Relationship between socio-demographic factors and incidence of teenage pregnancy

Education (individual and parental)

A dominant and robust finding across multiple regions is that schooling is protective against
teenage pregnancy. Large population-based analyses and systematic reviews conclude that
adolescents who are in school or who have higher levels of schooling are substantially less
likely to begin childbearing during adolescence (or to report unintended pregnancy) than out-
of-school peers (pooled ORs and adjusted estimates reported in regionally focused meta-
analyses). For example, meta-analytic work on sub-Saharan Africa reported that adolescents
not attending school were more than twice as likely to start childbearing compared with those
in school, and several national studies echo this protective association for both girls’ own
education and parental education (mother’s and father’s education). (Kassa et al., 2018)

Mechanisms proposed in this literature include delayed sexual debut related to school
engagement, stronger future orientation and aspirations, better access to information
(including sexual and reproductive health (SRH)), and structural constraints on
time/opportunity for sexual partnerships while in school. Programmatic evaluations further
suggest that keeping girls in school (and policies that remove economic barriers to secondary
schooling) reduces adolescent pregnancy incidence. (Alam et al., 2023)

Contrary or nuanced findings: although the preponderance of evidence identifies education as

protective, some studies report weaker or non-significant associations after controlling for
confounders (e.g., community deprivation or household wealth), or identify bi-directional
causality where early pregnancy causes school dropout rather than the other way round (i.e.,
reverse causation). One literature review noted the difficulty of disentangling the causal
direction in cross-sectional data and called for longitudinal designs to clarify pathways.
(Kassa et al., 2018)

Socioeconomic status and poverty

Socioeconomic disadvantage is among the most commonly identified risk factors for teenage
pregnancy. Multi-country analyses and country-level studies indicate higher adolescent
pregnancy rates concentrated among lower wealth quintiles, poorer households, and
communities with greater deprivation (food insecurity, unemployment, low parental
educational attainment). Mechanisms include reduced prospects for schooling and
employment, transactional sex as a coping or survival strategy, lower access to contraception
and SRH services, and cultural practices that intersect with poverty. (Penman-Aguilar et al.,
2013) (Okoli et al., 2022)

Programmatic and ecological analyses in some high-income settings also show that county-
level deprivation is strongly associated with higher adolescent birth rates, and that
deprivation exerts a larger effect in rural versus urban counties in certain contexts. These
findings point to the interaction of poverty with access to services and normative
environments. (Orimaye et al., 2020)

Contradictory or complex findings: while most studies link lower SES to elevated risk, a few
multi-site or controlled analyses report non-significant associations between certain
socioeconomic indicators and specific pregnancy outcomes when other variables (e.g.,
antenatal care utilization, BMI, or ethnicity) are included in models. Additionally, some
qualitative studies emphasize heterogeneity in how poverty operates — in some locales,
relatively better-off adolescents may have increased mobility and privacy that can heighten
exposure to sexual risk, producing localized exceptions to the broader trend. Thus, SES
effects are real but operate via multiple proximate mechanisms that vary by setting. (Sámano
et al., 2024)

Place of residence: rural vs urban

The rural/urban association with teenage pregnancy is context dependent. Meta-analytic
results in sub-Saharan Africa indicate that adolescents residing in rural areas were
approximately twice as likely to be pregnant as their urban counterparts in pooled analyses.
Many national studies (particularly in low- and middle-income countries) similarly identify
rural residence as a risk factor, frequently attributing the difference to earlier marriage, lower
school retention, and limited access to SRH services in rural settings. (Kassa et al., 2018)
(Chemutai et al., 2022)

However, the literature also includes important exceptions. Studies of urban disadvantaged
settings (e.g., slums and inner-city neighbourhoods) document high adolescent pregnancy
prevalence and show that urban poverty and neighbourhood deprivation can elevate risk; in
some countries adolescent birth rates are higher in the most deprived urban areas and in some
instances urban disadvantaged pockets show equal or greater risk than rural areas. Research
in high-income countries has also found higher adolescent birth rates concentrated in rural
counties for certain deprivation strata, revealing that rural–urban contrasts differ by country
and policy environment. The overall conclusion is that “rural” or “urban” status alone is an
imperfect predictor; local poverty, service access and social norms are decisive mediators.
(Brahmbhatt et al., 2014) (Orimaye et al., 2020)

