Factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda: a cross-sectional study

Adolescent sexual and reproductive health and rights remain critical public health issues 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 examined factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda.

A cross-sectional study was conducted among unmarried adolescent boys and girls aged 15–19 years in Iganga and Bugiri municipalities between February and March 2024. Data were collected at mobile money shops to target customers through face-to-face interviews using a structured questionnaire. The variables included sociodemographic characteristics, sexual behaviors, contraceptive knowledge, usage of mobile money shops, and environmental factors. Multivariate logistic regression was applied to identify factors associated with unintended pregnancies.

Among the 1267 eligible adolescents, 876 had ever engaged in sexual intercourse. Of these, 22.5% (n=197) reported experiencing an unintended pregnancy. The factors associated with a lower likelihood of pregnancy included school enrollment (adjusted odds ratio [AOR]=0.36; 95% confidence interval [CI]: 0.24–0.54), co-residences with parents (AOR=0.48; 95% CI: 0.33–0.69), and teachers’ awareness of students’ lives/worries (AOR=0.56; 95% CI: 0.37–0.84). Factors associated with a higher likelihood of pregnancy were knowledge of how to use contraceptives (AOR=2.28; 95% CI: 1.16–4.49), communication with parents/guardians (AOR=1.91; 95% CI: 1.32–2.75), parental support for contraception (AOR=1.64; 95% CI: 1.03–2.59), and mobile phone possession (AOR=2.31; 95% CI: 1.09–4.90). Adolescents who had experienced pregnancy were significantly more likely to consider community-based distributors as comfortable sources for sexual and reproductive health information (AOR=1.72; 95% CI: 1.11–2.66) and contraceptives (AOR=4.76; 95% CI: 2.39–9.47).

Nearly one-quarter of unmarried adolescents have experienced—or caused—a pregnancy in Eastern Uganda. School enrollment and parental engagement were inversely associated with adolescent pregnancy. Many adolescents may gain contraceptive knowledge and support after an unintended pregnancy. Community-based service delivery was preferred over facility-based options. Further researches are needed to develop a community-based platform for reaching underserved unmarried adolescents and promoting appropriate contraceptive use.