A generalised structural equation model of the individual and contextual correlates of teenage pregnancy and modern contraceptive use among adolescent girls in Malawi
Authors: Moyo Reuben Christopher , Nyasulu Khumbo , Thom Harvey , Baluwa Phyllis , Nkhoma Dumisani 
Published: October 2023

Abstract
Background: Adolescent childbearing is a global concern especially in poor and marginalised communities. Globally, adolescent birth rates (ABR) have decreased over the years though regions such as Sub-Saharan Africa (SSA) are still experiencing high rates of teenage pregnancies. Knowledge of how the individual and contextual factors jointly predict teenage pregnancy and modern contraceptive use in a multivariable generalised structural equation model (GSEM) would be more useful in understanding the causal relationships of the purported predictors of teenage childbearing. The aim of this study was to examine individual and contextual determinants of teenage pregnancy and modern contraceptive use among adolescent girls in Malawi.
Methods: We used data from the 2019/20 Malawi multiple indicator cluster survey (MICS). We simultaneously assessed the relationship between individual and contextual correlates of teenage pregnancy and modern contraceptive use among adolescent girls using the generalised structural equation modelling (GSEM) approach. The conceptual model used in the study to determine which variables to be used in the model was based on the assumption that teenage pregnancy and modern contraceptive use are predicted by many factors broadly categorised into individual and contextual factors. Model fit was assessed using akaike information criterion (AIC), bayesian information criterion (BIC) and likelihood ratio test. All analyses were weighted using women’s sample weights.
Results: A total of 5,770 adolescent girls participated in the survey. The prevalence of teenage pregnancy among adolescents was 27.1% while contraceptive prevalence rates (CPR) were 14.65% for all adolescents and 46.5% for adolescents in union. The risk of pregnancy was high among adolescent who started sex before their 15th birthday compared to those who started sex at the age of 17 (b=-0.32, p=0.130), 18 (b= -0.55, p=0.030) and 19 (b=-0.74, p=0.050). There was strong relationship between marital status and teenage pregnancy (b=3.54, p<0.001) as well as modern contraceptive use (b=1.75, p<0.001) and those who did not use condom at last sex (b=1.57, p<0.001). The likelihood of utilising modern contraceptive was high among adolescents aged 17 (b = 1.39, P<0.001), 18 (b = 1.86, P<0.001) and 19 (b = 2.65, p<0.001). The risk of using modern contraceptives was very high among married adolescents (b=2.15, p<0.001). Adolescents who got married before their 14th birthday and those who got married at the age of 15 had higher risk of using modern contraception compared to their counterparts who got married at ages 17 (b=-0.57, p=0.013), 18 (b=-1.19, p<0.001) and 19 (b=-1.11, p<0.001) respectively.
Conclusion: We conclude from our findings that individual factors have more influence on both teenage pregnancy and modern contraceptive use among adolescents. We recommend that programming for adolescent sexual and reproductive health programs and youth friendly health services should start earlier before they become sexually active to reduce risk of early and unintended pregnancies and improve modern contraceptive use among adolescent girls.