Marital and relationship status

Marital status (including formal marriage and cohabitation) is a highly predictive
sociodemographic factor in many low- and middle-income contexts: ever-married adolescents
have dramatically higher odds of adolescent childbearing compared with never-married peers
— a relationship that often reflects cultural norms and legal practices permitting early
marriage. Meta-analyses show extremely large effect sizes for marriage as a predictor of
adolescent childbearing. (Kassa et al., 2018)

In contrast, in higher-income settings marriage is rare among adolescents; there, pregnancy

outside marriage is common, and analyses focus on partnership patterns, contraceptive access
and use, and relationship dynamics (e.g., age-discordant partnerships). Thus, marital status is
a critical socio-demographic factor, but its prevalence and interpretative meaning are highly
context specific. (Kassa et al., 2018) (Brahmbhatt et al., 2014)

Family structure, parental education and communication

Parental education, open parent–adolescent communication about SRH, and family stability
show consistent associations with lower adolescent pregnancy. Pooled evidence indicates
adolescents whose parents are less educated and those who report poor communication about
sexual health are at elevated risk, suggesting family human-capital and information pathways.
Conversely, single-parent or absent-parent households often report higher adolescent
pregnancy rates, mediated by supervision, economic hardship and psychosocial stressors.
(Kassa et al., 2018)

Contradiction and nuance: some individual studies report non-significant associations of

parent education with adolescent pregnancy after controlling for community factors; other
studies caution that measures of “communication” vary widely (quality vs frequency), and
that in some circumstances parental communication can be associated with later sexual debut
only when accompanied by accurate information and supportive parental attitudes.
(Janighorban et al., 2022)

Age at sexual debut and contraceptive use

Younger age at first sex is consistently correlated with higher cumulative probability of
adolescent pregnancy. Lack of contraception use (or unmet need for family planning) is a
proximate socio-demographic correlate of pregnancy: adolescents with unmet contraceptive
needs, poor access to youth-friendly services, or who report barriers to service use (stigma,
costs, provider attitudes) have higher pregnancy incidence. Studies across Sub-Saharan Africa
and other regions document this proximate mechanism repeatedly. (Mekonen, 2024)

Complications of teenage pregnancies

Major maternal complications
Anaemia and nutritional deficiencies
Iron-deficiency anaemia is consistently reported at higher prevalence among pregnant
adolescents relative to adult women. Biological demands of maternal growth in younger
adolescents and inadequate prenatal nutrition combine with limited antenatal care to increase
anaemia risk, which in turn raises the risk of postpartum haemorrhage and poor obstetric
tolerance. Recent systematic reviews and cohort analyses report elevated anaemia prevalence
and associated adverse peripartum outcomes in adolescent groups. (Lambonmung et al.,
2022) (Karataşlı et al., 2019)

Hypertensive disorders of pregnancy (including pre-eclampsia/eclampsia)

Evidence about hypertensive disorders is mixed. Several large reviews and meta-analyses
indicate either increased or similar risks of pre-eclampsia among adolescents compared with
older women, but heterogeneity is substantial across settings and by parity. Some studies
suggest primigravity and biological immaturity underlie higher rates, whereas others report
lower or non-significant differences after adjustment for confounders such as socioeconomic
status and access to care. Thus, hypertensive disorders remain a frequently observed but
context-sensitive maternal complication. (Zhang et al., 2020)

