Individual, familial, community and health service factors associated with teenage pregnancy in Malawi: a community-based case-control study.

Abstract Background: Teenage pregnancies are a global concern. Malawi is one of the countries with the highest teenage pregnancy rates, with current teenage childbearing at 29%. There is a paucity of information on factors associated with pregnancy in Malawi. Therefore, this study aimed to identify individual, familial, community and health service level factors associated with teenage pregnancies in Malawi. Methods: This was a community-based case‒control study that used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. The study population comprised women aged 20 – 24 who participated in the survey. The study ran from September 2021 to October 2022 and used a sample size of 3,435 participants who were all women aged 20 – 24 in the dataset who met the inclusion criteria. Data were analysed using Stata 16 software. Logistic regression analyses were used to determine factors. Variables with a P value of < 0.1 in the univariate analysis were included in the multivariate analyses, where statistical significance was obtained at a P value < 0. 05. Results: Data on 3435 participants were analysed. In multivariate analyses: no teenage marriage (p <0.001); secondary education (p < 0.001); higher education (p < 0.001); richest category of wealth index (p = 0.004), use of contraception (p = 0.001) under individual factors and domestic violence by father or mother (p = 0.001) under familial level factors were found to be significant factors. Conclusion: This study found that teenage pregnancy is associated with individual and familial factors. The government has to sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy. Further research is also recommended to resolve inconclusive results.