The pooled proportion and associated factors of adolescent pregnancy in 47 low- and middle-income countries: A multilevel analysis

Background: In low- and middle-income countries (LMICs), nearly 21 million adolescents become pregnant every year. Half of these pregnancies are unplanned, and more than half of unintended pregnancies result in unsafe abortion, which accounts for a major proportion of adolescent pregnancies worldwide. This study intended to assess the pooled proportion of adolescent pregnancy and associated factors in LMICs. Methods: -values < 0.05 were regarded as statistically significant, and the adjusted odds ratios with 95% confidence intervals (CIs) were computed from the final model. The candidate model was evaluated using the Deviance Information Criterion. Results: The pooled proportion of adolescent pregnancy among all adolescent girls in 47 LMICs was 23% (95% CI: [20, 26]). It ranges from 10% (95% CI: [6, 14]) in North Africa/West Asia/Europe to 28% (95% CI: [25, 32]) in sub-Saharan Africa (SSA). No formal education (AOR = 1.10, 95% CI: [1.04, 1.16]), primary education (AOR = 1.58, 95% CI: [1.51, 1.66]), middle wealth index (AOR = 0.83, 95% CI: [0.80, 0.87]), rich wealth index (AOR = 0.58, [0.55, 0.61]), media exposure (AOR = 0.86, 95% CI: [0.83, 0.89]), aged 18 to 20 (AOR = 4.33, 95% CI: [4.17, 4.49]), female household heads (AOR = 1.40, 95% CI: [1.35, 1.46]), condom use (AOR = 0.79, 95% CI: [0.74, 0.85]), contraceptive use (AOR = 0.44, 95% CI: [0.42, 0.46]), knowledge of contraception (AOR = 0.38, 95% CI: [0.35, 0.41]), being married (AOR = 9.02, 95% CI: [8.91, 9.73]), having a bank account (AOR = 0.89, 95% CI: [0.83, 0.96]), being from SSA (AOR = 8.79, 95% CI: [6.96, 10.24]), Central Asia (AOR = 2.96, 95% CI: [2.16, 3.67]), South and Southeast Asia (AOR = 1.65, 95% CI: [1.35, 2.03]), Oceania (AOR = 4.11, 95% CI: [2.66, 5.01]), Latin America and the Caribbean (AOR = 5.83, 95% CI: [4.93, 6.49]) were significantly associated with adolescent pregnancy. Conclusion: The pooled proportion of adolescent pregnancy is high in the study area with significant disparity. Improving women's education, media exposure, financial support, knowledge, and access to contraceptive and condom use among adolescents were potential modifiable factors to reduce adolescent pregnancy. The WHO regions, such as SSA and the South and Southeast Asia regions, need particular attention to lower adolescent pregnancy rates.