P6 Improvements in social determinants and declines in adolescent pregnancy and child marriage in rural uganda, 1994–2018

Aims To identify the relationships among social determinants, public policies, behaviors, and adolescent pregnancy and child marriage – in the context of a declining HIV epidemic in the Rakai region of rural Uganda. Social determinants may influence key adolescent social transitions such as leaving school, marriage, and childbearing. Methods Data on young women 15-19 years from 17 surveys (1994-2018) in a population-based, open cohort of households in 28 communities followed continuously since 1994. Social determinants included school enrollment, a household assets measure of socioeconomic status (SES), and orphanhood (death of one or both parents). A previously validated measure (the Pregnancy Risk Index or PRI) was used to estimate young women’s risk of becoming pregnant - based on their sexual activity, nonuse of contraception or use of specific contraception methods, and method-specific contraceptive failure rates. The PRI was compared with current pregnancy, based on self-report and urine testing. Child marriage was measured as ever-married before age 18. Statistical evidence for change over time was assessed using regression analyses with robust variance estimation. The sample included 15,606 women-rounds of observation. Results School enrollment rose from 26% in 1994 to 61% in 2018 (p Conclusions Adolescent pregnancy and child marriage declined from 1994 to 2018 as enrollment in school and socioeconomic status increased and HIV-related orphanhood declined. Social determinants can have an enormous influence on adolescent health and social transitions.