Teenage pregnancy and its associated factors among teenage females in Farta Woreda, Northwest, Ethiopia, 2020: A community-based cross-sectional study

INTRODUCTION Teenage pregnancy is associated with poor maternal and perinatal health outcomes, and also has a major social and economic impact. Its magnitude and determinants in Ethiopia are not well understood, therefore the aim of this study was to assess the prevalence and associated factors of teenage pregnancy among teenagers in northwest, Ethiopia, 2020. METHODS A community-based cross-sectional study was conducted among 343 teenagers from 15 February 2020 to 24 March 2020. Multistage sampling technique was used to select study participants. Data were collected using a structured and pretested questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with teenage pregnancy. RESULTS The prevalence of teenage pregnancy among respondents in Farta woreda was 25.4% (95% CI: 21.3– 30.3). Residence (AOR=0.46; 95% CI: 0.11–0.80), early age at 1st sexual intercourse (AOR=1.68; 95% CI: 1.57–4.21), not knowing family planning methods (AOR=2.14; 95% CI: 1.54–2.54), not utilizing contraception (AOR=2.31; 95% CI: 1.06–4.99) and did not know a place where contraceptive methods are provided (AOR=3.46; 95% CI: 1.89–11.06) have significant association with teenage pregnancy. CONCLUSIONS Residence, early age at 1st sexual intercourse, not knowing family planning methods, not utilizing contraception and not being aware of a place where contraceptive methods are provided were associated with teenage pregnancy. The creation of awareness for the timing of safe sexual intercourse, the types and locations where family planning methods are available, and the promotion of family planning use for postponing pregnancy, should be taken into account within family planning. INTRODUCTION Teenage pregnancy is described as pregnancy in girls aged 10–19 years. It is estimated that 16 million girls aged 10–19 years give birth every year, accounting for almost 11% of all births worldwide1. Teenage pregnancy is more likely to occur in disadvantaged populations worldwide, frequently motivated by poverty and lack of education and work opportunities2. Pregnancy and childbirth are expected and desired for certain teenagers. In some cases, however, girls will face social pressure to marry and, once married, have children. Every year, about 15 million girls are married before the age of 18 years, and 90% of girls aged 10–19 years are married3,4. Teenagers face obstacles in accessing contraception including discriminatory laws and regulations on the availability of contraceptives based on age or marital status and stigma against health workers. Also, they face obstacles that prohibit contraception from being used and/or used reliably and appropriately, even though adolescents can obtain contraceptives5. Girls between 10 and 19 years of age account for 11% of births worldwide. Of this 11%, almost all births, 95%, are in lowto middle-income countries, like Ethiopia6,7. Approximately 16 million girls aged 10–19 years and 2.5 million girls aged <16 years give birth annually in developing regions8,9. Complications during pregnancy and childbirth are the leading cause of death for girls aged 10–19 years worldwide10. Industrialized and developing countries have distinctly Research Paper| Population Medicine Popul. Med. 2021;3(July):19 https://doi.org/10.18332/popmed/139190 2 different rates of teenage pregnancy. In developed regions, teenage parents appear to be unmarried and adolescent pregnancy is seen as a social problem. Teen parents in developing regions, on the other hand, are often married and the family and community can accept their pregnancy. However, early pregnancy in these cultures can be combined with malnutrition and inadequate health care to cause medical problems11. Worldwide, teenagers suffer from early marriage, sexually transmitted infections including HIV/AIDS, female genital mutilation, malnutrition, anemia, infertility, sexual and gender-based abuse, unwanted pregnancy, and illegal abortion12,13. The reviewed literature showed that age, marital status, residency, maternal education, partner education, lack of parent to adolescent communication on sexual and reproductive health issues and inadequate opportunity at community level for positive youth development, illiteracy, age at marriage and contraceptive utilization, have significant association with teenage pregnancy14-17. In Ethiopia, teenage mothers are more likely to experience adverse pregnancy outcomes like high incidence of unwanted pregnancies and incomplete and unsafe/septic abortions. According to the Ethiopian Demographic and Health Survey (EDHS) 2016, 13% of women aged 10–19 years have begun childbearing. As expected, the proportion of women aged 10– 19 years who have begun childbearing rises rapidly with age, from 2% among women at age of 15 years to 28% among those aged 19 years. Teenage childbearing is more common in rural than in urban areas (15% vs 5%, respectively) and