Determinants of adolescent pregnancy in Zambia: A secondary data analysis of 2018 Zambia Demographic and Health Survey

Determinants of adolescent pregnancy in Zambia: A secondary data analysis of 2018 Zambia Demographic and Health Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of adolescent pregnancy in Zambia: A secondary data analysis of 2018 Zambia Demographic and Health Survey Whiteson Mbele, Babucarr Jassey This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4150984/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Oct, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 11 You are reading this latest preprint version Abstract Background Globally, complications from pregnancy and childbirth are leading causes of death among adolescent girls aged 15–19 years. In Zambia, adolescent pregnancy contributes to adverse maternal and newborn outcomes, perpetuating intergenerational cycles of poverty and limiting opportunities for education and economic empowerment among young mothers. This study explored factors associated with adolescent pregnancy in Zambia. Methods This cross-sectional study utilized data from the 2018 Zambia Demographic and Health Survey. A total of 2,996 adolescents aged 15–19 years were included in the analysis. This study utilized the socioecological model to select potential influencing factors for adolescent pregnancy. Descriptive and multivariable analyses were conducted using SPSS version 22 software. Results The prevalence of adolescent pregnancy was 29.9%. Most adolescents had no sexual partners (59.0%), and 49.7% had initiated sexual intercourse. Factors independently associated with adolescent pregnancy included increasing age, marital status (AOR = 5.4; 95% CI: 3.7, 7.9), knowledge about contraception (AOR = 3.4; 95% CI: 1.2, 9.8), use of contraception (AOR = 3.4; 95% CI: 1.2, 9.8), literacy level (AOR = 1.7; 95% CI: 1.1, 2.6), and exposure to family planning messages in newspapers or magazines (AOR = 2.6; 95% CI: 1.1, 6.4). Other factors included wealth status (AOR = 2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR = 3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR = 3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR = 4.2; 95% CI: 2.0, 8.9 for poorer versus richest) and age at first sexual intercourse (AOR = 2.1; 95% CI: 1.3, 3.4 for 15–17 versus 18–19, AOR = 3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18–19). Conclusion Key determinants of adolescent pregnancy in Zambia include older age, early marriage, low literacy, low socioeconomic status, early sexual initiation, and limited exposure to family planning messages via newspapers. Interventions to address this problem should include behavioral change communication strategies that discourage early sexual debut, especially among older adolescents. Furthermore, leveraging media platforms, particularly newspapers, in disseminating accurate messages on contraception and enforcing statutory laws on the legal age of marriage are crucial efforts in addressing this problem. Adolescent Pregnancy Zambia Socioecological Model Introduction Adolescence, spanning from ages 10 to 19, represents the transitional phase between childhood and adulthood [ 1 ]. This unique period of human development is critical for establishing the groundwork for good health. Despite adolescence being perceived as a healthy life stage, there is a notable occurrence of injury, illness, and death, much of which are preventable or treatable [ 1 ]. In 2016, pregnancy and childbirth complications were the leading causes of death among adolescents aged 15–19 years globally [ 2 ]. Additionally, the consequences of adolescent childbearing also impact the well-being of their newborn, as evidenced by increased perinatal deaths and low birth weight among babies born to mothers under the age of 20 years [ 3 – 5 ]. Moreover, adolescent pregnancies have been associated with a higher incidence of unsafe abortions because most pregnancies in adolescence are unintended [ 6 , 7 ]. In sub-Saharan Africa (SSA), approximately 45% of pregnancies in young women aged 15–19 years are unintentional, leading to unintended births and unsafe abortions [ 8 ]. Approximately 50% of cases of unsafe abortion in sub-Saharan Africa occur among adolescent girls and young women younger than 25 years of age [ 7 ]. Several factors have been associated with a higher rate of adolescent pregnancy. These include rural residence, poverty, low education levels, poor access to contraception, low condom use, low levels of knowledge about pregnancy risks, and transactional sex [ 9 – 13 ]. In Zambia, the prevalence of pregnancy during adolescence is worryingly high. According to the latest 2018 Zambia Demographic and Health Survey (2018 ZDHS), 29% of young girls aged less than 20 years were mothers or pregnant with their first child [ 14 ]. This percentage is slightly higher than the percentages found in 2007 (27.9%) and in 2014 (28.5%) [ 15 ], indicating an upwards trend [ 14 ]. Moreover, girls residing in rural areas were twice as likely to become pregnant before the age of 20 years compared to their urban counterparts. Additionally, wealth and education level were shown to have an inverse relationship with adolescent pregnancy [ 14 , 15 ]. Adolescents without education initiated childbearing at a rate more than twice (53%) as high as those with secondary education (23%). Those in the lowest wealth quintile had the lowest (10%) level of adolescent pregnancy compared to those in the highest wealth quintile (45%) [ 15 ]. Regardless of the known negative effects of adolescent pregnancy, economic limitations, sociocultural and religious norms that hinder gender equality or endorse early marriage, early initiation of sexual activity, and restricted access to sexual and reproductive health (SRH) information and services, including contraceptives, are persistent obstacles to addressing adolescent pregnancy in Zambia [ 15 , 16 ]. Child marriage, defined as marriage before the age of 18 years, has been associated with an increased risk of adolescent pregnancy [ 15 , 17 ]. Moreover, child marriage eliminates the sexual and reproductive health rights of adolescents and limits their opportunities to achieve their full potential. The prevalence of child marriage in Zambia is among the highest globally, with rates of 31.7% in 2014 and 29% in 2018 [ 18 ]. Key factors driving child marriages in Zambia include heightened poverty levels, restricted access to quality education, limited life choices, and inadequate access to sexual and reproductive health services [ 19 ]. While the Marriage Act in Zambia sets the legal age of marriage at 21 years, customary law permits adolescent girls to marry at an early age, provided they have reached puberty [ 20 ]. Cultural practices have been shown to shape the sexual and reproductive behaviors of young girls [ 21 ]. In Zambia, one of the common cultural practices is the initiation of ceremonies or pubertal rites for young girls [ 15 ]. Attending these ceremonies symbolizes that one has passed childhood and is free to engage in sexual activities [ 15 , 21 ], an act that has raised concerns [ 22 ]. Adolescents constitute a significant proportion of Zambia’s population, accounting for 24% of the population, and this number is projected to increase from 3.7 million to 9.8 million by 2050 [ 23 ]. With the trending high numbers of pregnancies among this age group, this growth poses challenges for the country to deliver essential services such as health, education, and job training to prepare them for a productive future adequately. This heightens the demand for improved measures to prevent and manage adolescent pregnancies in Zambia. To design and implement effective, country-specific interventions and policies to curb adolescent pregnancies in Zambia, it is essential to understand the determining factors. Therefore, this study examined the factors associated with adolescent pregnancies in a nationally representative sample of women aged 15–19 years in Zambia using secondary data from the latest Zambia Demographic and Health Survey (2018 ZDHS). To comprehensively analyse intrapersonal, interpersonal, organizational, environmental, and community-level factors, we used the social-ecological framework of Broffenbrenne [ 24 ]. Methods Study setting Zambia, located in southern Africa, is a low-income country. As of 2022, the country has a total population of 19,610,769, with a female population of 10,007,713 and a male population of 9,603,056 [ 25 ]. Zambia’s Marriage Act sets the legal minimum age of marriage at 21 years [ 19 ]. However, customary law allows adolescent girls to marry at 16 years of age, and written consent is provided by their legal guardian [ 19 , 20 ]. Moreover, the country has cultural ceremonies for transitioning young girls from childhood to adulthood, giving them parental rights to engage in early sexual activities [ 15 , 19 ]. Therefore, the country has one of the highest rates of child marriage globally [ 18 ], with a high incidence (29%) of adolescent pregnancy [ 14 , 15 ]. Among adolescent girls attending primary school who become pregnant in Zambia, only 38% return to school after giving birth [ 26 ]. As a result, the transition rate from lower secondary to upper secondary school has consistently remained below 50% [ 27 ]. The high rate of school dropout among adolescents has been feeding into the country’s cycle of intergenerational poverty [ 26 ]. The country undoubtedly needs measures to curb adolescent pregnancy if it is to achieve sustainable development goal 4 targets (SDG 4) by 2030 [ 28 ]. Study design, sampling, and participants This was a cross-sectional study that analysed secondary data from the 2018 Zambia Demographic and Health Survey (2018 ZDHS). The survey data were collected from July 2018 to January 2019. The 2018 ZDHS used a two-stage sampling design [ 29 ]. First, each of the 10 provinces in the country was stratified into rural and urban areas, resulting in 20 sampling strata. In the first stage, 545 clusters (198 from urban areas and 347 from rural areas) were selected randomly from the 10 provinces. In the second stage, a fixed number of 25 households were selected per cluster using equal probability sampling, and interviews were conducted with all males and females aged 15–49 years who either were regular residents of the chosen households or had spent the night in the selected households before the survey. This resulted in interviews of 13,683 women aged 15–49 years. For this study, we included all adolescents aged 15–19 years with complete information on all variables of interest (n=). As a result, women aged 15–19 years but with incomplete information on any variable of interest and those aged ≥ 20 years (n=) were excluded from the study. Variables Dependent variable The outcome variable in this study was “adolescent pregnancy”, which we defined as females aged 15–19 years who were either currently pregnant at the time of the survey or had ever been pregnant, regardless of the outcome of the pregnancy. This included adolescents who had ever given birth, those who were pregnant at the time of the survey, and those who reported having a terminated pregnancy. In the 2018 ZDHS, women were asked questions about current and previous pregnancies. The following three questions were asked: (a) “Are you pregnant now? (yes/no or not sure)” (b) “Have you ever given birth? (yes/no)” and “Have you ever had a terminated pregnancy? (yes/no)”. A binary dependent variable was created, and adolescents who were pregnant at the time of the survey, had given birth before, or ever had a terminated pregnancy were categorized as “having adolescent pregnancy” and assigned a code of 1 for this variable; otherwise, they were categorized as “not having adolescent pregnancy” and assigned a code of 0 for this variable. Concentrating solely on adolescents who were currently pregnant during the survey would have resulted in an underestimation of the true prevalence of adolescent pregnancy. This is because some girls may have been pregnant in the past and already given birth, while others may have experienced pregnancies that were terminated. A similar concept has been used in prior adolescent studies [ 30 , 31 ]. Independent variables This study utilized the socioecological model (SEM) as a comprehensive framework for identifying factors that could influence adolescent pregnancy in Zambia. The socioecological model was first proposed by Bronfenbrenner [ 24 ] and later redefined by McLeroy et al. [ 32 ] to promote health-related behavioral change. Based on the SEM, factors that could influence adolescent pregnancy were selected at the intrapersonal, interpersonal, organizational, and environmental levels (Table 1 ). Intrapersonal The intrapersonal dimension within the socioecological framework examines the physical and cognitive attributes of the adolescent, along with her previous experiences [ 24 , 32 ]. Factors at the intrapersonal level include age, knowledge about contraception, current use of contraception, marital status, employment status, education level, wealth, exposure to media, and sexual behavior (early sex debut, transactional sex, unprotected sex, multiple sexual partners). Low education levels lead to limited knowledge about contraception and the consequences of early pregnancy. As a result, adolescents with low education levels are likely to engage in sexual behavior that increases their chances of pregnancy, such as early sex debut [ 33 – 35 ], unprotected sex [ 36 ], and underutilization of contraception [ 33 , 37 , 38 ]. Additionally, adolescents who engage in early sexual debut are more likely to have multiple sexual partners, engage in unprotected sex, and experience adolescent pregnancy [ 39 – 41 ]. Furthermore, poverty may push adolescents towards early sexual activity for economic survival, increasing their chances of pregnancy [ 42 , 43 ]. Exposure to media, such as newspapers, magazines, radio, and television, can influence adolescents’ access to information and resources related to sexual health. Media exposure can have both positive and negative effects on adolescent sexual health [ 44 , 45 ]. Although media content has the potential to reinforce unfavourable stereotypes and encourage risky sexual behavior [ 46 ], it can also serve as a potent instrument for spreading accurate information and advocating for positive social norms [ 47 , 48 ]. Interpersonal Interpersonal-level factors refer to the influences and dynamics at the level of personal relationships and interactions [ 32 ]. These factors play a crucial role in shaping adolescents' behaviors and decisions related to sexual activity and pregnancy. Supportive relationships, such as family influence, which enhance positive sexual and reproductive behavior, play a significant role in shaping adolescents' sexual and reproductive health behaviors [ 49 ]. These relationships influence the vulnerabilities and experiences related to the sexual and reproductive health of adolescents. For example, the relationship of an adolescent girl with the household head has a significant influence on adolescent pregnancy [ 50 ] because some adolescents may be married to the household head [ 51 ]. Moreover, the sex of the household head can predispose adolescents to pregnancy due to differences in parenting styles between male- and female-headed households [ 35 , 52 ]. In most LMICs, it is common for adolescents to become pregnant before they marry [ 16 ] because adolescent marriage commonly occurs as a consequence of unplanned pregnancy [ 53 , 54 ]. Organizational level Organizational-level factors are influences that institutions and organizations impact on individual behaviors and experiences. These include religious organizations, schools, and health institutions, among others. For example, the sexual behaviors of adolescents, including contraception use, are influenced by the doctrines of their religious affiliations [ 55 ]. Islamic girls are more at risk of adolescent pregnancy, as many of them are susceptible to early marriage and resistant to contraception campaign messages [ 44 , 56 ]. Similarly, adolescent pregnancy may be influenced by the unavailability of contraception at health institutions [ 44 ]. Furthermore, the provision of messages on contraception and family planning via media platforms such as radio, television, and newspapers or magazines by organizations such as ministries of health can reduce or increase the risk of adolescent pregnancy [ 57 – 59 ] Environmental level Environmental-level factors refer to elements within the broader community and societal context that can influence individual behavior and health outcomes[ 32 ]. These factors operate beyond immediate interpersonal relationships and include aspects of physical, social, and cultural environments. For example, being poor and living in rural areas predisposes adolescents to early pregnancy [ 16 , 60 ]. Moreover, cultural norms in which young girls are married once they reach puberty can lead to adolescent pregnancy [ 16 , 61 ]. Similarly, norms that restrict the utilization of contraceptives are key contributing factors to adolescent pregnancy [ 62 ]. Cultural expectations of male dominance and female subordination limit female adolescents’ decision-making autonomy concerning contraception use[ 63 , 64 ]. Table 1 Definition of predictor variables Variables Question/Description Response options and coding Intrapersonal level variables Age How old were you at your last birthday 1 = 15 2 = 16 3 = 17 4 = 18 5 = 19 Employment status Respondents currently working or not 0 = Not working 1 = Working Marital Status 1. Have you ever been married or lived together with a man as if married? 0 = Never in union 1 = Currently or formerly in union or lived with a man as if married Contraception knowledge Have you heard of any methods that women or men can use to avoid pregnancy? 