Individual and community-level factors associated with unintended pregnancy among adolescent girls and young women in selected Southern African countries: a multilevel analysis

Background: Unintended pregnancy continues to be a huge public health problem in sub-Saharan Africa (SSA), including in Southern Africa, where adolescent girls and young women (AGYW) face higher risks. Therefore, this study aimed to determine the multilevel factors associated with unintended pregnancy among AGYW in Southern Africa. Methods: This study analysed a weighted sample of 20,748 AGYW (15–24 years) drawn from the most recent Demographic and Health Surveys (DHSs) in nine Southern African countries. We fitted multilevel logistic regression models to examine multilevel factors associated with unintended pregnancy at p < 0.05 statistical significance. Results: The pooled prevalence of unintended pregnancy among AGYW in Southern Africa was 39.1% (95% CI: 38.8–40.1). Higher odds of unintended pregnancy were observed among AGYW with secondary education (aOR=1.88, 95% CI: 1.65–2.13), those exposed to media (aOR=1.14, 95% CI: 1.06–1.22), contraceptive users (aOR=1.24, 95% CI: 1.16–1.33), and urban residents (aOR=1.19, 95% CI: 1.10–1.30). However, AGYW aged 20–24 years (aOR=0.64, 95% CI: 0.60–0.69), and those with a history of pregnancy loss (aOR=0.78, 95% CI: 0.69–0.89) were associated with lower odds of unintended pregnancy. Conclusion: This study found several multilevel factors associated with unintended pregnancy among AGYW. Governments and sexual and reproductive health (SRH) programmes in Southern Africa should priorities targeted youth‑friendly services, expand access to SRH services, and tailor interventions to national and local contexts to reduce unintended pregnancies among AGYW in the region.