Peer-reviewed article

Why do adolescent girls become pregnant? Contextual pathways to adolescent pregnancy in rural Tanzania: a mixed-methods study.

Loishiye PJ, Magoti NC, Said S, Frank J, Cheche MB et al. · 18 Jun 2026

Abstract

Introduction Adolescent pregnancy remains a significant public health and social challenge in sub-Saharan Africa, including Tanzania. The study aimed to explore contextual reasons and determinants of adolescent pregnancy among girls using a mixed-methods approach. Design A convergent mixed-methods study integrating a community-based cross-sectional survey with qualitative in-depth interviews and focus group discussions. Quantitative and qualitative data were analysed separately and integrated during interpretation using triangulation and comparative joint analysis. Setting Community-based study conducted in Korogwe District, Tanga Region, northeastern Tanzania. Participants A total of 418 adolescent girls aged 15-19 years were selected through multistage sampling for the quantitative survey. The qualitative component purposively recruited pregnant and parenting adolescents, parents/guardians and community stakeholders. Primary and secondary outcome measures The primary outcome was adolescent pregnancy, defined as ever having been pregnant, including current pregnancy. Secondary variables included sociodemographic, educational, economic, relational and contraceptive factors associated with adolescent pregnancy. Results The prevalence of adolescent pregnancy in Korogwe District was 16%. In multivariable analysis, older age (18-19 years), school discontinuation, marital union and economic vulnerability were independently associated with adolescent pregnancy. Current contraceptive use was more commonly reported among adolescents who had experienced pregnancy, a finding likely reflecting post pregnancy uptake rather than a protective effect, given the cross-sectional design. Qualitative findings revealed that poverty, transactional relationships, early unions, gendered power imbalances and misconceptions about contraception constrained adolescents' reproductive autonomy. Integrated analysis demonstrated convergence between statistical associations and lived experiences, showing that economic precarity and educational limitations operated as structural pathways influencing early union formation and limiting contraceptive decision making. Conclusions Adolescent pregnancy among girls aged 15-19 years in Korogwe District is shaped by interrelated socioeconomic, educational and gendered factors. The identified factors and contextual reasons suggest that adolescent pregnancy is a socially patterned outcome rather than solely an individual behavioural issue. Multisectoral interventions addressing school retention, economic insecurity and gender power relations are essential to reduce vulnerability.