among women in Amhara (8.3%)14. Even though different studies were conducted at the national level, there is a scarcity of studies in the study area. Additionally, much of the focus of fertility and use of maternal health services are directed to the general population of reproductive age rather than this specific age group. Hence, we intended to assess the magnitude and the associated factors of teenage pregnancy in the Farta district. METHODS Study design and setting A community-based cross-sectional study design was conducted from 15 February 2020 to 24 March 2020 among female adolescents aged 10–19 years in Farta district, south Gondar zone in Amhara region, northwest Ethiopia. Farta district is one of the 15 districts in South Gondar Zone, situated in Amhara National Regional State, Ethiopia and located 660 kilometers northwest from the capital city of Ethiopia, Addis Ababa. The district is subdivided into 31 rural and 2 urban kebeles (smallest administrative units of Ethiopia). Based on the 2015 demographic survey projection, amongst the 276144 population in the woreda, 136221 are females. The current estimate of adolescents aged 10–19 years between 1 February and 1 March 2019, were 18984. In Farta district there were 10 health centers, 56 health posts and 4 private health clinics18. Participants The source population was all female adolescents aged 10– 19 years in Farta district. The study population was all female adolescents aged 10–19 years in randomly selected kebeles and had been living at least six months in the study area of the selected kebeles. Inclusion and exclusion criteria All women who have lived in the study area for a minimum of 6 months and female teenagers aged 10–19 years were included. Whereas the exclusion criteria were female teenagers aged <10 years and >19 years, seriously ill, and unable to communicate during the study period. Variables Dependent variable Teenage pregnancy was measured by the item: ‘Have you ever been pregnant’, which was asked of all female respondents regardless of their age. The answer options were: Yes (1) and No (0). Independent variables Sociodemographic variables included age, religion, ethnic group, marital status, education level, occupational status, monthly family income; and history of sexual and reproductive health, age at first sexual intercourse, contraceptive use, age at marriage (early marriage), age at 1st pregnancy, planned pregnancy, perception on teenage pregnancy. Operational definition Teenage pregnancy: pregnancy in teenagers aged 10–19 years confirmed by a healthcare provider13. Sample size determination Single population proportion formula was used to determine the sample size. A 95% confidence interval (CI), a margin of error of 5% and 28.6% proportion of teenage pregnancy among females17 aged 10–19 years was considered. We used a design effect of 1.5 to avoid the effect of the design that decreases the representativeness of the study. To compensate for non-response, 5% of the determined sample was added and the final sample size was 343. Sampling techniques We used the multistage sampling technique to select the sampling unit. First, all kebeles were stratified into urban and rural areas. The district constitutes 31 rural and two urban kebeles. A simple random sampling technique was used to select one out of two urban kebeles and eight out of 31 rural kebeles. Finally, the census was conducted at each selected kebele to register all women aged 10–19 years and to create a sampling frame. The final calculated sample size was allocated proportionally to each selected kebele after the population size of each selected kebele was identified. Research Paper| Population Medicine Popul. Med. 2021;3(July):19 https://doi.org/10.18332/popmed/139190 3 The starting point from the sampling frame was obtained by using lottery methods, then the study participants were selected from each kebele by using systematic random sampling techniques until the desired sample size was obtained. When the eligible woman was not available in the household, the data collector went to their house repeatedly within the study period, as the household was labelled and mapped before data collection, rather than going to the next home to fulfill the sample size; whereas when there was more than one eligible woman in a household, the interviewed woman was selected via lottery methods. Data collection procedure and quality assurance The data collection tool comprised structured questionnaires that were prepared after a thorough literature review and the local situation of the study area and purpose of the study were considered. Questionnaires were prepared first in English then translated to Amharic, which is the vernacular language of the respondents, by a language expert for ease of understanding by the respondents. Data were collected via face-to-face interview technique. To assure the quality of the data, technical training was given before data collection for data collectors, and pre-testing was conducte