Adolescent pregnancy: risk factors and consequences - a longitudinal study in the Eastern Cape, South Africa Open Access

Abstract

In South Africa adolescents having unprotected heterosexual intercourse risk both
HIV infection and unwanted pregnancy, and nearly one-third of women have a teenage
pregnancy. Understanding the interface of gender inequity and violence, HIV and
unplanned and unwanted adolescent pregnancies is important.
To explore whether young adolescent pregnancy (aged 15 or younger) increases
HIV incidence, we analyzed data from a cohort of 1,099 young HIV negative, women
participants in a cluster-randomized controlled trial in the predominantly rural Eastern
Cape province of South Africa, calculating HIV incidence using multivariate Poisson
models. Women who had had a pregnancy when 15 years or younger had an elevated
HIV incidence (IRR 3.02, 95%CI 1.50-6.09) compared to those never pregnant, or having
later pregnancies.
To explore prospectively risk factors for unwanted and unplanned pregnancies we
analyzed a subset of adolescent women aged 15-18 years (N=922), observing 174
pregnancies occurring over two years. Physical partner violence was a risk factor for
unwanted pregnancies, but measures of sexual violence and gender inequity were not.
Having a higher socio-economic status was protective for both unplanned and unwanted
pregnancies.
To investigate prospectively whether perpetrating intimate partner violence is
associated with fathering a pregnancy, we analyzed data from men aged 15-26 years (N=983). Incidence rate ratios were derived from Poisson models, adjusting for past year numbers of sexual partners, time since last sex, and treatment arm. Among the men, 16.5% (n=189) made a girlfriend pregnant and 39.1% had perpetrated intimate partner violence. Men who had perpetrated IPV in the previous year at baseline had an increased incidence of fathering, whereas those who had been violent but not in the past year did not have an elevated incidence.

Interventions that engage with relationship dynamics of teenagers are essential if
unwanted and unplanned pregnancies, and the fraction of the HIV epidemic in women
attributable to young teenage pregnancy, are to be prevented. Male perpetration of
partner violence is an important risk behavior for men and women, largely because
hegemonic ideals of masculinity emphasize male control of women, and displays of
heterosexuality and virility, in so doing they constrain women's reproductive choices.

Table of Contents

Table of Contents
CHAPTER 1:Introductory literature review

Adolescent pregnancy in South Africa 1
Short and long-term health consequences of adolescent pregnancy 1
Risk factors for adolescent pregnancy 3
Differentiating between unplanned and unwanted pregnancies 4
Intimate partner violence and unplanned and unwanted pregnancy 5
Risky sex and contraceptive use among women in South Africa 6
Perpetration of IPV and fathering unwanted pregnancies 7
IPV, men and unintended pregnancy 9
Conceptual framework: The theory of gender and power 10
The Stepping Stones Study 12
References 16

CHAPTER 2: Early teen pregnancy increases risk of incident HIV infection in the
Eastern Cape, South Africa: a prospective study

Abstract 24
Introduction 26
Methodology 28
Results 33
Discussion 35
Conclusion 38
References 39

CHAPTER 3: Risk factors for unplanned and unwanted teenage pregnancies
occurring over two years of follow up among a cohort of young South African
women

Abstract 50
Introduction 52
Design and Methods 54
Results 59
Discussion 61
Conclusion 64
References 66

CHAPTER 4: Perpetration of physical and sexual abuse and subsequent fathering
of pregnancies among a cohort of young South African men
Abstract 75
Introduction 77
Design and Methods 78
Results 82
Discussion 85
Conclusion 87
References 88

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	Adolescent pregnancy, HIV, Gender-based violence, Longitudinal Study
Committee Chair / Thesis Advisor	Sterk, Claire E, Emory University
Committee Members	Jewkes, Rachel, South African Medical Research Council Mccarty, Frances A., Emory University Marcus, Michele, Emory University

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