0 = Knows no method 1 = Knows some method Contraception use Have you ever used anything or tried in any way to delay or avoid getting pregnant? 0 = Never used any method 1 = Used some method Educational Level What is the highest level of school you attended: 0 = No education 1 = Primary 2 = Secondary/Higher Exposure to media 1. Do you read a newspaper or magazine? 2. Do you listen to the radio? 3. Do you watch television? 0 = No for all three platforms 1 = Yes for one platform 2 = Yes for any two platforms 3 = Yes for all three platforms Wealth quintile Composite measure of a household's cumulative living standard. This was collapsed into three categories for simpler analysis. 1 = Poorest 2 = Poorer 3 = Middle 4 = Richer 5 = Richest Age at sex debut Age at which adolescent had first sexual intercourse 0 = Not initiated sex 1 = 15–17 years 2 = 18–19 years Number of sexual partners Number of sexual partners in the last 12 months 0 = No sex partners 1 = One 2 = More than one Literacy Respondents were asked to read any part of a sentence 0 = Cannot read at all 1 = Able to read at least part of the sentence Interpersonal Sex of household head Is the household head male or female? 1 = Male 2 = Female Organizational level Religion What is your religion? 1 = Catholic 2 = Other Information dissemination about family planning via radio Respondents asked whether they had heard about family planning on the radio in the last few months 0 = Not heard about family planning 1 = Heard about family planning Information dissemination about family planning via television Respondents asked whether they had heard about family planning on television in the last few months 0 = Not heard about family planning 1 = Heard about family planning Information dissemination about family planning via newspapers or magazines Respondents asked whether they had heard about family planning in newspapers or magazines in the last few months 0 = Not heard about family planning 1 = Heard about family planning Environmental Place of Residence The type of residence where the respondent was interviewed as either urban or rural. 1 = Urban 2 = Rural Data analysis We analysed the data using SPSS version 22. We accounted for the multistage sampling design used in the DHS survey and generated representative estimates for the country by utilizing the complex sample procedure within the SPSS software. This was achieved by establishing a complex sampling plan (CSPLAN) using the CSPLAN command, considering individual weights, clusters (primary sampling units), and strata adjustments per the guidelines outlined by the DHS for managing individual weight variables [ 65 ]. The sociodemographic characteristics of the participants are presented using descriptive statistics. To identify factors that were associated with adolescent pregnancy, we first conducted an unadjusted logistic regression analysis and generated crude odds ratios (CORs). Predictor variables that were significant at p < 0.2 in the unadjusted model were included in the adjusted regression analysis model. We selected a cut-off p value of < 0.2 to ensure that all potentially important predictive variables were included in the multivariable regression [ 66 ]. According to the adjusted regression model, variables with p < 0.05 were considered to be significantly associated with adolescent pregnancy. We present the adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs). Ethical considerations A formal request was submitted to the DHS program through their website ( www.dhsprogram.com ) to obtain permission to use the data, and approval was granted on December 26, 2023. The original data collection for the Zambia Demographic and Health Survey (ZDHS) was conducted with ethical approval from the Tropical Disease and Research Center (TDRC) and the Research Ethics Review Board of the Center for Disease Control and Prevention (CDC) Atlanta. The procedures used to obtain ethical approval by the DHS are available on their website available at [ 67 ]. Since this study relied on secondary data sources, no additional ethical approval was needed. However, consent was obtained from individuals aged 18 years and above during the DHS survey. For participants aged 15–17 years, assent was obtained along with consent from their parents or legal guardians, as per the DHS protocol. No identifying data or images were used in the analysis. Results We included data from 2,996 adolescents in the analysis. The prevalence of adolescent pregnancy was 29.9% (n = 895), of which 24.1% (n = 723) had ever given birth to a live baby, 6.8% (n = 205) were pregnant at the time of the survey, and 1.7% (n = 50) had a terminated pregnancy. The majority of adolescents were not working (82.5%, n = 2473) and had never been in a union (84.4%, n = 2528). Most adolescents knew some method of contraception (94.8%, n = 2841) and had never used any method of contraception (82.2%, n = 2462). Close to half (49.7%, 1489) of the adolescents had initiated sexual intercourse. More than one-third of the adolescents (37.7%, n = 1128) had no exposure to either radio, television, newspapers, or magazines, and the majority (75.7%, n = 2269) were literate. More than half (50.3%, n = 1507) had not initiated sexual intercourse, and the majority (59.0%, n = 1767) had no sex partners. Most adolescents had male household heads (72.2%, n = 2162) and were from rural areas (55.9%, n = 1676). The majority of adolescents had never heard about family planning on the radio (88.3%, n = 2645), television (91.8%, n = 2750), or newspapers and magazines (96.2%, n = 2882). The details are presented in Table 2 and Table 3 . Table 2 Sociodemographic characteristics of adolescent girls in Zambia according to the 2018 ZDHS (N = 2996) Sociodemographic characteristics Frequency (n) Percent (%) Intrapersonal level factors Age 15 650 21.7 16 529 17.7 17 553 18.5 18 723 24.1 19 541 18.0 Employment Working 523 17.5 Not working 2473 82.5 Marital status Never in union 2528 84.4 Currently or formerly in a union 468 15.6 Contraception knowledge Knows no method 155 5.2 Knows some method 2841 94.8 Contraception use Never used any method 2462 82.2 Used some method 534 17.8 Exposure to radio, television, and newspapers or magazines No for all three platforms 1128 37.7 Yes, for one platform 807 26.9 Yes, for any two platforms 732 24.4 Yes, for all three platforms 329 11.0 Wealth quintile Poorest 510 17.0 Poorer 540 18.0 Middle 585 19.5 Richer 655 21.9 Richest 706 23.6 Age at first sex Not initiated sex 1507 50.3 Less than 15 360 12.0 15–17 970 32.4 18–19 159 5.3 Number of sexual partners No sex partners 1767 59.0 one 1201 40.1 More than one 28 0.9 Literacy Cannot read at all 727 24.3 Able to read at least part of the sentence 2269 75.7 Interpersonal level factors Sex of household head Male 2162 72.2 Female 834 27.8 Organizational level factors Religion Catholic 557 18.6 Other 2439 81.4 Heard about family planning on the radio Yes 351 11.7 No 2645 88.3 Heard about family planning on television Yes 246 8.2 No 2750 91.8 Heard about family planning in newspapers or magazines Yes 114 3.8 No 2882 96.2 Environmental level factors Type of place of residence Rural 1676 55.9 Urban 1320 44.1 Table 3 Prevalence of adolescent pregnancy among adolescent girls in Zambia in 2018 Frequency Percent 95% CI Ever given birth 723 24.1 22.0-26.4 Pregnant at the time of the survey 205 6.8 5.6–8.2 Ever had a terminated pregnancy 50 1.7 1.2–2.2 Any of the above 895 29.9 27.6–32.3 CI: Confidence interval Determinants of adolescent pregnancy among girls with sexual experience in Zambia To determine factors associated with adolescent pregnancy among girls with sexual experience in Zambia, we first conducted univariable logistic regression to generate crude odds ratios (CORs) in the unadjusted model. After that, adjusted odds ratios (AORs) were generated by conducting multivariable logistic regression, adjusting for all variables with p < 0.2 from the unadjusted model. The multivariable model explained 40.3% (Nagelkerke R square) of the variance in the dependent variable and correctly classified 72.5% of the cases. After adjusting for the effects of confounding variables, age, marital status, knowledge about contraception, use of contraception, wealth, age at first sex, literacy, and exposure to family planning messages in newspapers or magazines were found to be factors independently associated with adolescent pregnancy. Compared to those of adolescents aged 15 years, the odds of adolescent pregnancy significantly increased with increasing age (AOR = 2.0; 95% CI: 1.1, 3.6 for 16 versus 15; AOR = 3.8; 95% CI: 2.1, 7.1 for 17 versus 15; AOR = 4.1; 95% CI: 2.4, 7.1 for 18 versus 15; AOR = 5.9; 95% CI: 3.3, 10.5 for 19 versus 15). Adolescent girls who were currently or formerly married were 5.4 times more likely to have been pregnant than those who had never been in a union (AOR = 5.4; 95% CI: 3.7, 7.9). The odds of adolescent pregnancy among girls who knew about some methods of contraception were 3.4 times greater than the odds among girls who did not know about any method of contraception (AOR = 3.4; 95% CI: 1.2, 9.8). Moreover, adolescents who had previously used contraception were 3.0 times more likely to have experienced pregnancy than were those who had never used contraception (AOR = 3.0; 95% CI: 2.2, 4.2). Compared to those of adolescents in the richest wealth quintile, the odds of adolescent pregnancy significantly increased with decreasing wealth (AOR = 2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR = 3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR = 3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR = 4.2; 95% CI: 2.0, 8.9 for poorer versus richest). Furthermore, adolescents who initiated sexual activity at younger ages were found to be significantly more likely to experience pregnancy than were those who initiated sex at ages 18–19 years (AOR = 2.1; 95% CI: 1.3, 3.4 for 15–17 versus 18–19; AOR = 3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18–19). The odds of adolescent pregnancy among girls who could not read were 1.7 times greater than the odds among girls who could read (AOR = 1.7; 95% CI: 1.1, 2.6). Adolescents with no exposure to family planning messages in either newspapers or magazines were 2.6 times more likely to experience pregnancy than those with exposure (AOR = 2.6; 95% CI: 1.1, 6.4). The details are presented in Table 4 . Table 4 Factors associated with adolescent pregnancy among adolescent girls with sexual experience in Zambia according to the 2018 ZDHS (N = 1489) Variable Pregnant during adolescence n (%) Never been pregnant. n (%) Unadjusted model COR (95% CI) P value Adjusted model. AOR (95% CI) P value Age 15 (ref) 45 (32.8) 93 (67.2) 1 1 16 81 (44.7) 100 (55.3) 1.7 (0.9–2.8) 0.056 2.0 (1.1–3.6) 0.015 17 169 (59.9) 114 (40.1) 3.1 (1.8–5.1) < 0.001 3.8 (2.1–7.1) < 0.001 18 308 (66.8) 153 (33.2) 4.1 (2.6–6.4) < 0.001 4.1 (2.4–7.1) < 0.001 19 292 (68.5) 134 (31.5) 4.5 (2.8–7.1) < 0.001 5.9 (3.3–10.5) < 0.001 Employment Not employed (ref) 631 (56.3) 490 (43.7) 1 1 Employed 264 (71.8) 104 (28.2) 1.9 (1.5–2.6) < 0.001 0.7 (0.5-1.0) 0.078 Marital status Never in union (ref) 473 (46.3) 548 (53.7) 1 1 Currently or formerly in a union 422 (90.3) 46 (9.7) 10.8 (7.6–15.3) < 0.001 5.4 (3.7–7.9) < 0.001 Contraception knowledge Knows no method (ref) 10 (34.7) 20 (65.3) 1 1 Knows some method 885 (60.7) 574 (39.3) 2.9 (1.2–7.2) 0.023 3.4 (1.2–9.8) 0.024 Contraception use Never used any method (ref) 474 (49.4) 486 (50.6) 1 1 Used some method 421 (79.7) 108 (20.3) 4.0 (3.0-5.4) < 0.001 3.0 (2.2–4.2) < 0.001 Exposure to radio, television, and newspapers or magazines Yes, for all three platforms (ref) 43 (42.4) 59 (57.6) 1 1 Yes, for any two platforms 150 (48.5) 159 (51.5) 1.3 (0.8–2.2) 0.364 1.1 (0.6–2.2) 0.669 Yes, for one platform 230 (57.3) 172 (42.7) 1.8 (1.1–2.9) 0.011 1.2 (0.6–2.2) 0.579 No for all three platforms 472 (69.9) 204 (30.1) 3.2 (2.0–5.0) < 0.001 1.6 (0.8–3.1) 0.150 Wealth quintile Richest (ref) 54 (29.0) 132 (71.0) 1 1 Richer 177 (55.5) 142 (44.5) 3.1 (1.8–5.2) < 0.001 2.3 (1.2–4.1) 0.007 Middle 215 (62.6) 128 (37.4) 4.1 (2.4–7.1) < 0.001 3.8 (1.9–7.6) < 0.001 Poorer 210 (65.6) 110 (34.4) 4.7 (2.8–7.9) < 0.001 3.4 (1.7–6.8) < 0.001 Poorest 239 (74.5) 82 (25.5) 7.2 (4.2–12.3) < 0.001 4.2 (2.0-8.9) < 0.001 Age at first sex 18–19 (ref) 69 (43.2) 90 (56.8) 1 1 15–17 589 (60.7) 381 (39.3) 2.0 (1.4–2.9) < 0.001 2.1 (1.3–3.4) 0.004 Less than 15 237 (66.0) 123 (34.0) 2.6 (1.7–3.9) < 0.001 3.8 (2.1–6.9) < 0.001 Literacy Able to read at least part of the sentence (ref) 542 (53.5) 472 (46.5) 1 1 Can not read at all 353 (74.4) 122 (25.6) 2.5 (1.8–3.5) < 0.001 1.7 (1.1–2.6) 0.010 Sex of household head Female (ref) 220 (51.7) 206 (48.3) 1 1 Male 675 (63.5) 388 (36.5) 1.6 (1.3–2.1) < 0.001 1.0 (0.7–1.4) 0.971 Religion Catholic (ref) 157 (58.3) 112 (41.7) 1 Other 738 (60.5) 482 (39.5) 1.1 (0.8–1.5) 0.544 - Heard about family planning on the radio Yes (ref) 112 (57.4) 84 (42.6) 1 No 783 (60.6) 510 (39.4) 1.1 (0.8–1.7) 0.510 - Heard about family planning on television Yes (ref) 41 (42.6) 56 (57.4) 1 1 No 854 (61.3) 538 (38.7) 2.1 (1.1–4.2) 0.024 1.4 (0.7–2.8) 0.276 Heard about family planning in newspapers or magazines Yes (ref) 8 (26.5) 22 (73.5) 1 1 No 887 (60.8) 572 (39.2) 4.3 (1.8–10.1) 0.001 2.6 (1.1–6.4) 0.039 Type of place of residence Urban (ref) 260 (51.1) 249 (48.9) 1 1 Rural 635 (64.8) 345 (35.2) 1.8 (1.3–2.5) 0.001 0.7 (0.4–1.1) 0.124 Ref: reference category; AOR: adjusted odds ratio; COR: crude odds ratio Discussion This study used the 2018 ZDHS data to examine the prevalence of adolescent pregnancy and associated factors among Zambian girls. The prevalence of adolescent pregnancy was 29.9%, indicating a decrease from the reported prevalence of 31.7% in the country's 2014 demographic and health survey [ 16 ]. However, despite this decline, the prevalence remains notably higher than that in many African regions. Specifically, the prevalence of adolescent pregnancy in Zambia surpassed that in East Africa (21.5%), West Africa (17.7%), Central Africa (15.8%), Southern Africa (20.5%), and the entire African continent (18.8%) [ 68 ]. This underscores the urgent need for targeted interventions to address this pressing public health challenge in Zambia. The marginal decrease in adolescent pregnancy rates in Zambia from 31.7% in 2014 to 29.9% in 2018 may be attributed to the implementation of diverse strategies by collaborating stakeholders. For instance, initiatives such as the RISE project enrolled 4,900 girls from 157 schools in 12 rural districts in Zambia into comprehensive sexuality education programs between 2016 and 2018 [ 69 ]. A similar reduction in adolescent pregnancy has been reported in other African countries, such as Sierra Leone [ 70 ] and Kenya [ 71 ]. The odds of adolescent pregnancy increased with increasing age. These findings are consistent with a multicountry analysis conducted across 32 African countries [ 72 ]. A possible explanation for this observed finding could be related to factors such as increased exposure to sexual activity, higher chances of getting married for older adolescents, and greater autonomy and independence that accompany aging [ 73 – 75 ] Adolescents who were currently or formerly married had greater odds of pregnancy than those who had never been in a union. Married adolescents have limited decision-making power regarding their reproductive health [ 63 , 64 , 76 , 77 ]. Moreover, married adolescents have restricted access to contraception, and this is coupled with the cultural expectation of childbearing and fertility pressure that comes with marriage [ 2 , 78 – 80 ]. To effectively combat adolescent pregnancy in Zambia, strategies aimed at addressing barriers to adolescents’ autonomy in reproductive health within marital relations and promoting their access to contraception are imperative. Second, efforts should aim at addressing the issue of adolescent marriage by advocating for policies and programs that discourage early unions. In Zambia, the Marriage Act established the legal age of marriage at 21 years, but customary law permits adolescent girls to marry upon reaching puberty [ 20 ]. It is therefore essential to address this inconsistency between statutory and customary laws in Zambia to ensure that legal frameworks safeguard young girls from early and forced marriages, thereby contributing to efforts to reduce adolescent pregnancy in Zambia. Contrary to findings from previous studies in which knowledge and use of contraception reduced the risk of adolescent pregnancy [ 81 , 82 ], our analysis revealed that adolescents with prior knowledge of contraception and those who had previously used some form of contraception had greater odds of pregnancy than their counterparts. This could partly be attributed to contraception failure due to incorrect or inconsistent use of contraception [ 83 , 84 ]. Despite the increased use of contraception in most developing countries, contraceptive failure remains common due to inadequate contraceptive counselling, awareness, and utilization skills, which has led to unplanned and unwanted pregnancies [ 75 , 85 ]. To enhance the efficiency and effectiveness of contraception methods among adolescents, it is essential that strategies, in addition to promoting contraception use and access, include education on the correct use of contraceptives. The high rate of pregnancy among adolescents who used contraception suggests an unaddressed contraceptive need, potentially resulting from factors such as interruptions in the supply of contraceptives [ 86 ]. Qualitative studies are therefore warranted to explore the underlying factors contributing to the observed phenomenon and to gain a more comprehensive understanding of adolescents' experiences, perceptions, and behaviors