Determinants of adolescent pregnancy in East Africa: a systematic review and meta-analysis

Adolescent pregnancy remains a major public health and socio-economic challenge in East Africa, where rates remain disproportionately high compared to global trends. This systematic review and meta-analysis aimed to estimate the pooled prevalence of adolescent pregnancy and examine its association with key socio-economic factors across East African countries. Following PRISMA 2020 and Joanna Briggs Institute (JBI) guidelines, a comprehensive search of five electronic databases and national demographic surveys was conducted to identify relevant studies published between January 2013 and December 2023. Nineteen studies were included, covering cross-sectional, cohort, and case-control designs across Uganda, Kenya, Tanzania, Rwanda, Burundi, Democratic Republic of Congo, and South Sudan. The pooled prevalence of adolescent pregnancy was 23.6% (95% CI: 15.0-33.4), with the lowest rate observed in Rwanda (5.2%) and the highest in Tanzania (34.0%). Socio-economic determinants showed strong associations with adolescent pregnancy. Adolescents with employment were significantly less likely to become pregnant (pooled OR = 0.27; 95% CI: 0.03-0.50), while low educational attainment and poverty were also associated with increased pregnancy risk, although pooled effects were not statistically significant. The findings underscore the multifaceted nature of adolescent pregnancy in East Africa, driven by structural inequalities, limited access to education and reproductive health services, cultural norms, and economic vulnerability. Addressing this issue requires multisectoral strategies that promote girls' education, improve youth employment opportunities, expand access to adolescent-friendly sexual and reproductive health services, and challenge harmful social norms. Context-specific interventions that reflect national and subnational realities are essential. Future research should incorporate longitudinal and qualitative approaches to capture the lived experiences of adolescents and the long-term consequences of early pregnancy. Centering adolescent voices and investing in holistic, rights-based policies will be critical to reducing adolescent pregnancy and advancing gender equity across the region.