Key Factors Predicting Teen Pregnancy in South Africa

In South Africa, the fertility rate for adolescents 15-19 years old was 51.7 per 1,000 women in 2022, according to World Bank data. To address unintended pregnancies, the South African government offers free, multimodal contraception. We aimed to examine risk behaviors in young women that may contribute to unintended pregnancies; we conducted surveys at the Desmond Tutu Health Foundation Youth Centre (YC) in Cape Town, South Africa. The study adapted the 2017 U.S. Youth Risk Behavior Questionnaire with cultural modifications, alongside the London Measure of Unplanned Pregnancy. A convenience sample of adolescents seeking YC services were invited to participate in the survey. A total of 224 women with median age of 19 years (interquartile range: 18, 21) completed the survey between August 2017 and August 2018; of the respondents, 55 (24.6%) indicated a prior pregnancy. About half of the participants were attending secondary school, 24% reported ≥3 lifetime partners, and 17% reported substance use prior to intercourse. Condom use at the last sex act was 52%. Respondents reported onset of several high-risk behaviors, including smoking and alcohol use, by the end of secondary school. Half of the respondents reported depressive symptoms; 20% considered suicide. Of those who reported history of pregnancy, the majority (83%) indicated it was unplanned. Our findings highlight the significant prevalence of mental health challenges and substance use, emphasizing the need for a comprehensive approach to sexual health interventions-one that goes beyond education alone to address the broader social and psychological factors influencing high-risk behaviors.