regarding contraception use. Adolescents' socioeconomic status, measured as the wealth index, was another major factor associated with adolescent pregnancy. Adolescents from the poor, middle, and wealthy households had greater odds of pregnancy than did those from the richest households. Previous studies in Africa have highlighted the impact of poverty on adolescent pregnancy [ 35 , 87 ], and similar trends have been reported in European countries [ 88 ]. Poverty may push adolescents towards early sexual activity for economic survival, increasing their chances of pregnancy [ 42 , 43 ]. The socioeconomic pattern observed in our analysis and supported by previous studies underscores the urgent need for targeted interventions to address socioeconomic inequalities in access to sexual and reproductive health services and information for adolescents. As anticipated, early sexual debut emerged as a significant predisposing factor for adolescent pregnancy. Adolescents who engaged in early sexual debut had a greater risk of experiencing pregnancy. Previous studies have revealed that adolescents who initiate sexual activity at an early age are more likely to engage in sexual behaviors that increase their vulnerability to pregnancy, such as having multiple sexual partners and not using protection during sexual intercourse [ 39 – 41 ]. This finding underscores the importance of implementing targeted interventions to delay the initiation of sexual intercourse among adolescents. Literacy level was another significant determinant of adolescent pregnancy. Adolescents who could not read had greater odds of pregnancy than those who could read at least part of a sentence. Low literacy levels can lead to limited knowledge about contraception and the consequences of early pregnancy. Consequently, adolescents with low literacy levels are likely to engage in sexual behavior that increases their risk of pregnancy, such as early sex debut [ 33 – 35 ], unprotected sex [ 36 ], and underutilization of contraception [ 37 , 38 ]. Our study revealed a significant association between exposure to messaging on contraception through newspapers and adolescent pregnancy. This finding aligns with previous studies suggesting that media platforms, such as newspapers, play a crucial role in disseminating information about family planning, potentially lowering the risk of adolescent pregnancy [ 89 – 91 ]. However, exposure to messages through radio and television did not significantly influence adolescent pregnancy risk in our study. One possible explanation for this could be the variation in the reach and accessibility of different media platforms among adolescents. Newspapers may reach a more literate audience who is more likely to engage with and act upon the information provided [ 92 ]. Moreover, previous studies have reported mixed results regarding the influence of media-based family planning messages on adolescent pregnancy risk, with some studies showing a reduction in risk with exposure to such messages, while other studies have suggested an increase in risk [ 57 – 59 ]. It is therefore crucial for policymakers to consider the diverse needs and preferences of adolescents when designing and implementing media-based family planning interventions. These communication strategies should be tailored to maximize the reach and impact of messages across different media platforms, taking into account the sociocultural context of the target population. Strengths and Limitations This study used the most recently available data from the Zambia Demographic Health Survey. The analysis used weighted data from a nationally representative sample of adolescent girls in Zambia; hence, the results from this analysis can be generalized to all adolescents in Zambia. While most studies on adolescent pregnancy have reported only the prevalence of pregnancy in adolescents who either were pregnant or had given birth before, our study included even adolescents who had a terminated pregnancy, which reduced the risk of underreported pregnancy. However, the results from this study should be interpreted considering that it was cross-sectional in nature; hence, we cannot infer causality between the independent variables and adolescent pregnancy. Moreover, the data collection was retrospective and relied on self-reported responses, with no verification performed through records. Therefore, we anticipate that there could have been recall bias and social desirability bias. Conclusion While there has been a marginal decrease in adolescent pregnancy rates in Zambia, from 31.7% reported in 2014 to 29.9% in 2018, the prevalence remains considerably higher than that in many other African countries. Factors associated with adolescent pregnancy included older age, being married, low literacy levels, low socioeconomic status, early sexual debut, and lack of exposure to family planning messages via newspapers. It is therefore essential to align statutory and customary laws regarding the legal age of marriage in Zambia and implement behavioural change communication strategies that discourage early sexual debut, particularly targeting older adolescents. Additionally, the role of media platforms, particularly newspapers, in disseminating information about family planning in Zambia is crucial. Furthermore, efforts to promote comprehensive education on the correct use of contraception while ensuring consistent access to contraception among adolescents should be encouraged. Abbreviations AOR : adjusted odds ratio COR : Crude odds ratio LMICs: low- and middle-income countries SDG: Sustainable Development Goal SEM: Socioecological Model ZDHS : Zambia Demographic and Health Survey Declarations Ethics approval and consent to participate A formal request to use the data were made to the DHS program through their website [67], and permission to use the data were granted on 26 th December 2023. The approval letter is attached and available for review. The original data collection was carried out with ethical approval from the Tropical Disease and Research Center (TDRC) and the Research Ethics Review Board of the Centers for Disease Control and Prevention (CDC) Atlanta. As this study utilized secondary data sources, no additional ethical approval was needed. However, the process of collecting data for the Zambia Demographic and Health Survey (ZDHS) involved obtaining consent from individuals aged 18 and above. For participants aged 15–17 years, assent was obtained in addition to consent from their parents or legal guardians, as mandated by the DHS protocol. No identifying data or images were used in the analysis. Consent for publication Not applicable Availability of data and materials The data used in this analysis are publicly available upon request through the DHS program website (www.dhsprogram.com). Competing interests The authors declare that they have no competing interests. Funding No funding was obtained for this study. Authors' contributions WM led the study conception and design, analysis, and interpretation and drafted the manuscript. BJ participated in the corrections and review of the manuscript . All the authors have read and approved the final manuscript. Acknowledgements Not applicable References WHO. Adolescent health. [cited 13 Dec 2023]. Available: https://www.who.int/health-topics/adolescent-health#tab=tab_1 Svanemyr J. Adolescent pregnancy and social norms in Zambia. Cult Health Sex. 2020;22: 615–629. doi:10.1080/13691058.2019.1621379 Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121 Suppl 1: 40–48. doi:10.1111/1471-0528.12630 Conde-Agudelo A, Belizán JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. Am J Obstet Gynecol. 2005;192: 342–349. doi:10.1016/j.ajog.2004.10.593 Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36: 368–373. doi:10.1093/IJE/DYL284 Singh S, Bankole A, Moore AM, Mutua MM, Izugbara C, Kimani E, et al. Incidence and Complications of Unsafe Abortion in Kenya. 2013. Available: https://www.guttmacher.org/report/incidence-and-complications-unsafe-abortion-kenya Shah IH, Åhman E. Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women. Reprod Health Matters. 2012;20: 169–173. doi:10.1016/S0968-8080(12)39598-0 Darroch JE, Woog V, Bankole A, Ashford LS, Points K. Costs and Benefits of Meeting the Contraceptive Needs of Adolescents. 2016 [cited 14 Dec 2023]. Available: https://www.guttmacher.org/adding-it-up Doyle AM, Mavedzenge SN, Plummer ML, Ross DA. The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveysRevue: Comportement sexuel des adolescents en Afrique subsaharienne: Profils et tendances dans les enquêtes nationalesRevisión: El comportamiento sexual de adolescentes en África subsahariana: Patrones y tendencias en censos nacionales. Tropical Medicine & International Health. 2012;17: 796–807. doi:10.1111/J.1365-3156.2012.03005.X Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. Sexual behaviour in context: a global perspective. The Lancet. 2006;368: 1706–1728. doi:10.1016/S0140-6736(06)69479-8 Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med. 2016;168: 186–197. doi:10.1016/J.SOCSCIMED.2016.09.023 Sommer M, Mmari K. Addressing structural and environmental factors for adolescent sexual and reproductive health in low- and middle-income countries. Am J Public Health. 2015;105: 1973–1981. doi:10.2105/AJPH.2015.302740 Mmari K, Sabherwal S. A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: An update. Journal of Adolescent Health. 2013;53: 562–572. doi:10.1016/j.jadohealth.2013.07.018 Zambia Statistics Agency. 2018 Demographic and Health Survey Summary Report Zambia. 2018. Available: www.zamstats.gov.zm Menon JA, Kusanthan T, Mwaba SOC, Juanola L, Kok MC. “Ring” your future, without changing diaper - Can preventing teenage pregnancy address child marriage in Zambia? PLoS One. 2018;13. doi:10.1371/journal.pone.0205523 Malunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000–2022. Archives of Public Health. BioMed Central Ltd; 2023. doi:10.1186/s13690-023-01045-y Feyissa GT, Tolu LB, Soboka M, Ezeh A. Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence. Frontiers in Reproductive Health. 2023;5: 1105390. doi:10.3389/FRPH.2023.1105390/FULL A Situation Report on Child Marriages in Zambia | Zambia | World Vision International. [cited 16 Dec 2023]. Available: https://www.wvi.org/zambia/article/situation-report-child-marriages-zambia UNICEF. Case study on ending child marriage in the Republic of Zambia. 2021. Muthengi E, Muthoni L, Austrian K. Comparing Cohabiting Unions and Formal Marriages Among Adolescent Girls in Zambia: The Role of Premarital Fertility and Parental Support. Journal of Adolescent Health. 2022;70: S47–S53. doi:10.1016/J.JADOHEALTH.2021.11.024 Munthali AC, Zulu EM. The Timing and role of Initiation Rites in Preparing Young People for Adolescence and Responsible Sexual and Reproductive Behaviour in Malawi. Afr J Reprod Health. 2007;11: 150. doi:10.2307/25549737 Mbozi P. THE IMPACT OF NEGATIVE CULTURAL PRACTICES ON THE SPREAD OF HIV / AIDS IN ZAMBIA. 2000. Group WB. Adolescent Girls in Zambia: Executive Summary. 2015 [cited 16 Dec 2023]. doi:10.1596/K8898 Bronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977;32: 513–531. doi:10.1037/0003-066X.32.7.513 ZamStats. 2022 CENSUS OF POPULATION AND HOUSING PRELIMINARY REPORT REPUBLIC OF ZAMBIA. 2022. Available: www.zamstats.gov.zm Zuilkowski SS, Henning M, Zulu J, Matafwali B. Zambia’s school re-entry policy for adolescent mothers: Examining impacts beyond re-enrollment. Int J Educ Dev. 2019;64: 1–7. doi:10.1016/J.IJEDUDEV.2018.11.001 UNFPA. GRZ/UNFPA 8th Country Programme Evaluation: Zambia Final Evaluation Report. 2016. Sustainable Development Goal 4: Quality Education | United Nations in Zambia. [cited 18 Dec 2023]. Available: https://zambia.un.org/en/sdgs/4 ZDHS. 2018 Zambia Demographic and Health Survey. 2018. Available: www.zamstats.gov.zm Ahinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis. PLoS One. 2021;16. doi:10.1371/journal.pone.0246308 Donatus L, Sama DJ, Tsoka-Gwegweni JM, Cumber SN. Factors associated with adolescent school girl’s pregnancy in Kumbo East Health District North West region Cameroon. Pan Afr Med J. 2018;31. doi:10.11604/PAMJ.2018.31.138.16888 Mcleroy KR, Bibeau D, Steckler A, Glanz K. An Ecological Perspective on Health Promotion Programs. http://dx.doi.org/101177/109019818801500401. 1988;15: 351–377. doi:10.1177/109019818801500401 Cheedalla A, Moreau C, Burke AE. Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011–2017. Contracept X. 2020;2: 100048. doi:10.1016/J.CONX.2020.100048 Mohr R, Carbajal J, Sharma BB. The Influence of Educational Attainment on Teenage Pregnancy in Low-Income Countries: A Systematic Literature Review. J Soc Work Glob Community. 2019;4. doi:10.5590/JSWGC.2019.04.1.02 Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: A multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19: 1–11. doi:10.1186/S12884-019-2204-Z/TABLES/4 Jackson F, Haile ZT. Association between educational attainment and risky sexual behaviour among Ghanaian female youth. Afr Health Sci. 2023;23: 301. doi:10.4314/AHS.V23I1.32 Westall J. Poor education linked with teen pregnancies. BMJ : British Medical Journal. 1997;314: 537. doi:10.1136/bmj.314.7080.535d Mmari K, Sabherwal S. A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update. J Adolesc Health. 2013;53: 562–572. doi:10.1016/J.JADOHEALTH.2013.07.018 Bolarinwa OA, Tessema ZT, Frimpong JB, Babalola TO, Ahinkorah BO, Seidu AA. Spatial distribution and factors associated with adolescent pregnancy in Nigeria: a multi-level analysis. Arch Public Health. 2022;80. doi:10.1186/S13690-022-00789-3 Akanbi MA, Ope BW, Adeloye DO, Amoo EO, Iruonagbe TC, Omojola O. Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria. Afr J Reprod Health. 2021;25. Available: https://www.ajrh.info/index.php/ajrh/article/view/2995 Envuladu E, Ohize V, Zoakah A, Agbo H. Determinants and outcome of teenage pregnancy in a rural community in Jos, Plateau State, Nigeria. Sub-Saharan African Journal of Medicine. 2014;1: 48. doi:10.4103/2384-5147.129319 Larson CP. Poverty during pregnancy: Its effects on child health outcomes. Paediatr Child Health. 2007;12: 673. doi:10.1093/PCH/12.8.673 Parker RM, Williams M V., Baker DW, Nurss JR. Literacy and contraception: exploring the link. Obstetrics and gynecology. 1996;88: 72S-77S. doi:10.1016/0029-7844(96)00250-5 Alukagberie ME, Elmusharaf K, Ibrahim N, Poix S. Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reprod Health. 2023;20. doi:10.1186/s12978-023-01629-5 Stella A. TEENAGE PREGNANCY AND ITS INFLUENCE ON SECONDARY SCHOOL EDUCATION IN NIGERIA. 2019. Hust SJT, Brown JD, L’Engle KL. Boys Will Be Boys and Girls Better Be Prepared: An Analysis of the Rare Sexual Health Messages in Young Adolescents’ Media. Mass Commun Soc. 2008;11: 3–23. doi:10.1080/15205430701668139 Sserwanja Q, Sepenu AS, Mwamba D, Mukunya D. Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey. BMJ Open. 2022;12. doi:10.1136/BMJOPEN-2021-052684 Asp G, Pettersson KO, Sandberg J, Kabakyenga J, Agardh A. Associations between mass media exposure and birth preparedness among women in southwestern Uganda: a community-based survey. Glob Health Action. 2014;7. doi:10.3402/GHA.V7.22904 Svanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. J Adolesc Health. 2015;56: S7–S14. doi:10.1016/J.JADOHEALTH.2014.09.011 Worku MG, Tessema ZT, Teshale AB, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15–19 years) in East Africa: a multilevel analysis. BMC Pregnancy Childbirth. 2021;21: 1–8. doi:10.1186/S12884-021-03713-9/TABLES/5 Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19. doi:10.1186/S12884-019-2204-Z Baruwa OJ, Mkwananzi S, Amoateng AY, Naidoo N. Teenage pregnancy among unmarried teenagers in Malawi: Does sex of the household head matter? Afr J Reprod Health. 2020;24: 51–57. doi:10.29063/AJRH2020/V24I4.6 Prevention or Punishment? - Teenage pregnancy and child marriage in Chadiza and Petauke, Eastern Zambia - KIT Royal Tropical Institute. [cited 22 Dec 2023]. Available: https://www.kit.nl/publication/prevention-or-punishment-teenage-pregnancy-and-child-marriage-in-chadiza-and-petauke-eastern-zambia/ Teenage pregnancy and early marriage in Timor-Leste | Plan International. [cited 22 Dec 2023]. Available: https://plan-international.org/publications/teenage-pregnancy-and-early-marriage-in-timor-leste/ Manlove JS, Terry-Humen E, Ikramullah EN, Moore KA. The Role of Parent Religiosity in Teens’ Transitions to Sex and Contraception. J Adolesc Health. 2006;39: 578. doi:10.1016/J.JADOHEALTH.2006.03.008 Akanbi MA, Ope BW, Adeloye DO, Amoo EO, Iruonagbe TC, Omojola O. Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria. Afr J Reprod Health. 2021;25: 138–146. Available: https://www.ajol.info/index.php/ajrh/article/view/221412 Machira K, Palamuleni ME. Health Care Factors Influencing Teen Mothers’ Use Of Contraceptives in Malawi. Ghana Med J. 2017;51: 88. doi:10.4314/gmj.v51i2.7 Phiri M, Kasonde ME, Moyo N, Sikaluzwe M, Simona S. A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018). Reprod Health. 2023;20: 1–13. doi:10.1186/S12978-023-01567-2/TABLES/4 Pepito VCF, Amit AML, Tang CS, Co LMB, Aliazas NAK, De Los Reyes SJ, et al. Exposure to family planning messages and teenage pregnancy: results from the 2017 Philippine National Demographic and Health Survey. Reprod Health. 2022;19: 1–12. doi:10.1186/S12978-022-01510-X/TABLES/4 Kozhimannil KB, Enns E, Blauer-Peterson C, Farris J, Kahn J, Kulasingam S. Behavioral and Community Correlates of Adolescent Pregnancy and Chlamydia Rates in Rural Counties in Minnesota. J Community Health. 2015;40: 493. doi:10.1007/S10900-014-9962-3 Amoadu M, Ansah EW, Assopiah P, Acquah P, Ansah JE, Berchie E, et al. Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review. BMC Pregnancy Childbirth. 2022;22. doi:10.1186/s12884-022-05172-2 Ezenwaka U, Mbachu C, Ezumah N, Eze I, Agu C, Agu I, et al. Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: An application of the socio-ecological model. BMC Public Health. 2020;20: 1–11. doi:10.1186/S12889-020-09276-2/TABLES/1 Ahinkorah BO, Hagan JE, Seidu AA, Sambah F, Adoboi F, Schack T, et al. Female adolescents’ reproductive health decision-making capacity and contraceptive use in sub-Saharan Africa: What does the future hold? PLoS One. 2020;15: e0235601. doi:10.1371/JOURNAL.PONE.0235601 Shahabuddin ASM, Nöstlinger C, Delvaux T, Sarker M, Bardají A, De Brouwere V, et al. What Influences Adolescent Girls’ Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh. PLoS One. 2016;11: e0157664. doi:10.1371/JOURNAL.PONE.0157664 DHS. Guide to DHS Statistics DHS-7. 2023 [cited 9 Nov 2023]. Available: https://dhsprogram.com/data/Guide-to-DHS-Statistics/Analyzing_DHS_Data.htm Malhotra RK. Errors in the use of Multivariable Logistic Regression Analysis: An Empirical Analysis. Indian J Community Med. 2020;45: 560. doi:10.4103/IJCM.IJCM_16_20 The DHS Program - Data. [cited 22 Mar 2024]. Available: https://dhsprogram.com/data/ Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: A systematic review and Meta-analysis. Reprod Health. 2018;15: 1–17. doi:10.1186/S12978-018-0640-2/FIGURES/6 Sandøy IF, Mudenda M, Zulu J, Munsaka E, Blystad A, Makasa MC, et al. Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: Study protocol for a cluster randomized trial. Trials. 2016;17: 1–15. doi:10.1186/S13063-016-1682-9/FIGURES/2 Nuwabaine L, Sserwanja Q, Kamara K, Musaba MW. Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019. BMC Public Health. 2023;23. doi:10.1186/S12889-023-15436-X Mutea L, Were V, Ontiri S, Michielsen K, Gichangi P. Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003–2014. BMC Womens Health. 2022;22: 1–11. doi:10.1186/S12905-022-01986-6/TABLES/5 Ahinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis. PLoS One. 2021;16: e0246308. doi:10.1371/JOURNAL.PONE.0246308 Phongluxa K, Langeslag G, Jat TR, Kounnavong S, Khan MA, Essink DR. Factors influencing sexual and reproductive health among adolescents in Lao PDR. Glob Health Action. 2020;13. doi:10.1080/16549716.2020.1791426 Habitu YA, Yalew A, Bisetegn TA. Prevalence and factors associated with teenage pregnancy, northeast Ethiopia, 2017: A cross-sectional study. J Pregnancy. 2018;2018. doi:10.1155/2018/1714527 Gebrie Worku M, Tadesse Tessema Z, Birhanu Teshale A, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15-19 years) in East Africa: a multilevel analysis. [cited 8 Mar 2024]. doi:10.1186/s12884-021-03713-9 Mangimela-Mulundano A, Black KI, Cheney K. A cross-sectional study of women’s autonomy and modern contraception use in Zambia. BMC Womens Health. 2022;22: 1–8. doi:10.1186/S12905-022-02101-5/TABLES/4 Ahonsi B, Fuseini K, Nai D, Goldson E, Owusu S, Ndifuna I, et al. Child marriage in Ghana: evidence from a multi-method study. BMC Womens Health. 2019;19. doi:10.1186/S12905-019-0823-1 Grindlay K, Grossman D. Women’s perspectives on age restrictions for over-the-counter access to oral contraceptives. J Adolesc Health. 2015;56: 38–43. doi:10.1016/J.JADOHEALTH.2014.08.016 Heslop J, Banda R. Reproductive Health Matters An international journal on sexual and reproductive health and rights Moving beyond the “male perpetrator, female victim” discourse in addressing sex and relationships for HIV prevention: peer research in Eastern Zambia. 2013 [cited 8 Mar 2024]. doi:10.1016/S0968-8080(13)41697-X Dixit A, Bhan N, Benmarhnia T, Reed E, Kiene SM, Silverman J, et al. The association between early in marriage fertility pressure from in-laws’ and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India. Reprod Health. 2021;18: 1–9. doi:10.1186/S12978-021-01116-9/TABLES/3 Ahinkorah BO, Hagan JE, Seidu AA, Hormenu T, Otoo JE, Budu E, et al. Linking Female Adolescents’ Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes. Healthcare 2021, Vol 9, Page 272. 2021;9: 272. doi:10.3390/HEALTHCARE9030272 Iyanda AE, Dinkins BJ, Osayomi T, Adeusi TJ, Lu Y, Oppong JR. Fertility knowledge, contraceptive use and unintentional pregnancy in 29 African countries: a cross-sectional study. Int J Public Health. 2020;65: 445–455. doi:10.1007/S00038-020-01356-9/FIGURES/2 Chandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: Needs, barriers, and access. Reprod Health. 2014;11: 1–8. doi:10.1186/1742-4755-11-1/TABLES/2 Malunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000–2022. Archives of Public Health. 2023;81: 1–15. doi:10.1186/S13690-023-01045-Y/TABLES/4 Larsson M, Aneblom G, Odlind V, Tydén T. Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination. Acta Obstet Gynecol Scand. 2002;81: 64–71. doi:10.1046/J.0001-6349.2001.00169.X Sedgh G, Ashford LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. 2016. Available: https://www.guttmacher.org/report/unmet-need-for-contraception-in-developing-countries Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: A systematic review. Reprod Health. 2018;15: 1–11. doi:10.1186/S12978-018-0460-4/TABLES/2 Imamura M, Tucker J, Hannaford P, Da Silva MO, Astin M, Wyness L, et al. Factors associated with teenage pregnancy in the European Union countries: a systematic review. Eur J Public Health. 2007;17: 630–636. doi:10.1093/EURPUB/CKM014 Sserwanja Q, Turimumahoro P, Nuwabaine L, Kamara K, Musaba MW. Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey. BMC Womens Health. 2022;22. doi:10.1186/S12905-022-01974-W Dwomoh D, Amuasi SA, Amoah EM, Gborgbortsi W, Tetteh J. Exposure to family planning messages and contraceptive use among women of reproductive age in sub-Saharan Africa: a cross-sectional program impact evaluation study. Sci Rep. 2022;12: 18941. doi:10.1038/S41598-022-22525-1 Ajaero CK, Odimegwu C, Ajaero ID, Nwachukwu CA. Access to mass media messages, and use of family planning in Nigeria: A spatio-demographic analysis from the 2013 DHS. BMC Public Health. 2016;16: 1–10. doi:10.1186/S12889-016-2979-Z/TABLES/3 Underwood C, Serlemitsos E, Macwangi M. Health Communication in Multilingual Contexts: A Study of Reading Preferences, Practices, and Proficiencies Among Literate Adults in Zambia. J Health Commun. 2007;12: 317–337. doi:10.1080/10810730701325962 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Oct, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 13 May, 2025 Reviews received at journal 05 May, 2025 Reviewers agreed at journal 30 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 26 Mar, 2025 Reviewers invited by journal 10 Apr, 2024 Editor invited by journal 26 Mar, 2024 Submission checks completed at journal 23 Mar, 2024 Editor assigned by journal 23 Mar, 2024 First submitted to journal 22 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4150984","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284243713,"identity":"0d9887db-f461-4cb7-a566-6a0685181b0f","order_by":0,"name":"Whiteson Mbele","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCcYGKIOB8QBDBZDBzNxASEtjA1QLwwGGMyAtMENwamFgRGhhbAOxCGgxuN3c/uDDH5s83dnNBw58nFcbzd8O1PKjYhtuLXcONjbObEsrNrtzLOHgzG3Hc2ccZmxg7DlzG6cWsxuJjc28DYcTt93IMTjMu+1YbgNQCzNjGwEtf/6AtOR/OPx3zrHc+URpYWAD28IAVFyTu4GQFnuglpm9bWmJ2+4cMzjYc+xA7kagloP4/CI5I/3Bhx9/bBK33W5++OBHTV3uvPOHDz74UYFbCzo4DCYPEK0eCOpIUTwKRsEoGAUjBAAAVq5uACSqOOQAAAAASUVORK5CYII=","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Whiteson","middleName":"","lastName":"Mbele","suffix":""},{"id":284243714,"identity":"2c6c1cd6-7fb1-417e-9756-1d9683d2a8bc","order_by":1,"name":"Babucarr Jassey","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Babucarr","middleName":"","lastName":"Jassey","suffix":""}],"badges":[],"createdAt":"2024-03-22 16:09:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4150984/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4150984/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08063-4","type":"published","date":"2025-10-02T15:58:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92883906,"identity":"e5fa0138-5169-4ce6-941e-6292b8bd9ea5","added_by":"auto","created_at":"2025-10-06 16:10:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2094849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4150984/v1/63c9bcc8-a794-4442-8ffe-142d69a88455.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of adolescent pregnancy in Zambia: A secondary data analysis of 2018 Zambia Demographic and Health Survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdolescence, spanning from ages 10 to 19, represents the transitional phase between childhood and adulthood [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This unique period of human development is critical for establishing the groundwork for good health. Despite adolescence being perceived as a healthy life stage, there is a notable occurrence of injury, illness, and death, much of which are preventable or treatable [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2016, pregnancy and childbirth complications were the leading causes of death among adolescents aged 15\u0026ndash;19 years globally [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, the consequences of adolescent childbearing also impact the well-being of their newborn, as evidenced by increased perinatal deaths and low birth weight among babies born to mothers under the age of 20 years [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, adolescent pregnancies have been associated with a higher incidence of unsafe abortions because most pregnancies in adolescence are unintended [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa (SSA), approximately 45% of pregnancies in young women aged 15\u0026ndash;19 years are unintentional, leading to unintended births and unsafe abortions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Approximately 50% of cases of unsafe abortion in sub-Saharan Africa occur among adolescent girls and young women younger than 25 years of age [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several factors have been associated with a higher rate of adolescent pregnancy. These include rural residence, poverty, low education levels, poor access to contraception, low condom use, low levels of knowledge about pregnancy risks, and transactional sex [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Zambia, the prevalence of pregnancy during adolescence is worryingly high. According to the latest 2018 Zambia Demographic and Health Survey (2018 ZDHS), 29% of young girls aged less than 20 years were mothers or pregnant with their first child [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This percentage is slightly higher than the percentages found in 2007 (27.9%) and in 2014 (28.5%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], indicating an upwards trend [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, girls residing in rural areas were twice as likely to become pregnant before the age of 20 years compared to their urban counterparts. Additionally, wealth and education level were shown to have an inverse relationship with adolescent pregnancy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Adolescents without education initiated childbearing at a rate more than twice (53%) as high as those with secondary education (23%). Those in the lowest wealth quintile had the lowest (10%) level of adolescent pregnancy compared to those in the highest wealth quintile (45%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegardless of the known negative effects of adolescent pregnancy, economic limitations, sociocultural and religious norms that hinder gender equality or endorse early marriage, early initiation of sexual activity, and restricted access to sexual and reproductive health (SRH) information and services, including contraceptives, are persistent obstacles to addressing adolescent pregnancy in Zambia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChild marriage, defined as marriage before the age of 18 years, has been associated with an increased risk of adolescent pregnancy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, child marriage eliminates the sexual and reproductive health rights of adolescents and limits their opportunities to achieve their full potential. The prevalence of child marriage in Zambia is among the highest globally, with rates of 31.7% in 2014 and 29% in 2018 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Key factors driving child marriages in Zambia include heightened poverty levels, restricted access to quality education, limited life choices, and inadequate access to sexual and reproductive health services [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. While the Marriage Act in Zambia sets the legal age of marriage at 21 years, customary law permits adolescent girls to marry at an early age, provided they have reached puberty [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCultural practices have been shown to shape the sexual and reproductive behaviors of young girls [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Zambia, one of the common cultural practices is the initiation of ceremonies or pubertal rites for young girls [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Attending these ceremonies symbolizes that one has passed childhood and is free to engage in sexual activities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], an act that has raised concerns [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdolescents constitute a significant proportion of Zambia\u0026rsquo;s population, accounting for 24% of the population, and this number is projected to increase from 3.7\u0026nbsp;million to 9.8\u0026nbsp;million by 2050 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. With the trending high numbers of pregnancies among this age group, this growth poses challenges for the country to deliver essential services such as health, education, and job training to prepare them for a productive future adequately. This heightens the demand for improved measures to prevent and manage adolescent pregnancies in Zambia. To design and implement effective, country-specific interventions and policies to curb adolescent pregnancies in Zambia, it is essential to understand the determining factors. Therefore, this study examined the factors associated with adolescent pregnancies in a nationally representative sample of women aged 15\u0026ndash;19 years in Zambia using secondary data from the latest Zambia Demographic and Health Survey (2018 ZDHS). To comprehensively analyse intrapersonal, interpersonal, organizational, environmental, and community-level factors, we used the social-ecological framework of Broffenbrenne [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eZambia, located in southern Africa, is a low-income country. As of 2022, the country has a total population of 19,610,769, with a female population of 10,007,713 and a male population of 9,603,056 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Zambia\u0026rsquo;s Marriage Act sets the legal minimum age of marriage at 21 years [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, customary law allows adolescent girls to marry at 16 years of age, and written consent is provided by their legal guardian [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, the country has cultural ceremonies for transitioning young girls from childhood to adulthood, giving them parental rights to engage in early sexual activities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, the country has one of the highest rates of child marriage globally [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with a high incidence (29%) of adolescent pregnancy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Among adolescent girls attending primary school who become pregnant in Zambia, only 38% return to school after giving birth [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. As a result, the transition rate from lower secondary to upper secondary school has consistently remained below 50% [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The high rate of school dropout among adolescents has been feeding into the country\u0026rsquo;s cycle of intergenerational poverty [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The country undoubtedly needs measures to curb adolescent pregnancy if it is to achieve sustainable development goal 4 targets (SDG 4) by 2030 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, sampling, and participants\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study that analysed secondary data from the 2018 Zambia Demographic and Health Survey (2018 ZDHS). The survey data were collected from July 2018 to January 2019. The 2018 ZDHS used a two-stage sampling design [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. First, each of the 10 provinces in the country was stratified into rural and urban areas, resulting in 20 sampling strata. In the first stage, 545 clusters (198 from urban areas and 347 from rural areas) were selected randomly from the 10 provinces. In the second stage, a fixed number of 25 households were selected per cluster using equal probability sampling, and interviews were conducted with all males and females aged 15\u0026ndash;49 years who either were regular residents of the chosen households or had spent the night in the selected households before the survey. This resulted in interviews of 13,683 women aged 15\u0026ndash;49 years. For this study, we included all adolescents aged 15\u0026ndash;19 years with complete information on all variables of interest (n=). As a result, women aged 15\u0026ndash;19 years but with incomplete information on any variable of interest and those aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years (n=) were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eThe outcome variable in this study was \u0026ldquo;adolescent pregnancy\u0026rdquo;, which we defined as females aged 