Mukanga, for his guidance during the writing of my research proposal.

My special thanks also go to Chikupili Rural Health center for allowing me undertake this study. Many thanks to my mother Mrs. Lucy Musonda for her endless support during this research, my partner Jethro Mwanza for all the encouragement and support throughout the research and my friends: Shimpa Musonda, Chanda Mulenga, and Hellen Musonda for the love and cheer they gave me as I wrote this research. A special thanks to my little sister Kandemba Sanjase and DR Moonga who though late, gave me the courage to carry on in life and to do my best always. And most importantly God almighty for his strength and guidance throughout the proposal.

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