Obstructed labour, obstetric fistula and caesarean delivery patterns

Younger adolescents—particularly very young adolescents (≤15 years)—are at higher risk of
cephalopelvic disproportion and obstructed labour in settings where pelvic growth is
incomplete; this increases the risk of prolonged labour, obstetric fistula, maternal infection
and peripartum morbidity. However, adolescent mothers are not consistently more likely to
undergo caesarean delivery; some studies report lower caesarean rates among adolescents
(possibly reflecting lower access to emergency obstetric services or different clinical decision
thresholds), while others report higher operative delivery in higher-resource settings. These
divergent findings underline the role of health-system factors in shaping observed
complication profiles. (Althabe et al., 2015) (Scipioni et al., 2025)

Postpartum haemorrhage and infections

Adolescents show elevated risks for postpartum haemorrhage and puerperal infections in
multiple settings, often linked to anaemia, delayed or inadequate intrapartum care, and higher
rates of unassisted deliveries in resource-limited areas. Programmatic reports emphasize the
need for strengthened intrapartum and immediate postpartum care tailored to adolescents.
(Karataşlı et al., 2019)

Perinatal, fetal and neonatal complications

Low birth weight and fetal growth restriction
A robust body of evidence associates adolescent pregnancy with higher rates of low birth
weight (LBW) and fetal growth restriction. Meta-analyses and large cohort studies report
lower average birth weights among infants of adolescent mothers and increased LBW
prevalence, particularly for the youngest mothers and in low- and middle-income contexts
where maternal nutrition and antenatal care are poorest. Biological competition for nutrients
between a still-growing adolescent mother and the fetus is posited as a causal pathway,
alongside socioeconomic mediators. (Diabelková et al., 2023) (Lambonmung et al., 2022)

Preterm birth, neonatal mortality and stillbirth

Adolescents are at greater risk of preterm delivery and early neonatal mortality in many
settings, with the effect strongest among very young adolescents and in contexts with limited
perinatal care. Systematic reviews show elevated preterm birth risks in pooled analyses;
population studies link adolescent motherhood to higher neonatal mortality and stillbirth
rates, partly mediated by lower facility delivery, inadequate antenatal care and higher
prevalence of obstetric complications. However, some studies find these associations
attenuate after adjusting for socioeconomic status and health-seeking behaviours, indicating
both biological and social mediators (Noori et al., 2022)

Apgar scores and NICU admission

Lower Apgar scores at 1 minute and increased NICU admission rates are reported in multiple
hospital-based analyses of adolescent deliveries, consistent with the higher rates of
prematurity and fetal growth restriction. These neonatal complications contribute to short-
term morbidity and may have longer-term developmental implications. (Diabelková et al.,
2023) (Marvin-Dowle & Soltani, 2020)

Mental health, psychosocial and long-term complications

Perinatal and postpartum depression, PTSD and maternal mental health
Adolescent mothers have higher prevalence of antenatal and postpartum depression, anxiety
and post-traumatic stress in many cohort and cross-sectional studies. Mental health
complications are linked to reduced social support, economic hardship, and stigma, and are
associated with adverse infant outcomes including impaired bonding and later child mental
health risks. Routine screening and adolescent-friendly mental health services are
recommended in guidance documents. (Ladores & Corcoran, 2019)

Unsafe abortion and reproductive morbidity

In contexts with restricted access to safe abortion, adolescents contribute disproportionately
to unsafe abortion morbidity and mortality. Unsafe termination is a leading contributor to
maternal death among adolescents in many low- and middle-income countries. Even where
abortion is legal, stigma and service barriers can increase unsafe practices. (Althabe et al.,
2015) (Lambonmung et al., 2022)

Educational, economic and intergenerational consequences

Beyond direct health complications, adolescent pregnancy commonly precipitates school
dropout, reduced lifetime educational attainment, and constrained economic opportunities for
the mother—outcomes that perpetuate cycles of poverty and elevate risks for adverse child
health and developmental outcomes. Recent cohort studies and reviews document these
intergenerational effects, noting heterogeneity by social policy (for example, countries with
stronger school re-entry policies show mitigation of some long-term harms). (Noori et al.,
2022) (Varmaghani et al., 2024)