15\u0026ndash;19 years who were either currently pregnant at the time of the survey or had ever been pregnant, regardless of the outcome of the pregnancy. This included adolescents who had ever given birth, those who were pregnant at the time of the survey, and those who reported having a terminated pregnancy. In the 2018 ZDHS, women were asked questions about current and previous pregnancies. The following three questions were asked: (a) \u0026ldquo;Are you pregnant now? (yes/no or not sure)\u0026rdquo; (b) \u0026ldquo;Have you ever given birth? (yes/no)\u0026rdquo; and \u0026ldquo;Have you ever had a terminated pregnancy? (yes/no)\u0026rdquo;. A binary dependent variable was created, and adolescents who were pregnant at the time of the survey, had given birth before, or ever had a terminated pregnancy were categorized as \u0026ldquo;having adolescent pregnancy\u0026rdquo; and assigned a code of 1 for this variable; otherwise, they were categorized as \u0026ldquo;not having adolescent pregnancy\u0026rdquo; and assigned a code of 0 for this variable. Concentrating solely on adolescents who were currently pregnant during the survey would have resulted in an underestimation of the true prevalence of adolescent pregnancy. This is because some girls may have been pregnant in the past and already given birth, while others may have experienced pregnancies that were terminated. A similar concept has been used in prior adolescent studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eThis study utilized the socioecological model (SEM) as a comprehensive framework for identifying factors that could influence adolescent pregnancy in Zambia. The socioecological model was first proposed by Bronfenbrenner [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and later redefined by McLeroy et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] to promote health-related behavioral change. Based on the SEM, factors that could influence adolescent pregnancy were selected at the intrapersonal, interpersonal, organizational, and environmental levels (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIntrapersonal\u003c/h2\u003e \u003cp\u003eThe intrapersonal dimension within the socioecological framework examines the physical and cognitive attributes of the adolescent, along with her previous experiences [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Factors at the intrapersonal level include age, knowledge about contraception, current use of contraception, marital status, employment status, education level, wealth, exposure to media, and sexual behavior (early sex debut, transactional sex, unprotected sex, multiple sexual partners). Low education levels lead to limited knowledge about contraception and the consequences of early pregnancy. As a result, adolescents with low education levels are likely to engage in sexual behavior that increases their chances of pregnancy, such as early sex debut [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], unprotected sex [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and underutilization of contraception [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, adolescents who engage in early sexual debut are more likely to have multiple sexual partners, engage in unprotected sex, and experience adolescent pregnancy [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Furthermore, poverty may push adolescents towards early sexual activity for economic survival, increasing their chances of pregnancy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Exposure to media, such as newspapers, magazines, radio, and television, can influence adolescents\u0026rsquo; access to information and resources related to sexual health. Media exposure can have both positive and negative effects on adolescent sexual health [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Although media content has the potential to reinforce unfavourable stereotypes and encourage risky sexual behavior [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], it can also serve as a potent instrument for spreading accurate information and advocating for positive social norms [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eInterpersonal\u003c/h2\u003e \u003cp\u003eInterpersonal-level factors refer to the influences and dynamics at the level of personal relationships and interactions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These factors play a crucial role in shaping adolescents' behaviors and decisions related to sexual activity and pregnancy. Supportive relationships, such as family influence, which enhance positive sexual and reproductive behavior, play a significant role in shaping adolescents' sexual and reproductive health behaviors [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. These relationships influence the vulnerabilities and experiences related to the sexual and reproductive health of adolescents. For example, the relationship of an adolescent girl with the household head has a significant influence on adolescent pregnancy [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] because some adolescents may be married to the household head [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Moreover, the sex of the household head can predispose adolescents to pregnancy due to differences in parenting styles between male- and female-headed households [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In most LMICs, it is common for adolescents to become pregnant before they marry [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] because adolescent marriage commonly occurs as a consequence of unplanned pregnancy [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eOrganizational level\u003c/h2\u003e \u003cp\u003eOrganizational-level factors are influences that institutions and organizations impact on individual behaviors and experiences. These include religious organizations, schools, and health institutions, among others. For example, the sexual behaviors of adolescents, including contraception use, are influenced by the doctrines of their religious affiliations [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Islamic girls are more at risk of adolescent pregnancy, as many of them are susceptible to early marriage and resistant to contraception campaign messages [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Similarly, adolescent pregnancy may be influenced by the unavailability of contraception at health institutions [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Furthermore, the provision of messages on contraception and family planning via media platforms such as radio, television, and newspapers or magazines by organizations such as ministries of health can reduce or increase the risk of adolescent pregnancy [\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEnvironmental level\u003c/h2\u003e \u003cp\u003eEnvironmental-level factors refer to elements within the broader community and societal context that can influence individual behavior and health outcomes[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These factors operate beyond immediate interpersonal relationships and include aspects of physical, social, and cultural environments. For example, being poor and living in rural areas predisposes adolescents to early pregnancy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Moreover, cultural norms in which young girls are married once they reach puberty can lead to adolescent pregnancy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Similarly, norms that restrict the utilization of contraceptives are key contributing factors to adolescent pregnancy [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Cultural expectations of male dominance and female subordination limit female adolescents\u0026rsquo; decision-making autonomy concerning contraception use[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDefinition of predictor variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestion/Description\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResponse options and coding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapersonal level variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow old were you at your last birthday\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003cp\u003e4\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003cp\u003e5\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents currently working or not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Not working\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Working\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Have you ever been married or lived together with a man as if married?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Never in union\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Currently or formerly in union or lived with a man as if married\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContraception knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave you heard of any methods that women or men can use to avoid pregnancy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Knows no method\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Knows some method\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContraception use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave you ever used anything or tried in any way to delay or avoid getting pregnant?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Never used any method\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Used some method\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat is the highest level of school you attended:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;No education\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Primary\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Secondary/Higher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure to media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Do you read a newspaper or magazine?\u003c/p\u003e \u003cp\u003e2. Do you listen to the radio?\u003c/p\u003e \u003cp\u003e3. Do you watch television?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;No for all three platforms\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Yes for one platform\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Yes for any two platforms\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;Yes for all three platforms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWealth quintile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComposite measure of a household's cumulative living standard. This was collapsed into three categories for simpler analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Poorest\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Poorer\u003c/p\u003e \u003cp\u003e3\u0026thinsp;=\u0026thinsp;Middle\u003c/p\u003e \u003cp\u003e4\u0026thinsp;=\u0026thinsp;Richer\u003c/p\u003e \u003cp\u003e5\u0026thinsp;=\u0026thinsp;Richest\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at sex debut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge at which adolescent had first sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Not initiated sex\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;15\u0026ndash;17 years\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;18\u0026ndash;19 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of sexual partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of sexual partners in the last 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;No sex partners\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;One\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;More than one\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiteracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents were asked to read any part of a sentence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Cannot read at all\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Able to read at least part of the sentence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInterpersonal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex of household head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs the household head male or female?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Male\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Female\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganizational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat is your religion?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Catholic\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Other\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation dissemination about family planning via radio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents asked whether they had heard about family planning on the radio in the last few months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Not heard about family planning\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Heard about family planning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation dissemination about family planning via television\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents asked whether they had heard about family planning on television in the last few months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Not heard about family planning\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Heard about family planning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation dissemination about family planning via newspapers or magazines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondents asked whether they had heard about family planning in newspapers or magazines in the last few months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Not heard about family planning\u003c/p\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Heard about family planning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnvironmental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of Residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe type of residence where the respondent was interviewed as either urban or rural.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Urban\u003c/p\u003e \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Rural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe analysed the data using SPSS version 22. We accounted for the multistage sampling design used in the DHS survey and generated representative estimates for the country by utilizing the complex sample procedure within the SPSS software. This was achieved by establishing a complex sampling plan (CSPLAN) using the CSPLAN command, considering individual weights, clusters (primary sampling units), and strata adjustments per the guidelines outlined by the DHS for managing individual weight variables [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. The sociodemographic characteristics of the participants are presented using descriptive statistics. To identify factors that were associated with adolescent pregnancy, we first conducted an unadjusted logistic regression analysis and generated crude odds ratios (CORs). Predictor variables that were significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the unadjusted model were included in the adjusted regression analysis model. We selected a cut-off p value of \u0026lt;\u0026thinsp;0.2 to ensure that all potentially important predictive variables were included in the multivariable regression [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. According to the adjusted regression model, variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered to be significantly associated with adolescent pregnancy. We present the adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs).\u003c/p\u003e \u003cp\u003eEthical considerations\u003c/p\u003e \u003cp\u003eA formal request was submitted to the DHS program through their website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.dhsprogram.com\" target=\"_blank\"\u003ewww.dhsprogram.com\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.dhsprogram.