Adolescent pregnancy remains a significant public health and socio-economic challenge in sub-Saharan Africa, including Rwanda. It increases risks of maternal morbidity and mortality, obstetric complications, and poor neonatal outcomes. Beyond health effects, it disrupts education, limits economic opportunities, and reinforces poverty and gender inequality. It is shaped by structural and social factors, including limited access to sexual and reproductive health (SRH) information and services, poverty, restrictive gender norms, and power imbalances. Despite progress in reproductive health, disparities persist, especially in rural areas. This dissertation applies a multi-level framework to examine individual, interpersonal, community, health system, and structural determinants of adolescent pregnancy in Rwanda.
The research comprised four papers. Paper I was a systematic review and meta-analysis of adolescent pregnancy in East Africa, focusing on structural drivers such as low education and poverty. Paper II used a mixed-methods design in Burera (rural) and Nyarugenge (urban). A cross-sectional survey of 441 girls aged 12–19 years was analyzed using descriptive statistics and logistic regression. Paper III used a phenomenological approach with 20 in-depth interviews to explore adolescent mothers’ lived experiences. Paper IV surveyed healthcare providers to assess SRH service accessibility and barriers.
The review estimated a pooled prevalence of 23.6% across East Africa. In Rwanda, survey prevalence was 12.7%, higher in rural Burera. Protective factors included secondary education, delayed sexual debut, and access to SRH education. Risk factors included poverty, parental unemployment, and limited decision-making power. Qualitative findings highlighted limited SRH knowledge, early sexual initiation, coercion by older partners, weak parental guidance, peer pressure, stigma, and restrictive gender norms. Access to adolescent-friendly services was constrained by confidentiality concerns and limited availability, particularly in rural areas and for abortion care and HIV self-testing. Economic hardship and unequal access to education further increased vulnerability. Despite challenges, adolescent mothers showed resilience and aspirations for education and economic independence. Providers noted general service availability but emphasized urban–rural disparities and ongoing access barriers.
