Factors associated with unintended pregnancies among unmarried adolescents and the potential of using mobile money shops: A Cross-sectional study in Eastern Uganda
Authors: Komasawa Makiko , Sato Miho , Saito Kiyoko , Honda Sumihisa , Ssekitoleko Robert , Waiswa Peter , Muluya Kharim Mwebaza , Gitta Sheba , Aung Myo Nyein 
Published: January 2025

AbstractBackgroundAdolescent sexual and reproductive health and rights (SRHR) remains a critical public health issue in low- and middle-income countries, with adverse health, educational, and economic consequences. Uganda faces significant challenges with high rates of unintended pregnancies among adolescents. This study investigated the factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda and explored the potential of using mobile money vendors to provide SRHR services.MethodsA cross-sectional study was conducted among 1267 unmarried girls/boys, aged 15-19 years, in the Busoga region. Data were collected through face-to-face interviews, using a structured questionnaire. Sociodemographic characteristics, sexual behaviors, contraceptive knowledge, and environmental factors were analyzed. Multivariate logistic regression analysis identified factors associated with unintended pregnancies.ResultsOf the adolescents who had sexual intercourse (n=876), 22.5% (n=197) experienced unintended pregnancies. Fundamental factors associated with lower prevalence of pregnancy included being a current student (adjusted odds ratio [AOR]: 0.36, 95% confidence interval [CI]: 0.24-0.54), living with parents (AOR: 0.48, 95% CI: 0.33-0.69), and teacher engagement (AOR: 0.56, 95% CI: 0.37-0.84). Factors associated with higher prevalence of pregnancy included knowledge regarding contraceptive use (AOR: 2.28, 95% CI: 1.16-4.49), parental communication (AOR: 1.91, 95% CI: 1.32-2.75), parental contraception support (AOR: 1.64, 95% CI: 1.03-2.59), and mobile phone possession (AOR: 2.31, 95% CI: 1.09-4.90). Public health facilities and community-based distributors, including mobile money vendors, were considered comfortable channels for obtaining contraceptives for adolescents who had experienced pregnancy.ConclusionsUnintended pregnancies among unmarried adolescents in Eastern Uganda were influenced by educational, parental, and environmental factors. Enhancing SRHR education from earlier ages, parental involvement, and leveraging community resources such as mobile money vendors could improve adolescent SRHR outcomes. Innovative approaches outside conventional health and education sectors are necessary for sustainable and effective adolescent SRHR programs.Trial registrationThis study was registered at Japan’s University Hospital Medical Information Network (UMIN000053332) on 12 January 2024.Plain English summaryAdolescent sexual and reproductive health and rights (SRHR) is a pressing public health issue globally. Uganda has a high rate of unintended pregnancies among adolescents. This study investigated the factors associated with unintended pregnancies among unmarried adolescents in Eastern Uganda and explored the potential of using mobile money vendors to provide SRHR services.This cross-sectional study was conducted using a structured questionnaire at 60 vendors. It included 1267 unmarried girls/boys aged 15-19 years. Of 876 adolescents who ever had sexual intercourse, 22.5% experienced unintended pregnancies. Factors associated with a lower prevalence of pregnancy were: a current student (adjusted odds ratio [AOR] = 0.36), living with parents (AOR = 0.48), and teacher engagement (AOR = 0.56). Contrarily, factors associated with a higher prevalence of pregnancy were: knowledge regarding contraceptive use (AOR = 2.28), parental communication (AOR = 1.91), parental contraception support (AOR =1.64), and mobile phone possession (AOR = 2.30), which may imply that teenagers who had experienced pregnancy tend to become more serious about contraception and engagement of parents and teachers enhanced. In addition, community-based SRHR service distributors, including mobile money vendors, were considered comfortable channels.In conclusion, unintended pregnancies among unmarried adolescents in Eastern Uganda were influenced by educational, parental, and environmental factors. Enhancing SRHR education before starting sexually active and parental and school involvement may reduce unintended pregnancies among unmarried adolescents in Eastern Uganda. In addition, leveraging accessible community-based distributors, such as mobile money vendors, may be a potential channel for delivering SRHR information and contraceptives.