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) to obtain permission to use the data, and approval was granted on December 26, 2023. The original data collection for the Zambia Demographic and Health Survey (ZDHS) was conducted with ethical approval from the Tropical Disease and Research Center (TDRC) and the Research Ethics Review Board of the Center for Disease Control and Prevention (CDC) Atlanta. The procedures used to obtain ethical approval by the DHS are available on their website available at [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Since this study relied on secondary data sources, no additional ethical approval was needed. However, consent was obtained from individuals aged 18 years and above during the DHS survey. For participants aged 15\u0026ndash;17 years, assent was obtained along with consent from their parents or legal guardians, as per the DHS protocol. No identifying data or images were used in the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe included data from 2,996 adolescents in the analysis. The prevalence of adolescent pregnancy was 29.9% (n\u0026thinsp;=\u0026thinsp;895), of which 24.1% (n\u0026thinsp;=\u0026thinsp;723) had ever given birth to a live baby, 6.8% (n\u0026thinsp;=\u0026thinsp;205) were pregnant at the time of the survey, and 1.7% (n\u0026thinsp;=\u0026thinsp;50) had a terminated pregnancy. The majority of adolescents were not working (82.5%, n\u0026thinsp;=\u0026thinsp;2473) and had never been in a union (84.4%, n\u0026thinsp;=\u0026thinsp;2528). Most adolescents knew some method of contraception (94.8%, n\u0026thinsp;=\u0026thinsp;2841) and had never used any method of contraception (82.2%, n\u0026thinsp;=\u0026thinsp;2462). Close to half (49.7%, 1489) of the adolescents had initiated sexual intercourse. More than one-third of the adolescents (37.7%, n\u0026thinsp;=\u0026thinsp;1128) had no exposure to either radio, television, newspapers, or magazines, and the majority (75.7%, n\u0026thinsp;=\u0026thinsp;2269) were literate. More than half (50.3%, n\u0026thinsp;=\u0026thinsp;1507) had not initiated sexual intercourse, and the majority (59.0%, n\u0026thinsp;=\u0026thinsp;1767) had no sex partners. Most adolescents had male household heads (72.2%, n\u0026thinsp;=\u0026thinsp;2162) and were from rural areas (55.9%, n\u0026thinsp;=\u0026thinsp;1676). The majority of adolescents had never heard about family planning on the radio (88.3%, n\u0026thinsp;=\u0026thinsp;2645), television (91.8%, n\u0026thinsp;=\u0026thinsp;2750), or newspapers and magazines (96.2%, n\u0026thinsp;=\u0026thinsp;2882). The details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of adolescent girls in Zambia according to the 2018 ZDHS (N\u0026thinsp;=\u0026thinsp;2996)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapersonal level factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever in union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently or formerly in a union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraception knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnows no method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnows some method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraception use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever used any method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsed some method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to radio, television, and newspapers or magazines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo for all three platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for one platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for any two platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for all three platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth quintile\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRicher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRichest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot initiated sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of sexual partners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo sex partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiteracy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCannot read at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to read at least part of the sentence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInterpersonal level factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex of household head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganizational level factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning on the radio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning on television\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning in newspapers or magazines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnvironmental level factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of place of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of adolescent pregnancy among adolescent girls in Zambia in 2018\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver given birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0-26.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnant at the time of the survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u0026ndash;8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver had a terminated pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u0026ndash;2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny of the above\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e895\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e29.9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e27.6\u0026ndash;32.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCI: Confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of adolescent pregnancy among girls with sexual experience in Zambia\u003c/h2\u003e \u003cp\u003eTo determine factors associated with adolescent pregnancy among girls with sexual experience in Zambia, we first conducted univariable logistic regression to generate crude odds ratios (CORs) in the unadjusted model. After that, adjusted odds ratios (AORs) were generated by conducting multivariable logistic regression, adjusting for all variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 from the unadjusted model. The multivariable model explained 40.3% (Nagelkerke R square) of the variance in the dependent variable and correctly classified 72.5% of the cases. After adjusting for the effects of confounding variables, age, marital status, knowledge about contraception, use of contraception, wealth, age at first sex, literacy, and exposure to family planning messages in newspapers or magazines were found to be factors independently associated with adolescent pregnancy. Compared to those of adolescents aged 15 years, the odds of adolescent pregnancy significantly increased with increasing age (AOR\u0026thinsp;=\u0026thinsp;2.0; 95% CI: 1.1, 3.6 for 16 versus 15; AOR\u0026thinsp;=\u0026thinsp;3.8; 95% CI: 2.1, 7.1 for 17 versus 15; AOR\u0026thinsp;=\u0026thinsp;4.1; 95% CI: 2.4, 7.1 for 18 versus 15; AOR\u0026thinsp;=\u0026thinsp;5.9; 95% CI: 3.3, 10.5 for 19 versus 15). Adolescent girls who were currently or formerly married were 5.4 times more likely to have been pregnant than those who had never been in a union (AOR\u0026thinsp;=\u0026thinsp;5.4; 95% CI: 3.7, 7.9). The odds of adolescent pregnancy among girls who knew about some methods of contraception were 3.4 times greater than the odds among girls who did not know about any method of contraception (AOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.2, 9.8). Moreover, adolescents who had previously used contraception were 3.0 times more likely to have experienced pregnancy than were those who had never used contraception (AOR\u0026thinsp;=\u0026thinsp;3.0; 95% CI: 2.2, 4.2). Compared to those of adolescents in the richest wealth quintile, the odds of adolescent pregnancy significantly increased with decreasing wealth (AOR\u0026thinsp;=\u0026thinsp;2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR\u0026thinsp;=\u0026thinsp;3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR\u0026thinsp;=\u0026thinsp;4.2; 95% CI: 2.0, 8.9 for poorer versus richest). Furthermore, adolescents who initiated sexual activity at younger ages were found to be significantly more likely to experience pregnancy than were those who initiated sex at ages 18\u0026ndash;19 years (AOR\u0026thinsp;=\u0026thinsp;2.1; 95% CI: 1.3, 3.4 for 15\u0026ndash;17 versus 18\u0026ndash;19; AOR\u0026thinsp;=\u0026thinsp;3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18\u0026ndash;19). The odds of adolescent pregnancy among girls who could not read were 1.7 times greater than the odds among girls who could read (AOR\u0026thinsp;=\u0026thinsp;1.7; 95% CI: 1.1, 2.6). Adolescents with no exposure to family planning messages in either newspapers or magazines were 2.6 times more likely to experience pregnancy than those with exposure (AOR\u0026thinsp;=\u0026thinsp;2.6; 95% CI: 1.1, 6.4). The details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with adolescent pregnancy among adolescent girls with sexual experience in Zambia according to the 2018 ZDHS (N\u0026thinsp;=\u0026thinsp;1489)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant during adolescence\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever been pregnant.\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnadjusted model\u003c/p\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted model.\u003c/p\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7 (0.9\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.0 (1.1\u0026ndash;3.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169 (59.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.1 (1.8\u0026ndash;5.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.8 (2.1\u0026ndash;7.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e308 (66.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.1 (2.6\u0026ndash;6.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.1 (2.4\u0026ndash;7.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e292 (68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.5 (2.8\u0026ndash;7.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5.9 (3.3\u0026ndash;10.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot employed (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e631 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e490 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e264 (71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.9 (1.5\u0026ndash;2.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.5-1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever in union (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e473 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e548 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently or formerly in a union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e422 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e10.8 (7.6\u0026ndash;15.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5.4 (3.7\u0026ndash;7.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraception knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnows no method (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnows some method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e885 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e574 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.9 (1.2\u0026ndash;7.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.4 (1.2\u0026ndash;9.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraception use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever used any method (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e474 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e486 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsed some method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e421 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.0 (3.0-5.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.0 (2.2\u0026ndash;4.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to radio, television, and newspapers or magazines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for all three platforms (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for any two platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3 (0.8\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1 (0.6\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, for one platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e230 (57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.8 (1.1\u0026ndash;2.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2 (0.6\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo for all three platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e472 (69.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.2 (2.0\u0026ndash;5.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6 (0.8\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth quintile\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRichest (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132 (71.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRicher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.1 (1.8\u0026ndash;5.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.3 (1.2\u0026ndash;4.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.1 (2.4\u0026ndash;7.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.8 (1.9\u0026ndash;7.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.7 (2.8\u0026ndash;7.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.4 (1.7\u0026ndash;6.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e239 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7.2 (4.2\u0026ndash;12.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.2 (2.0-8.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;19 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e589 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e381 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.0 (1.4\u0026ndash;2.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.1 (1.3\u0026ndash;3.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.6 (1.7\u0026ndash;3.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.8 (2.1\u0026ndash;6.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiteracy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to read at least part of the sentence (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e542 (53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e472 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCan not read at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e353 (74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.5 (1.8\u0026ndash;3.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.7 (1.1\u0026ndash;2.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex of household head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e675 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e388 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.6 (1.3\u0026ndash;2.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0 (0.7\u0026ndash;1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e738 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e482 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1 (0.8\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning on the radio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e783 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e510 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1 (0.8\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning on television\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e854 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e538 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.1 (1.1\u0026ndash;4.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4 (0.7\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeard about family planning in newspapers or magazines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e887 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e572 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.3 (1.8\u0026ndash;10.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.6 (1.1\u0026ndash;6.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of place of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e249 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e635 (64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e345 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.8 (1.3\u0026ndash;2.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.4\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eRef: reference category; AOR: adjusted odds ratio; COR: crude odds ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study used the 2018 ZDHS data to examine the prevalence of adolescent pregnancy and associated factors among Zambian girls. The prevalence of adolescent pregnancy was 29.9%, indicating a decrease from the reported prevalence of 31.7% in the country's 2014 demographic and health survey [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, despite this decline, the prevalence remains notably higher than that in many African regions. Specifically, the prevalence of adolescent pregnancy in Zambia surpassed that in East Africa (21.5%), West Africa (17.7%), Central Africa (15.8%), Southern Africa (20.5%), and the entire African continent (18.8%) [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. This underscores the urgent need for targeted interventions to address this pressing public health challenge in Zambia. The marginal decrease in adolescent pregnancy rates in Zambia from 31.7% in 2014 to 29.9% in 2018 may be attributed to the implementation of diverse strategies by collaborating stakeholders. For instance, initiatives such as the RISE project enrolled 4,900 girls from 157 schools in 12 rural districts in Zambia into comprehensive sexuality education programs between 2016 and 2018 [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. A similar reduction in adolescent pregnancy has been reported in other African countries, such as Sierra Leone [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] and Kenya [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe odds of adolescent pregnancy increased with increasing age. These findings are consistent with a multicountry analysis conducted across 32 African countries [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. A possible explanation for this observed finding could be related to factors such as increased exposure to sexual activity, higher chances of getting married for older adolescents, and greater autonomy and independence that accompany aging [\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAdolescents who were currently or formerly married had greater odds of pregnancy than those who had never been in a union. Married adolescents have limited decision-making power regarding their reproductive health [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Moreover, married adolescents have restricted access to contraception, and this is coupled with the cultural expectation of childbearing and fertility pressure that comes with marriage [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. To effectively combat adolescent pregnancy in Zambia, strategies aimed at addressing barriers to adolescents\u0026rsquo; autonomy in reproductive health within marital relations and promoting their access to contraception are imperative. Second, efforts should aim at addressing the issue of adolescent marriage by advocating for policies and programs that discourage early unions. In Zambia, the Marriage Act established the legal age of marriage at 21 years, but customary law permits adolescent girls to marry upon reaching puberty [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is therefore essential to address this inconsistency between statutory and customary laws in Zambia to ensure that legal frameworks safeguard young girls from early and forced marriages, thereby contributing to efforts to reduce adolescent pregnancy in Zambia.