Abstract

Background Adolescent sexual and reproductive health and rights (SRHR) remains a critical public health issue in low- and middle-income countries, with adverse health, educational, and economic consequences. Uganda faces significant challenges with high rates of unintended pregnancies among adolescents. This study investigated the factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda and explored the potential of using mobile money vendors to provide SRHR services.

Methods A cross-sectional study was conducted among 1267 unmarried girls/boys, aged 15-19 years, in the Busoga region. Data were collected through face-to-face interviews, using a structured questionnaire. Sociodemographic characteristics, sexual behaviors, contraceptive knowledge, and environmental factors were analyzed. Multivariate logistic regression analysis identified factors associated with unintended pregnancies.

Results Of the adolescents who had sexual intercourse (n=876), 22.5% (n=197) experienced unintended pregnancies. Fundamental factors associated with lower prevalence of pregnancy included being a current student (adjusted odds ratio [AOR]: 0.36, 95% confidence interval [CI]: 0.24-0.54), living with parents (AOR: 0.48, 95% CI: 0.33-0.69), and teacher engagement (AOR: 0.56, 95% CI: 0.37-0.84). Factors associated with higher prevalence of pregnancy included knowledge regarding contraceptive use (AOR: 2.28, 95% CI: 1.16-4.49), parental communication (AOR: 1.91, 95% CI: 1.32-2.75), parental contraception support (AOR: 1.64, 95% CI: 1.03-2.59), and mobile phone possession (AOR: 2.31, 95% CI: 1.09-4.90). Public health facilities and community-based distributors, including mobile money vendors, were considered comfortable channels for obtaining contraceptives for adolescents who had experienced pregnancy.

Conclusions Unintended pregnancies among unmarried adolescents in Eastern Uganda were influenced by educational, parental, and environmental factors. Enhancing SRHR education from earlier ages, parental involvement, and leveraging community resources such as mobile money vendors could improve adolescent SRHR outcomes. Innovative approaches outside conventional health and education sectors are necessary for sustainable and effective adolescent SRHR programs.

Trial registration This study was registered at Japan’s University Hospital Medical Information Network (UMIN000053332) on 12 January 2024.

Plain English summary Adolescent sexual and reproductive health and rights (SRHR) is a pressing public health issue globally. Uganda has a high rate of unintended pregnancies among adolescents. This study investigated the factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda and explored the potential of using mobile money vendors to provide SRHR services.

This cross-sectional study was conducted using a structured questionnaire at 60 vendors. It included 1267 unmarried girls/boys aged 15-19 years. Of 876 adolescents who ever had sexual intercourse, 22.5% experienced unintended pregnancies. Factors associated with a lower prevalence of pregnancy were: a current student (adjusted odds ratio [AOR] = 0.36), living with parents (AOR = 0.48), and teacher engagement (AOR = 0.56). Contrarily, factors associated with a higher prevalence of pregnancy were: knowledge regarding contraceptive use (AOR = 2.28), parental communication (AOR = 1.91), parental contraception support (AOR =1.64), and mobile phone possession (AOR = 2.30), which may imply that teenagers who had experienced pregnancy tend to become more serious about contraception and engagement of parents and teachers enhanced. In addition, community-based SRHR service distributors, including mobile money vendors, were considered comfortable channels.

In conclusion, unintended pregnancies among unmarried adolescents in Eastern Uganda were influenced by educational, parental, and environmental factors. Enhancing SRHR education before starting sexually active and parental and school involvement may reduce unintended pregnancies among unmarried adolescents in Eastern Uganda. In addition, leveraging accessible community-based distributors, such as mobile money vendors, may be a potential channel for delivering SRHR information and contraceptives.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

UMIN000053332

Clinical Protocols

https://www.umin.ac.jp/icds/index.html

Funding Statement

This study was funded by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (23K16346).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of Uganda National Council for Science and Technology (UNCST) gave the ethical approval for this work (SS2284ES). Ethics committee/IRB of Uganda Christian University gave the ethical approval for this work (UCUREC-2023-710). Ethics committee/IRB of JICA Ogata Sadako Research Institute for Peace and Development in Japan gavethe ethical approval for this work (JICA [DI] 202312220002).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Institutional address: Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency (JICA), 10-5, Ichigaya-honmuracho, Shinjuku-ku, 162-8433, Tokyo, Japan, TEL: +81-3-3269-2911, FAX: +81-3-3269-2054

List of abbreviationsAIDSacquired immunodeficiency syndromeAORadjusted odds ratioCIconfidence intervalHIVhuman immunodeficiency virusSRHRsexual and reproductive health and rightsSSASub-Saharan Africa