title: Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women.
abstract: BACKGROUND
  Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort.
  
  
  OBJECTIVE
  Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status.
  
  
  RESULTS
  Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29).
  
  
  CONCLUSIONS
  Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; nicola.christofides@wits.ac.za.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Christofides
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Jewkes
authors.affiliation: Rollins School of Public Health, Behahioral Sciences and Health Education, Emory University, Atlanta, GA, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Dunkle
authors.affiliation: Rollins School of Public Health, Behahioral Sciences and Health Education, Emory University, Atlanta, GA, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: McCarty
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.
authors.forename: Nwabisa
authors.initials: N
authors.lastname: Jama Shai
authors.affiliation: Department of Psychology, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Mzikazi
authors.initials: M
authors.lastname: Nduna
authors.affiliation: Rollins School of Public Health, Behahioral Sciences and Health Education, Emory University, Atlanta, GA, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Sterk
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data*; D049168:Pregnancy, Unplanned; D011275:Pregnancy, Unwanted; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012307:Risk Factors; D063507:Sexism; D012923:Social Class; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data
keywords: South Africa; adolescent pregnancy; gender-based violence; unplanned pregnancy; unwanted pregnancy