Intrapersonal and interpersonal determinants of adolescent pregnancy among girls aged 10-18 years in Igembe north sub-county, Meru county, Kenya

Abstract

Globally, 10% of total births occur among adolescent girls aged 10 - 18 years, 90% of whom reside in Africa. Adolescent pregnancy entails high morbidity and mortality risks yet, intervention show mixed outcomes, with those found to be effective showing small effect sizes across contexts. In Kenya, adolescent pregnancy is about 18%, with Meru being one of the high burden counties, accounting for 24% among estimated 18,123 adolescent girls countrywide. Igembe North sub-County accounts for the highest proportion (59%) of adolescent pregnancy in the County. Few studies exist in Kenya on person-centered risk factors, hence the need for research to further clarify personal and interpersonal determinants of adolescent pregnancy. This is needful to enable improvements in interventions design. The current study specifically investigated occurrence of risky sexual behavior, intrapersonal and interpersonal determinants of pregnancy among adolescents who had begun childbearing, based on the Socio–ecological theory. Through a cross-sectional mixed methods design using explanatory sequential, quantitative dominant approach, 398 participants were sampled from an estimated 18,123 adolescent girls aged 10-18 years who had begun childbearing in Igembe North sub-county. Participants were recruited from 8 sub-County hospitals through simple random sampling. Quantitative data was collected using structured questionnaires (Cronbach’s , 0.88) and qualitative data through 8 focus group discussions of 8-12 participants each. Variable characteristics were summarized descriptively and frequency distributions displayed in tables and figures. Bivariate logit regression identified determinants of adolescent pregnancy (p< 0.05). The prevalence of risky sexual behavior was 59% (p= 0.001). Early sexual debut (p= 0.01); being married (p= 0.001) and; having primary-level education (p= 0.001) had an association with adolescent pregnancy. Significant intrapersonal factors were, perceived behavioral control (OR 3.98; 95%CI -0.92, -0.84; p=0.049) and intention to have sex (OR 2.01; 95%CI -0.46, -0.076; p=0.018). Living with a single parent (OR 2.42; 95%CI 1.12, 18.95; p=0.01), maternal education (primary) (OR 2.39; 95%CI .1.23,3.48; p=0.01), living with a sibling who had had adolescent pregnancy (OR 2.10; 95%CI 1.22, 5.23; p=0.03), has communication with parents on reproductive health issues (OR 0.53; 95%CI 3.12, 13.64; p=0.01) and peer pressure (OR 4.23; 95%CI 2.22,10.98; p=0.03) were significant interpersonal predictors. Intentions to have sex was a strong predictor of pregnancy and was likely mediated by family relational environment and peer factors. It is recommended that combination multi-level interventions should harness intervention components that build protective behavioral intentions as well as strengthen social dimensions to prevent adolescent pregnancy.