Why do adolescent girls become pregnant? Contextual pathways to adolescent pregnancy in rural Tanzania: a mixed-methods study.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Adolescent pregnancy in rural Tanzania is shaped by social norms embedded within broader economic and gender inequalities. Cultural expectations surrounding initiation, marriage, sexuality, and fertility can normalize early sexual relationships and transitions to adulthood, while gendered power imbalances—particularly within age-disparate relationships—constrain girls’ ability to negotiate contraception. Importantly, the authors argue that norms do not operate independently; socioeconomic deprivation limits girls’ choices and reinforces gendered expectations and power inequalities. Effective prevention therefore requires addressing harmful gender norms alongside educational and economic conditions that constrain adolescent agency.
Objectives To examine the prevalence, determinants, and contextual pathways contributing to adolescent pregnancy among girls aged 15–19 years in Korogwe District, Tanzania.
Methods This convergent mixed-methods cross-sectional study combined a community-based survey of 418 adolescent girls aged 15–19 years with qualitative research involving 24 adolescents, parents, teachers, and community and district stakeholders. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, while focus group discussions, in-depth interviews, and key informant interviews were analyzed using thematic framework analysis. A socioecological framework guided the study, including attention to community norms and structural influences. Social norms were explored qualitatively through participants’ accounts of cultural expectations, initiation rites, traditional dances, early marriage, gendered relationship dynamics, attitudes and beliefs about contraception, and parent-adolescent communication.
Results Adolescent pregnancy prevalence was 16%. Older age, never attending school, school discontinuation, marital union, and employment status were significantly associated with pregnancy. Qualitative findings identified poverty and economic vulnerability, contraceptive misconceptions, traditions and social norms, education and knowledge gaps, and limited parental communication as key pathways. Participants described norms positioning contraception as inappropriate for unmarried or nulliparous adolescents, fears that contraception causes infertility, initiation rites that signal readiness for adulthood and sexual relationships, and cultural practices perceived to normalize early sexual activity. Economic hardship also encouraged transactional relationships and early marriage, while gendered power inequalities limited contraceptive autonomy.
Conclusions Adolescent pregnancy is a socially patterned outcome of intersecting socioeconomic, educational, cultural, and gendered vulnerabilities rather than solely individual behavior. Prevention efforts focused only on information or contraceptive access are unlikely to be sufficient; integrated strategies should strengthen school retention, economic security, adolescent reproductive agency, and transformation of harmful gender norms.
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