\u003c/p\u003e \u003cp\u003eContrary to findings from previous studies in which knowledge and use of contraception reduced the risk of adolescent pregnancy [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e], our analysis revealed that adolescents with prior knowledge of contraception and those who had previously used some form of contraception had greater odds of pregnancy than their counterparts. This could partly be attributed to contraception failure due to incorrect or inconsistent use of contraception [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e]. Despite the increased use of contraception in most developing countries, contraceptive failure remains common due to inadequate contraceptive counselling, awareness, and utilization skills, which has led to unplanned and unwanted pregnancies [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e]. To enhance the efficiency and effectiveness of contraception methods among adolescents, it is essential that strategies, in addition to promoting contraception use and access, include education on the correct use of contraceptives. The high rate of pregnancy among adolescents who used contraception suggests an unaddressed contraceptive need, potentially resulting from factors such as interruptions in the supply of contraceptives [\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. Qualitative studies are therefore warranted to explore the underlying factors contributing to the observed phenomenon and to gain a more comprehensive understanding of adolescents' experiences, perceptions, and behaviors regarding contraception use.\u003c/p\u003e \u003cp\u003eAdolescents' socioeconomic status, measured as the wealth index, was another major factor associated with adolescent pregnancy. Adolescents from the poor, middle, and wealthy households had greater odds of pregnancy than did those from the richest households. Previous studies in Africa have highlighted the impact of poverty on adolescent pregnancy [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e], and similar trends have been reported in European countries [\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e]. Poverty may push adolescents towards early sexual activity for economic survival, increasing their chances of pregnancy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The socioeconomic pattern observed in our analysis and supported by previous studies underscores the urgent need for targeted interventions to address socioeconomic inequalities in access to sexual and reproductive health services and information for adolescents.\u003c/p\u003e \u003cp\u003eAs anticipated, early sexual debut emerged as a significant predisposing factor for adolescent pregnancy. Adolescents who engaged in early sexual debut had a greater risk of experiencing pregnancy. Previous studies have revealed that adolescents who initiate sexual activity at an early age are more likely to engage in sexual behaviors that increase their vulnerability to pregnancy, such as having multiple sexual partners and not using protection during sexual intercourse [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This finding underscores the importance of implementing targeted interventions to delay the initiation of sexual intercourse among adolescents.\u003c/p\u003e \u003cp\u003eLiteracy level was another significant determinant of adolescent pregnancy. Adolescents who could not read had greater odds of pregnancy than those who could read at least part of a sentence. Low literacy levels can lead to limited knowledge about contraception and the consequences of early pregnancy. Consequently, adolescents with low literacy levels are likely to engage in sexual behavior that increases their risk of pregnancy, such as early sex debut [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], unprotected sex [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and underutilization of contraception [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study revealed a significant association between exposure to messaging on contraception through newspapers and adolescent pregnancy. This finding aligns with previous studies suggesting that media platforms, such as newspapers, play a crucial role in disseminating information about family planning, potentially lowering the risk of adolescent pregnancy [\u003cspan additionalcitationids=\"CR90\" citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e]. However, exposure to messages through radio and television did not significantly influence adolescent pregnancy risk in our study. One possible explanation for this could be the variation in the reach and accessibility of different media platforms among adolescents. Newspapers may reach a more literate audience who is more likely to engage with and act upon the information provided [\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e]. Moreover, previous studies have reported mixed results regarding the influence of media-based family planning messages on adolescent pregnancy risk, with some studies showing a reduction in risk with exposure to such messages, while other studies have suggested an increase in risk [\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. It is therefore crucial for policymakers to consider the diverse needs and preferences of adolescents when designing and implementing media-based family planning interventions. These communication strategies should be tailored to maximize the reach and impact of messages across different media platforms, taking into account the sociocultural context of the target population.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study used the most recently available data from the Zambia Demographic Health Survey. The analysis used weighted data from a nationally representative sample of adolescent girls in Zambia; hence, the results from this analysis can be generalized to all adolescents in Zambia. While most studies on adolescent pregnancy have reported only the prevalence of pregnancy in adolescents who either were pregnant or had given birth before, our study included even adolescents who had a terminated pregnancy, which reduced the risk of underreported pregnancy. However, the results from this study should be interpreted considering that it was cross-sectional in nature; hence, we cannot infer causality between the independent variables and adolescent pregnancy. Moreover, the data collection was retrospective and relied on self-reported responses, with no verification performed through records. Therefore, we anticipate that there could have been recall bias and social desirability bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile there has been a marginal decrease in adolescent pregnancy rates in Zambia, from 31.7% reported in 2014 to 29.9% in 2018, the prevalence remains considerably higher than that in many other African countries. Factors associated with adolescent pregnancy included older age, being married, low literacy levels, low socioeconomic status, early sexual debut, and lack of exposure to family planning messages via newspapers. It is therefore essential to align statutory and customary laws regarding the legal age of marriage in Zambia and implement behavioural change communication strategies that discourage early sexual debut, particularly targeting older adolescents. Additionally, the role of media platforms, particularly newspapers, in disseminating information about family planning in Zambia is crucial. Furthermore, efforts to promote comprehensive education on the correct use of contraception while ensuring consistent access to contraception among adolescents should be encouraged.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e: adjusted odds ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOR\u003c/strong\u003e: Crude odds ratio\u003c/p\u003e\n\u003cp\u003eLMICs: low- and middle-income countries\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSDG:\u0026nbsp;\u003c/strong\u003eSustainable Development Goal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSEM:\u0026nbsp;\u003c/strong\u003eSocioecological Model\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZDHS\u003c/strong\u003e: Zambia Demographic and Health Survey\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA formal request to use the data were made to the DHS program through their website [67], and permission to use the data were granted on 26\u003csup\u003eth\u003c/sup\u003e December 2023. The approval letter is attached and available for review. The original data collection was carried out with ethical approval from the Tropical Disease and Research Center (TDRC) and the Research Ethics Review Board of the Centers for Disease Control and Prevention (CDC) Atlanta. As this study utilized secondary data sources, no additional ethical approval was needed. However, the process of collecting data for the Zambia Demographic and Health Survey (ZDHS) involved obtaining consent from individuals aged 18 and above. For participants aged 15\u0026ndash;17 years, assent was obtained in addition to consent from their parents or legal guardians, as mandated by the DHS protocol. No identifying data or images were used in the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this analysis are publicly available upon request through the DHS program website (www.dhsprogram.com).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWM\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eled the study conception and design, analysis, and interpretation and drafted the manuscript. BJ participated in the corrections and review of the manuscript\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAll\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. Adolescent health. [cited 13 Dec 2023]. Available: https://www.who.int/health-topics/adolescent-health#tab=tab_1\u003c/li\u003e\n\u003cli\u003eSvanemyr J. Adolescent pregnancy and social norms in Zambia. Cult Health Sex. 2020;22: 615\u0026ndash;629. doi:10.1080/13691058.2019.1621379\u003c/li\u003e\n\u003cli\u003eGanchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121 Suppl 1: 40\u0026ndash;48. doi:10.1111/1471-0528.12630\u003c/li\u003e\n\u003cli\u003eConde-Agudelo A, Beliz\u0026aacute;n JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. Am J Obstet Gynecol. 2005;192: 342\u0026ndash;349. doi:10.1016/j.ajog.2004.10.593\u003c/li\u003e\n\u003cli\u003eChen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36: 368\u0026ndash;373. doi:10.1093/IJE/DYL284\u003c/li\u003e\n\u003cli\u003eSingh S, Bankole A, Moore AM, Mutua MM, Izugbara C, Kimani E, et al. Incidence and Complications of Unsafe Abortion in Kenya. 2013. Available: https://www.guttmacher.org/report/incidence-and-complications-unsafe-abortion-kenya\u003c/li\u003e\n\u003cli\u003eShah IH, \u0026Aring;hman E. Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women. Reprod Health Matters. 2012;20: 169\u0026ndash;173. doi:10.1016/S0968-8080(12)39598-0\u003c/li\u003e\n\u003cli\u003eDarroch JE, Woog V, Bankole A, Ashford LS, Points K. Costs and Benefits of Meeting the Contraceptive Needs of Adolescents. 2016 [cited 14 Dec 2023]. Available: https://www.guttmacher.org/adding-it-up\u003c/li\u003e\n\u003cli\u003eDoyle AM, Mavedzenge SN, Plummer ML, Ross DA. The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveysRevue: Comportement sexuel des adolescents en Afrique subsaharienne: Profils et tendances dans les enqu\u0026ecirc;tes nationalesRevisi\u0026oacute;n: El comportamiento sexual de adolescentes en \u0026Aacute;frica subsahariana: Patrones y tendencias en censos nacionales. Tropical Medicine \u0026amp; International Health. 2012;17: 796\u0026ndash;807. doi:10.1111/J.1365-3156.2012.03005.X\u003c/li\u003e\n\u003cli\u003eWellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. Sexual behaviour in context: a global perspective. The Lancet. 2006;368: 1706\u0026ndash;1728. doi:10.1016/S0140-6736(06)69479-8\u003c/li\u003e\n\u003cli\u003eStoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of \u0026ldquo;transactional sex\u0026rdquo; in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med. 2016;168: 186\u0026ndash;197. doi:10.1016/J.SOCSCIMED.2016.09.023\u003c/li\u003e\n\u003cli\u003eSommer M, Mmari K. Addressing structural and environmental factors for adolescent sexual and reproductive health in low- and middle-income countries. Am J Public Health. 2015;105: 1973\u0026ndash;1981. doi:10.2105/AJPH.2015.302740\u003c/li\u003e\n\u003cli\u003eMmari K, Sabherwal S. A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: An update. Journal of Adolescent Health. 2013;53: 562\u0026ndash;572. doi:10.1016/j.jadohealth.2013.07.018\u003c/li\u003e\n\u003cli\u003eZambia Statistics Agency. 2018 Demographic and Health Survey Summary Report Zambia. 2018. Available: www.zamstats.gov.zm\u003c/li\u003e\n\u003cli\u003eMenon JA, Kusanthan T, Mwaba SOC, Juanola L, Kok MC. \u0026ldquo;Ring\u0026rdquo; your future, without changing diaper - Can preventing teenage pregnancy address child marriage in Zambia? PLoS One. 2018;13. doi:10.1371/journal.pone.0205523\u003c/li\u003e\n\u003cli\u003eMalunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000\u0026ndash;2022. Archives of Public Health. BioMed Central Ltd; 2023. doi:10.1186/s13690-023-01045-y\u003c/li\u003e\n\u003cli\u003eFeyissa GT, Tolu LB, Soboka M, Ezeh A. Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence. Frontiers in Reproductive Health. 2023;5: 1105390. doi:10.3389/FRPH.2023.1105390/FULL\u003c/li\u003e\n\u003cli\u003eA Situation Report on Child Marriages in Zambia | Zambia | World Vision International. [cited 16 Dec 2023]. Available: https://www.wvi.org/zambia/article/situation-report-child-marriages-zambia\u003c/li\u003e\n\u003cli\u003eUNICEF. Case study on ending child marriage in the Republic of Zambia. 2021. \u003c/li\u003e\n\u003cli\u003eMuthengi E, Muthoni L, Austrian K. Comparing Cohabiting Unions and Formal Marriages Among Adolescent Girls in Zambia: The Role of Premarital Fertility and Parental Support. Journal of Adolescent Health. 2022;70: S47\u0026ndash;S53. doi:10.1016/J.JADOHEALTH.2021.11.024\u003c/li\u003e\n\u003cli\u003eMunthali AC, Zulu EM. The Timing and role of Initiation Rites in Preparing Young People for Adolescence and Responsible Sexual and Reproductive Behaviour in Malawi. Afr J Reprod Health. 2007;11: 150. doi:10.2307/25549737\u003c/li\u003e\n\u003cli\u003eMbozi P. THE IMPACT OF NEGATIVE CULTURAL PRACTICES ON THE SPREAD OF HIV / AIDS IN ZAMBIA. 2000. \u003c/li\u003e\n\u003cli\u003eGroup WB. Adolescent Girls in Zambia: Executive Summary. 2015 [cited 16 Dec 2023]. doi:10.1596/K8898\u003c/li\u003e\n\u003cli\u003eBronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977;32: 513\u0026ndash;531. doi:10.1037/0003-066X.32.7.513\u003c/li\u003e\n\u003cli\u003eZamStats. 2022 CENSUS OF POPULATION AND HOUSING PRELIMINARY REPORT REPUBLIC OF ZAMBIA. 2022. Available: www.zamstats.gov.zm\u003c/li\u003e\n\u003cli\u003eZuilkowski SS, Henning M, Zulu J, Matafwali B. Zambia\u0026rsquo;s school re-entry policy for adolescent mothers: Examining impacts beyond re-enrollment. Int J Educ Dev. 2019;64: 1\u0026ndash;7. doi:10.1016/J.IJEDUDEV.2018.11.001\u003c/li\u003e\n\u003cli\u003eUNFPA. GRZ/UNFPA 8th Country Programme Evaluation: Zambia Final Evaluation Report. 2016. \u003c/li\u003e\n\u003cli\u003eSustainable Development Goal 4: Quality Education | United Nations in Zambia. [cited 18 Dec 2023]. Available: https://zambia.un.org/en/sdgs/4\u003c/li\u003e\n\u003cli\u003eZDHS. 2018 Zambia Demographic and Health Survey. 2018. Available: www.zamstats.gov.zm\u003c/li\u003e\n\u003cli\u003eAhinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis. PLoS One. 2021;16. doi:10.1371/journal.pone.0246308\u003c/li\u003e\n\u003cli\u003eDonatus L, Sama DJ, Tsoka-Gwegweni JM, Cumber SN. Factors associated with adolescent school girl\u0026rsquo;s pregnancy in Kumbo East Health District North West region Cameroon. Pan Afr Med J. 2018;31. doi:10.11604/PAMJ.2018.31.138.16888\u003c/li\u003e\n\u003cli\u003eMcleroy KR, Bibeau D, Steckler A, Glanz K. An Ecological Perspective on Health Promotion Programs. http://dx.doi.org/101177/109019818801500401. 1988;15: 351\u0026ndash;377. doi:10.1177/109019818801500401\u003c/li\u003e\n\u003cli\u003eCheedalla A, Moreau C, Burke AE. Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011\u0026ndash;2017. Contracept X. 2020;2: 100048. doi:10.1016/J.CONX.2020.100048\u003c/li\u003e\n\u003cli\u003eMohr R, Carbajal J, Sharma BB. The Influence of Educational Attainment on Teenage Pregnancy in Low-Income Countries: A Systematic Literature Review. J Soc Work Glob Community. 2019;4. doi:10.5590/JSWGC.2019.04.1.02\u003c/li\u003e\n\u003cli\u003eWado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: A multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19: 1\u0026ndash;11. doi:10.1186/S12884-019-2204-Z/TABLES/4\u003c/li\u003e\n\u003cli\u003eJackson F, Haile ZT. Association between educational attainment and risky sexual behaviour among Ghanaian female youth. Afr Health Sci. 2023;23: 301. doi:10.4314/AHS.V23I1.32\u003c/li\u003e\n\u003cli\u003eWestall J. Poor education linked with teen pregnancies. BMJ : British Medical Journal. 