Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis

BACKGROUND: Sub-Saharan Africa has among the highest prevalence of teenage pregnancy in the world. Teenage mothers and their children are at risk to a host of medical, social and economic challenges. Adolescent pregnancy is a significant cost to the mother and newborn child, and also to their family and the wider society. Despite measures taken by some sub-Saharan nations to tackle the issue of adolescent pregnancy, the phenomenon remains a public health concern that is widespread throughout the region. Currently, there are few studies that examine the predictors of teenage pregnancy in the sub-Saharan region. The objective of the present study was to systematically review predictors of pregnancy among young people in sub-Saharan Africa. METHODS: A literature search was conducted using Medline, CINAHL and EMBASE electronic databases. Following duplicate removal, abstract and full-text screening, 15 studies were ultimately included in the final review. Narrative synthesis was used to synthesise the qualitative and quantitative findings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses. RESULTS: Twenty-seven predictors of teenage pregnancy were identified and grouped into six themes (Partner and peer-related predictors; Sexual health knowledge, attitude and behaviour-related predictors; Parenting and family-related predictors; Economic, environmental and cultural predictors; Personal predictors; and Quality of healthcare services predictors). The most obvious predictors included sexual coercion and pressure from male partners, low or incorrect use of contraceptives, and poor parenting or low parental communication and support. CONCLUSION: This review emphasises that the large prevalence of adolescent pregnancy in sub-Saharan Africa is attributable to multiple predictors that our study was able to group into six themes. Policy changes and programmes must be implemented in sub-Saharan Africa to address these determinants in order to reduce adolescent pregnancy within the region.