title: Relationship between school dropout and teen pregnancy among rural South African young women.
abstract: BACKGROUND
  Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa.
  
  
  METHODS
  Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday.
  
  
  RESULTS
  School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)].This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)].
  
  
  CONCLUSIONS
  Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.
authors.affiliation: Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Center for Population and Development Studies, Harvard University, Cambridge, MA USA, mrosenb@hsph.harvard.edu.
authors.forename: Molly
authors.initials: M
authors.lastname: Rosenberg
authors.affiliation: Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
authors.affiliation: Department of Epidemiology, Division of Infectious Diseases in the Department of Medicine, University of North Carolina-Chapel Hill, NC, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Health Policy and Management.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Geography, and.
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Demography and Population Studies, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sulaimon A
authors.initials: SA
authors.lastname: Afolabi
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana.
authors.forename: Mark
authors.initials: M
authors.lastname: Collinson
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
mesh_terms: D000293:Adolescent; D044383:Black People; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012424:Rural Population; D012725:Sexual Behavior; D012923:Social Class; D012959:Socioeconomic Factors; D013019:South Africa; D013332:Student Dropouts / Q000706:statistics & numerical data*
keywords: School enrolment; South Africa; adolescence; sexual risk; teen pregnancy