1997;314: 537. doi:10.1136/bmj.314.7080.535d\u003c/li\u003e\n\u003cli\u003eMmari K, Sabherwal S. A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update. J Adolesc Health. 2013;53: 562\u0026ndash;572. doi:10.1016/J.JADOHEALTH.2013.07.018\u003c/li\u003e\n\u003cli\u003eBolarinwa OA, Tessema ZT, Frimpong JB, Babalola TO, Ahinkorah BO, Seidu AA. Spatial distribution and factors associated with adolescent pregnancy in Nigeria: a multi-level analysis. Arch Public Health. 2022;80. doi:10.1186/S13690-022-00789-3\u003c/li\u003e\n\u003cli\u003eAkanbi MA, Ope BW, Adeloye DO, Amoo EO, Iruonagbe TC, Omojola O. Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria. Afr J Reprod Health. 2021;25. Available: https://www.ajrh.info/index.php/ajrh/article/view/2995\u003c/li\u003e\n\u003cli\u003eEnvuladu E, Ohize V, Zoakah A, Agbo H. Determinants and outcome of teenage pregnancy in a rural community in Jos, Plateau State, Nigeria. Sub-Saharan African Journal of Medicine. 2014;1: 48. doi:10.4103/2384-5147.129319\u003c/li\u003e\n\u003cli\u003eLarson CP. Poverty during pregnancy: Its effects on child health outcomes. Paediatr Child Health. 2007;12: 673. doi:10.1093/PCH/12.8.673\u003c/li\u003e\n\u003cli\u003eParker RM, Williams M V., Baker DW, Nurss JR. Literacy and contraception: exploring the link. Obstetrics and gynecology. 1996;88: 72S-77S. doi:10.1016/0029-7844(96)00250-5\u003c/li\u003e\n\u003cli\u003eAlukagberie ME, Elmusharaf K, Ibrahim N, Poix S. Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reprod Health. 2023;20. doi:10.1186/s12978-023-01629-5\u003c/li\u003e\n\u003cli\u003eStella A. TEENAGE PREGNANCY AND ITS INFLUENCE ON SECONDARY SCHOOL EDUCATION IN NIGERIA. 2019. \u003c/li\u003e\n\u003cli\u003eHust SJT, Brown JD, L\u0026rsquo;Engle KL. Boys Will Be Boys and Girls Better Be Prepared: An Analysis of the Rare Sexual Health Messages in Young Adolescents\u0026rsquo; Media. Mass Commun Soc. 2008;11: 3\u0026ndash;23. doi:10.1080/15205430701668139\u003c/li\u003e\n\u003cli\u003eSserwanja Q, Sepenu AS, Mwamba D, Mukunya D. Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey. BMJ Open. 2022;12. doi:10.1136/BMJOPEN-2021-052684\u003c/li\u003e\n\u003cli\u003eAsp G, Pettersson KO, Sandberg J, Kabakyenga J, Agardh A. Associations between mass media exposure and birth preparedness among women in southwestern Uganda: a community-based survey. Glob Health Action. 2014;7. doi:10.3402/GHA.V7.22904\u003c/li\u003e\n\u003cli\u003eSvanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. J Adolesc Health. 2015;56: S7\u0026ndash;S14. doi:10.1016/J.JADOHEALTH.2014.09.011\u003c/li\u003e\n\u003cli\u003eWorku MG, Tessema ZT, Teshale AB, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15\u0026ndash;19 years) in East Africa: a multilevel analysis. BMC Pregnancy Childbirth. 2021;21: 1\u0026ndash;8. doi:10.1186/S12884-021-03713-9/TABLES/5\u003c/li\u003e\n\u003cli\u003eWado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19. doi:10.1186/S12884-019-2204-Z\u003c/li\u003e\n\u003cli\u003eBaruwa OJ, Mkwananzi S, Amoateng AY, Naidoo N. Teenage pregnancy among unmarried teenagers in Malawi: Does sex of the household head matter? Afr J Reprod Health. 2020;24: 51\u0026ndash;57. doi:10.29063/AJRH2020/V24I4.6\u003c/li\u003e\n\u003cli\u003ePrevention or Punishment? - Teenage pregnancy and child marriage in Chadiza and Petauke, Eastern Zambia - KIT Royal Tropical Institute. [cited 22 Dec 2023]. Available: https://www.kit.nl/publication/prevention-or-punishment-teenage-pregnancy-and-child-marriage-in-chadiza-and-petauke-eastern-zambia/\u003c/li\u003e\n\u003cli\u003eTeenage pregnancy and early marriage in Timor-Leste | Plan International. [cited 22 Dec 2023]. Available: https://plan-international.org/publications/teenage-pregnancy-and-early-marriage-in-timor-leste/\u003c/li\u003e\n\u003cli\u003eManlove JS, Terry-Humen E, Ikramullah EN, Moore KA. The Role of Parent Religiosity in Teens\u0026rsquo; Transitions to Sex and Contraception. J Adolesc Health. 2006;39: 578. doi:10.1016/J.JADOHEALTH.2006.03.008\u003c/li\u003e\n\u003cli\u003eAkanbi MA, Ope BW, Adeloye DO, Amoo EO, Iruonagbe TC, Omojola O. Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria. Afr J Reprod Health. 2021;25: 138\u0026ndash;146. Available: https://www.ajol.info/index.php/ajrh/article/view/221412\u003c/li\u003e\n\u003cli\u003eMachira K, Palamuleni ME. Health Care Factors Influencing Teen Mothers\u0026rsquo; Use Of Contraceptives in Malawi. Ghana Med J. 2017;51: 88. doi:10.4314/gmj.v51i2.7\u003c/li\u003e\n\u003cli\u003ePhiri M, Kasonde ME, Moyo N, Sikaluzwe M, Simona S. A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001\u0026ndash;2018). Reprod Health. 2023;20: 1\u0026ndash;13. doi:10.1186/S12978-023-01567-2/TABLES/4\u003c/li\u003e\n\u003cli\u003ePepito VCF, Amit AML, Tang CS, Co LMB, Aliazas NAK, De Los Reyes SJ, et al. Exposure to family planning messages and teenage pregnancy: results from the 2017 Philippine National Demographic and Health Survey. Reprod Health. 2022;19: 1\u0026ndash;12. doi:10.1186/S12978-022-01510-X/TABLES/4\u003c/li\u003e\n\u003cli\u003eKozhimannil KB, Enns E, Blauer-Peterson C, Farris J, Kahn J, Kulasingam S. Behavioral and Community Correlates of Adolescent Pregnancy and Chlamydia Rates in Rural Counties in Minnesota. J Community Health. 2015;40: 493. doi:10.1007/S10900-014-9962-3\u003c/li\u003e\n\u003cli\u003eAmoadu M, Ansah EW, Assopiah P, Acquah P, Ansah JE, Berchie E, et al. Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review. BMC Pregnancy Childbirth. 2022;22. doi:10.1186/s12884-022-05172-2\u003c/li\u003e\n\u003cli\u003eEzenwaka U, Mbachu C, Ezumah N, Eze I, Agu C, Agu I, et al. Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: An application of the socio-ecological model. BMC Public Health. 2020;20: 1\u0026ndash;11. doi:10.1186/S12889-020-09276-2/TABLES/1\u003c/li\u003e\n\u003cli\u003eAhinkorah BO, Hagan JE, Seidu AA, Sambah F, Adoboi F, Schack T, et al. Female adolescents\u0026rsquo; reproductive health decision-making capacity and contraceptive use in sub-Saharan Africa: What does the future hold? PLoS One. 2020;15: e0235601. doi:10.1371/JOURNAL.PONE.0235601\u003c/li\u003e\n\u003cli\u003eShahabuddin ASM, N\u0026ouml;stlinger C, Delvaux T, Sarker M, Bardaj\u0026iacute; A, De Brouwere V, et al. What Influences Adolescent Girls\u0026rsquo; Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh. PLoS One. 2016;11: e0157664. doi:10.1371/JOURNAL.PONE.0157664\u003c/li\u003e\n\u003cli\u003eDHS. Guide to DHS Statistics DHS-7. 2023 [cited 9 Nov 2023]. Available: https://dhsprogram.com/data/Guide-to-DHS-Statistics/Analyzing_DHS_Data.htm\u003c/li\u003e\n\u003cli\u003eMalhotra RK. Errors in the use of Multivariable Logistic Regression Analysis: An Empirical Analysis. Indian J Community Med. 2020;45: 560. doi:10.4103/IJCM.IJCM_16_20\u003c/li\u003e\n\u003cli\u003eThe DHS Program - Data. [cited 22 Mar 2024]. Available: https://dhsprogram.com/data/\u003c/li\u003e\n\u003cli\u003eKassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: A systematic review and Meta-analysis. Reprod Health. 2018;15: 1\u0026ndash;17. doi:10.1186/S12978-018-0640-2/FIGURES/6\u003c/li\u003e\n\u003cli\u003eSand\u0026oslash;y IF, Mudenda M, Zulu J, Munsaka E, Blystad A, Makasa MC, et al. Effectiveness of a girls\u0026rsquo; empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: Study protocol for a cluster randomized trial. Trials. 2016;17: 1\u0026ndash;15. doi:10.1186/S13063-016-1682-9/FIGURES/2\u003c/li\u003e\n\u003cli\u003eNuwabaine L, Sserwanja Q, Kamara K, Musaba MW. Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019. BMC Public Health. 2023;23. doi:10.1186/S12889-023-15436-X\u003c/li\u003e\n\u003cli\u003eMutea L, Were V, Ontiri S, Michielsen K, Gichangi P. Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003\u0026ndash;2014. BMC Womens Health. 2022;22: 1\u0026ndash;11. doi:10.1186/S12905-022-01986-6/TABLES/5\u003c/li\u003e\n\u003cli\u003eAhinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis. PLoS One. 2021;16: e0246308. doi:10.1371/JOURNAL.PONE.0246308\u003c/li\u003e\n\u003cli\u003ePhongluxa K, Langeslag G, Jat TR, Kounnavong S, Khan MA, Essink DR. Factors influencing sexual and reproductive health among adolescents in Lao PDR. Glob Health Action. 2020;13. doi:10.1080/16549716.2020.1791426\u003c/li\u003e\n\u003cli\u003eHabitu YA, Yalew A, Bisetegn TA. Prevalence and factors associated with teenage pregnancy, northeast Ethiopia, 2017: A cross-sectional study. J Pregnancy. 2018;2018. doi:10.1155/2018/1714527\u003c/li\u003e\n\u003cli\u003eGebrie Worku M, Tadesse Tessema Z, Birhanu Teshale A, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15-19 years) in East Africa: a multilevel analysis. [cited 8 Mar 2024]. doi:10.1186/s12884-021-03713-9\u003c/li\u003e\n\u003cli\u003eMangimela-Mulundano A, Black KI, Cheney K. A cross-sectional study of women\u0026rsquo;s autonomy and modern contraception use in Zambia. BMC Womens Health. 2022;22: 1\u0026ndash;8. doi:10.1186/S12905-022-02101-5/TABLES/4\u003c/li\u003e\n\u003cli\u003eAhonsi B, Fuseini K, Nai D, Goldson E, Owusu S, Ndifuna I, et al. Child marriage in Ghana: evidence from a multi-method study. BMC Womens Health. 2019;19. doi:10.1186/S12905-019-0823-1\u003c/li\u003e\n\u003cli\u003eGrindlay K, Grossman D. Women\u0026rsquo;s perspectives on age restrictions for over-the-counter access to oral contraceptives. J Adolesc Health. 2015;56: 38\u0026ndash;43. doi:10.1016/J.JADOHEALTH.2014.08.016\u003c/li\u003e\n\u003cli\u003eHeslop J, Banda R. Reproductive Health Matters An international journal on sexual and reproductive health and rights Moving beyond the \u0026ldquo;male perpetrator, female victim\u0026rdquo; discourse in addressing sex and relationships for HIV prevention: peer research in Eastern Zambia. 2013 [cited 8 Mar 2024]. doi:10.1016/S0968-8080(13)41697-X\u003c/li\u003e\n\u003cli\u003eDixit A, Bhan N, Benmarhnia T, Reed E, Kiene SM, Silverman J, et al. The association between early in marriage fertility pressure from in-laws\u0026rsquo; and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India. Reprod Health. 2021;18: 1\u0026ndash;9. doi:10.1186/S12978-021-01116-9/TABLES/3\u003c/li\u003e\n\u003cli\u003eAhinkorah BO, Hagan JE, Seidu AA, Hormenu T, Otoo JE, Budu E, et al. Linking Female Adolescents\u0026rsquo; Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes. Healthcare 2021, Vol 9, Page 272. 2021;9: 272. doi:10.3390/HEALTHCARE9030272\u003c/li\u003e\n\u003cli\u003eIyanda AE, Dinkins BJ, Osayomi T, Adeusi TJ, Lu Y, Oppong JR. Fertility knowledge, contraceptive use and unintentional pregnancy in 29 African countries: a cross-sectional study. Int J Public Health. 2020;65: 445\u0026ndash;455. doi:10.1007/S00038-020-01356-9/FIGURES/2\u003c/li\u003e\n\u003cli\u003eChandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: Needs, barriers, and access. Reprod Health. 2014;11: 1\u0026ndash;8. doi:10.1186/1742-4755-11-1/TABLES/2\u003c/li\u003e\n\u003cli\u003eMalunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000\u0026ndash;2022. Archives of Public Health. 2023;81: 1\u0026ndash;15. doi:10.1186/S13690-023-01045-Y/TABLES/4\u003c/li\u003e\n\u003cli\u003eLarsson M, Aneblom G, Odlind V, Tyd\u0026eacute;n T. Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination. Acta Obstet Gynecol Scand. 2002;81: 64\u0026ndash;71. doi:10.1046/J.0001-6349.2001.00169.X\u003c/li\u003e\n\u003cli\u003eSedgh G, Ashford LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining Women\u0026rsquo;s Reasons for Not Using a Method. 2016. Available: https://www.guttmacher.org/report/unmet-need-for-contraception-in-developing-countries\u003c/li\u003e\n\u003cli\u003eYakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: A systematic review. Reprod Health. 2018;15: 1\u0026ndash;11. doi:10.1186/S12978-018-0460-4/TABLES/2\u003c/li\u003e\n\u003cli\u003eImamura M, Tucker J, Hannaford P, Da Silva MO, Astin M, Wyness L, et al. Factors associated with teenage pregnancy in the European Union countries: a systematic review. Eur J Public Health. 2007;17: 630\u0026ndash;636. doi:10.1093/EURPUB/CKM014\u003c/li\u003e\n\u003cli\u003eSserwanja Q, Turimumahoro P, Nuwabaine L, Kamara K, Musaba MW. Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey. BMC Womens Health. 2022;22. doi:10.1186/S12905-022-01974-W\u003c/li\u003e\n\u003cli\u003eDwomoh D, Amuasi SA, Amoah EM, Gborgbortsi W, Tetteh J. Exposure to family planning messages and contraceptive use among women of reproductive age in sub-Saharan Africa: a cross-sectional program impact evaluation study. Sci Rep. 2022;12: 18941. doi:10.1038/S41598-022-22525-1\u003c/li\u003e\n\u003cli\u003eAjaero CK, Odimegwu C, Ajaero ID, Nwachukwu CA. Access to mass media messages, and use of family planning in Nigeria: A spatio-demographic analysis from the 2013 DHS. BMC Public Health. 2016;16: 1\u0026ndash;10. doi:10.1186/S12889-016-2979-Z/TABLES/3\u003c/li\u003e\n\u003cli\u003eUnderwood C, Serlemitsos E, Macwangi M. Health Communication in Multilingual Contexts: A Study of Reading Preferences, Practices, and Proficiencies Among Literate Adults in Zambia. J Health Commun. 2007;12: 317\u0026ndash;337. doi:10.1080/10810730701325962\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent, Pregnancy, Zambia, Socioecological Model","lastPublishedDoi":"10.21203/rs.3.rs-4150984/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4150984/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobally, complications from pregnancy and childbirth are leading causes of death among adolescent girls aged 15\u0026ndash;19 years. In Zambia, adolescent pregnancy contributes to adverse maternal and newborn outcomes, perpetuating intergenerational cycles of poverty and limiting opportunities for education and economic empowerment among young mothers. This study explored factors associated with adolescent pregnancy in Zambia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study utilized data from the 2018 Zambia Demographic and Health Survey. A total of 2,996 adolescents aged 15\u0026ndash;19 years were included in the analysis. This study utilized the socioecological model to select potential influencing factors for adolescent pregnancy. Descriptive and multivariable analyses were conducted using SPSS version 22 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of adolescent pregnancy was 29.9%. Most adolescents had no sexual partners (59.0%), and 49.7% had initiated sexual intercourse. Factors independently associated with adolescent pregnancy included increasing age, marital status (AOR\u0026thinsp;=\u0026thinsp;5.4; 95% CI: 3.7, 7.9), knowledge about contraception (AOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.2, 9.8), use of contraception (AOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.2, 9.8), literacy level (AOR\u0026thinsp;=\u0026thinsp;1.7; 95% CI: 1.1, 2.6), and exposure to family planning messages in newspapers or magazines (AOR\u0026thinsp;=\u0026thinsp;2.6; 95% CI: 1.1, 6.4). Other factors included wealth status (AOR\u0026thinsp;=\u0026thinsp;2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR\u0026thinsp;=\u0026thinsp;3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR\u0026thinsp;=\u0026thinsp;4.2; 95% CI: 2.0, 8.9 for poorer versus richest) and age at first sexual intercourse (AOR\u0026thinsp;=\u0026thinsp;2.1; 95% CI: 1.3, 3.4 for 15\u0026ndash;17 versus 18\u0026ndash;19, AOR\u0026thinsp;=\u0026thinsp;3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18\u0026ndash;19).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eKey determinants of adolescent pregnancy in Zambia include older age, early marriage, low literacy, low socioeconomic status, early sexual initiation, and limited exposure to family planning messages via newspapers. Interventions to address this problem should include behavioral change communication strategies that discourage early sexual debut, especially among older adolescents. Furthermore, leveraging media platforms, particularly newspapers, in disseminating accurate messages on contraception and enforcing statutory laws on the legal age of marriage are crucial efforts in addressing this problem.\u003c/p\u003e","manuscriptTitle":"Determinants of adolescent pregnancy in Zambia: A secondary data analysis of 2018 Zambia Demographic and Health Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-27 13:54:56","doi":"10.21203/rs.3.rs-4150984/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-13T07:51:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-05T04:40:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-04-30T14:07:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T10:52:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280505140856845545141647212118817107142","date":"2025-04-04T13:54:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251842961846752980992035995600040759148","date":"2025-03-26T08:36:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-10T21:53:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-26T19:45:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-23T17:44:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-23T17:44:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-03-22T16:08:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7dee9935-835b-45b5-8723-547afcecd9ea","owner":[],"postedDate":"March 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:04:30+00:00","versionOfRecord":{"articleIdentity":"rs-4150984","link":"https://doi.org/10.1186/s12884-025-08063-4","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-10-02 15:58:04","publishedOnDateReadable":"October 2nd, 2025"},"versionCreatedAt":"2024-03-27 13:54:56","video":"","vorDoi":"10.1186/s12884-025-08063-4","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08063-4","workflowStages":[]},"version":"v1","identity":"rs-4150984","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4150984","identity":"rs-4150984","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}